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2014
Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section PLEASE CCIMPLETE FORM AND FNCI.OSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name ~of Deceased Date of Death or Period to be Covere d by Search LJ 1LLlAM ~ . GU rf ~ 7~ L ~ ~~ ~ _ rT~. / ~ First Middle Last Na~Y~e of Father of Deceased Social Security Number of Deceased ~Du~'~4i2~ N, c,~N~TELFy r!171- l8 -3,?S ~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death ~j12/c~ ,rj. /~if,~'HE~ /D i 2 ~3 ~~ First Middle Last Month Day Year Place of Death ELgN j ~¢ T GeJ~ 1~1°1~~E~c 5 /=Lj(~$' ~JTGHESS Nairre of Hospital or Street Address Village, To~Y' County Purpose for Which Record is Required To _~E LE T What was your relationship to the deceased? ~'U~'t/Ef'!~L ..f7~rC~~T~--- -__ In what capacity are you acting? S19!'Lie _ If attorney, name and relationship of your client to deceased _ Signature of Applicant ~ Dater `~' ~~ Address of Applicant S ~ GOMP~a*TE FOR DEATHS OCCURRLNG AS OF JANUARY y' 19$8 --~ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death PLEASE Ph~,~NT NAME ANp AppRESS WHERE RECORD ~HQU~.p BE $~NT _ Name Address __ City __ _ State _ Zip Code DOH-294A (6/2000) Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy Of Death R@COrd Vital Records Section ,, °°P~~A~~ C4MRl~~Tf~FOFtM ANf] rwNOI~QS~'~F~EE :..~: ~ ,• FEE: $10.00 per copy or No Record Certification. Plsase do not send cash or stamps. Name of Decease~n ~ ``-c~ ~~„ !`/ s First Middle Last Name of Father of Deceased ~O\~ cQ. C. ~CU~<S First Middle Last ~ me of Mother of Deceased Mai i ~ 7 ~~ t`~C ~ C.\ C~ ~ , ~SUr1 First Middle Last ~, ~~-,~~~- Place of Death ~~ ~ ~ ~ ~ ~ a ~ Name of Hospital or Street Addre r .Date of Death or Period to be Covered by Search i -~ a a ~! ~ , ~~ . Social Security Number of Deceased ~/~ s a~ - a ~~ a Date of Birth of Deceased Age at Death Month Da Year jn ~ S ~IIS ~o~.~C~55 Village Town or City County Purpose for Which Record is Required ~.~~ Wis. What was your relationship to the deceased? t `'~-~ ~ In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant ~ _ ~` Address of Applicant f ~J ' rn _ ~''•"04MpMM~TE`FQR LISA'!`hf~'~?1;:~tJr•lrrtrv5a e~• Number of copies requested with confidential cause of death << ~ a~ ~ Ls ~ Number of copies requested without confidential cause of death Name Address City - DOH-294A (6/~000- State Zip Code NEW YORK STATE DEPARTMENT OF HEALTH ~/ital Rcrnrtlt .5'2CtlOn Date of Birth of Deceased First Middle ~.ast Maiden Name of Mother of Deceased First Middle. Last Place of Death ~~~ ~~/vim ~1~// '~ ~~~ Name of Hospi al ar Street Address Purpose for Which Record is Required Morrth Day Year I ~~ Viltaa~. Town or City ,-',~ /~'~-j~~/~~ss Application to Local Registrar for Cop of Death Record 7 What was your relationship to the deceased? /~ ~ , In what capacity are you acting? If attorney, name and relationship of your client to deceased ~~ /- Dal //7 /~/ Signature of Applicant y ~,~ Address of Applicant ~~ ~D~ ~©~ ~~/~ S~r~~ ~ / Number of copies requested with confiderrtial cause of death Number of copies requested without confidential cause of death Name _ Address City DOH-294A (6/2000) State Z.ip Code v,9~ Age at Death Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Co of Death Record Vital Records Section PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. P~;EASE PRINT OR TYPE Name of Deceased Date of Death or Period to be Covered by Search First Middle Last Name of Father of Deceased Social Security Number of Deceased ~-~ N 7c n/1 o S/ Dt? % t First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death First Middle Last Month Day Year Place of Death /7 AD~~na~ 5i. ~:. 17v?CHESS Name of Hospital or Street Address Vie, ~ y County Purpose for Which Record is Required Tc ~E77L~ z-:s~~ar~ What was your relationship to the deceased? FU/y~r2f3L .hi i~tcT~~~--. ___ __-__----- Inwhat capacity are you acting? S ~~''~~ -------------------- --- If attorney, Warne and relationship of your client to deceased -__ ____-___. ___- Signature of Applicant __-~~z~~_._ ~' ~ ~ - ------ Date ~ " ~ - ~ `f - - ~ ~~~'S Fi~L1.~,~-' ~ ! 2.~~1L ---=-- _. Address of Applicant ~~ L- ItgAiN °iT GJ~~ ~ COMPLETE FOfi DEATHS OCCURRIN,Ca AS OF JANUARY 1 79$8 --~ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death f~LEASE PRINT NAME AND ADDRESS WH.ER~ F3ECORD SH~U~.D BE SENT Name _ -_-- - ---- -- Address _ -- - - - - City State Zip Code - DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH vital Records Section __ Application to Local Registrar for Cod of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. r"{.:fKM~f:. r Name of Deceased ~ ~_ ~ ~ Middle Last Name of Father of Deceased~~~-f~-11~1D~~ l ~.Qil--- Firs Middle Last Maiden Name of Mother of Deceased ~,~l~ti ~irst Middle Last Place Dea[h ~~- n Name of Hos ital or Street Address Purpose for Which Record is Required QR TYP~~ .. ;.. of Death or Period to be Covered by Search 1 - ~ `~~I Social Securit~~y~~Nu^^mber of Deceased ~~-~w~ ~~ Date of Birth of Deceased Age at Death ~~ ~ ~ ~~~ Monlth Da Year ~ ~ ~ ~ Village ow r Clty Count What was your relationship to the deceased? ~~ a- -y-~~'yc' In what capacity are you acting? ~D..f ~ If attorney, name and relationship of your client to decea ed_ Straub, Catalano ~ Halvey _F~ tnc~r<x! 1 ic.rr~e Signature of Applicant .- :<..~ -: << <,~, rcxa 1'.(.). 1Sc~A 1 3 1 Address of Applicant 1 ~g 1 "`~.:~M!?"l;,f`;'FE FQR []C~AThl:a: t;a~:4ur'fn~~v4a e+v .,~~ sue. Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name Address City State Zip Code DOH-294A (6/0001 -_ ~~ - istrar n to Local Reg /~ EALTH AP i~catio f Death Record N~tN YORK STATE DEPARTMENT OF H for Copy o vital Records Seciton First Middle Last ~ A e at Death Maiden Name of Mother of Deceased Date of Birth of Deceased g ©! '' ZZ- ~~ Z-~' Last Month Da Year First Middle - A ~ Place of Death ~[ ~~ ~~ Gj~ i ~,{J~/9 / ~,~.5~ r~-~C S, ~~ (~U ~ ,,// Coun Villa e, Town or Ci Name of Hos ital or Street Address Purpose for Which Record is Required ~- Duca~~kre ~r~ , ~ ~~iD~ What was your relationship to the deceased? 1~v Ctn. In what capacity are you acting? /~ d ~ Gc tf attorney, name and relationship of Your client to deceased Signature of Applicant Address of Applicant Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name _ Address City _. State Zip Code DOH-294A (6/2000) Q~~~ ~~~ Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy, Of Death R@COrC~ Vital Records Section ... . Pl.t„A~E t:aMR>"~T'E F~i~M ANQ fTN~t*QS~'FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ;: p~;~q~~`P ,.. Fi1NT QR TYRE' Name of Deceased .Date of Death or Period to be Covered by Search . _ ~ O1_I~,~1~1 First Middle Last Name of Father of f~ceased ~ Social Security Numbe1r~ocf-1D~eceased ~ d~ 1 ~ J- f First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death h First Middle Last Da Year Mon Place of Death ~ ~ r - ~-~~~ ~n5 ~-- ~~ I 1~ IN 11/ -e ~ S S Count Name of Hos ital or Street Address Villa e, own or ity Which Record_is Required _ for ose Purp n ` ~ ~` What was your relationship to the deceased? ~~~~ '~'t' C'~~ ~ ~~ In what capacity are you acting? PSV%1(~~~ D ~_ p ~ -~~M'-n.~x-~~ If attorney, name and relationship of your client to deceased "-' StrauU, Catalano & Halvey Fug jc,r~zl t fame . i _ Signature of Applicant ~ . T D to 1'.(1. L~~z l~il Address of Applicant ~ 5 ~ ~, ~. , 1 ` CtJMI?I~ETF FC?fi U~At tt~: 4J44~~t~rurv4a [~-3 ~,+~ ~L~.. Number of copies requested with confidential cause of death .~ Number of copies requested without confidential cause of death Name _ Address City State Zip Code p~ ~ /~S DOH-294A (6/000) DAVID L. POSNER ELLEN L. BAKER SCOTT D. BERGIN RICHARD R. DuVALL LANCE PORTMAN RICHARD J. OLSON MATTHEW V. MIRABILE KIMBERLY HUNT LEE REBECCA M. BLAHUT SEAN M. KEMP JESSICA J. GLASS CARLA S. TESORO BETSY N. GARRISON DANIEL C. STAFFORD MICHAEL J. CARROLL ANNE B. LETTERIO DIRECT TELEPHONE. (845) 486-6826 E-MAIL: avalencia@mccm.com January 15, 2014 M~CABE & MACK LLP ATTORNEYS AT LAW 63 WASHINGTON STREET POST OFFICE BOX 509 POUGHKEEPSIE, NY 12602-0509 TELEPHONE: (845) 486-6800 FAX'. (845) 486-7621 www.mccm.com Attn: Town Clerk Town of Wappinger 20 Middlebush Road Wappinger, New York 12590 Re: Estate of Sarwat Lodhi Our File No. 13797-0001 Court File No. 2013-968 PHILLIP SHATZ J. JOSEPH McGOWAN ALBERT M.ROSENBLATT THOMAS D. MAHAR, JR. RALPH A. BEISNER JESSICA L. VINALL KELLY L TRAVER MICHAEL A. HAYES, JR. (Retired) HAROLD L. MANGOLD (Retired) JOHN E. MACK (1874-1958) JOSEPH A. McCABE (1890-1973) EDWARD J. MACK (1910.1998) JOSEPH C. McCABE (1925-1981) Dear Clerk: Please be advised that this office represents, Mansoor Ahmad and Rebecca M. Blahut, co- Administrators of the Estate of Sarwat Lodhi C tidied enclo~eea opy of the Certificate appointed by the Dutchess County Surrogate s of Appointment. We are in the process of closing the decedent's bank herefore, enclosef a dCheck made certificate is required in orderlno ern the amounttof $10.00. payable to the Town of Wapp g Thank you for your anticipated assistance with regard to this matter. Very truly yours, ~ McCABE & MACK LLP ~~ KELLY L. VER KLT/ alv Encl. Administrator cc: Mansoor Ahmad, scat`°~'t° f ~eat~` `~evv. Apps ~o ~ for ....... . MENT OF HEp`LTH >; .. ~:;~~~`>`:'>`:..