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HomeMy WebLinkAbout0914 ~ ~ 5;~3185 - ...e~...•n..~. •.n.~ w...~~..~~~~~ v~ ~~~na~~~ . MEDItAI EXAMINER'S CERTIfICATE 0~ DEATN r S' 3 O ~ 6 S A ~ 1 DE(fASFD NAMf Fr~t M+ddk losl ?o pAlf ¢tiOVIN Month L) Q ~ a~ Ou~ Yta 1u NObt U ( liW J S~~ PAEtKHt p[A1M MAIED ~ 3~N r p4 ~ S[lc ~ kA(E S OATE Of BIRiN ~ A p.,... wa~ ~~fu s ~~a~ n Nt 1~ Q0.1E PROdOUN([~ DfAD Jd N~NB A. w~.+~Ml ?r,,~na an wiws r• o~,, 'a ~u ~lale au ril 24 1932 43 r~s DeC 18~ I~~ir`aiq5 x~c a ~ H~ lo &t(HPIA(E (S?We a f«e~gn m q11IEN Of WtU11 (OUNIRYi t MARYiEO~]C AEYEt ARAkRifD? COUNTY Oi DfA1N O ~ : , ~ > O1"'"~'~lew York U. S. A. ~noowEO p DIYOKF~ ? ~~erick ~ J O a IQ Ui~ OR 10'MN OF OfA1M II. NAl1E Oi lIOSRIAI OR IMSIIfU1hk1 (II not n hospld I2o. USUAI OC(UFAIION (14nd of wqk da~ 11b [lNp pf $US+!liSS OR C) i n tt o) w I~fe. even d i~hred ) IliDUSIR F~ederick ~~'~"r`e~l~ Mem~Hos ital ~e~c~ier-~`~ ~lone :J ~ O 3u USUJU R[LUEN(E (YYAen daeosed ~r~d. d n~t~lWwn: Resdtnu belor Ik. Ufr OR IOYMN iU y+L~ Un t:rri~ 13e SfR[Ff RNO NDA18fR ` J o~:~~ s~~~r land ~a"~'~ederick t. Pleasan ~SC] ~47 Rt 1Jl Box 138~A 4~ ~ H ~ 1~. FAiMER S NAMf F~tst N~ddb lott IS MOIHER S MiUDEN biAME Fast 1l,ddle ~0~1 ~ Jacob Parker y Lena Bordon ~ c~ O i6o WASpE(EASEDEYfQINUi ARMEOFORIES? Ibb SO(ULLSf(URi11fN0 17. WfORMANT ~QEU ~~erick ~r~ ~'a~~~ Dr. David Denton S~~ t I?iSD I?lai• land ~ 21'701 No ~acxxxxxxxx 808»2fr-23 Y ~ r--~ ~ UGQI.t.INit 1\It3Yl, ; ~ g ~ 16 tAUSE Of DEAiH (E~ra m1y one cwu per ~ t~. (o). (b~. ond (~)j, A iARI 1 D(A(H WAS UUSED BY ` ~ ~ tFi~rkU 4~51! ND inlty \ J ~a r IMMFOIAtE (AIISF (o) A. ~ / I I /`yC ~l c!,~~!• ~ i• • 6;r,~ ~ ~>Z~L_ - ~j ~ ti.: f OIIE 10, OR AS A(ONSfOUfN(E Of p Condu~ons, d onY, whaA go.+ rol = ' ~ •J~ r.te to ~mmrd~ote coute (o). ~ - s~o~u~g tAe ~nde~ly,ny ~QUU ~ ~ j0. OR AS A(0!~SEWttiCE CF bTt. ~ ,i _ - - _ ~ /1WYf1(14t lflYtYiY1'!IYf. lA M~T4 OIII Wlt O{~~~[~~ 1/1 14[ 1[[u~.u~~ nK~. n,r:M': _ } ~ i~w i.. ~ ' _ ' ' -~._~a a . . :i~ ~ OJ~ 1%. (WiWt10N i01t WHI(H OVFRA(1GN 20 AUTOPSY~ ! ' ~ j ~f ~ " WAS PERiORIrIIiD? - ~ _ ~ ~ r[s[) tio~ r~ UU$E 11b 11.4i Oi UIlU~2Y Mpnth, p:y. Yc+y lli HOIIY 1t11iiR( 0(((ikitiD (fr,t~e r~:twr o1 ~~~~j m Fcn 1 0~ Pcrt 1. U~;n 1t ) + O: I i' ?R OR ( FiOUR A M - . i w DEATH ~ Y M 19 . Y~L' , 't'.wC[ C: Svuii ji~ i~~,nr_, io;m, suee!. 2i i ii~ ki ~i S i:reei or i i ir i~o i~t~ cY icwn iw~~~~ l~~~t ; r; 1 ~ifory. o!!Ke bu.k~mg ctc ) : ' ~2 : J. ~ Q~ ' 1 took churge oi ihe remoins drstrib~l utwve, held un Autopsy l:ispethon'~~, Inqu~~y [J. u~~~ in rTip cp~n~a~ . , ~ ~j~ . ~~om: ~lutural couses Aec~d?N Q, Su:c~d~ Homiude Und?tennmed monner , r/~ H ' "~'-y f ~ • qilEF kiDt(:d kl(A!':1iR ? / W •rN1 ` ~ i :uS10 ~111~_ • Xt. . ~ ~1 ~1~ i7 ~y ~ RU JtiSCSilIYf :JfU:(x! flt.Alli!P ? ?h' DAIESIfNfD > • -"!-+~--c--d-- a~ EXAIYtIkER'S r'~- ~ ~ DEPfltr ~~ED+C~?t E~~t:v~R ? Dec. 18~ 1~75 a H _ NAME I~rP~I RObBl•ts,J Thomas Dt U ~~u~~u st-~r. w~_ti~. , . , ~ • • _ 1 r! Frecierick~lttaryland . " ~ 13a C~vA~.CFFqL1T:UV. l.y.Ulit - -T. 1k 1.4YtF0~fi7cc~-~ ~~pcr~4~uil ~3! IOiA~tLti u t+Ia.1n ~ pt ~O/a~ I:s ~rl ~ t , J l/ l r) i~'= 1 ' ~ Hcmov:el»l~ti•'- 1~~"~*22-~i.975 FiTankl-in Str'~~et Cemetery Elmira~ New Yoi•k ?`-1 ~-w~v.~~ ~ ~l'"--.; 12n:1 Nc~rt!t,~f.t~ir~C:s~3t~~.o{ ~c;z . _-•~~o_ .•SiRAR y~~;,e~=~~--- ~ c:., i,`S 'f _ C.-1~?'~ 1~'rederick 1Ici. '~17~11 a ,,,,,a~,~, ' r» „ obet ~ E. I).v3['i•eV'.~s.. S~~ ~u~L ~r~l 915~ •c;., - - - - "~:°'e'r°__== _ ( i ~ { E ~ s%~3185 i ~ ~sai a~R -s P~-~ ~ 4 s ~ ~::EL ~hi cur,~: u S1. LCCtE CG~N' Y. F: A. HCG~R PGIiR~tS Cl.fHK Cl,C;;II CC•U, . , ~ 3 a ~ ~ - . ~ ~ E ~ I ~ 1 a s ~ ~ I I ! g.»x 352 PacE 913 E ~ i 't ~ ~ . _ - ~ ai" 4'*~.~.- . _ ~ . , .~i~