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HomeMy WebLinkAbout0379 i iY iY((G AL CNTRI[S OR PRINT IN P[RMANENT RLJICK INK. n~ t_ COL cS MUST [iE LEGIE3LE ~9::0 '6 ~i 2~ 3p ~ ~ric:OlAP: ETE CERTIFICATES WILL [3E RETURNED. t tern csr 1:: (:1.-11; . • rnl ~ 1. LUCIE CCUti t Y. F: STATE FiLB NUMBER ROGER ('OITR1 S ~ t • •.un CLERK C;itC~111 L: UI:1•.:•ttf nU,I::+WIUUt•.t Ne~f y'+I f ! ?~~S NEW YORK STATE r-rn:tl~t~•::=~:~~ _ 7 i ~ i ~ •Il ."1x,11 DEPARTMENT OF HEALTH ~ X2134 J~ ' CERTIFICATE OF DEATH 1 I t /a _ + •+.c t- a..!•f- . .1 MiULU IASi ?SEX 1A GATE Oi DEATN ]N HOUR f wLE `f(fwLE VONfN oAr rEAw~ , Lr~? l_-L ~ I ~ ' . ~ - - ~t F~..l .1 ~•+Ur.utRtYCAR It UNUCRIOAY 5U[(1[+[NT OORN •YCIEMf1 OiU$ARYEDf ONCI57 T•GCxAL SECU:i+tY _ _ NUYUEN 111jjj i DA.S - -••U+:w: WNU[CS uuNIH OAY r[AA NO Y[S IF f/[i LP[CIFY WAR OR OATE9 - Ii ~ r, ? f 1 ~ 1 OF SCRYICE II '1 r3-1 ~ ~ ~ ,8 ' 1 Yt wR•: - • A ' ! •JNi r O{ DI AU/ ~C!1 EOCA(av It-MICR UNE ANU SPCCU rG OC 1/0`,P+IA! ON OIIH R It/•.i1TUilON bU If IN NOSp(l Al O:1 E! 3F .'1+'A•ix NI 1 1 IIF NE111LL 11. 6cVE AI:U{1L:.S1 / INSIITUi:UN ICHEa.K ONCI' A:)M CAYE ~ - . - t~~ • f•]CITYOF 1 Itr]OOA ~,Y•~r.x••iDa•~trEAP • Wt , i~iOwr1 OF - 1 '^['7 [/~EfiG[NCr R00/• i ~ .•1?~ ~ ' .'f, ' I/t• i)renF;^r 'at IGUfPATt[f1i I . I ~ . • ~\IELAG[ or rndrll ,~wy• W ~ (X INPALIENT ; t 1 ' V • , ' 1! + 111':I+t - 1p ~ 'r-: f N :C Wf1AI 1 • MARITAL S'AIU i 1r11f CK 4N1 I SURY3Y,t(G SPOUSL lIF W.G E /:IYC 11,IA.tU! N AR!•z . W r; 1:IY If Nl.t 1 4x t-a.u NI N1/7 1 IlCYCR MARfI'.[!) 7 17 rrtDOWCO ,1 1 - ~eccxlia Clicl: - ( • •._r. U.~.~ 2I~MARRICO 00 S[PAMi[O • UrrORCED f t - - • ~ ~ • :.•1 'i 7~-w ' . . 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