~::> YORK $ection ~ ~ stamps Records ... ~ 1~1»~:...>: ease do not send cash or a~'.: , ~ . ertrficat-on. Pl ord C Rec No or oy rc P FEE: $1 ::;;: Search 'e ~of Decease I,r • Middle First peceased Nine of Father ~~. Middle Firs of Deceased e of Mother Ma-den Nam Firs ~ lace °f Death ~ 3 p Street Address ital or equired Name of 1'1°s -ch Record is R purse for .~>';:::;::;;>.::::>:::~e Covered by ~~~~,1~~~•:: ;.. or perwd to pate of peath ~~ ~ Z Numper of Deceased ~~~~ Social SecuntY at Death Age Est ZS to of B-~' °f DeceasedC L~l•3 Da 1 Yew ~c7 Da °~, ~~ ~ ~ `'`~~ ~ ~`5 ~ ~eG Month ~ 3 ~,~ ~,, 51 ~,e ~,~5 Coun ~ ,~ l ~s ow~PC- ~ , ~ e ~ v Villa ~ ~ ~ SS ~S~ ~~, ~f it ~u~ ~ -~0/1 the decease' ~y - to ~ t~onsli P to ece~ our rela d mat was y are you act+ng~ our client In what caps ame and rela~onshlP of y If attorney, n of Applicant ~ ,~ '' Signature ss of Applicant pddre ,.:;:; '.`:"~::.:~~:~ _.~o of death S• Name - Ipddress Gfil -- ~- l pate~• I,1~ ,~~~oool NEW YORK STATE DEPARTMENT OF HEALTH Application to Local Regi co d for Copy of Death Re FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased j~ /t ,MO ~1 ~C ~~ ~Q ~ ~ \ 1, ~"~" Last First Middle Name of Father of Deceased First Middle Last Maiden Name of Mother of Deceased Middle Last Date of Death or Period to be Covered by Search ~1~a1~~ Social Security Number of Deceased c~sa - ~-1- o~ ~ Date of Birth of Deceased Age at Death (~ / ~ `'Velar M ~n~lS First Place of Death ~~ Q jJ ~ r~ ~, e /1.~-~-- ~ ~/~{~P ~ I ~ Gt/GI ~ ~ T `. ~ [ 1r Villa e, Town or 1 Name of Hospital or Street Address Purpose for Which Record is Required .ers N~ ~I.c~ h~csS 2~~ County OTC What was your relationship to the dece~ S In what capacity are you acting? . If attorney, name and relationship of your client to deceased Signature of Applicant ~ A (,~`~~ ' / Z ~- c~ Address of Applicant ~ ~ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name Address Zip Code State City DOH-294A (6/2000) Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section .. :.. ...:..........F?r~~.:.... .> .: .:: : ~::: ~ >.. -.:il,.ili.. ;:.... lf~;,t~~~::Ell~~~ .. E.FI~E>::.;~>'. _>'> .':::::':<::;:;>< `< FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. `~ <<~ ' ! . 11 ..:::.~~. Name of Deceased Date of Death or Period to be Covered by Search First ~ ~ Middle ~~ ^~,~~--nn Las1~IC,~ci ~~ ~ 2- Name of Father Deceased Social Security Number of Deceased Firs ~ Middle Last ~ Maiden Name of M ther of Deceased Date of Birth of Deceased Age t Death a , o ~"~ ~~ ~~eG ~ ~ ~~ ~ f i " Firs Middle Last Month Da Y ar ~ Place of Death a 3 ~~~-1 G,,~ `•\,`~A l S off, 3 ~~~1~~ 5 6 ~,-~- ~'~~~`~ ,~ ~ l ~s~ -{ f,~ )r,~~O~~t~Qrs Sze, ~~s l Name of Hos ital or Street Address Villa e, own or Ci Coun Purpose for Which Record is Required ~P~ ~ ~~ ~/ ~ S ~~ l SS v .e S What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Si t f A li t `` ~~ ` gna ure o pp can Date 1 Address of Applicant ~ '~ ~ ~ ~~ ~ `~~ ~ ~ of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) NEW YORK STATE DEPARTMENT aF HEALTH Vitat Records. Section FEE: $30.00 per copy or No Record Certification. Please do not send cash or stamps. _<~r Name of Deceased Edith L. Travis ~..~~ nn,~i~a Last Name at Father of Deceased Russell Bennett Maiden Name of Mother of peceased Rose - _ First Middle Last Place of Death 8b Robinson Lane Name of Hospital or Street Address Purpose far Which Record is Required F~lNT Oil T1!~'.E~ ~~ _ ___ _ .~ _ .. Date of Death or Period to be Covered by Search February 24, 2014 Social Security Number of Deceased 094-38-9338 Date of Birth of Deceased Age at Death. December 10, 1911 102 r,e~.,~t, Dav Year Wappinger Viltaae. Town or Dutchess What was your relationship to .the deceased? ------ ~~- In what capacity are you acting McHoul Funeral Home, lnc. ~_______ ___. if attorney,.name and relationship of your client to deceased _ -,..~._ . March 14, 2014 Signature of Applicant Date"-"...--_- 89 Route 82 Hopewell Jct NY Address of Applicant ~,, ~- CpMF?~~'E FU__ Fi~~ F~tS ~'t.t~ursrsi~~e+u~ ~~ ci ~' Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death T Name .._ Address City _ State Application to Local egistra~ far Cann of Death Recar~ Zp Code DC~H 294A (SJ2oo0} i ~~~EW~__m.~ ..RK_STAT_ ----. DRIVER~.~.,ICENSE IQ: 781 -~3Q 029 CLASS D TEMP. VI~1~G1R EXP: 05-25-13 WA JF4 »~ ,: r;FalNto ~~~-r~`~ EE ~ `128tH •' 3~(' `~ EVES E NONE /--~,: _...c' R Al ~ ~~~, .~~" ISSUED. 06-13-12 EJ6'~R~S. aT-04-20 ~~Mro lC?'y' gy;; r u ~i. +r .i.~ `,'r i~ ~^ $~ .T. ~; ~. _ R:. 37: NEW YORK STATE DEPARTMENT OF HEALTH v:F~~ oo..r.rric SpeTinn Application to local Registrar for Copy of Death Record FEE: $10.04 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Middle Last Name of Father of Decease ~~ Firs Middle Last Maiden Name of Mother of Deceased ~jr1~1C.t.2 ~irst Middle Last Placed~ of Death ~~~ Name of Hos ital or Street Address Purpose for Which Record is Required r of Death or Period to be Covered by Search Social Security Number of Deceased Date of Birth of Deceased Mon~h Day Year .- - d' "~ What was your relationship to the deceased? ~ ~ -~-arc' In what capacity are you acting? ~ If attorney, name and relationship of your client to dace ed_ Straub, Catalano ~ Halvey l:~.tnf~r<tl l tune 'Signature of Applicant . ~ ;~ ,,,- , „ , , , r~,~; ~ '. U. lsux l :i 1 Address of Applicant , . _ ~COMF Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name Agellat Death d~ ~~ziz.l~ ~1g Address State Zip Code City NEW YORK STATE DEPARTMENT OF HEALTH ~ ra..l 0.,...,rrJc Cr~ntinn Number of copies requested without confidential cause of death FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. rr«~H Name of Deceased k~ ;~,a~_r ~C L:1 C First Middle Last Name of Father of Deceased ~-~ N Ja n/~ o S/ Dv i t First Middle Last Maiden Name of Mother of Deceased First Middle Last Place of Death /'I ADr~roS Si . Name of Hospital or Street Address Purpose for Which Record is Required lication Local Registrar for Copy of Death Record ~l:NT::OR TYPE Date of Death or Period to be Covered by Search Social Security Number of Deceased Date of Birth of Deceased Age at Deatli ~{ ii aG ~~ Month Day Year 17 uTcNESS Tc `~r77L~ L=s~/aT~ What was your relationship to the deceased? FuN~r~'AC .~/ i~EcTa f-.- _ ---- ---- Inwhat capacity are you acting? S'~"~''~t ----_----- -i If attorney, Warne and relationship of your client to deceased ._-____ --- Signature of Applican' Address of Applicant GDMPI~ET'~ FQR QEA-`T'H5 :4C~4JRRkNC A: --~ Number of copies requested with confidential cause of death Name _ Address City _ State Z- Zip Code i-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH < r.~..~ o.,..r..fle ~nrtinn _ _~ Application to Local Registrar for Copy_ of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased 1~.~,ti ~ Middle Last Name of Father of Decease C ~~ Firs Middle Last Maiden Name of Mother of Deceased ~~2 ~irst Middle Place of Death - ~1 _ _ _ p Naml of Hos ital or Street Addres<s-A7~-G'~ Purpose for Which Record is Required of Death or Period to be Covered by Search Social Security Number of Deceased ~~i _ ~ ~ ~ ~ Date of Birth of Deceased Mon~h Day Year -- ~"v~ V What was your relationship to -the deceased? ~Cl a. ~~^'c' 6Y~~ c. In what capacity are you acting? If attorney, name and relationship of your client to dace ed_ Straub, Catalano ~ Halvey P~.tnE'r<tI I ir,rrie Signature of Applicant . - :<.. ~ << <', rcc: t'.