HomeMy WebLinkAbout2457 lozzs~e
r~` ^
~ I 3-~
n
*trc Fc~? S DO UG LA3 D 1~ ~l V
Add Fce t ~~~St Lucie Co~:~'~:
i4,r Tnx =~~~Qerk of Circ~.; . ..:t .
Int Tas S ~~.BY ' ~ ~ ~t I I ~ ~ r i r ot~
jL> > ~ Deputy Llr,. 1 1 ~ ~ \ E '
T• . al ~
" ~ CONNECTICUT STATE DEPARTMENT OF HEALTH
~~S Public H~.I~h Siat~.~~c~ Section-H~rtiord, Conn~cticut U.S.A.
Certificnte of Death~
r ~ p,,.u a Dc~rH: t~) St~te ot G+nneet~cut l 2. Uw~L Rr~tns~CC o~ f)[Cts~•o: (t) Sute
I! i_i Cnuntr (e) Tbwn I~ Counts ~(e) Ibwn I (d~ L Re+~6rn~. I~.~A.
~ FAIRFIEI.D ST~'.MFORD ~ FAI~F~ELD ( STAMFORD • Citr „~,o„~~
+ ,tam~ of Hoep~t~l or In~tiwtEOn /el ~ircet Numbtr N^ C
~ ~A1
11f net in • AwD~ul or inuitation ~ive S~reet t~a Ilf rur~l. ai.~e locwlicn! I( Yes. n~m~ CU.
or,~At~~~~ • 81 Bracewood Lane IIorou¢h
STAMFORD HOSP~TAL STAMFORD. OONN. STAMFORD ~
3 s o? <F~nt) IRtiddl~) fLaatl I t. S~cu~ SLCURRY NUM/LR i
~ ~vp~ o~_Dr;nu THERESA _ _ _
c"`•:`° PRIZ IO
~ ' MEDlCAL CERTIFICATIOM (Trpe or pnntj
PERSONAL AND STATISTICAL PAR7ICULARS Z±, C~~sc n? D~.~rN fEn~er ony one eause per boz (~1(bl •nd(c)j .
y.
Sc~ i. R.cs D1~RUC~R Ncrc¦ bt.u~co i~rc~vw~
~p Q PART 1. D[ATM WA! CAUlCD BT:
~j I ~ IMMLDtAT~ GAUfL ~AJ ~['M'EG4 ~
L'e~~~ k'hite W~oowcn ~ RI~'O~CCO ~ O1~~ET ?~p
~ DEA711
~ ~ t~ fa~A11RICD, k~IDUKCD OR DIYOIIRD, LIK MA~D[N NAMi Ot
~vu~ oR Hl'S~AND /yG~ffsl.'G G4~2iet~f4 TO ~'~f l~lOqT~f
John Pri~io
9. Dwst or /AtontA) (Day) <Year) pUS m(b)
~ D[wTH Au~st 13. 196~ CendltiOM.
If anr, vhie6 I ~
~ ~..,'.e: • d_- s~.e rue w G rG j q O~'~l G. e~ O~w ~
r 10. Dwrc nI B~ct11 AcC (in yr~n 1! unJrr 3 i~a~ . • ~ aDw~ cauat p' ,
N tut Dirtrday) ~onths ~ L~ys Houn ~ bitru. (a). aLct~ni
the undetlr- Dv[ To (e)
j~ 3fl. 2~ 2913 52 tait uwe
~~~,`BiRrnruu (Crty or wAn) (State or torci~rt country)
PART It OTNLR Siew~nceKr Coanen~~Hs Co~twunHC 2S. ~Y~~ '
, Port Chester, Nex York TO DCA7M /UC HOT RlLwTtD T4 TNL T6RY~NAL D1SCA AUtOtST
CONYITI9N C~rsN tx PARf I(~). I Prnrorrtol
; j:. (a) Usu~~ OCCUPATIO:( (Gire k~nd ot work don~ durin[ most ot d /,~T<~a/ hal~ ~~~r ~~~V~R` ~'~'"1ir Ye~ o
workEnQ life e.~en if retired) q~~
~ IIAUSEAVI l P_ 2~. $U~G[~Y RCLCYAMT TO COTG7710KE RRGR7LD IN ~7iK 22.
