HomeMy WebLinkAbout2492 i
10228d5
STATE OF NEW JERSE' !vt~ s
" UFfICE OF REGiSTRAR OF VITAL STATISTICS
Township of West Milford
4-~~/d.-/// P~ t~.~ c«~. N.
Thrs is w Certify that the foltowing is correctly copied from a record of Death in my o~ce.
MAM[ O~ DiCtAf[D ?lAC[ 0? D[ATM OAT[ 0/ D[ATN
Chllton Mesiorial Hospital, uannock ToMmship
John Fi. Ryan Morr
fOCIAL S[CYRiTt NUM~~R fEI COLOR MAARAI CONOITIOM OAT[ O? ~I~TN Ai~
ra. ~os. o~rs
' 154-03-9151 Male White Married June 5, I911 61 ~
~
/lAC[ 0? ~IRTX CAUf[ 0? O[ATM ~
~
New Jersey Acute Coronar Thraabosis.
SYIKEM[NTAL IM~ORMATIOM 1? OEL1i1 ~Af DY[ TO [iTi~MAL CAUiEf
ACCIO[MT. fU1CIDt OR NOMICIp[ DAT[ O/ OCCY~REMC[
I'
i
a
~ MNiR[ qp IMJV~f OCCURf 3
i ~
GT7 O~ t~AM ~01N~R •t~~t
OID INJYRf OCCUR IN OR A~DUT NOMt. OM /Atll, iN IMpUfT~IAL rLl1Gt. IM ~USLlC rlACtl
. ~
WNILE AT WORK Q
NOT WHiLE AT WORK C MEANS OR INJURY j
i ;
' MA~[ O! KtfOM ~110 C[RTIII[O GYf[ O/ O~ATN AOO~[!i ;
Nilliam A. Somerville, Jr., D.O. Lakeside, Herritt~ N. J.
3
~ ~
!
; . .r~~1~11r~CY...~Q.......is..1~. ~ 3
. .
~ ,
~ Dau of issue '
~ Rcgistrar of Vital State:tia ~
€ ~
~ Taan Hall -~lest I~ilford. N. J. ~
,
~ '
~ .............................................._........Addreaa ~
00 NQT ACCErT THIS CERTiFICAT[ UNLESB TH[ RAISED ~EAL i
~ ~
g OR Ttl[ REaIfTRAR OF V1TAL STATtSTIC! 13 AFFIXEO HER[ON.
€
~
~
~
x
!tec Fee ~ J DOUG t.~1 ~ i~~' y
l~dd Fee = ~~8ti Lucie c
1'.~: T1x 3~~Clerk of C;: -
lt,t T'~: ~ ~Hy ~ _
: 3 L~ _ DeFu cy ~ , ~5~ 1 0 2 ~ ~ ~ . ~ ~
,
, : ~ .
,i~,r,. . ~ ~
• ~
~
~ooK 6 ~5 ~a~E2492
_ - - . Y~ ~
~..w.~~~~: .