(.). lSuX I a 1 Address of Applicant s~ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Agelat Death d" ~~~ Ilg Name Address State Zip Code City r ,~ (d ar ~J~ tion to Local Reg~str Ap lice for Co of Death Record NE1N YORK STATE DEPARTMENT OF HFJILTH py - FEE: $10.00 per copy or No Record Certfication• Please do not send cash or stamps. ..:. y.:. i,.... ti:: ..:: . . . :.:;::.:.:::.>;:::..;,:><.::.:.;~,;>:<.;; :.:.:~::;.~:.;>:fi:_,.~.,.~,... ered b Search Date of Death or~ /Period to be o/v Name of Deceased ~ ~~~. f f 0 Iv1Q,IC,~CT ~ ~~ ~~~ T C C.i~unr o ~t~ Y First Middle Last Social Security Number of Deceased Name of Father of Deceased First Middle test Age at Death Date of Birth of Deceased Maiden Name of Mother of Deceased 0 / Z Z. - ~ 9 L ~". -- Middle Last mv~u~ -- First /0 ' ' 1 T- , s Place of Death ~(~ ~~ ~Ct.~ ~ rvA~J/~ / ~S / ~-~C S~ ~~ Vill ,Town or C' Name of Hos ital or Street Address Purpose for Which Record is Required - ~v What was your relationship to the deceased? . c are you acting? D ~ Gc In what cape ity If attorney, name and --~°"^"~h'^ "~ your client to deceased Signature of Applicant Address of Applicant Number of copies requested with corrfider-tial cause of death , Number of copies requested without confidential cause of death Name Address State Zip Code City ~~ / DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH \%,f~l Rnrnrr~C SP_Ctl~n Application to Local Registrar for Cop of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~ ` _ First Middle fast Name of Father of ceased First Middle Last Maiden Name of Mother of Deceased FirsC~ ~ ~ Middle I..ast Place of Death 1 l ~~~~o~l~. ~ Name of Hos ital or Street Address Purpose for Which Record is Required _ pate of Death or Period to be Covered by Search Social Security Number of Deceased dSl - 1 ~--I - ~'~'--t S . Date of Birth of Deceased Age at Death .Month Da Year lia e, nor ~ Count What was your relationship to the deceased? '~ `~ " In what capacity are you acting? ~ ~~~~~ C~ -~~~'~`~ If attorney, name and relation hi of our client to deceased S~tr!'aul~, Catalano & Halvey Furycr~tl t~tc~me ~ . _ ^- _ I ,?, - lU Signature of Applicant ' -~ ' ~ '' ~'~ ` T, ~~c.~ i;, . jai Address of Applicant ~, '. Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name Address City State Zip Code g,~,ps DAVID L. POSHER ELLEN L BAKER SCOTT D. BERLIN RICHARD R DUVM.L LANCEPORTMAN RICHARD J. OLSON MATTHEW V. MIRABILE KIMBERLY HUNT LEE REBECCA M. BLAHUT SEAN M. KEMP JESSICA J. GLASS CARLA S. TESORO BETSY N. GARRISON DANIEL C. STAFFORD MICHAEL J. CARRDLL ANNE B. LETTERIO DIRECT TELEPHONE' (845) 496-6826 E-MAIL. aV0lencia~rnLCm.COm January 15, 2014 M~CABE & MACK LLP ATTORNEYS AT LAW 63 WASHINGTON STREET POST OFFICE BOX 509 POUGHKEEPSIE. NY 12602-0509 TELEPHONE.: (845) 486-6800 FAX: (845) 486-7621 www.mccm.com Attn: Town Clerk Town of Wappinger 20 Middlebush Road Wappinger, New York 12590 Re: Estate of Sarwat Lodhi Our File No. 13797-0001 Court File No. 2013-968 PHILLIP SHATZ J. JOSEPH McGOWAN ALBERT M ROSENBLATT THOMAS D. MAHAR. JR. RALPH A. BEISNER JESSICA L VINALL KELLY L. TRAVER HIAROLD L. MANGOLD (Retired)) JOHN E. MACK (1874-1958) JEDWARD JMMACKE(19141998~) JOSEPH C. McCABE (19Y5.198t) Dear Clerk: - dvised that this office represents, Mansoor Ahma ovemberb23, 201 Blahut, co- Please be a Administrators of the Estate of Sa Surroo ate's Courdtled enclose a copy of the Certificate appointed by the Dutchess County g of Appointment. cess of closing the decedent's bank accounTe n encloe a check made W e are in the pro certificate is required in order to clop h eamounttof $10 00. payable to the Town of Wappinger i ou for your anticipated assistance with regard to this matter. Thank y Very truly Yours, L McCABE & MACK LLP KELLY L. VER KLT/alv Encl. mad, Administrator cc: Mansoor All or Perwd to ~ ~ .:..:::.::.: ::;7ff ~ oa~e ~ ~ ~ Z :.f. ,:>r~: o2S ~ .. .'...~~.~., gecurdY Numpar of Dew ath .:.:.:.:..:::.. ~ceas ;mss goc~a- A'9e at De Ne-me °f Middle ,~ ~ ~O ¢ics~a~r peceas~ I~t ~S pate of girth ~ fees c Yew 1 ~- 5~i Nye of ~ pa ~. ~ ~ ,~~,J ~ ~ a- /~ M;da~e F-rs ~' Mother of used is JeC. MorRh d 3 l'~t~ ~ Q~ ~~1s ~o,, 1, N~18 ~ ~ s r~P 5 M~~ ~ Middle -,~,1~ ,~rwn °r G J ~ , Firs ~ s ~ ~ of peak ~ 3 rem rL f pla Hos -~ °r S~~a ~ Aequ~red - n ~ jam, ~ / ~UJ Nye of for Which R~° ~ ~`~' '1 Ur Pu~ose a deceffi~'~ tto~h~P ~ ~ ~ de~~ Da What was Y°u ~ e Y°u ~~hiP °f Your clie~ t° f. ~. ~ -n vet °~~ a and relat-0~ ~ 1~ If attomeY ~ n~ ,~., of APPircar`t 3 ~ ,, Signatureof APPi~c~ Address . y.. .:$.. ~ cue of death .:..:,,s;7.'•.:~~':.' ~ ~ ~o~ ~ dead ted ,A'f"~~` WWW"" :..:~ <;; ~ ;~~.:::..~r ~ coP~~ req~ w~hout cow r of ooPi~ reA~ted Nuh'bs ' Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for. Copy of Death Record Vital Records Section ~'} FEE: $10.00 per copy or No Record Certfication. Please do not send cash or stamps. :,..,.. ...... :;•. v ........n....... ~ .............. ~...............................~ . ~..... :•::• :::...::::.:.:.............::...:...::::::::::•,:::••.~::::::•::::::::::::•.~v:r.G:r...?. r.. r::i.~ , r ,. .x ~.~ . ~., ,:f .. ..,~.y/~:.::.~::.::: .:.... .~Y ..~... •: ?4v ?:.riw, v::.: Fti'bi:C:~': {:.;;.;:;i:::;i}:;;:':>i:j;~ :i: }:.: . ~' /`i~.•:. f.An.:..... n r.t.}......nvr.....::.~.. .i>~::•:<':•iX~i:[:. Name of Deceased Date of Death r Period to be Covered by Search First Middle Las a.s ~ Z Name of Father Deceased Social Secunty Number of Deceased Firs ~ Middle Last C~ Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death ,~~ ~~eG tt l1~ ~~ ~ Middle Firs Last Year Da Mor>th G Place of Death OZ 3 ~~~~ I'C,~ t S ~. 3 L~. ~ s l ~,.~ ~~~~ ~ Name of Hos ital or Street Address Villa ~ Town or C Coun Purpose for Which Record is Required j,~~ -~ ~,w ~,/ ~ s fa--~ ~ ss ~ ~~ s What was your relationship to the deceased? In what capacity are you acting? If atton~ey, name and relationship of your client to deceased Date 1 ` ~~ ` ature of A licant Sign PP 3 " ~ ~ ~~ ~ `~S ~ ~ 1 Address of Applicant ~ of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name Address City State Zip Code DOH-294A (6/2000) A~lication NEW YORK STATE DEPARTMENT OF HEALTH for Cod Vital Records Section r~ocal Registrar of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. P~,~AS~ PRINT QR l'YP~ Name ~of Deceased Date of Death or Period to be Covere d by Search ~,J 1LLlAM ~ . LU rf ~ 1 ~ L F y First Middle Last ~ , rT~ J s~ Name of Father of Deceased Social Security Number of Deceased ~A~~~~ N. wH~T~~Ey X79- ~8 -3.~5 ~ - First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death First Middle Last Month Da Year Place of Death ELyivT g T GcJYa !°p~~~E2 5 f=At.LS ~UTGHESS Name of Hos{vital or Street Address Villa e, T County Purpose for' Which Record is Required To _~E ~E What was your relationship to the deceased? GU~t/E ~£'!~L J7/rte ~l T~ - In what capacity are you acting? s 14!'bir ~- If attorney, name and relationship of your client to dece ased Signature of Applicant ~ Dated. 9' /~ Address of Applicant 5 ~ _ __ C~MPL„k~T~ FOR Di~ATHS OGCkJRRk GAS OF JANUARY '! '1.9$8 --~ Number of copies requested with confidential cause of death __. Number of copies requested without confidential cause of death DOH-294A (6/2000) ~'~ NEW YORK) S[(T~~ ATE DEPARTMENT OF HEALTH ~~1~9) Q~l`AI~f,C .lP_CY~Un __.___ Application to Local Registrar for Cope of-Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~ 1 ~ ~ ~C~S ,~>'t~ I First Middle Last Name of Father of Deceased ,..~ ~<s C Middle Last of Death or Period to be Covered by Search ~~,~ , ice, a01~ Social Security Number of Deceased ~~~5- a~ - a3c~ ~ First Mai me of Mother of Deceased Dat~ f Birth of Deceased Month Da Year First Middle Last Place of Death r'1~ ~ ~ ~ , ~~ ~ ~~-~-~2.s~~ i ~S ~ ~ ~ 5 ~~--11!! ~ a ~ ~ 1-1 U Name of Hos ital or Street Addrefss Villa e, Town or Ci Purpose for Which Record is Required ~~~ ~~ t I „ Aga at Death 5a i~a~-C ~~5 What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Jl~l/i Signature of Applicant ' `~"" ~ r 2 Address of Applicant n 1`!MP 1 4 ~'V~~ r ~ S~ Number of copies requested with confidential cause of-death Number of copies requested without confidential cause of death Name Address State Zip Code city ~~~- NEW YORK STATE DEPARTMENT OF HEALTH - ~------ Application to Local Registrar for Copy of Death Recor Maiden Name of Mother of Deceased First newaie ~~ Place of Death ~~ /~/~/ ~l~// '~ 2i-/~ Name of Hosp' or Street Address Purpose for Which Record is Required Date of Birth of Deceased_ I Age at Death Day Year I ~~''~~s ~ aids Town or CItY ~,~ ~vs,~~fs 7 ~~trr/ , f ii'C<~or What was your relationship to the deceased? ~, ~ ~ In what capacity are you acting? If attorney, name and relationship of your dierrt m deceased //7 /y /= Dat Signature of Applicant ~D dox ~Dy ~~~ S/~~~ /c. y ~a~/ Address of Applicant Number of copies requested with cwnfidantiail cause of death Number of copies requested without corrfidar~tial cswse of death Name Address Zip Code State City DOH-294A 16/2000) Name of Deceased ~ /1 ,p,~ O ~ ~C ~a ~~ ~ Middle 1, r " ~t First Name of Father of Deceased Middle Last First Maiden Name of Mother of Deceased Middle Last First pMce of oeaa~ ~ C, a~ ~ r~ ~r e. „~,.:.