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a¢~ STATE OF ~VEW JERSEY •
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OFFICE OF REGISTRAR OF VITAL STATISTICS
Lakewood Ocean County
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CITY. ~OwOY~11 O! ...wN~..N' ANY OO{INiT
_ riir ~ to s~?/p that the foDowing is correctly copied i~ a record o~ Death in my otaoe.
NAME OF DECEASED PLACE OF OEATN OATS OF DEATH
Carolyn L. i+lsop Paul Kimball Hospital June 3,1975
SOCIAL ilCURITY UMBER SEX COLOR MARITAL CONDITION DATE OF BIRTH AQE
YRS. MOS. Dl?Y
unable to locat femal cau. idowed June 17,1904 70
FLAC! OF 91RTN CAUSE OF OEATN
Washington ~.C. Cerebral thrombosis
SUPPLEMENTAL INFORMATION IF DEATH WAS DUE TO.EXTERNAL CAUSES
ACCIDENT. SUICIDE OR HOMICIDE GATE OF OCCURRENCE -
' SPECIFY
WNER! DIO INJURY OCCURt .
dTY OR TOrIN COUNTY STATE
OID INJURY OCCUR IN OR ABOUT NOME, ON FARM, IN INDUSTRIAL PLACE, IN PUBLIC PLACET
SPECIFY TYPE OF PLACE
WHILE AT WORKt MEANS OF INJURY
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NAME OF PERSON WHO CERTIFIED CAUSE OF DEATH ADDRESS
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Ronald Schiraldi ri.D. ~ Lakewood i3.J.
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Sm Vital tutus
351 Ridge five ~ kew N.J.
Address
Hpril 16,1979
Date of Issue
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ut/RR M4SMtNY OD, INC. TIIiIITYI/. N. J.
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