The URL can be used to link to this page

Home My WebLink About28491 5158`?'~# '~ - - ~__-- __ - - - -. . _ ____._ __ . _ -~-_~' - -- NEW JERSfY STATf DE~ARTMENT Oi MEALTN , ~ . ^y_•y ~ CERTIFICATE OF O~ATN ~ . ~ .. , - y ~ r } ~ ~,"'~ ~ ~ OF A'~~ ~'•'' Ir~il j ~ ~ '~ W~i~'+1 ' . - '. • (Lwtl p ~T~Ois0~Ai11 ~ .:' ; ~ ' 3 ~~ • ~ ; ~ ~ s _ ~ ~ ~> -_.~IrBi~'~ ~ R. ~ TSO~IP3011. S'8. ~ .,~ ~ : 1 :~ ~ 8' ~ : . ` ~ r , y. /IACE OF DEATH I:,~tr a Towrt~l ~ Jt+ Gr+mr ~+. Rssd~ns INo. +no S~I ~b. C~q a Towe I~ `~~ k~~~bxi•y ; C2~tie~stsr ^ 120 Tiab~r_Laa• Clarkab~r• I bw Nanr ot No~p~W a tmtaw.un (lt not aUw. ~a F:o. ~n0 S~) -- k• ~~~Y ~0. Suw ~ y. N~W~ Gty l~a i ' Ui~~r~~~i 1~~~~i tal ~l~zs~stsr N.J. i 7p v„ a ~w ~ _ ____ _ - - ------ 60. If 1bpiW a ~n~utuua~. ~lwct oa~~u Goa r~ Yr~u! 7~. Wr O~a~w~d w~r M tl.:. Miltl- 70. Wo 7c. Dsa fran~ O OOA O tnw~yne ~ --~ Mwid ~ ~ tROw~~d H. YK' ~nw WR w/ OMn Y o e~«wKr ^ o~n«: . ~ a s.w. ~ ~ s.w,.ae ~ o a.awe. .I Q Y~i - 3X-M - ° , _ T~ _ - - Fjq~jTj~- •• •. ~ O~ : ,--~ 9. O~u ot BuO~ . ~~O .lq La~ Br~+d.r tla INWc. "1" Yur ~ito. udN ^1" D~y _ ~ -. ~ ~~ v. N~Me ^~ owvs ' .~ouws I YINUf~1 . ILa1l. ; . 2~1~~.2? ~ 1 ~10 i 67 r--- -t- ~ ~ _~ r~~,~ ~„~ F 12a 9+eAWw (Sin~ a Fa•yn Counuvl 1 12D, Gi.t~n of wMt Gw.nuy ~ 1~. Sunnrg Spaiw Ut Wd~, Nl~n1~n N~mtl t1. ~oNM 6w/M M~OM ~ ~. . Pl~ila., Pa. ~ USA ' D~r~tk~ ~!. B~lu lbt-0~-6~21 . 16. Raa f] Anwn:+n f~oun i 1& E~nn.c Oip~n .- .. ..~un~Z' U[na t~i..c~-v! -~ ~~ N~me and A...yw ol last Emobv« lD w~ua n oaw ~sv.uh- : J c~io R~+ .y, ~ , `. ls~risax S.K.F. Ballb~aria~ IYIY~tr~ ~ q ti,.:. _-. clwn ~.~~nw. ti ~ ~ ~ ~ ~ ~ _`i" _ _' -y ~1~/~ ~, 1l U,,.,. !1carWlion (KrKf .: +wk da» mo~t o} 19 Kr+o or 6..:.+u u~ In4~„t~y i Z ~.~.-..~+~~-.~..a- ' ~ Pkila.. Pa. ~ ~ - - - - ~ : ~ D~~~l~~a~at Pla~a~r ~ Ballb~aria~_ ~_ i_- -~ ~ IMp! ~~ 20. NAME OF FATHER (F~rtt (N.~SdKI ~(l~+U 21 MAIDEN NAAAE OF IIlOTHER IFr~q iM.QdNI ILJNI ~ ~ ~~~ .. R~b~rt B. Tk~aps~x F~ia ~ ETI~ -- -. ~ ~ta wm.a 1nr«mr+t -------'-2te. R.a~an,u~~p - ' ztc n•.rrrx. xd su.n ~ 2eo Gcy w ~a.~-..----! ?~•. suu ~ : D~r~t~ M. Tl-~s~s ' Yif~ 120 Tieb~rLai~ C1ark~D~r• ~N.J. C~~ ~_ ??a Dupo~ition Q Raew~al ~ 7!4 Na~es ot t:e.nnay a Gemrtay __ ~ TZt. Gt~ a To.n ~?20. Sun ~ Dupo~i L ~a.,~,,,,, °Otn«~ ! ~s?'