(61 IADUSTRY oR Bustxus IJ~me ot oD~r~ttnn ~(b) Date perlormed
O~m Home
«~~5 DECEASCD A L~E7ERA1:~ Yc3 OT Nf~ ~O
(b) T~HC or ~Nll'AY
, (b) If pe~, tive wvr- - 25. (a) ACCID[H7 SUKIDC HO~i1C1O[ yorr Afonth, Doy, Yea?
~ Unit or Ship ~ ? • ? ? •
m .
' i:,~. r.,>,E_ Fra.nk Rich ~NJUAY OCCI'RR[6 Id) ~'L4C[ 0/ ~N]U~Y (f.p., in O~ oLowt ho,ws,
~ (C~~y or town) . (5tate or fore;`n countrr) ~4'hile at Not While fa~m• fa<<O?y, ~trut, o~u bfdp., ~lc.)
~ Ita~y K•ork ~,c wo~r p
1S. HllTll?LACE
i
i6. hw~c~ CaI'l~fe~ ~~+ZO ~el Ctnr, TONN, OR Lccwr~ox Cour+rr STwre
~ i F (Git~ or to~rn? (State or toreiro countryl
f i f y /t) Dcsc~:re now Iwu~r O~ccaRCO.
~ ~ ~ li. Q:RTIi~LACf I4~~
/Entsr nalrrt e J iw jr ry i~t P~~ t /
I I!. 1::rcnH~r.Ya N~xc o. Part 1! o! itsw s!.)
~ John Prizio 2~• 1 HEREBY CERT[FY, that I attended the fIKlJ(d ({om ~
~
~ p ~ ~ Jr f v ,cs ~96 r. w A,~g~s~ ~3 ~9~s" i
~ I7. SVR3A4 CAEMATION O~ RC/tOYAL D11f~E_~ I9 . _
~ + Cemetery or C~em~ury St. Mary~ s Cemeterv tbat I lut sav the deceued alir~ pe~_~4
~~1~ ~9~
~ I Flaee T~iiJ1 Of Rp@~ N~ Y. •nd that deatA It uid to hive occurred on-
A~~~s .
~ • Y0. N~xe or EM~AL?l[R ~r Soot M~s Ex~~~~ea ( Lieease numbQ at rf: / s A m •
E LL J. SHAW s,~H.~~~ o. p~ru~,~
~ . S~cx ruas Lict c N~e~uss oa LuHaee Fuxwt. Di~ttot ~~y s1
V
~ ~ _ AJdreas @StL` Y' ~r~ ~ D~4 ~ 3 /b ~
~ IH1~ CERTIFICATE RECEIVED FOR RECORD OA1 _•,~y.' r' ~tsrxwa
~ ~I A ~
~ FUK~! \'c_! rt ~~t ~y ~ ~ ~,r ^
~ _ _ ~ ~ • v~~c • / • .
~ ~ ~r3- - ~'~s i ~ • ~
~ ' ~Q ~ M~,,~~1 ~ •
N, . t ~~ls
:T'`~=r,p~~ f J , a^.?,~`?
i ri-
I hereby certify that th~~~~ ~~r'~'~~~:~CT'py of the
record ~n file in theSt~ . ~ y`~ ~~c•`-: _F,i~~fice•~t. attested
by the raised seal of t ~f•
.
: ~ : ~ V ~
s%~~%(, .F-~.~, is ~ , ' ;l
. ``1~.~,~
r - ~ H ~ ~ ~i
;~t';'.• _ - Registrar
Legal Fee: $2.00 ~ y - ~ Y{''`~,~-
~ t.G ..r r`_ - . - - - - -
p G_ _ 2 7 P,•3 3: 3Z ~
~ ~ Nove:lber 9 , 1979 c1~
~l - • _ .
eoox 675 PACF24~7 ~
~
- _ ~
: