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493'749
NEr JERSEY STATE DEPARTMENT OF NEAITN ~ "
~ettw~warwrttl CERTIFICATE OF. DEATN •*.Ta~tLCrr1?r~tt1
araCCS 1. NAME Ot: /First) l Ni//Ie) . !Lest) Sea S. pAT F'. t? ' 11i' AT
l~eelals Ju~y 2~, 1972
•t~Os t'o11 DECEASED
•TA*~~ lT,~r.r?rw) MARX C. KIMnER ~ F 7 20 72
rs.ACa Celr !w Rece ARe /a,ra. M rrdtr 1 Yt N wda 21 Hra. 6. Drs el OinA /rr•~edeceaM~er~
% r' ~ K veF ac%tra .l ae.sa) .
leu M.tMa,l s s w '
iitlite 70 Dec. 11 1901 No
0. oinkplsce /SMtr w /emir serelrp) Ciriuw d dr cerr.rr,t 10. Married Q`, Neaer Merited /1. Secial Secrra No.
Meng 2ork USA .idwvea [ ~ Di.«red [ ~ not a~ai~able ~
.euoa»ta 2. PLACE OF DEATN 13. USUAL E (U iwaruwietr: resideece Ae(aee edriasie.) f
C«~, r 4r. ~~eraey . w c..r, BerBen I
w Cir, (ekrt bs a.d Ei.e .sax) e. C~«, ~ ee?rck M. a.d Ei.....e)
°T " Teaneck T r
c. .oe ~ sPwa w aurt.rraw pre artea s• ea Adiresa (N creel. P.O. Ad~resa)
~tj HOfp'al So]~ Nane Hospital - 60 Liam! tr s
Mrirrrie.
1 , a. erptrs. 4rw . re? wr res rest i.d r .era i/ rrti.d 11. Ki d siweaa at ry .
HOU891~iitA ~
IS. FrUer'a Nara 16. Ilrelet's Nare j
Dennis Watters Hunt
17, letaeauwr'a Nave a.d Ad~eaa
Mr. Herbert Eimber 60 Lirntood Street Bear enfield Nslr Jars 07621 I
CAUSE Ia. PART 1 DEATH YAS CAUSED BY Enter e.l, eee terse jet lice /r (el: e.J lc) Appterirre ierenel oeteree.
r eraser sad deatA
k.rcdire Came fe)
4ee/rtiens. i/ er,..riicl Dee a!H
rw rise to eiere terse '
•Y.r•. ateliet tie
C«.~a~«..ea• hnrt terse test Dre ro /e/
PART 11 OTHER SIGNIFKANT CONDITIONS 19.. Yas .weps, ISd. H,es, ten Cardi.ls ce.sidaed ~
eA.:rr.a:M. rerleeed! i. deretri.ieE cave e/ derlrt }
Yes Nr Yes Ile [7 t
aCi or 20e. Aecide.r Sricide HaeNCide IOA. Date awd Hone e( Mjrry 20e. He. I.jrr, OccrrreJ !Ester Deter el inpr, i. Pert I a. II e/ /tee IIR 1
.c ' C]. O ~
to tie Mst e/ ine.dd ;
IOd. Infer, Orerrred _ IOe. Place el Injrq /r.d. in o? eiwt io.rr. 201. City. Teo.~r~.ee~ai~wk- • _ . _ Cewie, &ue ! t
a6ile u Nor Ylile f1 jtrrtory. ttrret, o//ice it/d., etr.) .''e~~7C*~~ i
York r Fork w .
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f
ceosse~ASS. 21. Ipe.rededre:ariwed)tke~deceastd(/rr~,e.) ~~wrr~~"~'x'f'r ' •R'~~~~.~~.~~~
~ ~ ~ sl 3~ 1. o`o' i.Ll. t
Deets ocrrrrr/ u s• Iv • n..e tk leer stetr/.korr; wJ to tie test e/ rr7 bfi 1~r c.rtrs kqf ~ ~ ~ '
ec?tsus p~,~ 22b. •.rY' ~ ~ t . 22c. Dare SiReed ~
TRACT 22a. Attewdirrs P6s. ~~r 1'• ~ ebt': ~:7j; ~ - ~ {
•t~°.
H ' AME . H06P .R' ~ 7 21 72 I
Siprtrte .i~r: , _
23s. Brrisl. Crest' ~ !Reroesl 23b. Cexter, ar Ctewrx, Nare =/`:j:a: _sy 2~r' aria it ~ C&, Beare
~ /Bwrial fount Car'1>tel Ceallete , ~ : ~ - > ~ y```~ Henr Jersey
23d. dMeiel Dare Mr. Da, Yr. 2N. Frneral More Nara ~~!f- _ . ~ 187 So.Tr?8a~.n6tOn ~e
a; Nex ors o 621 ,
! Jn1~ 24, 1972 Sisarerts lsescrial Rome' ~w .
~ Zfc. Feral Oireear N. j. Licase Ne. )teji ~ 2Sr Dre Rec J. 6, lots!
(a/ ,..i., Re
Zoo " 21- ~9T2
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493'749
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