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- 495146 - -
""'~~Q STATE OF NEW JERSEY -
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OFFICE OF REGISTRAR OF VITAL STATISTICS
~ ~ RARITAN TOWNSHIP HUNTERDON COUNTY
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CiT9. iNNt~QM OR .vNMI\.r ANC COYNTY _ -
Tibir it to ct17ifp that the following is correctly copied from a record of Death in my office.
I NAME OF DECEASED PLACE OF DEATH OATS OF OEATN -
RAYMOND RILEY - HUNTERDON MEDICAL CTR . MAY 28 1963 -
- - - RARITAN TOWNSHIP
SOCIAL SECURITY HUMBER SEX COLOR MARITAL CONOITIOH GATE OF BIRTH AGE
147 01 1101 - MALE .KITE MARRIED DEC 18 1900 vas. _MOS. oAYS _
62
PLACE OF BIRTH CAUSE OF DEATH "
NEW JERSEY - - ~ _ BRONCHO PNEUMONIA BILATERAL - ~
SUPPLEMENTAL INFORMATION IF DEATH WAS DUE TO.EXTERNAL CAUSES
wCCIDENT, SUICIDE OR HOMICIDE - DATE OF OCCURRENCE
SPECIFY - -
wHERE DID INJURY OCCURt - - -
GTY OR T011N COUNTY STATE _ -
~ DID INJURY OCCUR IN OR ABOUT HOME. ON FARM. IN INDUSTRIAL PLACE, IN PUBLIC PLACET :
- SPECIFY TYPE OF PLACE
WHILE AT 1MORKT MEANS OF INJURY
~ NAME OF PERSON WHO CERTIFIED CAUSE OF DEATH ADDRESS
'j PAULINE R GOGER MD HUNTERDON MEO CTR
N J 08822 ^
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. . .................G.
~ c. ~ Re 'tray of Vital Statisti
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R.D. #7„ Flemin~tont N. J. 08822
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~ - J~~ Address
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D.H. OO1N
:I.N[11 M7~LiiNiNa OC.. INC. T11tNTOlt\ N. J. i= -
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CLERK CIRCUIT CCU?1
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