.n6:sY C~=~t~r;~-- - - 6 Clarksb~r• 'Y.J. { - ^ ~ ~. - ~ ~ ~ ' --- - --- --- - TY3n. `twr of Fuws~ D -^~ ?3t N 1. l~oente Nu. ILACi 0/ ~ r 1L. 1~.~r~ and AdOteK d furw~i llane ~ A10C0f1 ~ ~ Da~i~ Flu~~ral li~a~ ~ , . . ~ _ 24tl1 ~ - -•- - - - - 171 D~larar.~ St. '..y'~~ • o~ -1- ~-2•0. au .K....a w ~ ~w~w ; Y~~~Du~, ~1~x Jar~~~ 080~6 `' ~ _ -- G "~'"~ 1978 1 ~----- ~ !~L VIIl~ Mti. AM~ M d~OrYr- O AlMM~ Ar~ Q Yd E~a~. D OM ~?So ~. •~. e~s~ o ,. W w sr+.w M~ti a.e ~o ~.~ru~ ...ed. .~ f _ - - ~ . / % C( 6tiLp ; -_ , - r . ~ _ _ . r r 1Se • ~ t~~ ~ ~ 76a Har ot ~ 16b. P+aw~noed DeaO v . •. i L Oeatl1 ;.nvw } Gwi[ ~ " . . ~ . ~ ~ ( , } -~~,r ~,,,, ~~ 27t /ANT 1 1 dutt Causr w _ (Enter wdY ot+e ~ l,~e fo~ bl. mf ~~I. : I..ta.aE Otwesn m~t and O~att~ ~ L Q ~ ~~~~_ %~-~-~.?/ - , o,,.~a~.~ f ~ ./ 1 y /j ~ ~tL ~ ~ ~ Ow b a ~s ~ odn of /~ - - ~ ---- --- -- i o~ ^ r'~ C-~'f l ~ ~( Cs~~tii'v~ s~ - ~ YMT11 s+qndieant owdA~ona - ~uwn ow~u~Dut,ip ro de~m --- c,eEUW :o cw.r .n P - - - ----to 4W~u1 t~ E^srr.rxr o` Coro~er~ i. ~~',D Y~i. Q!b .^ Yei C No u~ t 30. OeaN du~ p L3 Nom~c4e ~ 31a Dew x fwaw ~n;wy eccu~~eA ---_- : 37p. pat~ ol lryKy ~ 31c Ho~w of In~urV { 0 Attdent G Und~: Imaty~tan ~', ~ . ~ ~ f] Su~cd~ = OtMr - HE4. ~a 1 31d. In~ury ~t VYwk ' 3te *',otof Inlu.y ~ L' O~t.u ~•Wnq 31f Louton tNo. arxl S!.1 ~ 714 Gtv a Town ' 31A. S:.b ~ . tlr i~ f C] Y~s G Nu ~ _.ume : Se~eet ..: Osns. ~ . i - - - ~sss~ _ . • _ Fum~ _:i f.ccw. - - -- ' ' - --- -- ----- -- ' -------__~ ~ THIS IS A CERTIFIFD COPy FRO!a Tti~ C'FFTC~ c,'F Tfi~ ~EG1Si RAR t?F VITAL STA7ISTICS - _.: - DO NOT /ICCEPT 1~IS COPy t1,~1L ,'- E RATS~V SEII ~ ~F rNF G OF WOODHUR~ ~S AFFI HFREON ; ;~ 4 j . ~`. ~ . . ~~ - A U G l 2 1978 'J~l?"; C1~ TSSC:'E 5158'74 198i f E3 - 4 P!~I i2~ 2 I ~-iEe Rhr ~: c~t.~r:~ Si.ll,'Clf CGl1~j'f.F; :. ROGE R P01 i f~:.5 CLEFK Cs~•CL'.' `:r ::~ ~ ::tft•_~z~,: .. c~~: d~a .-, ~ ~ r I . Lcc`~CC~ `~ ' -L ! ~..~~ r l,.oc. _ ~ ~ ~ , UAVIa J. PHILLIPS Ll R~GISTRAR B~`~347 ~~~2842 !~'~ODBt;~'Y, NEG~ J~RSEy 08G9b ~~.,.~~..~ _ . . ~ _ _ ~. ~.~~_ ~~---~~~ '' - ~ ~~ ~ =~.~~~ ~ .,_._ : ~.~~ .~~=:~..