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HomeMy WebLinkAbout0948 ' A~l COPIES MUST BE L[GIBLE. .s i':COMPIETE CERTiFICATES WIIL BE RETURNED. ~ • ! .)~C7~~ • . , y~ iq~ r 6TATE FILE HUti18E11 '1 CCHlU~ ~U? T,uct o,v~sww «coop~oaat~ NEWYORKSTATE s~~~ DEPARTMENT OF HEALTH L J REG~S~E11 NUWE11 CERTIFICATE OF DEATH SfAT~51~CAlpSTRIC7 1 NAYE fIR3T ' V~OOIE I.A~T f Bf.X .lA. 0~1~EOF~EATM ~B NOY NA~.t FEYKE VONTN DAY VEM `~E"~ Chandler P. (Urry ~ ~ ? ~ 24 ~ 85 ~0; 25 ~ i REB. a AOE ~f UMOEN 1 ~EM if UNOER ~ OAY s OECEOENT sORN e VETERAN OF U~ ARYEOFORCEit 1 NOCIABE~ECURITr wOMi1q OAtf MOU1l! V~MU~ES YOMM W~ KA11 NO •ES IF vES. SPECIFY WAii Op MTE3 68 ~ + 10 ~ 13 ~ 16 Q aE~ 11?-05-?9SS ~ ~ ~ , ~ 6A COUNf~ Of OEAiH •8 IOCAUTV (CNECK ONC AND SDEG1Fr) M.. NOSWIAL OR OTMER IhSTITU~ION eO ~f IN MOSP~TA~ t7q ef li ~NVAiIEM ~ ~ UF NEITNE0. 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NAME AHD IOCAU7Y Of f1A\I OA CGMPAN~ 1 1 ~ ~ 1`ruck Driver ' Truckir~ ~ Lvcai q45 tv'~~h ~ra 17A STATE ~178. CWHTY ~ 1)C LOCAL~IY (CHECK ONE AND SPEGIFY) ~ 17E. ~f CITY OR YR Gc ~5 ES~ fNCE ~ ~ ~GTM~ ~ WRHINC17YORVILUUEU~lR6t Z Neversink i1SJRl RESIDEMCE ~ N Y ~ ~u l l iv~A _''C]tio~~ o~ i~s ~ IF NO. SoEUiY TOWN: Y~1iERE0ECfDENi n----•-'--------~-- -'---!~uoeof_ D li~E0. ~ 170. STAEET AHD MUY~EH OF RESIDENCE (~IICIUDE ZIPLOOE7 ~ W ,hevers ink R.R.1 Box 26 Rt. 55 Neversink,N.Y. 12765 ~ FIRST YIDOIE WT 1~/B'~M FIRST MIDDiE LAST NAMEOf ~NAMEOi ~(]rV~B . FATHEIt MOTMER: 1~:~ 1 W NAYE OF ~HF ORMAIfT ~ 198. MAIUHO ADOit E55 ONC W D£ ZIP CODE) Dora G1~rry (Wife) ~R.R.1 Box 26 Rt.55 Neversink N Y 12765 70A BUR~ALCRE1AA710N, NEfAOVAI O:i MONTM DAY YEJTp p9. ~UCE OF BUHUI.CREI.UTIOM, HEYOVAI OR 20C IOCAT1pH (CITY OR TpNN. SiATE) 1 8 B OTMER DISPOSITION ~SPEGIFY) OTMEH DISOO4R1pM 1 o Burial ~ 7 ;28 $5 ~ fiural Cemetery ~Grahamsville,N.Y. a 31ANAYEANDADDRE640FFUNEMLHOME ~Z1E REO~STM710NN0. si_ d R.?msa 's F~neral Homes Inc. 275 So ~in t Libe N ~ ~ Q1 y 2tA rlwME Of FUNEFULL DIRECTOR ~22 TVRE OF F EM D: ECTOR ~ 2?C RCG':s7MTtON NQ o , ~ a~ L , . ?SA S iURE O~ 6t5T ~~TE 40NTH DA11 3~A B Ull OR PE YAl R SUED I~B ~ ONTN OAr YEM G S y . . . . .1 FtlEO ; 1 ~G / !~G ~ P ' `5 TO BE COMPL ~ _OR_ TO B OMP E Y ri. CERTIFYING PNYSICtAN NLY ~ CORONER OR .SEDICA.L EXAt.:it1ER ONtY ~ A IOTHE BEST OF MY KNOWIEDa^sE. ~EATH OCCURHEOAT TNE / ~ A OK TME BA5~5 OG EXAY~NATiON ANO/OR 1NYC571WT{p1( ~~OAONER ~ TIME, DATE A.YD ViKE AHD OVE TO THE UUSES STAiEO ~ iN MY O~tN10N OEA7H OCCURRED AT TME T~V E WTE L~ va!,iH DA~ rUR A'~DP.J~CEANDOVETOTMECJWSE9STATEO ~COaOUERg . vxrs~cvV~ , t ` ^ ' / ~ ( SK+NATURE J~jy..~ V ~ ~ ~ ~~~~J ANO ~EiRN NER W 510NAtURE ? . . ....................ti........... 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