Loading...
HomeMy WebLinkAbout0963 V~RIFIED TRANSCRIPT 845933 a wr~wN ~ir~l •u~e rae nuw~p~n ccNSV~ sus• ~e.ct pmt~nN ~tr; wncoas~N~ci ~(-n_('~~ ~ NEW YOP.K STATE ~ ~ ( ~ DCPARTMENT OF HEAlT11 ~tt.' ~NUru p CEi~TIFICATE OF DCATH J # :tAhS11C/~1013f11H'f 1 N~41 ~~.1i1 Y14411 ~Ayf ) SCl ~ D~1! 0104A1~ ~P~1 ~ Y~14TN OA~ ANy , ( L NEC. _ YAI~ /(W1lC ` ~ S l~• ~ ` flES. ~ ' ~ ~ ~ A+~ ~i UN4[R ~ ~(Aq K UN4tN 1 OAV 9 O[CCOCMT OdIH O~~ NhN O~ V S~VEO fbN:lZl J;rO~U? SLC OY p+r NUHO[N S ~rONtMi W?1S ~qv~3 ~~tiWt! ~ONtH O~r ~ tiC3 IiYfS i?CC~fYWMO110ATES 1 1 , ~1~ ? Of 8ERVICE ~ • EA113 ' ° Q ~0-,~ ~ N CWAIYp~OIAtN 10l1 IOCA~IIY'CNCCKONEANDS~E ~~t1~T~OC NOSh11~OqO1NCA~H5ilfUipy •O ~iMtNOSY1 AtU+~ At U 1NVAIIfN Z ~ ~~~Tr~ ~ (~Nk11MER.GrvEACONE3S1 1, ~NOOA~~ONICNCGKOME{~ p4~:'G~uN4~tE ` ~ /1 ? YON1N 0A~ ~(A~ xtOWN Of ( • Y 1 ~ t(] E1J[RGEMCY POOY • ~ • ~ \ \ ~i['70UT~A/1ENi ~ - 1 ^ ~ V~lU6E Of ~ ` ) ~ \ ~ ~X7 V I=-i-~- J!J O~~l~v~~! .!~'?L~KIN~At1ENfr VJ • S~AiE O? O~A111 10 Crt~h 1 OF WMA l~ MARIIA~ y1AlUSICH[CRpNkI 57HVIVIN65?OUSt pf WIiE W~E 4A1p(h NAMFI W M1N1RY ~f N T ULA) Nlry~1 9 ~ ~ ~r-~ t[] NE~ER MARRIEO Wlpp'NEO ~ 1"cl •J ~ t 4ARA~ ~M+w~ ~ Q WYG~ICEO r,"(_( U F4Cf MrHrtE, t~t+~ K t Oi SPAN~iIf pNMa1N1 ~~-~-IS]. ' A?~~/~ICA!11NOU ~F~ESCHCCKONE ? YES O p 13 EONCAl10H INMCAiE?~~GNESTOMOECOMFIEtEDOH?~ 1 3 O iNt R ~ S? E C~FYI t0 NER O NrCwN ORM~i NSS~EC1irI O t ! E I; v E` t Rf Y• 1 • t p t a~i~ i t t«~ f G~ , ~ t ]O CFHTqA~ oa ~ O? O O D? O O ? O O I~ CJ rJ O O ~O SWiNA4ER/CAN 00 OI Ot O] W 6S 00 Q7 p~ p} 10 I1 1• IS 1• 11 ~4 16i?USU ~OCCVPATpN(OONOtENTENRE11NE01 160-K~HOOiOUSINES$ORIHOUSiH~I 16C MA4EANOl4CAlt1~OFFMYORCOMFANY ` 1 1 ; ~n c~nco ,,~~'~'~,c~;~~ LU~i IIA S~AiE ~ I?B. GOUH Y ~ t)C IOCA~rtY 1CMEC NE ANO SPEpFY1 ~ ~ VE 1F ItY 0(i V~IU~ PESNKNCI V ~ ~1 t ?C~TYOF ~ WOH~NC1IYORYtIUGEIIMITSt lJSDA1 RfSlDFNL'E _ ~ p_ ~ ~ ! \ 1 ' Op,TowNOF ~ _ i rES N ~ W i w_ _ L ~ _ J S/ _ .J tl 1. _ .a _ yC~lt.t6E OF ~ ~ ~ ~ ~ D (r1C`- - ~ - - - - ; O If NO. S~ECIf1/ TpWN: ~EO DECEDENT N t STREEt AND N B£A OF REStDENCE UNCIUDE ZIP CODEI ° ' i n~. . ? ~ ; ~('uv tiGv ~ n ~RS~ MlpplE 1 J I1~ST ~ YIDOIE IILST NAYC pp N / NAIDEl1 t iA1NER. i~I ~ ~441M R p~r ' ~pw HAUEOFtNiO t ~t96 WUt:nGAOORE55(~HCWO liP~.~ E~ , ~Ip.r1G. ~ t~ ~ ~ `i ~inr t, 7 ZO~ i11/f.:A! CpEYA!lO+l. Af~OYA~pR 6/DNiH OAY YL'A9 200. VIACEOFOUf1Ul.tpi\!A110H,q YOy L jQC ~($CRi1pN~~OWH_S1A~E/ - 18B pTMER pSPOSIl10H 15PECIfY1 OTN q O15POS111CN ~ ~ _ {-tl 1 L~Ji~?_ ' ~ ~ ~~'1 ~~j~ J'~ (1l, Wn ~ Yhtr4 !n(' ' ~ Q ql~? y i~ANA4EAHOADR~tSSUFfUNEMLHOLIE ~2/ flEGIStRAiqMNO. d Ct Z~ 1~~ G f ~3~ omH Y r,~~~ , K~,n_ N- ~ ~7Sj ; G~ J ~ ~ y~2AN YEOFFUHERAIWNf~T N ~228. 'N~iUHE FU RA~WRC TON ~?tCpEGISitUf~ONHO ~ ~?~c? ~r c ~c ; ~ .~l ; v? ~ 7 : . . . . . i ti~ SIG ATUR OFqEGiST AN 1~iE Y Oii AlP "'VEO 21 EAV • t YONiN OA FAR A, bl~ l R£~OV EA~f1t 1. 8 VOH:N pAY Y p ~ ~ 1 FiIED ~ 1 I ~ ~ 1 1 ~ _ _ • . . . . \.%~a , , , a , , , ~3 , ~ ~ - - TO BE COMPlE7ED BY ~~R~ TO QE COMPLET~D BY ?3 C~RTIF1/1NG PHYSICIAN ONLY ,S CORON~R'OR MEOICAL EXAtJ~~f:ER ONLY A iOTHE 8E5T Of M KNOWtEO.iE. OEAi~ CUkREO AT TNE A ON T~/E BA5~5 QF EX~GINi?i1JN AND~OP /NVCSTM.AfpN, C~~E~ : T~YE.DAiEI1Np EwNDDUET07N C US A7ED ~NVVOP~N~OHOE~iHOCCURREO~triMEtewE.WTE O ; " ~ uON7w Wr rEwq AHD o'l/1CE AND OUE 7q THC GAUSES SiATfO CORaNFR'S ~ /~J / ~1 ~ I ~~I~..