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HomeMy WebLinkAbout0983 ~l~p-?IQ ~ 838a84 ~ c~~ o~ ~unr r~c BNR8/W OM VItA4 ~ut~ otM~Twws o~ H~u.nr , • • ~rri~I~k~''f ~/+~aaan~~~,,~ vr. - - ~ ~ ~ ~ ~ 'j ~ 7 ~9~5 ~ . ~ . : . ,~.....~.•~:R~T •r~.~ Y . • ~ , . S EP ~y.. yy,,: ~ . . . ~ 'i ' at~ ~ b ~ 1 ~1 ' ' ~ ~ • ~ ~t• . ~ {i. ~ ' ,--c:_~f l3~--85-208935 .L:~~ • . . • ; CERTIFICATE OF DEATH Certificate No. o~?'iE'~~t~o~ ~ 1. NAME OF r ~ lC \ OECEASED ~'~F'~ ~ 1 ~~~'v~ - ~ (1 Ypf o~ Pirint) (Flrft N~eM) (MiadN Nu~) (Last Namq ~ a Ro be /il/ed in b the Ph icianl NEW vORK CI .D. am~ o osp ~ a nft u on. ~c. n osp k) e 1 C t o ~ ' curr o aO~rti~~s~on M.ACE s. 80RODUt~F1 ~1 not hospltal. stre~t sddrKS + 1 pOA 3~tpailcnt ~ ~ ~ ~ •MiOelh . DiY ~ Vti~ OF r . 2~Emvy. Rm,(~lnpatiint . . s~a. ~aTH ILe~U~c ~ S cic.~i ~e ~/!3~ Jr!_~ Yr_,_.. ~ . , , 3i. DATE ANb (MOM~) (Wy) ~Vl~r) 3p. NOUR 1. SEX 3, APPRt)XIMAIE A(SF. ~ HOUN OF ~ ~ ~ „ HAM ~ ' OEATH S I U ' ?PM ' )~st. 6. 1 HEREBV CERTIFV TN.A~T/• (Check Ony L7 ! a!lM~O~d tfx dec~ss~O. ?A stilf pAysfclan o1 thit InttitutWn ~1tMdsd lM datsse0. ;'~`4~- ' 7 ?p. 1ttRAW lM dttp"std. ~i`, ~ ,~~y . ~ r+~Q c~ . • ~y~„ 1 • 3'.S ~ ` t' u ~ ' ' ~ , C lrom 19 to 19 and lstt ssw h....~.alive at r - ~ 00 "i~j~ s~w 19 ~ 1/u~tf?!t tfilily tb~l lqp~nitiC InjutY O~ 00{SODIn4 OIO NOT pl~y iny pLt Ih csusinq aeat~, snd tna~ d~atn tl~d ~+ot occur In any un~~s~u! ma~na and w~s ow ~nt~re~y tq N A T U R A l C A U S E S: ' ' : ~ ! •$N.ftrst Iny~u,tbn ~ tfv~ss~f ~ te~ ~fiti~t ~ ~ Wi1MtlmY ~andtAlf ' r<d• Of •"~T~~14~s~~ Syn~tuH" ~~L'~='~'-• M•~' i~~ ~ Y T ti, ~~ti'~ T~~" a . .=-,~SY~+f!.i a l. j-~ ' - . : ~ ti ~ ~ r\ Naemo/ VnYSKisn ~ Aoar~ss +a~ r --~6.L ~s ^ l. ~~~h,,ti~ (TYOS w P+Nnti ~1~`'.~~ ~ , PERSONAL PARTICUTARS fTo be Iilled in by F~rneral Director) _ Q~:~~ 7.USUALRESIOENCE .b.COUNTV .c,CITYTQVYNOR .d. H .e• ~ y~ • s.STATE ~ LOCATION • ~ ~ ItMIT5OF7 Gt~ O/~~' ' ~ • •Ui~Gl~ .~Od/ ~!/.~'t .l : ~s C7~vo i . ~on MAR~TAL STAt S(Chtck onr 9. CIT12EfM OF v11HAT CO TRY 10. NAME OF SURVIVING SPOUSE(It wi q~w ma~dcn nsm~) ,~~~.