~ ......... Search Date of Death) o`r Period to be Covered by 1 f lal ~7 Social Security Number of Deceased ~`'~s a - ~-1- 0~ I V Date of Birth o/f (Deceased --~~ (~lv lT~f ~ ~~(F GJ~I ~ vile Name of Hos ital or Street Address ~ Purpose for Which Record is Requir / ~~ ~ C, ~1V ~C~ ~- 'I-' 111/1 o~y T.....n nr CiKI 1 27/ v Age at Death ~ufc~s:S What was your relationship to the deceased? -----'-"- c are you acting? ~ s~ In what cape rtY If attorney, name and relationship of your client to/deceased /,/ / /G~ bcant ,~ .. • - - - ~ Z Signature of App ~ ~ `~ Q ~w n ~ `~ L'Uc~A _____1- licant ' r ~ ~ - U • Address of App ...._. . Number of copies requested with coMidential cause of death . Number of copies requested without confidential cause of death Name Address Starts Zip Code i Cry DOH-294A (6/2000) Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section PL~AS~ CC~MPLET)= FORM'ANb ENCLQSE FEE FEE; $10.00 per copy or No Record Certification. Please do not send cash or stamps. PI.~ASE PRINT OR TYPE _ Name of Deceased Date of Death or Period to be Covere d by Search LJ1LLlAM ~. GUrfi1~LF~~ f_ ,T` /~{ First Middle Last Name of Father of Deceased Social Security Number of Deceased ~p~~~~ N- wH•T~L~y U79- ~~ -3.~.~ ~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death ~/~/c~ .,Q, /~if,~'HEt~ /0 ~ 2 ~3 ~,~ First Middle Last Month Day Year Place of Death ELq/v1 ~} T Gv~l t'1°f/~~E~c 5 /-ALLS J,,JTGHESs Name of Hospital or Street Address Village, Tc-ei°-E'rtg~ County Purpose for Which Record is Required T ~ _~'~' L E i ' What was your relationship to the deceased? /`-L~/k/EIr?I~L ...17~N~~7-Q~- ____ In what capacity are you acting? _ ~ 19 J'LJ ~ If attorney, name and relationship of your client to deceased Signature of Applicant ~ Dated 9' /~ Address of Applicant "'' S 1C3 COMPL„~TE FQR DEATHS OCCURRING AS OF JANUARY 1 '19$8 -~- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NiAM~ ANp AI~QRESS WHERE RECQR[J ~HOUL1~ BE SI~.NT _ Name -_-- Address City ____ _ State _ Zip Code ___ DOH-294A (6/2000) ``~ Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for COp~/ Of Leath R@COrCr Vital Records Section ..: ~:.PI.IA;a:~ C~QM'R:!"s"T~ FARM ANQ ~N~I~C~:St~' fz~~ : ,~ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLI;A~~ P :FtINT~ QR TYPE:. :: ::,.::;::;:: ;~::: Name of Qecease ~`, ~C~s I~~>'~~ '4, ..Date of Death or Period to be Covered by S ~ ate . ~ ~, a a ~ earch First Middle Last Name of Father of Deceased ~o~~ ~. c. ~c~d~s Social Security Number of Deceased ~~~ s a~ - ~ 3~ a First Middle Last Mai me of Mother of Deceased ; ~ ~i`~~ Date of Birth of Deceased ~ ~~ ~ ~ Age at Death t L ~ (~ , ~Ca,S~r~ 1 a ~j First Middle Last Month Da Year Place of Death ~~O ~C ~ ~.~,; ~ ~.~.C~~ ~A ~.., M ~ ~~; p~-S ~ ~ (S ` "" ` ' 'r ' ~ r } ~~,(;-~-C YIiL~S ~ a T or C i , o w n Village Name of Hos ital or Street Address Count Purpose for Which Record is Required ~~ J'~`r\s(. . . What was your relationship to the deceased? ` ~tF~C In what capacity are you acting? If attorney, name and relationship of your client to deceased ) ~ + I Si nature of A licant Date 9 pp _ ` licant f L~ ' ~n ~ ~ r 1, Address of A ~` pp i Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death 1/~ V DOH-294A (6/0001 Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record ' Vital'Records Section FEE: $10.00 per copy or No Record Certfication. Please do not send cash or stamps. :...: :<: :..~ Name of /Decea~'~, ~ ~~/ 0 ~, e Covered by Search Date of Death or Peri t~ ~~ ` ~ ~ First Middle Last Name of Father of Deceased Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death First Middle Last Month Da Year Place of Death /~ ~~/~~ ~/~// ~pi~~~s / u/~j~ 7~ 2i C °~' Name of Hos i al or Street Address oun Villa ,Town or Ci Purpose for Which Record is Required /~1i/y ~l.~S~/~~'Sf What was your relationship to the deceased? ~/lfr/ ,~i/'Cf~o~ In what capacity are you acting? /' ~' If attorney, name and relationship of your client to deceased '" /- /~7 /L/ ~!~ Signature of Applicant °y ~ ~O~ Date ~°~~ s~r~y ~ y ~~/ ~ Address of Applicant I Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) \ / Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section PLEASE CQMPL.ETE EORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PR1NT QR TYPE Narne of Deceased Date of Death or Period to be Covere d by Search First Middle Last Name of Father of Deceased Social Security Number of Deceased ~3iv7cni~o Si Dv Tt First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death First Middle Last Month Day Year Place of Death NarY~e of Hospital or Street Address b~+ll~ya, ~ y County Purpose for Which Record is Required T~ .`7 c 77L ~ t= s ~ ~a r~ What was your relationship to the deceased? FUN~Y~AC 1~ii~~cTc+~-- __ __-._ In what capacity are you acting? S i-ar~~ _ -- -_----__-.- __-- If attorney, Warne and relationship of your client to deceased __ __________________ Signature of Applicant ~ ~ __-~'~'~ -' -Z`` _.___ _-___ Date ~ ' ~ ~_-~ `'~' ----------- Address of Applicant _~~_~_. r~ in/ _5T. G.1r ~:~/'S fi~~~~, n.' ?~ 1 2~.j(r ---=-_------- COMPL)wTE FQR DEATHS OCCURRING AS OF JANt1ARY 1, 1g8$ --~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PR1NT NAME ANp ADpRESS WHERE RECORD SH(JUI~C? BE SENT Narne ~ - _- Address __ City _ State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Copy of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Middle Last Name of Father of Decease ~ ~~~ Middle Last Maiden Name of Mother of Deceased ~irst Middle Last Place Death ~~-~~ Name of Hos iial or Street Address Purpose for Which Record is Required .~-~ ~~ ~~ :;:: RINT QR TYRE . .:. ,„ ,Date of Death or Period to be Covered by Search ~ ~ ~ __~~~ Social Security Number of Deceased Date of Birth of Deceased Age at Death Monlth Day Year V What was your relationship to the deceased? ~I'1 a- .~.~va In what capacity are you acting? ~ ~ If attorney, name and relationship of your client to decea ed_ Straub, Catalano ~ Halvey F~itnc~r<ti 1 tc~rtte Signature of Applicant .-~,~ ::~ ~,:rc~ca tiC). lSc~\ 1;i1 ,Address of Applicant Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Ild Name Address City _ State Zip Code DOH-294A (6/0001 ~/~V~ W ,r Ap I~cat~on to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record \/ifal~Roenr~ic Sactinn ~~~ .... :~~ ': ' .,.L:1~=: >: ' .'':Ells ,: :. ;' FEE: $10.00 per copy or No Recard Certification. Please do not send cash or stamps. Name of Deceased Date of Death or Period to be Covered by Search C c.~-vnr o ~t~-to~Y c,~~<'o M l p, l~yi~ First Middle Last Name of Father of Deceased Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Aqe at Death First Middle Last Month Da Year Place of Death , / V~ ~~ 5~ ~ ~j i ~~/~ / ~s ~-~.~ Si G~ Name of Hos ital or Street Address Villa ,Town or Ci Coun Purpose for Which Record is Required /`) ~6uo+vicetA~ Y"r ~ got" What was your relationship to the deceased? ~~G#~fZ In what capacity are you acting? l1l~C~X7 d ~ lGc ~ deceased n t to If attorney, name and rela~onship of your clie ( ~ ~ '~ / / 7 ~ ~ ~ ~ ~ ` Signature of Applicant 5 Date // Address of Applicant ~- ~ U C ~ ~ 'cam Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) ~" ~ / Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH fior Copy ofi Death Record Vital Records Section PL~A~E QOMR1»~TI FO{~M AND l~N~t"Q;a~ FEE> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. .. <_ .. ' F~t,t~ASE'P: ,,:.. RINT`Qf3 TYPE :.... ;. Name of Deceased .Date of Death or Period to be Covered by Search 0~ - f ,~ ' ~ l ~-~ First Middle Last Name of Father ofceased ~ Social Security Number of Deceased ~~ 1 ~ ~~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death h First Middle Last Da Year Mont Place of Death ~~~~ ~n5 ~- ~~. II '' ~~ lJ~ 1~V ~-P SS Count Name of Hos ital or Street Address Villa e, own or i d is Required Purpose for Which Reco r l~ What was your relationship to the deceased? ~~ ~ ~A,IC`~~ In what capacity are you acting? PSV~.~(.~i~A.L~ ~- ~ -~'`" If attorney, name and relationship of your client to deceased "-' Straub, Catalano & Halvey Fl.li 1C'1'il) f~iOr~le Signature of Applicant -~ , ~_ ~^! D to - - t~~t~ t;u.~ i.~~ Address of Applicant ~ j ~ - ~ , . . C:~MM1,-G 1'C I'VtS uCHI'1'l.', til4ys+nrui~M ~+v +.. Number of copies requested with confidential cause of death ~. Number of copies requested without confidential cause of death Name , Address city ~ns,~is State Zip Code DOH-294A 16/0001 DAVID L. POSNER ELLEN L. BAKER SCOTT D. BERGIN RICHARD R. DuVALL LANCE PORTMAN RICHARD J. OLSON MATTHEW V. MIRABILE KIMBERLY HUNT LEE REBECCA M. BLAHUT SEAN M. KEMP JESSICA J. GLASS CARLA S. TESORO BETSY N. GARRISON DANIEL C. STAFFORD MICHAEL J. CARROLL ANNE B. LETTERIO DIRECT TELEPHONE. (845) 486-6826 E-MAIL: avalenCia~mCCm.COm January 15, 2014 M~CABE & MACK LLP ATTORNEYS AT LAW 63 WASHINGTON STREET POST OFFICE BOX 509 POUGHKEEPSIE, NY 12602-0509 TELEPHONE: (845) 486-6800 FAX: (845) 486-7621 www.mccm.com Attn: Town Clerk Town of Wappinger 20 Middlebush Road Wappinger, New York 12590 Re: Estate of Sarwat Lodhi Our File No. 13797-0001 Court File No. 2013-968 Dear Clerk: PHILLIP SHATZ J. JOSEPH MCGOWAN ALBERT M.ROSENBLATT THOMAS D. MAHAR, JR. RALPH A. BEISNER JESSICA L. VINALL KELLY L. TRAVER MICHAEL A. HAYES, JR. (Retired) HAROLD L. MANGOLD (Retired) JOHN E. MACK (1874-1958) JOSEPH A. McCABE (1890-1973) EDWARD J. MACK (1910.1998) JOSEPH C. McCABE (1925-1981) Please be advised that this office represents, Mansoor Ahmad and Rebecca M. Blahut, co- Administrators of the Estate of Sarwat Lodhi, who died on November 23, 2013, appointed by the Dutchess County Surrogate's Court. I enclose a copy of the Certificate of Appointment. We are in the process of closing the decedent's bank account and a certified death certificate is required in order to close the account. Therefore, I enclose a check made payable to the Town of Wappinger in the amount of $10.00. Thank you for your anticipated assistance with regard to this matter. Very truly yours, .-- McCABE & MArCK LLP ~V y ~--~ KELLY L. VER KLT/alv Encl. cc: Mansoor Ahmad, Administrator Surrogate's Court of the State of New York Dutchess County Certificate of Appointment of Administrators Certificate# 26644 File #; 2013-968 IT IS HEREBY CERTIFIED that Letters in the estate of the Decedent named below have been granted by this court, as follows: Name of Decedent: Sarwat Lodhi Date of Death: November 23, 2013 Domicile: Town of Pleasant Valley Fiduciary Appointed: Mansoor Aitmad Rebecca M Blahut Mailing Address: 9 Glengowan Street 63 Washington Street Whitby Ontario Canada L1 R01<8 Poughkeepsie NY 12601 Type of Letters Issued: LETTERS OF TEMPORARY ADMINISTRATION Letters Issued On; December 10, 2013 Letters Expire On: June 10, 2014 Limitations: THE FIDUCIARIES SHALL HAVE AUTHORITY TO ACT SEPARATE AND INDEPENDENT OF EACH OTHER. THE LETTERS ISSUED BY THE COURT SHALL REMAIN IN FULL FORCE AND EFFECT FOR A PERIOD OF SIX MONTHS FROM THE DATE GRANTED AND ISSUED BY THE COURT. and such Letters are unrevoked and in full force as of this date. Dated: December 11, 2013 IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the Dutchess County Surrogate's Court at Poughkeepsie, New York. WITNESS, Hon. James D Pagones, Judge of the Dutchess County Surrogate's Court. Erica S. DeTraglia, Esq, Chief Clerk Dutchess County Surrogate's Court This Certificate is Not Valid Without the Raised Seal of the Dutchess County Surrogate's Court Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section >:; FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. .... ... . ;.:....... ......:::.:»: Name of Deceased n n ~O ~~C ~~ rem ~ ` (; First Middle Last Date of Death or Period to be Covered by Search if ~ o f ~~ Name of Father of Deceased First Middle Last Sociarl Security Number of Deceased~'f / , v ~ ~ ~ ~ ~ D ( v Maiden Name of Mother of Deceased Date( o~f Birth of Deceased ~ I ~ L' ~ Age at Death '~ First Middle Last Yelar nt~ M Place of Death ~(~ wh; ~e C,a~ ~~~ ire , ~Pf ~ , Wot.~prrrS~,-s N`~v Name of Hos ital or Street Address Villa ,Town or Ci / Z~ ~.~fcti.css Coun Purpose for Which Record is Required ~~ <<- il~~~ ~- -~ ~Vl -What was your relationship to the deceased? In what capacity are you acting? ~ S r c ~' ~ If attorney, name and relationship of your client to deceased ture of A licant ~ Signa PP ~ Address of Applicant 1 / Dat , l ~~ Z -~J Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) ' Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. <~ <' :. ': ;: fit .::.. ~~ :::::::: :; - Name of Deceased Date of Death or Period to be Covered by Search ~l a ~ ~ ~ First Middle Las C~ - Name of Father Deceased Social Secunty Number of Deceased Firs ~ Middle Last ~ Maiden Name of Mother of Deceased firth of Deceased Date of B eath D Age at ~~ r ~ ~ SUNG " r ~ ~~ C ~ ~ it ~ ~ `~ ~1`t ~ Middle Firs Last ar Y Da Month Place of Death 02 3 ~~--~~ ~' ~, `(~A l S o`Z. 3 ~~~ ~ S L ~,- ~ ~f ~J`~ ~ ~l S ~j ~ c~ ~ ~ '{ I,~'~Otvl~'QYS ' cx- ~S / ' ' ` Name of Hos ital or Street Address or Ci Coun own Villa e, ~ Purpose for Which Record is Required What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased / Date l d ~"~ Signature of Applicant ~ ` ~ ~~ ~''( `~~ ~ ~ ~ Address of Applicant ~ U ber of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) sT~~ _ CO-MP/.~R~IAL D8i`V~R 3 ENSE ID 797 62~ 235 CLASS C r ~; (i~l{Q1E : ~L p s t, ~tK ? ~..fB R ~ K$.N2 ~ `~"" ti~ 156U~.08-08-12 ':~g._ ox' wfl2 5:0&14-2f1 aneiaew~o NEW YORK STATE DEPARTMENT OF HEALTH VITAL RECORDS SECTION Application to Local Registrar for Copy of Death Record Fee: County District -$30.00 /Other Districts - $10.00 per certified c ;py or No Record Certification Identification Requirements: Application must be submitted with copies of either A or B. (Note: Copy of Passport required if request is made from a :foreign country that requires a U.S. Passport for travel.) A. One (1) of the following forms of valid photo-ID: -OR- B. Two (2) ofi the following showing the applicant's name • Driver icense and address: • Non-driver photo-ID card • Utility ar telephone bills • Passport • Letter from a government agency dated within the • U.S. Military photo-ID last six (6) months Name of Deceased: Social Security No. of Deceased: Karen A. Caporale 052-54-0901 First Noddle Last Date of Death or Period to be Covered by Search: (mmLdd/yyyy) Date of Birth of Deceased: Age at Death: 01/10/2014 10/18/1957 56 From To mm / dd / yyyy Maiden Name of Mother of Deceased: Death Certificate No.: (ltknown) Irene M. Moss First Middle Maiden Last Name of Father of Deceased: Local Registration No.: (If known) Joseph P. Allison First Middle Last Place of Death: 16 White Gate Apts Apt I Wappinger Dutchess Name of Hospdal or Street Address V+liage, town ar city County Number of Copies Requested: (For deaths occurring as of January 1, 1988 specify with or without confidential cause of death.) Copies requested with Copies requested without Total number of confidential cause of death ~ confidential cause of death copies .requested ~_ Purpose for which Record is Required: What is your relationship to person whose record is required? Husband In what capacity are you acting? If attorney, give name and relationship of your client to person whose record is required: If you are not the parent or child of the deceased or the spouse of the :deceased at the time of death, you .must submit documentation of a lawful .right or claim. Date Signed: Signature of Applicant: Montn Da Year FOR REC31$TRAR'S USE ONLY {Phpiooopy ID arxd atC~h ~to applicatron farm) O1 14 2014 Type ofi iD: Driver License Address of Applicant: dssui g state: Robert Caporale Expiration :date; (Applicant's Name) NUmber: 16 White Gate Apts Apt I ^ OtheriD, Specify (Street) Number: Wappingers Falls NY 12590- Type:: (City) (State) {Zrp) Number: Telephone No.: ( ) Type: DOH-294A (06/2005) </~r [~ n /~~ il(/JvTJ (/.J\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section FEE: $10.00 per copy or No Record Certfication. Please do not send cash or stamps. Name of Deceased Edith L• First Middle Number of copies requested without confidential cause of death Name of Father of Deceased Russell Bennett First Middle Last Maiden Name of Mother of Deceas~uGh ~ hmc t. Rose - First Middle _ _ _ Last Place of Death 86 Robinson Lane Name of Hospital or Street Address Purpose for Which Record is Required piication