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HomeMy WebLinkAbout0988 ' i ~ t ` . ~ ~ ~ . . l . . . ~ . . . . ~ . . . . . . ' . : . - ' . - ~ . . . . . ' . . . . . . . +fr.. r .ra ~ (1 ~ . : , . . . . ' ' 1 , ' 1 „{t~~ ~t~+} _ r . C • . ~ ~ . . ~ ~ . ~ ~ - ~-'~'~'1'.. _ . . r~+:~ 4 , ` . C " . ; • . . . , 1 . r ' ; , ~ , . TH z , q $ -,r Y: OATE F ' ~ ~ . , ~ ~ _ ~ CER'~IC~i~~bEA . , ; ~f ti t q RF_ . ~ . 156~~~ ts~~4 0"~~~b : tt " N ' 4 Ce~t c~f o. er ; , : AEPaR ; n~:' . ~ ~ ~ . ~ „K. BA~;a S~+ --~U~ t: . ~ ~ 1. NAME OF : r c . _ , ~~.~:,r :E . sr- i . . . . _ ~ z~ „ , . . , r ~ ti. ' ; -~~ECE~?SED s ~ J'a t . , ; pq . T P ~ . * { ~ :~``~s ~ . . JaN ~==~4 PI~ uu ; '~Typb~b~T'r~nU . "ffl~~'~Vs~el /Middld~Nanrtl ,.~Lest Ns e1 .pce t ~,;a ~ ' „ ~ . . . . . t " . il -~t'.* . ~ {„t~i1 _ l.~r ~ ~ . . ° ~ . ' lfi ~S ~ tiA~4;\ ~iR.k ~ . ~ . ' • ~ ! g ~ .y : . -s~a-= ~ . . . . . . . ; ~ 2. PLACE ' NEW''ffbAK~.`I ' MEDICAL CERTIFICAT~ OF ~EATH :"/~O bA /ided ~`'by th~f'1?~isk/Ahl. = r~?a~~ ~Y~ . ~b" Nams t lMSpit~l oi otMi t~cit'ity " 4a. !f ~p',~~1: t. ~t• o ~P _ _ OF - Za eOAOtJGH if ~io'~ ,J~3 "=tt~i it ldA~a~ - ; , ~ F~c~sy`7 .Chick~ = ~ t " ` - ` _ DEATH.' ; x ; ~ ~o yI `fi. ~r ~'~s 4 ~!`d'rrtri:• ~ E1 ~OA ~ 3 `~8utpttknt Montb ' Dsy Year 4~~ . , ! i.~ d a : ~i~F ~ . Q ~ i! N" f , ~ ~ . , . r< c~.r• ~ .''4 b~ ~ tiK+t ~ ` N ~s ~^r~.?;Z=' . ' 3a. Data ani~` Hout /Month~ ~ds"~ (~e i bU~i 4 X PP~ ; : . , . : . A , i,'of ~eath_ ~;~~'Aw? rr~t, ;1 a~;~ ~bTM~'M; AM~M ~~SE~,{~ S:~A ~ ~O.,I~M ~ ~ _ ~y. , ; . . . , - a w Q. ~ ' ' •~t ' : Y~~ 'S`. ` s.-r a ' : s, . . . . ~ f:~. 7 ~ , . _ . . . , ~ . _ 8. 1 HERE~6YpCEit~~~~1Tr~CheCk`OnlJ ; , . ' f,- - ~i . . . :a.' . l. . . 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Uwal Otai~pstio~ /Klnd "ivo.k don~ ~ 4b K&id"d1 8uairwss ~ ~ ~ " ' F ~ • - s~. : ~ ' i . . hPla ~ 6. ~ h ~ l a`~ ~fi ~ a4:sat~ b~F a N/ y wY = 1~ E a x a t l C~r 1 t ~ o n.~ ~ t t y`' p t n i. n s i s t l. b v w n~ e i~ a c e d~ M w a ~ k n o w n ' ~ Iry ~ ; O~ 12~~ 6 1 - 1 ? : ' ' O 1 t " C) 3 `~J~'1 ''i] 6 + ` . ~ g ~ J . ~ t 8. NM~E'_- . ~'~~E f 19 j i~IiioeNl i!fA~ bF Mbirii~`fi~~~~aFF"i~ _ ~ rT- _ ~ - ~ m . . . YOs. NMAE'8F AMANfi > - § ~O TIONS~Ni 20~. Al~bFt~SS lChy Sf~t~J /Iipl , ~+i ~ . 1 ~ l , _ . r_ . . - ~3~ , rV ~~..~cir-.. ~ ~i ~j! ~ a~~_;4. , ~3""'" ~ ~ A.. ; ; ~ v 2t~ NAME ~ Nf~~€tf4'tt , A M/Cfo = 1iti:~tOCA~ibN ~ Town s~ . , tp~,~ ~ ; i - '~4:' ; Srd~ tiwi ~ ~3 f e 71fE 1 D 6i tl~l l~1~A ' .r.f ~ r p A*~,~ . _ ~ ~ ' - ~ ~ r": G`..- ~ 'Q ~ ~ ~ . L . . • ~ ~ ~ ~ r r 2Ya> IU~"b1i~L~~ , . ; . ~2 : . IC15~RESS, . ~ - : ~ _ : -~e . . e . ~ ~j ~ ~ _ -.th C M+ ~ ! . ~ , , , ~ . r~ J~ ~ . . ~ 'M1' . . . . . 'i ~ , ' ~ f: • . ~ r.~. . . . ~ ~ . . . . . . . . . r . ' . ~ . 4. BUREAU 0~~~1~~`%1L~~~.`'(~1~~1~ ~ ~ ' [~~i"7~#'~M~iVTr'~~~"`~i~AC'~~ °''~~C~6`~ 111EW ~1~~1"~C , - ; ~ v~u naM - ~ f • ; ; . . ~ ~ . ` . - - - ~ F . . . - . . . ' . . , , . . . ~ I . . . , ' ` ~.r, ~l,~ E I . - ' . . . . . . . . . . . . . . . . . . . ~ . ~r ' '~4 ~ , . , . i This°iz 4C~°cert_ify~ths~~ihc fa~Egoing°is a~tu~ji~i~py°ef a rt~drd ~on~'~ilc' iri"`Iht'~l~par"iirent ot Hea~ih: stht ~t f ~ H - . [hp~r~~nr~St ~nr~!lea~th°does not±ttnify to ~he t`ruth ~of'Ihe`statcrrifilts madt~ ~ht~~, a~~n'~°i~i~~ilry as t~~"1he ~,~Ht : ' facts has been ~ii~ol~idEi1'by (aw~. ' ,~`#D ~ t~: ' . ~ . _ %J L - . ~f si~ - . , ~i . ' , _ _ . _ , . * - - • , ; w - . '-~C~'q^~oi r , : ~ . f - _ M; _ . oo,Not a~cepl"thii"I~anscd~ pt'unbss H`beats'the ra~ aeil'o/.lhe'Oepartmenl ol'Heatth. The reproduc~ion or srteation , Cy'•.,,...„.,.~i ot lAG{ trsnsuipt N prohibited by 5ettioA 321 bt ihA Nerv"YOtk Cif~'H~IIMi COde. . , rf' . pt f . a~ eru~na~ et~`n~rti . 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