~t 1 O Nsver Ma~rled `4'-'n ~ ` 2Q11i~n~dorStWratW ? A ' ~ti{'~~'~ ~ 3OWidoweq 4 DQvwc~d /7 l • a,~_ A71i 11. (MOOInj . . ~ aY) . " ~ar - . . . . v. OATf Oh AtiE AT UNOER 1 Ve~r ~r t,E551na~ 1 4AV ~,t~ uto ` BIRTH OF ~O LAST ~ MOnlhs . Oiyf NOUrf , M+rt. ~ OECEDENT ~ ~ BIRTHOAV f~ ~ ~ ti . ' ~S;`~tQ. ' i 13. USUAL OCCUpATtON i~~ o~ wo?k tlon~ nng most ol p. KINO OF 6US~NE55 1~. SOCIAlSECURITV NO. ':;?:~+'1l5• workioq Iifstime; noR snta ntired.) • a,.•.L• , t ~ . ~'3~'iEr . n. C ,7/~ ~ ~ / T/ ~ ~ yl5 T.1(-'.~.,5 t . IS. BIRTHVLACE (S le o~ ForNge Country) 16. OTHER NAME(S) 9Y WNICH DECEDENT WAS KNOWN ~~,~,4 h• ~ ~ L~~/~ - ~ ~ a::,; .~t~•'~'•ti~~, 17. NAME OF FA~NER Oi OECEOENT 1l.MAIOEN NAME OF MOTHER Of p CEDEN e1;~,~.`'',.`~ ~ ~~~..~•:ji~.;.. ~O ~ ~Q ~ , ~ a.~ ~ . ti~ Y' Mcs ~ 3, + 19i. NAME OP ~NFqRMANT .b. RELATIONSHIP , t.ADDRE55 (City) (St~t~1 ~t~~ 1.•~i~~~~ . TO DECEASEO ~ ~ ~ = . . ~G, ~ ' A i ' ~ / ~.C /~X~'~ , . ; {;N:~ ' ..._r;~-~. ~t 20a. NAME tIf CEMETERV ; b. LOCATION {City, Town, Stat! i~A Country) ~t, DATE OF BURIAI OR ~ ' ~!Z AT! • I~ / ~ ~.'Tiii tT~•.C O .l~t/ Q/ ' TI~/~J`1 £ / `i : t.~\11 s. FU~1 pAl, t)INEC ~ON " . b. ADDRE55 ' ' - ~ - R~verdale-oa-Nudsoa Fuaerai N ~ ~ ~ + i 6110 Riverdate Arre. . ~ BUREAU OF VITAL REC4RDS DEPA~~1i1HY'F OF,'~1~4TH THE CiTY OF NEW YORK . • ~ i~ ~ ~ ; .•-•-_i; ~ / ' • ~ : : I~~ . ~ ~ - ~.-~.,4 ~ ! l•~/,`±~~:- '1 ' ? t i~.S~~ ~ ~ _L,;:~.V~~~~~4 r ::._-~.b~::~.~^~: . - _ . . , . - i„ . T~1~ 1~ an~ryr ihN th• fenyoln~ i~ i,t~ oop~~ s~t~d;~p,l~~aptod~l• . ' , o . s . . ~ • r ~ . , TA~ CePutment ot liedlh does nat attl[~ t~?~t~+'b14 , P..tAs~ ~~iteaest~ ~aad~ th~rson. ~a ~o Ip4ulo? ~ 1~ ' IA~ f~ct~ bu bee~ p~o~idc~ by Iar. . t 00 I:OT ACCEPT TMit TRANSCIt1~T UNLUi TNt R~IitO i!'AL Op 9Ht DEMItT?IE~1T ~t NEAt~.Tl1 If ~ , ~ 1 A//IXILD it1ERtQN. RErR00~CtI0M ~R ALtEpAT101if Allt ~BOHI~IYtp ~r LA11. - ' ~ -~/#~+p~JIYI"1'~Y-sV~-.~wJ-.VtA....r.r~•'n~""/~' ~ ._I+JC~s~-:---~.r~::: ..~..yyF~i~~~tr.`.. r-.rrcoV~~V~~':1S-i~n'ia`~s~~L{;.''-..:~:.+f1:'7:i~s~isJs'~ri: ~Q j ~ ~ ~ •J~ v. FILE~ ~ _ . ~~OOUGLt+IS~- , . ST. lur. ~ ~ BOOK PAGE 838284 , z--,~-~::~-~;-~.,.~.+•,~~.•~-__=- _