~, ~ 1 ~ 1~}'i SIGHATURE ~'~rS~LN ~ ~y! SK'iNATURf ~ ~ ~ ~ i~t E ~ ~EJIw~~NElI 4 LL~ n iNE ?HTS~GAr iiEHDEO ~NE DECEASEO C. ~A57 SEEH AUYE B PNOYOUHCEOOEAO C. NOUR D OATF 51GHEG ~ F' YpIrT WY 1'[~R YJNiN p~~l 1f[AR YCM1N OAV ~EAH MONiH pAl rE~n~ r YW~tN ~ DAt •CA~ i ~ ~ W ~~o~. ~ , , TQ , ? , ~3 , 7 V 1 1 I 1 ~ 1 t ~ 1 ; ; AT K~ 1 1 w 1 , O NAYf OF ATiCIiO~NA VHYS~G~AN, IF OiNER TMAN CERTIFiER E SKiNAiUHE UF Cqi(?1Eq pR Cp5lphfR S M~57~U1N ? OThEF iM~' ~kNIYKR ~ 3°c ~ ~ ' • _ ~ 2i NA EANOAOOaE+SOFGE IERIVMYS~CUN.COROHEF_I.~EOKAIfI(AMINER COAONER~ PNY UH.YE P~CT ? ~ - ~ ~~s ~ z6 ~ r ~i~ ~'~;r~' ~ ~ T-~,., k !1. OEATN WAS GtU5E0 8Y ENTEA OMIY OHE CAUSE ?ER ~INE fOR tAL lBL AND ICI AMPOivJU[ ~Htt RY/.l CiWEEN ONS[ f AHU U[AiN ?ARIf 14YEC~n TE_CAU:E n / ~ { r ~ _ ~ ~ ' 4'~/t ~i~-~( , Z'L?+-~ L~~-t Y1~~'LS~I~ C..'~t~•e~%1rr- / vJ1,. ~ ; WYf R15E TO WE :O.4R AS A CO++' WlEM[E CF. iY1t[pATE ~ CWSEI~i ~ei r, ~ sT~~,~ WElO.0i1AlACONSEOVEMCECf ~ CWSE AS~~ W . (q PAqT11 O~rICN$If.N1ilCaNi~'ON~1110MC COHO.TIONSCUNiP'pU11HG10 z6A AU SY! =~7 ~FY[S WER[ i:NpN SCONSICCp[OIH ?i YIUSCASCFEf[RP.(D ~ a OEAiHOUfNOTpElA1COTOCAYSEG~rENIHP~Rt~~w~ ~ VCHS rE$ M UfiERY~lnHG/N1CAU5EOFD[AtM iOCOAONLnON i V 0 ~ 1 t? YES 7 Q NO - 4EO+CA~ ttAN~N[M ~ { ~ ? rE5 2 NO j 7PA ~OEC~«~F ~~U,~Ni e.OW~rr,;~ w@ pA1E C~s.Nt ~f1r ~OC H1;f'IOf ~LD OL:CN16kNOW~NJYR~~GI'Vp.'~[O ~ ; btrcCiDE UNU£(CNYtNCO.CENfNNG YJNfTO~r •tt~ , IN~URY ~ , •~riaSr~Gwnur+ - ~ ~R ~ ~ ~ i ~ 1 ~ ~ 1 y / ?PE ~M:UNVATNONK+ ~~d hA[EOf~N~uH+~fO~df ~~06LIX~l:pq~Slef.FT~NC.UtrURVNIrc;F.iGV~H.COVhTt.STAt[I ~ Y[S NO ~ F4CiONY.O~i1CEtll00.lIC ~ .~.5 ~ 0 ~ 1 ~ ~ : ~~~o --3 P ~ • y x ~ 845933 ~ g. ~ I HEREBY SOLEMNLY ATTEST THAT THIS IS A TRUE TRANSCRIPT FROM THE ~ REGISTRAR OF DEATHS, KEPT IN THE TOWN CL~$k'S O~' IC I , AT SM THTOEPN, _ COUNTY OF SUFFOLK, STATE OF NEW YORB. ~ : ~ , ~-.,1 ~ . . . ; - DATED AT SMITHTOWN ~~,S'-- j~' ~ z; , ~ - ,2- ~ . . ~r _ _ SIGNED OFFICIA FGI~,STRAF2:~:0 ` VITAL ATI TI " ~ 600K 55U PAGE gs2 - - ~ '4 . ~~li`,+i. ~ _ i _ . . . " . . , - _ ..,.r~~~~~