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HomeMy WebLinkAbout0961 ~ ~ -o y--oio~~iy~l~x~ 8428`70 r S~a ' TOWNSHIP OF HAMILTON~ COUNTY OF MERCER ~ ~`p DIVISION OF HEALTH Phone 609 890-3828 ' ~ ~ _ 2100 Greenwood Avenue CN00150 Hamilton, N.J. 08850-0150 • a i ~ ' i . .~i . ~ • `T~ 11A: , . . . Th,i,d .i.4 ~o ~QJcti.~y ~h,a.t ~iee ~ol.~ouii.ng .i,d a ~icue copy • . o~ a necon.d ~.i,Ped .in ~hi.a depan.~nent. ~ ~ ~ ~ y~; ` ~ Uate o~ .i.eeue ~ /3 7 ~ ` ' GNtRNING: Do no# accep%t .thi.d copy un,~eda ~he naided eea,~ o~ ~he - Reg.i.d#hah o~ V.i,ta,C S.tart.i.a.t.i.cd ,i.a a~~tzed he~.¢on. REC~RD OF DEATH s qf~~1~w~~a•S NO. s 14036 NANF OF IFosU lM1J/1N ~1.~.~1 j. ka t. DATE OF DEATH ~°r;;; ~5~,°,~~, . Frank Sebesta - M 9-2-?6 ~ Color or Racc S. A`e f~~ y~s. it under 1 Yt 11 under 2f H~s. 6. Dut of Binh 7. i~s dtceastd erer in U.S. Aratd Forces! !as! bvt6d~y1 Mosr s ~ys Nor~s Nu. lYes, wo, o~ r~4~or~~ !I/ rrs, IV~ W~~ W J~ffS O~ltIK I White 57 _ _3/21/1919 YES 4JWII 8. BinApl~ce /Stotr w/oreit~ cor~try) 9. Cicism d~h~c coun~ry• 10. Man~af ~ tieter NarnadL~ 11. Socid Secwi~y No. Windsor, New Yor USA •~eo~.~~=t Divorced; ; 072-05-9239 I2. PLACE OF DEATH 13. t1SUAl RESR)F.KCE (i( ins~~wc~~+n reiidence bclore ~dwiuion) ~«~~r Mercer ~u~ ~ N.J. ~«~r Mercer b. Cicr C] (Cbeck bos ~nd 6i~e n~se) ---c. (:icy [ - (Chrrk Doa and ai~e nasel re"~ Hamilton 7:~~ ~ Hamilton c Nu~e o 1 nw ~n Aospu~ w institu~wn s~re str~et e~s d. Suee~ Addre~i (11 rur~l. P.O. AdAress) "°'p"~°` Hamilton Hospital 25 Bruno Crescent, Yardville N.J. . In s~ ~iuuce 1~. a. U~val Occupation ~vr ~ o/ ~rwl Iwe las~~~ ~o~~ o/ vorb~~ /i/~. ~w~ i rN~rr/) 11. S. Kind ol Brsinei~ or Indusur Military Service U.S.Army ~ IS. Fuher's Nuee 16. ?bcher's N~;drn Nree Frank Sebesta UNKNOWN 17. Inlwsanc's N~ae ~nd Address ~ Mrs. Frank Sebesta 25 Bruno Crescent Yardville N.J. ~ 16. PART 1 DEATH ~A~ CAUSED BY E~rs• w!~ wr ~~r:~ jer /iw~ /or r! (t) Approsieu~ intert~l ~et~ten onaet tnd deaih ~a~.«cw,~a, ~cute Coronary insufficiency _ car~~:o.,. „+.~a Coronary Artery Disease ~ew ri~~ ro ~iovt c~rrr ~ to (1) _ '7~1". st.ri~~ ri~ alr.- lyi~~ c~rr~ l~i~ Due to (cJ A.S~ PAAT Il OTHER SIGPtIF1CMIT CONDITIONS 19~. 1u •~xopsr 19b. It yes. ~e~e (indin~~ coe~idered pedo~sedl in deurninin~ c~uae of deatbl Yes ~ Dto Yc• ~ No 20~. Acciden~ Suicide Hoaieide IOb. Due u~d F1our of Injury 20c. Hor ~j~r peeurreE /E~~n ~~eri~ o/ ~~jr?r P~rt I u ll o/ l~e~ !1). O n O M. to ~1t irar oJ ~r 4~arle/ e. ' . 20d. lnjury Oecurrod IOe. Pl~ce o( Injur~ f~.s. i~ o? ~br~ lo~e. 20f. Ciq. To~n a Loc~iiw County &ue ~hile ~t ~ Na *'hile 0 /an~. /artory. st~eN. o//i~t ~N~.. elt.) ~ork at ~ork 21. 1($~~~ eaamineA) ~A: deceased oe) a1C , D~ub ortrrre/ ~t q': 1`L~k'A~1`~br l~re srstr/ ~bvr: .~J to rb~ 6~at o/.r 4+ovlrlae. /ro~ t!e ~~vsea fu~eJ T2~. A~~endine Phrs• 11ed. Esa~o. ~ Coun~r Phrs. Q 27l+. Addrei• 22c. D~ie Sijncd s~a~.«.~ Mathew R. Lapin, M.D. 539 W. State St. g-2-76 23a. Buri~l. G~a~a~ion. Rewo~d 23b. Ceweierr «Crc~a«~ Nrae lh. L~kioe Cicy Se~u IS~rri/yl Burial Newtown Cemetery Newtown, Bueks Co. Pen ~ 2)d. Bunal Ds~e Ab. Uar Yr. II~. Funeral Ho~ N~as 24b. FYnti~! fiost Addres~ 9-7-76 Hartmann Funeral Homes . 539 Centre St. Trenton ~ 24c. F~neral (~~rec~ot Si~nx~re N. Licens~ lVo. ?S~. R~i u I~wriiy e it Si~n e 2Sb. Date Rec'd. by Lu~t H-Z171 . • Michael J. Hartmann 3172 Wi ~ R`'""" 9-3-76 84287U '87 AUG 19 P 1:51 ~F'~~~~ f:~; . ~ ~oox554 ~~~E 959 00 . . , ST.Lt` ~ - _ _ . _ , _ _ _ _ _ ~ - - . ~