to Local Registrar for Copv of Death Record Social Security Number of Deceased 094-38-9338 Date of Birth of Deceased Age at Death December 10, 1911 102 Month Da Year Wappinger Dutchess Town or What was your relationship to the deceased? In what capacity are you acting? McHoul Funeral Home, Inc. If attorney, name and relationship of your client to deceased Signature of Applicant Ho ewell ct Address of Applicant 89 Route 82 p ~ 2 Number of copies requested with confidential cause of death Name Address City DOH-294A (6/2000) W Date of Death or Period to be Covered by Search Travis February 24, 2014 last February 24, 2014 Date NY State Zip Code A~plicstic~n t® i_~~al Registrar NEW YORK STATE DEPARTMENT OF HEALTH ~~~ ~~ ~ ~~#h Re~~r vital Records section FEE: $10.00 per copy or No Record Certification. ''Please do not send cash or stamps, ~~ Pt.;~a45E I~+Rflk4T° R TYt~tS Name of Deceased Oate of Death or Period to be Covered by Search // lj(fiGL~~/1'! ~ ~Nir/Ei rte' G~' 070 • ~`~/ First Middle Last Name of Father of Deceased Social 3ecuri Number of Deceased ty First Middle Wst Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death First Middle Last Month Da Year Place of Death ~ 07 .L ~Ylf°E/1i~L 13G ~/p- ~l`3~jo ~ G{~,~'i°~yy~~'S ~<<s <~vr~'~i'~=.5~ Name of Hos ital ar Street Address Villa a Town or C Coun Purpose for Which Record is Required ~/y/yl~L I ~~ S What was your relationship to the deceased? i~D 1n what capacity are you acting? t'"~ If attorney, name and rel sip of your client to deceased Signature of Applicant pate vT ~;?S D~ Address of Applica ~~ ~<<~ ~~ t'~~O.r/ N /~.SaB- . 'i.:1:/1l1Ti:G1'G rwrra~s+.r-. •~~.+r ww,~.... - Number of copies requested with confidential cause o1 death Number of copies requested without confidential cause of death Name _ Address City State Zip Code va~~ ooH-z>34A cs~2aao~ Application to Lacal Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section --- _. PLEA$E GOMPLETlr FORM AND 1~NCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. _ PI~PASE PRINT QR TYPE Name of Deceased Date of Death or Period to be Covered by Search First Middle Last Nar7~e of Father of Deceased Social Security Number of Deceased ° 7 9 - ~ ~ ~ 3~ 7 ~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Deatfi First Middle Last Month Day Year Place of Death /~ ~~/~/_,i/ui ;~~ , WAP~ ~ ~, --ll :- i Name of Hospital or Street Address Village, T•~-er-~i#~ Count Purpose for Which Record is Required What was your relationship to the deceased? j%6~,~~~ D 4 i. ~ i2cCTa t~ In what capacity are you acting? 5~,~~ __ If attorney, name and relationship of your client to deceased Signature of Applicant - Date ~ "" ~~ '/ `~ Address of Applicant ,~ i/ ~ / ~ i Z.~ 9~ __ _ GOMPL,~TE FQR D1~,ATHS OCCURRING A~ OF JANUARY 1 7988 D Number of copies requested with confidential cause of death -__ Number of copies requested without confidential cause of death PLEASE PRINT ~1;AM~, ANI~ AI~.I~I~~S~ VVk~~Fi~ RECORD aHOULp BE SENT Name ~ --- Address City State _ Zip Code DOH-294A (6/2000) ,~,~~lica~~ror~ ~~ Lana" ~ec~~strar (~Il VV `lr~l tl `; f~~~l l- L)l._F~'ARl IUIL_NT C.)F I-tEAL"1-I-1 ~,~~, ~~ ~~ ~~~,~.~ ~~~~~~ ter,-..-~.~.,,,.,,,.. P1.~,4~r~ CcJIVII~I..~Tk FnRM :4ND kNirl~4SE FCC IE_1::: :b IO.i)) pcr colry ar Ni, Ftecc:,rii l;artific~ation. Please da not send cosh or stamps. f~~.k~ASl=. PFD f~arnr~ u'i I~~~.c~?~ysE~d Sri - ~~-avl I u:;l IVli~i~ l~! i~t~Jrni, c,l f _ilhc~r ul I:)~+r:r!,iscd F-c~ .- Chevy I=a-.1 i liddl R I p~.Jle al pc~Jlh or Period la Ue Covered Uy S ~rrclr Leh 1=~~. ~~ Zo1 ~ _La ~ t Social S~+cririly Nr.lrnber of pece~zsed ___._ L.i ------- -- - IVl~ucicn IJ~~rne of Mlithl:.r of L)~r:eased ~u~ =y ~~ i-,~ ,l IViirJl le 1-'Icu:i:i cil Ch:ulir ~I~ lavrt- c~?.in1 Ni:Ur'le ul I I~a~hil, l cJr :~Ir~~ir r .cress Purpo~,c 1r,r VVhJCh f~terord is 1=teduiredry-_~ or Ci (;~ punt Vvhat w~~~, your rc;hrlu.Jrrsl,ili to the deceased? In vvll; t r:~y,~ic.ily ari~,r ycrri t.u:Gru~? I1 atrcrlic:y, Jl~unra to `:i~n~llur~! ul ~ilJl~llc:~ill ___- F,riilrec;s ul AI,Iilicru'lt _- Ot yOUi C~IG?nt to deL'e%JSed ~v-~~ ~ ', ,. _-- _ _t lalulWLh TE FQF~ D~ATI~:~ ~CCUI~iI~ING AS Oi _~ANIJAR~(~I~`t;+FSB _ ~:J"wr~lu,~r cJ( r~olire': recluesl?LI Wllh clil'ltlClenllal cruse of de>alh _ _. I~lrirnhr!r rrt c:uliies rerluesli~il willroul conficli/~rlli~rl cause of de~rl:h IV ~u r1 e Arirlre~.s CITY _ ,...-r- -,-r-.... 4r1 k.~#~l~ ~r1-DINT N.~M1lI~ ANt~~ A(:7pR~$~ WI-1~I~~. I2~GOf~I~'SHQl:l4.[~ 8~; ~~IVT Slate pate of Birllr of peceased Lash fyfontli pav Year A .J at peafh °l Z ~/ `~ °C~ li~~ Cade _ __- DOII~?'I~a~~~ rr~,rv~nru Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section PLEAaE CpMPLETE FORM AND ENCL(7SE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PL,EASE~ PRINT OR TYRE Name of Deceased Date of Death or Period to be Covered by Search First Middle Last Name of Father of Deceased ~Al.'fr2 ,Mr~(Z2rrISK~~ First Middle Last Maiden Name of Mother of Deceased I, ~ Tip ~ ~z r ~E (UA1~~ nlnw n/ First Middle Last j Place of Death ~ ~ IGH ~~~ ~'~ Name of Hospital or Street Address Purpose for Which Record is Required T o S e rTi~ E S 79 'rr` Social Security Number of Deceased ~ 1 ~ - ay-- 3553 Date of Birth of Deceased Age at Death ~ ~~ 3~ ~/ Month Day Year wR~'P~~~c2 ~D~~ cr~~55 ViTown or~r County What was your relationship to the deceased? ~ w I~-,l2FFL 1~ (2 EC'T-Dk'- I r~ what capacity are you acting? SAM t If attorney, name and relationship of your client to deceased Signature of Applicant ~-~~ ~- ~`~~.~.~ Date ~ ' 3 ' /~ Address of Applicant ~ ~ ~ M!~ ~ N ~~= GiJ,~ P i~t/G E/25 GALLS ~~ / 2 5~G G~MPI„~TE FOR Q~ATHS QGCURRIN~ AS OF JANUARY 1 7g$8 --~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ~ _ PLEASE PRINT NAME AND ADDRESS WI-iEFiE FtEGCFip SHQULD BE SENT I Name Address City __ DOH-294A (6/2000) State ~ ~~3/~ Zip Code r NEW YORK STATE DEPARTMENT OF HEALTH Vital Rnrnrris SP_CtiAf1 i Application to Local Registrar for Cop of Death Record FEE: $10.00 per copy or No Record Certfication. Please do not send cash or stamps. Date of Death or Period to be Covered by Search Name of Deceased Cyr afl~s ~. M owl t Jr! ~~ First Middle Las Name of Father of Deceased I~ ~ Socia{ Security Number of Deceased ~ i I l1Gw. ~ e~~ or First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death ~ C ~ JX{"'~'l F~ t Middle Last Year Motrth _ Da ors Place of Death 02 6 C~~- l-~- f(~a Wa ; Name of Hos ita~ r Street Address N~I~ Purpose for Which Record is Required ~u~t~n55iOr''~ ~ ~~~eSS -What was your relationship to the deceased? S c7n In what capacity are you acting? 5 d~ If attorney, name and relationship~f your client to deceased Signature of Applicant Address of Applicant _ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name _ Address City - DOH-294A (6/2000) State ~IS ~~ CChC-~5 or City County ~ ~ Date 2 - `~ - ~ ~ Z'ip Code Q J E _~ b ,<,~ 1 g-Fi TBR TMOMPSON DRI~YE VIEN~~.2~2118'13030 ~~~ - ilia L~j ~, ... ; i - ~..Lattri Dana birtp F( i ^P ~ i Ll~~/i 959 ~~'•~ `- ~~~ 4~ry J tGndouemerc~ Ls 1tC\' "-. BLll W~O'NlE 1.111 812 0 0 9 ~~ ~ Fle~hi VAesertaNon~ E ~u~, ' IDD~081394488-. 6-FT-O'iN~ !NO'DFE 1~13313Qiy 1C Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Co of Death Record '~ Vital Records Section - ,: FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of De th or Period to be Covered by Search First Middle Last N~a~e of Father of Deceased V T~ ~~ r ,~C-~ ~C' r- Socia! Security Number of Deceased First Middle Last Merl N~me of Mother of Deceased Date of Birth of Deceased Age at Death M D~ ~~ a ~ 2 First Middle Last onth Y -- Place of Death ~ "7 i S S ~ d . Gc)a ~ ~ ° ~ / 5 ~ ~ ~~ , ~ ~. 5 ~~ (~;,~ ~`~ / ~ S S Name of Hos ital or Street Address Villa e, Town or Ci Coun Purpose for Which Record is Required ~e~Le ~'~-~~->'~ What was your relationship to the deceased? c~ ~ .r S P In what capacity are you acting? S ~o u S e If attorney, name and relationship of your client to deceased ~'"4;7 ~`'~" ~ ~ ~~PP% Si t f A t ~ li ~ ~ gna ure o pp can - Date ; ~ Address of Applicant Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) • ANEW YORK STATE ~DE?1TiFIC~AT10~' CARD ID: 579 X64 360 CLASS lG '. ~'k9AYJ~S-KFFLC,R,LtiCY,B i 1~tiI ~r ; ~. 5~.~~ EYES. '}~' f fl: NONE ~°`,.,~,.:. .~ -i~--~~,, ISfiUED: pi,27-p8 EXPIRES: 11-07-16 ~ r ANEW Y1QRK STATEa IDE'1TIF1C~31'I~ti CARD ID: 5~9 964 360 CLASS 10 "k: W'M 4~S-1CE~1.2H, I,t1 CY,B RD ~~; u ~ C3E~f 1~Q ~. 11-07 "~' ,~ EYES. '1iI-, 3-04 " E:;NONE ~t~n t~ ,/ R: NONE t r_ -: - ~a.F.