HomeMy WebLinkAbout0432 •
t . TYPE ALl ENTRIE8 OR PRINT IN PERMANENT BLACK IN IQf 4°
r*t 1 ~
2 ALICOPIE8 f~AU8T 8E LEGIBLE. ABSTi~ACT & TIT~'~ ~ ~ Irr~t,n~l W ~'f
3- INCOMPLETE CERTIFICATES WILL BE RETURNED. SARASOTA LE BUX SU38
v! •OIREY M?SI I _ _ _ i 33s,~ . X4405 iTATE illt NUM~EiI
CEMWS Wi~
rRACt olr3aN REOOROEOaSTTacT
lam NEW YORK STATE
SEOISTER/R1tMER DEPARTMENT OF HEALTH
- CERTIFICATE OF DEATH ~ J
9uhaTICAI OISi1MCT 1 NAPE i T WOOIE LAST Z SEyEyy¦~~ aA OAtE Oi OEAIN
REC ~
Raymond W. Bartlett ~ TEQ E ~N; ,O , / Q~Y
I
RES . AO.E MTYNOER 1 TEM V UNDER I OAY • OECEOfMI 3011N • YETERANOi uS ARYEOTOSICEtt t SO~«~ECVMTT
' YONTW I OATS NOW , 1•IM•ILS YONTN OAT I ?EAA ~ Ta Oi 3ERY1CE rwAw oR pATEa
1 j l 2 l~•
TEARS ,t~
Oi OEAtN I N LOCAIITT KNECK ONE AND SPEC1iY1 I SC N03/1TA? OR OTNER INSTITUTION , puN10 ICN CK ONEI 1 ApYISSgN pAtE
8C I QpTY Oi I IIi NEItNER 6AIE ApOREttI 11 OA
• YONTN p•T TW
~y~, ! pYTMT1ENT
~ WEST. ~ ?TOWNOi ~ ~ Lawrence Hospital: YE~EN`Y~ ~ I
17~'K~ °i BrOnXV i l l e I . III.wtIEMT I I I
.STATE Oi SMTN r0 CITIZEN WNA 11 YAgItAI STATUS ICNECKONE) SIIRTIVYIO SPOUSE {If WKE ONE W110EM NANEI
~ ~ ICpIMT11YrMOTUSwt C[O~UNt~/1 1[]NEYEwwRRIEO aOw100WE0 Eleanor. Can-eron
N . Y . V . S . A . Z ~uwRIEOd1 SEIARAtfO • Q o1YORCEO
13 T~pWCK 1 ,ir iCN ? rE4 0 is EDUCAtgM IMpCATENIW1EfTORAOtCOYNETE00NlT
13 OTNEIIISIECIiYI IQNEAKAN SOOYNER3? EIEYENTART NIONSTYIOOI CO1lE0E
E iUERTO RICAN ORIOWISPECtiTi O 1 2 a • • • f • ~ 1 ! a • 1 t a •
White as ~'N~DR cl??c~nnn?? ???E7L n?nnc~
• 1N AYERKAN _ _ 00 01 OQ al M a OS 01 « a /0 11 IZ to 1• 1• IS It
11 ISw1/N1Al 000UPAT1pN IDO tgtENTER RETY1E01 ISS KWOOf WSINESS OR UIOWTRT ISC NAYS AMO LOCALITY Oi fMIY OR COYMNY
/ I
Printer ; Covex'>`urent ~ Westchester Count
--y-----
I TA STAn ,1 TS COUNTY I 1 TC LOCALITY ICN ON AND 61ECIfYt I 1 n Ii CItY oR YN1AOE- a wES/OEtIC!
I I ~7atroi ~`on~cers ~~n*T~~E~w'tST
uS4Al ~E3gEMCE N . Y . I WEST . I Q TOWN Oi I TE. No
--------------'.---.---------+-QYKIAOEOi ____a Q ? MND.SiECIiYIOWN.
