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PS-3720 /
080
CE11TIfICATE Os ~EATM
vS a 12.72. CONN. STATE OEt'T. OF HEALTH
OECEASEO-NAME nASr ~ roar wr SEX .
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RCMOLO G~TILII,LA ,male :r.r[ ¦ar.[¦
GATE Oi RWM frp¦Tr O.•..U¦, RACE- ..¦r[. ?eu¦o .r[n.uu AOE wr {/.pfA r .W ,¦,oe¦ r w. PATE Oi OEATM Irpwr» o.•. rtAq
r,pu. ayc tv[an, M¦r»w. n[.¦s, - - o.•s rows rr
May 25, 1908 ,white 68 L I_ _ .August 5t_-1976 _
COIMiY f,7i pEATN TOEYN f>i DFATN NOfiNTAt OR OTHER INSTITUTION - ¦.nE pr upr ~r 4rwaA a•[ Sr11E[r .no ¦..¦ht,4
,.New London New Landon Lawrence and Memorial Hos~it.Als__
pTY 1t STATE Oi fNRTN (f:OrIWT. I not U S 1 pTIZEN Oi fCo,,.rry) YARiUEO. NEVER MARRrtO. wDOWEO. LAST SOUSE (H rrN. p. w.a.rwr• eMrr)
OTVORCED LEGALLY SEPARATED
v[u.a MLOtuc[ ..New London, Connecticut _ O.S.A. _ .widowed glsie Hlenk
u•[o u pE.r» _ SOCUU. SECIRITV NIMBFR USUAL OCCAI~ATION ,G.E .rw p rv¦. pouf ouw..c rosy or KINp Oi fIUStNE55 OR MaQUSTRY -
000Wr[o a0¦..¦O urE. E•l+ N w[nA[p
y,nT4T.p¦ Grt „.012-09-3733 Fire Chief (retired) _ r[. City _of New London
.p.¦SLJ. RESIDENCE w•STATE COUNTY TOWN STREET AND NWRER
,,.Conn/cticut New London r[New London 67 Sunse+. Street
wws o¢c o w veTEfiAN+ Ii YES. DtYE wAR - Istlr ON SN[?--_ .
pr[nn .ES uoI -
Yes r. World War Two O.S.
iATNER - E rear ropaE aa,r MOTHER - MA10EN NAVE n¦sr r00.E aAST
Joseph Geritilella ~ Marauerita Valitutto
RIiQAYANTF NAME YAILWG'ADORE55 pr¦[Ei OA wr s w0. aT• O¦ rpw¦- sT.TE. nrI -
Carl Mcl~enna rI¦ 81i8 Bank Street New London Conn. Ofi 20
VAAT I trEATN WAS CAUSED BY: (ENTER ONLY ONE CAUSE frEq UNE FOR (y, NL Ap10 fc1 - .rrwpur.r[ r¦rfHY ¦[T¦fEM
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VARi H ,iNER 51GNKICANi POApT{OMS Ca•p. r.p.,i Ca•T~¦.,nra ro Ol.rb ¦ur Ypr 11Ea.T[p ro C.Ux ::rr[w r.¦r , Ir rAUTOVSY i fi YES r.+P~Gi CO.Lp[¦[O
RTtitiT INSTRUCTIONS i ~s «"•or ~ pErE.r.-~ c.wx or a.t»
RE.A(I CAREFULLY - = - - r - - - L - - _['_NO - - -
- - ACf7DENt,tUK,DE NOERGf>E. DATE fK ,WURY ,rp¦r» y. .au. 1 NOIA 1 NOW INJURY OCCURRED Wn¦ urw[ Ot iww;wr Na/ORr At WORK
OR alrapEt(r11:vE0 ~vrw., i ! I rur r o¦ r.¦r »..r[r .p ~ ,s.EUrr .ts O¦ +a
NT LEGIBLY with a 7e, i ii ~ r ~ ~
ert Buck Record Ink. PLACE of ~IURY .r wtrE r.wr Sr¦[[r f IOCATrry[ ~sr.E[r ,H ¦r O gyp. ur• y, r6+.. srad SiAGERY RELEVANT TO cOMOr r1pN REVORfEO IN ITEM 1•
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tN COMPLETED: this a. ,r,
r; u'd be SQ(lt t0 the CERr,itCA' -PMT SIGAN: rpur» o.• n[u rip.r» o.. •e.¦ ¦..o a.sr v. .¦r~»[¦ •ar•[ a+ OE A:N OGGUpPEO o¦ r.a wr[...,o. r0 r..[
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n. acE. .p.. _ ~sSLsN~ ~_ia7~ . ~ 2-_ ~~2~- a~` ~17!!_ L r,. //ff ~ r
r.h~•~' death occurred. ---`~f ~ - -
I~'~ CER TIF lCA~ - VEpCAL EIf/WINE .w r. prt¦.o¦ O¦ !w[ NtE • wpyw Or Gt. t» ! rr•E OEC ~r us rwO.p.wG[p p[.O
' OuE TO 1?[ x's, Si.TEO pE.t» ¦[S(JL T[p O. «..OI/r 'yy rQy T» p.. I[.¦ »OY¦
CERt,ir`ER~~NAME/ n•rE «?.,r. -~y~y ~~yGItATWE o[c¦[[ «r,nE ,J-- -
MA,UNG ~ESS- CERTIi~ER sT.[[* O. ¦ra u0. • ,S_ ~i v.*a ~ ~ ire T E ED , r..
TIURIAa. ATION. REMOVwt CEMETERY ~ ! IfX:Ai~ON a+. O¦ row. rr sT.r
,y[o.n
,N .L}ariat I Ced~.~ t~ ' New London, Connecticut
GATE r'* p.• rE.M r iUNERAL ?~E~ •AD011E~ -O¦ ¦r p _•t• e. •:w.. strE ter, - - - -
t.. A 1976 _ ~t,: A_lde t i ~T81 Ocean Avenue, Ne~.~ London, Conn. 06_ ?
fUN R. ECr M EMBA.VER - t: 1 . . prya1MER ¦•.e...s e.re•. r ~ IICEtiSF YWEf R
_ John Mrr? in _ _ _ ' 2.. 2026
CE CITE RECERIED iOR~ qN ! NY - - - Rrt31S:RM V -
Al~~ 6 rI 1976 I ~~~tt~~ 1
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501080
(9c0 SEP 26 Pt; 12~ 54
HLEO RHC FEGOdOf 0
St.llIC1E COUNjY•flA.
' ROGER POITRAS
_ CLERK CIRCUIT CGS T
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