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HomeMy WebLinkAbout1557 + . 1 a - - - - _ . , ~ iccosucc o~aT+.c• ? flEW YORK STA7f,~~ ~=~~-c •~~c ru.+~c• , OEPARTMENT OF HC ' ~ 29OA BUREAU OF VITAL R ~ ~ - t _ 0~; l ~ CERTIFICATE 0~ DENrH - n 75 A~~' - 364 . TYPE I~IL ~NTRIES OR PFINT IN PERMAYENT B~ACK INK. AP[~ 2~~~ F~ 1. NArAE~ F~N1T M~[~DIE L4Sr 2. !la ~ [~~t( G? D[ATti rOUA ~ 1. t ~I L ?LMA?[ MOMiM D~? ?(A~I ' q~ ` _ Vincent L. Sui tan ~ O ~ 9:25q,., ! . , : W ~J t~ ' . _ .:14.L~~ •~Ct lMw~~(. Y[G~O. 6. •4t .r''!~ 1•• f~w(~1~1 1 O? dA vt~lwA11 O? U.S: A11Mt0 fCACIl~ OQ- 1/ rts- asat~r? nrAR. O11 tiy , !1~ x~[AICW ~AD:AM. [7C./ 4C\fVl,i~1~~ :~Rl, VIM. . i OAT(~ 01 ~[AYIC[ S r _Whi te ']1 , T~{ MO'-' YMIIMOrMM • ~_r~ N / •ws. . ~ ~ ~ ~ ~ - t:~ ~ ' ' ' • _y ' ' ' ~ - : - ` 7A. CONMT• INYSI 176. TOM't ~~C.C1~• 0~1 rlll~G[~7D.lCVGINOI~T~?IM ~~E. MOSrIT~L JR O`MCR ~M]TITyl10N !,i ~j~•'._. . 1 ~ ~TOMM. CIT?OAYItL~G[ ~l/ NCI~w[4, wl~[ S~~CCT S NO.1 Wju~~`= 1~_~_ Na~sau ;N: Hemp. Mineola 10 Days ~ Nassau Hospital ..i' ~ ~i { ~ ' S.S7~TC C~ ~~ATti O[CLO[MT •O~M 10. GIT12(M O~ Ah~T 11, 61A~ITAt STATUS 12. lV11VIVtf1G S?OVS[ Ilf }r1?[, lAAIO[M NAYt,I ~ ~N C~.. a.- ~ ICOVhTll~.IIMOTY~A MON1« 04~ ?(~1~ CO~MT~TT ~ . - _ ~ ~ ' ~ _ _ N~w York 2~22;01 U.S.,. Married Florence Whitley _ ~ ~ 1~A. JSUA± JC~Y~Af10M ([V[M 1/ A[TtA[DI ' 118. RIMO O~ ~U~1NC93 OR IMOYSTit~ ~ ( 1lC. fOt~A{, ~[(yRITT MO. - ' Sanitation Man ; Sanitation ;107-32-8306A ; , ~ - 114A. STaT[ ItB. CCS:VT7 1~C- •Owr~ ~ 1{D. CITf 0~1 VIll/1C[ I~E. WttNIN TN[ IIF. STIIC[T ANO NUM~[A ' . . . ~I . ~ I ' y; h j ; CCA~ORATC L~MITf! I i . New York; Nassau ~ ; Hempstea~ Park" ~ r~ ~ p ~ 14 Covert Avenue ~ , ~ _ . . ; 0. ~ ISA. I~~w(11'S NpuE: ISB. MO?MEw'~ uAlO[N M~~I(. ~ s . ~O ~ ~ I1113T MtODI[ - - 1~3T ~ f1113t 1./1OCi[ . lA3T . ~ 1 ~ " , ~ Leonard S~ltan : ~ Catherine_ O~Flau herit J IEA. IYfO~MM1'S AANL' ,SEB_ Y~.I~MG •DDR[S3: IIMCIVD[ 2~P COO[I - - ~ w' . F lorence Sultan - ; 214 ~over-t Ave., F1oca1 ~Par-k, NY 1 1001 f-~ o c3 O r-1 - V~ ~ '~PART 1 GEw~n w~t C~. St0 [~'[~-C~~r tME C~JSE ?E~ l~Mt f0~ t1.1. iH). 1~O ~~PwOi~wATC ~MT[IlY1tl ~ V C? L. 1 ¦[T@YC[M OMiET • oc~rN ~ ~ .3 i ~ 17. . 1M4C:~qE LAUS[ - . . . ~ `'a s~ ~ Cv/C ~;S ~ ~ i w ~ l~ ~.~¢~ss~ - ~ - A' ~ - ~ - - OL•E TO O •S 4 C EOt7CRt Oi - - W ~ T~ ~ COMOITIOMS.II AN7, wMICN ~ ' ~ _ - '3 d um- '~0 ~ c+vc-w~sc TO IMMCDIATS ~D~ ~I - ~y .a~ ~ . C1l~SC IA~ STATtMC TM[ . ~ j.1 jJ .p~ ~j ' YMD[Rl~lpi CAY1[ lA3T DY[ T 11 AS ? COM1[QV[wC[ O . _ . . . . ~ ~ ~ ~ ' ICI - ` !