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HomeMy WebLinkAbout07775163~8 4~~lora~ ~to'St~-~m'~a t334I9 d Title (File I~b. G~018--768ST) . ~ 13. (~i tV~s Dtcusrs w Vtrct~-H! Ya or T:o n~_ C ` (bl I! f~'+. tin rar ~ Unit or Ship ~..~~ ~pr1a~~~ze~[.kh ti~ r i~; ; : ~. . ~. (G~iy or ~OM~4I I,t~!! ot ~Ofe:~N Cfl1111tfy) ~ /S. BIRTt1-LM1fC ~ p 11~~s18/A ( ~.,~K i~'1~f?~r~: ~ ~ ''~k~~9'~l ~ ~i ~ L . ~ ii. 23~Hr ~ , r !; , /G~t~ or townl ~ (Sette or lorri=n eouqtryl { i - R ~saia f ~ ~~:_ B~:t,~,~,R _ 1 , , • ~ e ~'~`,,~,.~~c•r, r'~'C ~ ti . ~Z, /a) Uwe~ Oeeurwtca+ IGi•e~klnd ot ~•ork done durmt most ot ~ ~or4ia~ life eren if ret~red) ! housel~i~'e ~ ~t., ,•~ ~ (ii iweusr:r ae Bus~vcss 0~ hOIil~ ~ ' . .- ~ : : i~ ~ S ~ c4-,~ ~ cawe ~s To~i , ~ ll. a~'*H~R ,OU~r in~ 011 ~s~~p or forr~sn countr~l Of I'.',~ht_breast•_. ~ ~ n! . . c .G , / f-: ! (~ ,~ T ~ ' ' . _ - ` ~ D~~ a ~ ~•'" /)tont4l ~Quly . IDar) ~Ye~rl ~ : 15th jE ;~1.967 ~e Tp I-) COTditiOTt. ~. ~ +~ .h,, ~rh~c6 .,ervical ?r~ ctetomy 2~;week •T[ ot If1es» l~ D ~ AeC I~n yefn i! under 1 .rar it under 1 da) ~ ~i•e nse W _ ~ . . . • 't - _ . -. .. . aa,ive eawe , 3 n~i"1915_ "'si '••` °iri"di'' lAont6s Lara Hours Ddi~u. ~~~ ~y ~--~-,.~ /a). aeat~n~ ~e $ rf~ t,1 C v$1' l: 1~QB~ tse under • j~ ~ ~ 1981 FE8 -9 P!: 2 58 i~~ee ~-~c ~ecaiSaf ~~ sc~ucit cnuH~Y i~ a RCGER POIiR,LS n CIEFY, CIItC~tT Crtl:t !.~ G'!~~;r,1 \'f f'~ ' . ~ I. 5i63'~~ C OJ~ ti~ c i~l~ t,iT STA I'E Dk:PAK I ~1f:t~~1 Ut iit_.~i.l l~ AubGt H.,I~h 5~,~~.~;~. 5~~~~on-H~rl~otd, Cann~clicul V.5 A. Certificate of Death ~ I ~yed' ~ ~, a D~„TN; ~,- ha~e ot Coon~etieut !. Vsv~~ Rr.s~nakcs or nece.sso: ~a) s~.~e COlll~ee'f ~(~l,it e 1 7bw 1 e C ~ ount `] ~ ftb aw ~yen 8 , ~ k ~ ~ ~ Y ( 3. )s lt..,.l~nc~ ' ~ ~n '~~w, A ;. ~~ -~, ~. /V ~`. ,• f ti Xi* • C~IY ..r t/a~.,urt t r~~ta' ~~ p( HaD~~~~ or In~titutioo te) titreri 1+umE~r ~ 11! nat ~n • MyD~pl or inriitutwn si~e Street No !Il su>d, t:ro loc~t:on) ~~ , 1'es ~p ]f ~ n~me C A~ en. Hos~i ts ~, 41 Fa irF'ax Av ~ue ~e~~°+~+evr P / t ~ . . o. HorouyA . ~ . _ , -. .~ i t ~ ~-~ i ~~a 7 i ~ii, ~ ~~ ~; . / Meri~er, _ -~-- ~r„~t~ ~~ ' ~-t~eei~ f'~ *~YR a p ~ r~ f~ ~ ~~.~ • j.K1~ft~ ' v ~~wski _=`--- ~. ~K1~1. $iCUIl7Y hUM~LR I ~ - - '_'C^,: n~tl ~ yf''} . °i° IT-vr ~ `~ ~-~~!~~'~ ~y~ - r - _ _ _ , ~~_~_ ` ~" ~ A/C~ICAL C[RTlFlCATlOrI IT~~~ ~r ~nnt) PERSONAL AN~ STATtSTICAL PAi~TICl1i.AR5 ~2. C~l'~/ n~ [1[4tH ~$Afft OOIJ O7M taYN Mt SOI ~~~~~~ •I~d(~)] ~ -- iis s. A•cs 4_ M~R.ie~/~ s~rea 3t~~iten r i ~ ~~,, l~~ ~..J ~ ~4• •. /Iq:M MAf ri4{td/'1 8T: ~ IAttt{~L .rTweew f ~8 1~ 1a e~+c ],@ ixrcai~n Cwvu (~1 ) ; . - f J ; : . ~._ Woowtn ~ 11avo~cso ~ ~ •• ~ .