ITO iTRER ANO NUYSER Of RESWENCE IIMCLUOE ZW COOEI ;
I ?Oo Thomas Place 10701
~---i i1MT YIOOIE IAiT I'YNAIOEN fM3t YIOOI! ?AiT
Walter E. Bartlett I,p„ ~ Edna Skerre[t
1 en ttl? tMYE Ds It1iORYANT , IN NAllWO w00REi3 TIttCUIOE Zr COOEt
Mrs. Eleanor Bartlett ~ 106 Thomas Place, Yonkersi N.Y.t07 1
CREYATgN. RENOYAL OR YOMTN OAT T Z06 it ACE Oi WRWL. CREYAT1p1•, IIEYONAl 011 S9C IQCAT1pNICITY 011 TOWM. StATEI
t ti E3 OTMEII 013i'OSrtION ISPECYtiI OTNER OISP031tION I
o Burial 3 ; 14; 78 Pinela~et Cemetery Pinelaw~. L . I . ~ N
M tIA NAPE ANO ADDRESS Oi fuNENAI MOPE 12t• REON{tRATION NO
sl _ Q Have Malone3- Homns for Funerals In•-_ 07 N . Bro ci~l y ~ O1U97
tH1 MANE OP iuNERAI OMECTOII I ZZS iuNERAI , Y1C 11fO13TMi1p/ NO
Donald I~•. Hess ~ U241o
>1EA SIONAT Oi 11E I p?i•AtE YONTN OAY Z OR lE R S YONiH OAr (Y~EM
TO BE COMPLETED BY T L~OMPLETED Y
n CERTIFYING PHYSICIAN ONLY OHEW El~J1MiNER ONLY
ATOTNE SEST Oi YTIIMOWlE00E. OEATM OCCYRIIEOAT THE A T11E Qi T1QIL'- CORONER
27 TMAiOATtANOiIwCE TOTNECAUSE3~TwtEO YoNTN DAr YEAR wNp • AN • O ~ E ~*E ~ nCOwuNEws
r UhITS.1:lAM
I I 516NA
EtW SIDIIATUIIE _ I 11T ~ ? w OII AI
~ S T11E A NDE THE DECEASED C lAt{i SEEN ALNE • i~~._ _ - ~ .r Sp~D EaAYINLR
j 3J ~ ~ YONTN- YEAH YONYN OAY tEA11 YDI1/N DAY rEAR ' ~ OAT •LAA
r
{ W f110•/ I ~t0. ~ I 1 I ~ I 1 -1 I I
` V ll I I~ ` 1 1 I~ t 1
~~TtTEMO1M0 K NER T CI/ERt1ilER E ~ .
3UG ~ • - r
J O. _ y.
a1 nArE ANO Oi iIf RIMY oN YE E NER. CORONER'S
~ ? ~ • ~
I ' -
!T OEATN Lib CAUSED OT ENTER ONE C~WSE PER LINE iOR IAl lil t`i TIMANEO
OEA'11YN
IAllT1 IW1E TE SE Z,
{ w .
EAYE EElE i• Ou! .
~ CMEf WTE ISI ,
E~
~ ~ ra caN.E NcE /
€ ~ M M11T3 w tIppNNS Cow IONS CONTR/WYIN0 i0 7SA AuT Y ZM YTEt WERE iWpN63 CONSTOEREOw WAS CASE EiERRED
u E OCMtSE ON£N NI ?ARTIIAI TES I OETERlRNINO THE GNSE Oi pEATMT TO C0110N O1 ERt
tJCN$ ~ D ~i t ? YES : ? tto / • ! NO
aoA SPECKT K NOYIC/OE ~oR DATE Oi INJ aoc ?IOUR OF a00 OESCRtSE /lOw Ita11111? OOCU1111ED
IMw
E TIOATtO E EO. iENOM10 ~ r_ owiN Wr rEAw I INZURT ;
OR_ 1 , I 1 1
I I 1 I ~ Y I
>SK M1111R'T At t•'ORK7 I a0i /LACE Of INJURY NOME I ZO0 ?OCATION ISIREET • NO. CITY OR YI11/10E. TOWN, CQUNTY. STATEI
~ YES /q I iACTOM. OfFKE 5100 . ETC I ~
! QS ? ? 1 1
1
(a- Ip~$
{
4~4~OS
130 APR 24 P~ ~ ~ 1
FILED GNU FFCUnI:I:J
S ROGER
Poi
TTRnsa.
CLERK CIRC131T CE't; T
R! fi~k~ ~'EFiFI:C- 9~
- eo~'~~c Jc3U PAGE 432
- -
- _