{Z . ~ ~ PART li. OTM[R SIGMI~ICA/f7 COkD+T~OM3 COMO:T:04+ COhTR1'jVTIMG 70 1lA. AYtO~it~ I~D. IrTCS~YfEA[ IIMDIMCS lIDCA[D IM - i¢ : - O[AiM ~uT ~OT 11[LiTCO TO C43[ G7Y41 lY OA11T 1 IA1 TES ' MO O[TCIW1MIwG TNE CAU [ O~ O[RTNT '7 ' ry'~ ~1 ~i j T[3 ' '7t0 - _ - _ . I~o . ? O ~ { 19A. •CCIDCMT, NOMICIOC. ~~DD. ~OMTM~O~• ?[M ~9C_ MOY¦ IOD. MOMr DIO INlY11V OCLYR~ l[lIt[4 MATy11( pi IMJY111E5 IN +I7 f, Ow II.1 . YM', ~ ~ ~ ~ ~ SYIC10[. YMJC~[AY111[D ~ • 1 ~ . . _ . r1 ~ '1- 1 1 - ~ _ . . ~ q ~ i - - ~ .7i 19E. ~MJU~• AT Ml011R~ 19F. P~w[E O~ IYJJRi, NCYC~ 19G. LOCAt10N (STI1[ET ~ NO., tIT~ OA •itlb?i, 70!!M, COYMTII, iTAT[I ~ V • E'~ ~ ~(3 Mp . 1 fACTOR~_ p/Ft~[ tLOf_, ETC. 1 . . . ~ # . ~ ~ C"'~ ~ ' ~ ~ O ~ ' 1 _ ' . : s ~ Q .-t ~ ~ TO ~tF rna~,LcTF~ ev nn - T(1 RT [~fY1P1 'TF(1 RV ' V~' ~ 20_ PRRT 1 ~ERTIFYINv PHYS1p/W OhLY 20. PART It ~ROtiER OR MEOIClIL EXAMtNER ONLY ~ ~ f~ ~ a ~ A.TO TM[ ~[ST O~ Y RMOItiI[OGE, O[~TN OCtI`AACO aT A. OM 1M[ •1~SI3 OI EIA4~MAr:01~ MO/O11 Il~YCSTIf~11TICN, IN Y~ - ~Z Tti[ TtMC, OAT[ OLACC AI~D DU[ TO TML u yTw DPt •E~11 OOINION OCATM OCCYA~[O a• T~[ TI?~C. O~.T[ AlIO ?LACE MO ~ E'~ N~i O \ I «u5[3 E - ~ ~ Ol[ TO THE CAUS[S 9TAT[D- _ . a a a o. ! s~cMC . ° ~ ~ ~'7 , s~c~co . nnt___._.......:.... ' W W W cV . s _ U C.~ a~ . B_ TM[ PMT {(~4~1 lT7[MOEC TM[ O[C(~3[O ~ C. lA3T S[G, ALIY[ D110NOLVCCO O[AD C. MOYA ~ D. O~T[ S7plE! ~ ~ " ~ Mp O~~ E~• MOMTM OAT TC~A YQ4TA C~T T[.AR VOMTI{ DA• •[All - - MOpTM O~T T[A~ ~ 1 1 1 ~ ~ ~ ~ ~ ~ . M t~ /1 Q _ _ IIIOM: ~ ~u TO: 1 a~ ~ ~ ~ Z OM ~ ~T _ . N: ~ ~ H~ ~r~ MM7 ' v~ ~ D. ?TT[IID3MG ?M7l4C1?w~ {/.OTN[II TICM1 C[tT~J1[P: E. COROMLII'S ~NPt1C1AM, 1/ O~M[A Tn.W C[IIT1/1[R: - a W 4i ~ - " :x . ~ • WA1-~ ~ ' ~f~: ~ - . ~ N ~ . ;t, r - ~ ~ ~ 4{ . 21. C M ~•~Rtl1~~.C ~ •!Itf~C1lw. COlOU[R, 1t[DtC~t [1Yt~titfl, CO~OM[~'f ~MTifCIM.~!CD~CAl OI~ TOM): - . ~ H ~ > 6~ ' ' iZ~ _~'~'yr~;~=~~. '.~',~q.~.~ i io.~ f~v~ ho~ z ,r/yi~ aa, ,~,~1 - - ' a ° ' ' •T'-'--°` ' - V~ ; : ~ 22Ay ~W~3D~t ~ ~l~ O~t •C?• j2d. •l~C[ O• Wlllal. CA[Y~TfOM OA ¦[MOV~L 2IC. lOG?T1011 ICIT~ O~I IORI{. ~TAf(,f - 2 Hol y Rood Ccmeter e~tbur N Y - - t-! - ~ °~N- ~ _ ~ 097 Hempstead urnptke ,2". ""„T"""~' t ~ ~i~F~une Inc. Frankl ' ci , < ~ r.r:~: _ t t4A. I~t~['~[ ~~~1t . . a~ ~iu~ • Rsc• '2~C. cs~srlMY~oM Nf. ~ : _ - s. ~1}: " - ; " ~ 05728 - 2 ' _ ~ Z6A;':~Ii~a~ ~t~f • ~ : _ ~/'-fr~M O• 1ItAl1' 1~ . YK•011•11[YD~~L ~[IIMtf taWtD 30~_ MOrTM ~~r 1~AA . , ~Q - , , 5 3; 72 E. Trucks , ; . v~°o ' ~ : . . . _ - ~ ~ i ~ - _ . - = - . - . . i . S t