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C.\Y OR nEMI YOAK duAcAU OR VITAL AeCO~IDS ~F HEALTH
Q S~'729 ~ ~
oate MAR 1~ 1980
r•11.EO ~
_ ~ t;.erti6gte Na. r..r..:.-,~1~.!~~.:....1':.._'3.~.~.....-
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o ' • ~ I ~ ~ ~ ` 1. NAPE OF
(Pri~1 t7N~~) llnt Nw Yiii~ lire Lut 1fw .
~ - PERSONAL PARTICULARS MI~IGL CBRTIFIGTB OF IDBATH '
(Ti h /iW f. b Pnnwrl Wr+tar?) (Ti M W./ to t+s W )
New Yark is rtr?cs or DtAT :
t USUAL RESID)i11CS: (e) cute-~ (s) 11Er1? YORL CTTY: (1) 'an~.._._.
_`~e ens (e) PoMp~ T S ar I~tlatio ~l/ +d i+ ~ iwHi~+irw. ~ +b~M tea/ .rwk+?
(b) Co. _ _....ad T.one_..~ell..04 (~I ~ ~
aeM ~ Mew ~ r+riieeee. pceih eiand~r ~t ~t~os '
ca; xo. 29-06 Crescent Street__.•s'~' t.=~. 3
(t/ f. prat s~ stir besWii)..._ _ 1{ DATtiAND (ltow ) (Dor)~~ (Year) ~ (Hov)
HOUR O! G!
(c) Ls~t? et te.ida•e. w iwp~ .t 17 Yre DswTH
New York iarediateb is 6atf asx eoLOR R RACS /s es Ap
~ SINOLL~~,, 11ARRItD, wznowsDr b,arried ~ ~ '
OR DI1/ORCiiO (awls NM swJ)
20 I HEREBY CB IFY that, in accordance anth the pm~isions
,DAIS os (lte.a) (Dad) - (Year) of Lw charEe of the ded bod7 at .
sI1:TH os 9e pt. 11, 1912
DtCSDSIiT _
1 ear '
I .............19.._........
s wat; thta...._ dsp of
41 sr.. .oe. ( i'~ °r ~ I fwrther oa tif)? , troan the ind t0atjaa and (a
l)aral Ocagattra tst~ at w.rk /o.. brts w< ootarr+ed an the date and at the borer stated a6otie ~
Painter B t.dre~) (natural aad that the eausea of
D. a1.a ai ~ I~+..
~ is ~ rids ..t! ..a a... ddttb were: t
ewer 0>n en PART I '
7 SOCIAL attCURITT 110. (a)C~u (y_ ,
f 104-24-0301 i.e
a allrrarLACS Ca~..e.
wtu t>,)____ . ~ ~
cats ~ seey. c.•a~s) Gertnan~ sugr
ad L.e~ ~
~ os wllwr cotlirrR>t wAR r
A2 TI~I[
OTr DTiA~?Htx U • .S •
toe. ~YAa DItC=Aa1CD~ 1sR If Ysf. QM vnr K 4en • !
a. IN U11Y2'RD aTATM 19 a, see+toe 1
1t NA111i OP stsrled --.......Asit~t~ll lts~w •
~ATt~sRO>. >~artin Steif
DEC=DRlPP /
Approted.......----..I._.. •
~I 12 O!~[OTHtR Ei
opDSCSnstrr k ria ASchler 'Q''
~ t NAl1S OT I)1>'OR1tA11T IItELATIONBHIP TO DECMASED~ ADDIttiSa w
_ a~rrsn Lin e i FusY~and- 2~ c~~~ ~~-pa~~nr ~;t r T ~+tv
~ na. lime at Ceesesf K Cresater7 tab. 7.aeatb• (Ctb. Town tx Conwb ani State) ` lie. Date d Banal o'r Geweto~ `
Cypress ullls C~I^ete*rv ~ ~r~aklyn, ld. _ I j„ty 'jam ~~?54
raln[ 1T
niRSC
oLA I A. "t~;&ys L.T~Cityl Nvl[BRR 12:2
!B(JREAU OF RB~QOttDS AND STATISTICS. , " _ ~ /!1R,I' OF iHBALTH CITY OF NBA YORK
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_ :i ..yee.~ sr roc:'. en my custoetr.
~~-•s..~~~Ilt'GfS71tA7t •
TAa Department of Health does eat eettlfp~o dlsltatA of lAe stateyaents made tAeteon, as no lat)u14 a. b
. lM tads Aas beta p?or1dM b7laer. '
00 NOT ACCEPT THIS TRANS(:RIPT UNLEif THt: RAISEO SEAL Oi TNlE DEPARTMENT Oi HEALTH tf
AiitxEO THEREON. REPRODUCTION OR ALTERATtONi ARE PRQHIa1TE0 aY LAM.
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!~A f,~: 28 P:-, 3~ 28
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