~e~ir.~i~is Q ~ Li711CI~8~~ o••n ..r. D[ATM i a =r ltuaees ~~iudweo oa D~vo~cso. w~rt •eocK Nwre w ~ ~ _' •t . _ . . _ - . ~ ~•~ «~ H•~s••M• ~'he n~ ore ~le.z ex sk~, , . • 2 tiYeE ~: , ,, , F 11. It~(O~wess'! I1Ari ,. ~ / ~~BF~Qre $~~?,~e~ s~C~ ~)~, 19. Bvu.t~ ~ta~[atee~. oa~~ ~ p. ~j7-8 I~% __..)!!'~ ~ r.. ~ Cemetery or (i ." ~ -~ ` - - ~ '• - r~.« 1~6eri,de,n'~,Con~....~, Z ML 01 M L7ili ~l pOT S F/aI~ALM[D ~.Ktpk n~rneer .'r ~ ~ar~ ~~-'S~~mp~en f~ ii e ;1189 1. SIGNA~7,~V{R[/.~s I~LI~StO ~t~4L11[R O~ ]JR;v:~p FVN[t~L DI~LCtOR ~7~-T8~7'~ -_~~~, n .~~i.ntrFw. t,,..'/.iS:~o,'E waen.. 5~S C ~~,1defY-, ~'/JdT3~s/fi- ~=: f .,.~- - THIS CERTIFICA2'E RECEIVED FOP. FECOR~ fjy~ Ju17 17. ~~o UHit YS-{ '.•~ :. .- . ~~, ,. ,% ~ 'T ~ ~ ; ~ ~. rl ; .c ~~ , I cerf~~~-`"t2t~Y this is a truc iracucriPi ~, ; ~'. as recurded in this off oe. / ~ r . i ~ P~ar 11 Otws~ Stct+~n~~wt C~I~tn~71.~N5 Co~rsi~c~iNO Z3. W~a " i~ 10 LLATN •UT HOT RCL~TtD T4 Titi T[RMlK~-1, LSy~.~~t AUTOflY `~ CONDITIOM Ctr~x tx 1"~RS J(a). Fee-c~arss! ~ • . , - - ~ Ys (~ N~ 0 2~. Suaeut Reur~nT to Cor:ortwr~ Reroarea en Inu t2, -- ~ 1~) l3~p~,~oter~onStBCi~iQ1[ly ~~~~~ulermN }}1L , a[iE~ cervical tra cLo~o~s 6*~6?~ • :+i 1 ~~:[ O- 1-:~i•l~r 2S 1~-) /lcttasxi S~~ccac Hoacccc~ ~ t~~• M~~. ~r. Y~~- ^ ^ ~ 1 in. ftl INJUtT (/t[URatp Idl }'L~: t O- IwJU11Y (~.y . iw e. ~A~rt Aw~, N"Ailr ~t \ot NAilt ~~•"`~ lacewY. ~t.~sl. eAre OfJO., ~te./ N'ork ~ ~t K or4 ~ ~e) C~rT. Torw, oa Loe~nox CouNty Sr~r[ !!1 Lc~cRirc Nnr lw~cn Oicca~ca. ~Ewter watr-a eJ iwjrry ns part I o. P~.t Il ol :t~• ~sJ 2G. ! HER~BY CERTIFI. tD~t I•tueded tAe dee~uad t oe~ - .' ,July,.10„ 1S6Z 7-15-6~ ~~ - :• ' ~ 7-1~J"s~ 1! - ~ th~t I last aa~ fAe dec~~sed ~Lve on , fnd tb~t ~eatA ia a~id te A~re oec~rr.d o0 7~~ ~~67 • < : :'-. - : . - , , .t .: y ~:45 A.m 2~. S~cw~tu~s or PNrunwr A. _L~ ~~i9T'Y~II~ ~ _ : r New Iiaven, Conn. j, 7-l,b~s?~ ~ Addrea! ~ ..~. ~--~' .-Dntr : / I HT , ~ , `u /j j ~ 4 ~ of the information ~. ~,~~ ~ w '•~ ~ ~ . y - _ ....» .4!~_. • ~•L '~. ~ ~ ' w~ ~~ ~ ..... .......... .... ............... .......... .. , .......... •• ............................... '>_ ~ ~~~~t, • r e' ,Z , Ae ~d°ss~stant°t,statistics ':., '~s ~'r Doied at New Haven. C;onnect~a~t, U.S_A., this ~y pf QC~obes'~ 19~~, ~ __ • , NOT GOQD WITHOUT SEAL • ~~'~348 ~~f ?7? .~~~~:~ _. ~y __ __- ._. ~ ~~ l~ a ~ ~ ~ J 5 ~