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HomeMy WebLinkAbout2685 ~1 11b FEB 2 1981 [~ATE This is to certify that the foregoing is a true copy of a record in this office. WARNI[dG: NOT OFFICIAL l3NLESS SEAL IS AFFI2{ED. • ~ % ~; ~ ~ ' .,~~v~ c ~ _ ~..~ ~ Registrar of Vira Statistics ~, uty gistrar ~rc::/ ~ kkYt~EkSEVSiA7E L~~°ApTV~1TOR NEAITN i . • , ' '' . ~ • ' __ ~ CERTIFICATE OF DEATH ~ ouCE ~ + 1. NM1E Of DECEASED y /M~ ILa~r ~ ' 2. OATE Oi OEATH ~ . jly'~`~ iam °~'. - Geier ~ ~ ~r.~~~<<-.. H. ~~~~f.~ I-l3-79 ~ ~, __ _ I 3a PLACf O~ DEATH IGty o* Town) ~ 3t. Co..nty Ca R•sr:e~~a INo ~rA St 1 ~ b Cay o• iow*+ ~ ~u`5'°`"`E ( Edison Townshi -~Middlesex ~ ~ _ ___ P ._ 55 Brook Street ~ Woodbridge ' ; i Sa N~me o! Hoso•~at or ~~st~tut.o.+ IM not e~tne+, p..e ~1o anC 5~.) ~c Co~nrr ! b S~ate ! 1e ins4e Gty l~m~ta 1 . ~ ;~ Kennedy Medical Center Iliddlesex N.J. ~ x,,., --N, ! o ~ -- ------- ~' w i~ II N;,tO't~~ p Insi~tu!.on. cP.eU cdrect bo^ ~ 6. lAp~ti! Statut 7~.'J."a+ DecuxC ere, ~n U.S M.Ltr~ ~ 70. 1YSr 7c Date ~ ~ ~ ~ ~ DOA Y i'wnent ?;' :r,.r.ed 3"' ~v.ao..ed 1/ "'Vti' ente~ K'r i~0 D~tet f ' c.om ~ ',~, i "~ Emergency ": O~ner 1_~ S.~ 1 C: Srw~ated a X,}(~, Y~1~ I I ! 1 I . - - - - - - 0 9_k .wced 1~ ves ~7 No , io ' ' ~ .«_zrru~ B. Sea 9 Darr ot B"tn ------ ~--- . 1 p - ~-- -- -- ~ ~ - -- ~ i ~ Q qe _a~t B.,tnOav ~ 1 ta. u„de. •'t~_v~x r~ 11G Unoe• °T' Day ; i Male Jan. 11, 1909 7p i- ~~~.»s ;_ o,., ~ »o,,.~ _~ ..,...,.., ~ ~ ~~. 9~~r. , _~ _ -- 1 ~ , ------ I v xe ~Sute o• Fu~e~s Counnyl i tIb C~t,r~n ot wnat Cou~try t3 Su•.,. ~~~; Spo~..+~ 11~ W.}e. Ma•Cen Name- 1~ $oual $carrty Numoer ' '~` ' Pennsylvar.ia ~ U.S. ; - 135-03-1839A ~ ~~15 Raa -~-------• 16 ftnn~c0~, .r---- - --1- -~-- -- --- ---'-- --- ~ ~ - i ~ .~ Amr~u~ I~A.an 9 :_' ~4^~c~n "~ Um.. i_.o'afyl ~ 11 l~a~.minAAdd.euo UsrEmp~o~er ~ . 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