-~,w-~ ISbUED: Oi•27-OB EXPIRES: 11-07-16 ~~~ NEW YORK STATE DEPARTMENT OF HEALTH Application to Local Registrar Vital Records Section for Copy of Death Record PI.E,A~E CQMPLETI` FARM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. - _ Pt„EASE PRINT QR TYPE. Name of Deceased Date of Death or Period to be Covered by Search aFrsy M~QE~ ~'~~~~~1 Fi ~ - ~- ~ ~ rst Middle Last Name of Faiher of Deceased Social Security Number of Deceased RE~Sr ~vwti~vG S/?. O ~~f - 3a - yz~ / First Middle Last Maiden Narne of Mother of Deceased Date of Birth of Deceased Age at Death L~ A2oL~,~~ T2 uF O / ~ ~} / ~3 ~~ ~~ First Middle Last Month Day Year Place of Death ~f D N~/DA .~2~ v~ Gc1r~P/'%i/~E2 ~ u iCl~ ~ S S Name of Hospital or Street Address V+N~#e; Town or~Cttg' County Purpose for Which Record is Required ' 7 o s~TTL~ ~S ill T~ What was your relationship to the deceased? r' ~~L 1J ~ 2FCT02 _ __ In what capacity are you acting? -_ ~~ ~ If attorney, name and relationship of your client to deceased Signature of Applicant Q• Date ~ '~ --~`f ______ Address of Applicant - M n/ S T i iitl"C~25 G/~LLS <U~/ZS~O _ GUMPI*#*TE FOR DEATHS OCCURRING AS OF JA(~UARY 1 19$S -~- Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death P~.~AS~ PRINT NAME AND ACJDRESS WHERE RECOFip SI~Qt1LD RE ~~NT Name Address City _-- _-- State _ - -- Zip Code --- --- DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH App~~ca~tion to LoCa~ Reg~$tratr Vital Records Sertion for Copy of Dearth Record _' ':`: PLIrAS:~ ~OMP!"FTE FORM AND ENGL,OS~'FEE <, .. ... ..,.. FEE: $10.00 per copy ar No Record Certification. Please do not send cash or stamps. Phl~AS~'PFtINT QR T1(P~>; Name of Deceased .Date of Death or Period to be Covered by Search bl-~ ~~ ~L1 Vl First Middle Last ~ - , ~O ~ t `~ Name of Father of Deceased Social Security Number of Deceased Tc~ h ~..~ lee r' ~ First 1 Middle Last 0`"13 _ ~ - coo ~- ~ Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death A~v,~ 4c 1 t t~e r- t t- t 3 -- z~ g ~- First Middle La Month Da Year Place of Death 1~--row ~Cr~av-e_ Roa~ ~~ t~ . \ ~~1~"~ Name of Hos ital or Street Address Villa e, own it ~ Count Purpose for Which Record is Required • C~-tc~ ~ Lt~ ~~tr-=~ What was your relationship to the deceased? ~ (nerz~~ 1~1r'~.c-~z1Z In what capacity are you acting? C~1 ~ ~~ ~ o ~ ~(,yt t t-U If attorney, na r ionship of your client to deceased Signature of Applicant Date ~ ~@' I`{ Address of Applicant ~ ~~~~ ~~ P-r^ge-~ (~1~1~, Ivy IZ~~ ~ l~ nni-~_ ~n ~ a rr, i~nnrn NEW YORK STATE DEPARTMENT OF HEALTH Application to Local Registrar Vital Records Section fior Copy ofi Death Record PLEASE CCOMPL,ETE FARM AND ENCLOSE FEE _ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT QR TYPE Name of Deceased Date of Death or Period to be Covered by Search (', H Fk R LES K- Pq rt'E Rsa nl First Middle Last ~ ~ ~ 8 - I ~ Name of Father of Deceased Social Security Number of Deceased First Middle Last ~ ~~ 6b ~ I~G~ Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death .~ EA nl 3 kCLTo nl 6 ~ 3 ~ ~ ~ ~ First Middle Last Month Day Year Place of Death ~ /tf MFJ/~kET ~~ , W f}Pt°i~GFRS FltGLS. .:D~~TGyESS Name of Hospital or Street Address Village, ~Fewrrrer£~ty County Purpose for Which Record is Required - To s~T 7TG s E LS T+g7"~ What was your relationship to the deceased? ~U nJ~TCA( .~~~ GTd 2 _ In what capacity are you acting? ~qM - If attorney, name and relationship of your client to deceased Signature of Applicant -_'~P~.y.,~ Q. ~~~ ~ __ Date_ .3- 3- /µ Address of Applicant G ~ ~ ~,~~„/ y~-- ~~ P~~IFPS i=AGLS ~ i 2590 COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 '1988 --~-- Number of copies requested with confidential cause of death _____ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADR4~ESS WHERE RECQRD SHOULD B>` SENT. Name Address City ___ _ State Zip Code __ DOH-294A (6/2000) Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section ;: FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased /1 ~~ ~ Date of Death or Period to be Covered by Search Middle Last irsf Name of Father of Deceased Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased ~~~~~ r~ ~ Date of Birth of Deceased Age at Death ~ ~. ~,~ First Middle Last Month Da Year Place of Death ~~ /' Name of Hos ital or Street Address Villa e, Town or C' Coun Purpose for Which Record is Required ` What was your relationship to the deceased? ~ ~ In what capacity are you acting? If attorney, name and relationship of your client to deceas ed ~ ~ ~~ -s ' ~,/ J /~~ ' j`" ~~ Signature of Applicant = ~ Date Address of Applicant =-~ " .z~ ~ ~ ~ ~' ~s' ~~ ~~~ Number of copies requested with confidential cause of death _~ Number of copies requested without confidential cause of death Name Addre~s!uzznx IaEuo[y~ !xoa!u.-sza ,C~utst City aisag •g uas!Il!M laizlnrJ •d~g `''~~r DOH-2~I 2I~~1~iIdd~Ac~ ~O I~IAc~O,L ~I-~al~ an~o.L a4~ 3o aa~30 zip COde laai!Q - ILLS-L6Z ~Sb8) - Ib-L6 Sb8 Sf l'~IdrJl`IIdddM30NMO.L'MM 06SZ[ .CN `S'I'id'3 S2I3~JMddb'M Qb'02I HSflg3'IQCIIY~I OZ ruoioed •d gdasop xx~~t~ unno.r. NEW YORK STATE DEPARTMENT OF HEALTH ~ /:1.1 ~.........Iw Qi.n~i'.n Application to Local Registrar for Copy of Death Record ` ~y~!{~ ,w,,~~~t~i ::: ;. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ,. ,.. <:: :: Nam f Deceased ~ ~ Date of Death or Period to be Covered by Search G- (~l- ~r' ~ Cp First ~ Middle Last Name of Father of Deceased Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death First Middle Last Morrth Da Year Place of Death Name of Hos ital or Street Address Villa e, Town or Ci Coun Purpose for Which Record is Required What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Date Address of Applicant Number of copies requested with cor>fidential cause of death Number of copies requested without confidential cause of death Name _ Address City _ State DOH-294A (6/2000) ~~~ ~ Z.ip Code ~~ '/ZCT' ~~ ~P NEW YORK STATE DEPARTMENT OF HEALTH VITAL RECORDS SECTION ~jGX~JZ~a> / A lication to Local Re 'strar PP ~ for Copy of Death Record Fee: County District - X30.00 /Other Districts - S'10.00 per certified copy or No Record Certification Identification Requirements: Application must be submitted with copies of either A or B. (Note: Copy of Passport required if request is made from a foreign country that requires a U.S. Passport for travel.) A. One (1) of the following forms of valid photo-ID: -OR- B. Two (2) of the following showing the applicant's name • Driver license and address: • Non-driver photo-ID card • Utility or telephone bills • Passport • Letter from a government agency dated within the • U.S. Military photo-ID last six (6) months Name of Deceased: Social Security No. of Deceased: Bernard McCann First Middte Last Date of Death or Period to be Covered by Search: (mm/dd/yyyy) Date of Birth of Deceased: Age at Death: 03/07/2014 04/05/1926 87 From To mm / dd / Maiden Name of Mother of Deceased: Death Certificate No.: (If known) Bridgit Duffy First Middle Maiden Last Name of Father of Deceased: Local Registration No.: (If known) John McCann First Middle Last Place of Death: 13 Fleetwood Drive Wappingers Fails Dutchess Name of Hospital or Street Address Village, town or city County Number of Copies Requested: (For deaths occurring as of January 1, 1988 specify with or without con~dentiaf cause of death.) Copies requested with Copies requested without Total number of confidential cause of death 10 confidential cause of death copies requested 10 Purpose for which Record is Required: What is your relationship to person whose record is required? Funeral Director In what capacity are you acting? If attorney, give name and relationship of your client to person whose record is required: Funeral Director If you are not the parent or child of the deceased or the spouse of the deceased at t e time of death, you must submit documentation of a lawful right or claim. Date signed: Signature of App' ant' Mo~+n Da vea~ FOR REGISTRAR'S USE ONLY (Photocopy ID and attach to application form) 03 10 2014 Type of ID: Driver License Address of Applicant: Issuing state: Anthony J. Calabrese Expiration date: (Applicant's Name) Number: 1028 Main Street [] Other ID, Specify (Street) Number: Fishlcill NY 12524 Type: (City) (State) (Zip) Number: Telephone No.: ( }(845) 896-6166 Type: DOH-294A (06/2005) ~~ I { ~ ~~~~ Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH far Ca of Death Record Vital Records Sertion ,. ,: „.. ",.:. Pl.t»AS~ CQMPL,ETE F©FiM AND EN~L~QSfr`FEE .. >> FEE: $1 t).00 per copy or No Record Certification. Please do not send cash or stamps. ,. f~~.l"ASSw PRINT OR TYPE Name of Deceased N~a a r~fi ~ I hav-~ .Date of Death or Period to be Covere d by Search Fir t Middle Last 3 - ~ - I `-i Name of Father of Deceased Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death ~/\l ~ n t~r~c~ ~~oe 3 - ~ Z - y C~ ~3 First Middle Last Month Da Year Place of Death l3 1~1i?~,,j ~ck~~n~~c ~~~ Wa er' ~ _p~t~,~-~ ty Name of Hos ital or Street Address Village, own Count Pw~pose for Which Record is Required ' c~~ d-~ L- ~ t'~ What was your relationship to the deceased? ~I ~ In what capacity are you acting? If attorney, name and rel ~onship of your client to deceased ~~~~~~`~ Signature of Applicant Date Address of Applicant ~ ~ ~S ~ N~ C ~~ ~ CQMPL~TE FOR QEATHS Q~CUF~RIrJO 4S OF JA RY 1 1'~~8r Number of copies requested with confidential cause of death Number. of copies requested without confidential cause of death Name __ Address City _._ nnr-r_~q:ae rar~nnn- State Zip Code Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy o~ Death Record Vital Records Section PLEASE GOMRLETE FORM AhID t~NCtrOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEAS~:PRINT QR TYPE Name f ec sed / l i~ ~G~ 7T ~GZ ~ ~m ~ rs Mrddle Las'f Date of Death or Period to be Covered by Search 1 ~J~j Name of~F~a~iher of Deceased ~'~~ Fiat' ~ ~ ~) ~ Middle ~~' `L''~st" - Social Security Numb`e~r of Deceased ~ ~~ c./ ~ 7 ~' Maid n Name of Mother of Deceas ~, ~rr~ . i~ ~ ~~ Date f Birth of Deceased ~a~ /g ~ Age at Death ~ Middle La First ~ar Month Da Plac~ f~D~eatl~ ,, ~~~~~~2~ ~,~, ~ 99 fVl{J,~I,JI 7L711.[C_ %t(~C/ /~Q f ' ~ ` ~' J /~~G~~ Ir(J /~ Name of Hospital or Street Address Villa e, T nor r County Purpose for Which Record is Required What was your relationship to the deceased? /r In what capacity are you acting? If attorney, name and relationship o .,your clien to eceased /` Signature of Applicant Y Address of Applicant !/Y , Date COMPI,ET~ FQR:Q~ATHS OGCUFiR[NG AS OF J~INUARY 1 '(.988 Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death PLEA$E PRINT NgME ANQ gDDRESS;WFiERE R~C:..;QRp 5H!QtJ~t] BE SENT ' Narne Address City State Zip Code DOH-294A (6/2000) ~~~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section ___ Application to Local Registrar for Copv of Death Record ,. t y •:. ~ , t Lt Y ... .: : .. + ~ ~ n.. ~ .. ...:::.v ...... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. :.. ... <:. . . •, _ -- Name of Deceased Date of Death or Period to be Covered by Search Edith L. Travis February 24, 2014 First Middle 1st Name of Father of Deceased Social Security Number of Deceased Russell Bennett 094-38-9338 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Rose December 10, 1911 102 First Middle Last Month Da Year Place of Death 86 Robinson Lane Wa in er pp 9 Dutchess Name of Hos ital or Street Address Villa e, Town or Ci Coun Purpose for Which Record is Required What was your relationship to the deceased? In what capacity are you acting? McHoul Funeral Home, Inc. _.__ If attorney, name and relationship of your client to deceased March 14, 2014 Signature of Applicant Date -- 89 Route 82 Hopewell Jct NY Address of Applicant ? Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name _ Address City DOH-294A (8/2000) State ~~? `h~~~ Zip Code Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH far Co of Death Record Vital Records Section PI„EASE CQMF+!^ITE FARM AND ENGL~OS~'FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. _, ;. :.: :F~.~ASis PFi1NT QR TYPG, ;: N me of Deceased ~(~tv~~ ~{ar I~~~- aok .Date of Death or Period to be Covered by Search ~ 1- - S --I I I ~ First Middle Last Name of Father of Deceased ~~~~~ __``''`` ~ ~ a G Social Security Number ofgDeceased ~ ~ ~ ~ b r Z I - 03Co Z- s M dle as L en Name of Mother of Deceased Maid Date of Birth of Deceased Age at Dealh ~ First Middle Last Month Da Year Place of Death Name of Hos ital or Street Address it a e, own or City Count Purpose for Which Record is Required ~ ~-~ L ~~= ~4~t ~~ What was your relationship to the deceased? ~'LLV1'~f'~i D t+f~GtZIZ In what capacity are you acting? cYl (~_(i'lA t~ Q ~ ~VYI l ~ ~ If attorney, name and tionship of your client to deceased Signature of Applicant Date ~ ~~ ~ (~ ~ ~ I Address of Applicant ~ 3 ~ I ~ ~ COMPLETE fQR DEATHS Q~CURRING AS OF :JA~1EaARY.1 til188 ' umber of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name __ Address City `_ nnN_na,a ~aionnrn State ~~'~~ ~ Zip Code Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of Dea or Per d to be Covered by Search ~~ L~ Cam' First Middle Last Z 2Z ~U _ ( - Name of Father Deceased Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death First Middle Place of Death Name of Hos ital or Street Address Purpose for Which Record is Required Last I Month Town or Year What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant _ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) Date ` Ap{~Iication to Local ,Registrar NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section for COhY Of ~eatrl Record ............:........:....:........::.:............................. FEE: $10.00 per copy or No Record Cert'rfication. Please do not send cash or stamps. >~ ~ ~i..fw : :~ : `:?C~1~``: - Name of Deceased . Date of Death or Period to be Covered by Search ~ ~~~ i~- h L 1 ~a v~ S ~ ~ ~ c . . First Middle Last . ~. y j ~ Name of Father of Deceased ceased Social Security Number of De ~ ~ ~ _ r ~a ~ 3 3 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death /~ /L~ / ~/ / / ~ First Middle Last Month Da Year Place of Deat U ~ ,1w~1/IS~~'~ ~rc~! ~ ~ G-~J-7 ~ Vv~/~ Vl~L FJvt`~C'/~.SyS Name of Hos ital or Street Address Vlla e, Town or Ci Coun Purpose for Which Record is Required. w ~'.c ~ What was your relationship to the deceased? In what. capacity are you acting? ~`~~ P If attorney, name and relationship of your client to d eceased ~ Si nature of A licant •~= 9 RP Date -~~ Address of Applicant ~ ~ /~ ~~ ~~ i ~~ / 2 -~ `~ Number of copies requested with confidential-cause of death Number of copies requested without confidential cause of death Name ?,tN ~~ c~~ -~ U~l C~E' Address ~ ~ /~ ~ ~h~~~ City. ~ ~ State ~ C~ Zip Code / ~~y ~ +71~ DOH-294A (6/2000) Application to Local Registrar NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Death Record Vital Records Section :. , >: FEE: $10.00 per copy or No Record Cert'rfication. Please do not send cash or stamps. .: . Name f D ed ~ Date of Death or P rind to be Covered by Search First Middle Last Name of Father of Deceased Social Security Number of Deceased First Middle Last Maid nA N~me of other of Deceased v ~~~ addle t First Date of Birth of ~j Month ceased / ~ ~ ear Age at De th Place of Dea ~~~'~ Name oY H s i a or tre dress i s , T n Coun r Ci Purpose for ich Record is Required What was your relationship to the deceased? In what capacity are you acting? pUt-' ~~ U~-F~«'e Cc~~1~ ~~'`J~' ~ ~~~Tj~ ,,-/L~~~~~,7~0 deceased If attorney, name and relationship of your clientto ~ Signature of Applicant ~~'' / ~ Address of Applicant ~~~ l ,~ r'I >©Oz~ l U Date ~ ~ ~ ~ /J ~ ~~Sia 2D V,~,(;,OA,~u~~.C F~'~-L S ~~~ >~1~`~~ ~-1- Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Application to Local Registrar for Copy of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Na of ece ed Date of Death or Period to be Covered by earc ~ t ~ Middle Lit Na of F they of Deceased Social Security Number of Deceased Maid n„ ame of Mother of Deceased Date of Birth~of Deceased Age at Death Middle Last Month Da Ye Placce of Death ~ ~ / ~ /~ Nafn~ Hos ital'ar treet A ress [,V~ill/a own i ~[/ Coun Purpose for Which Record is Required What was your relationship to the deceased? ~ ~~ 7 ~ G~ t-1 Ct~ ~-pr).DiJG-f)~G /-~ ~F/-~Tl~ Inll/4,~~1G A7"l~'~J- Inwhat capacity are you acting. 7L ~` If attorney, name and relationship of your client to deceased T" i., Date / ~ ~ " ~ - Signature of Applicant Address of Applicant /'/yY~~ ~~ ~"'1'~~L'r6'JSh~ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death Name _ Address City State Zip Code DOH-294A (6/2000) Appl~~ation to Local ,Registrar NEW YORK STATE DEPARTMENT OF HEALTH fir Co pf Dei~th Re~QCCI Vital Records Section FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name~of Deceased ~~~~- Date of Death or Period to be Covered by Search ~~ t ~ Middle Last ~ g ` Fi l Name of Father of Deceased Social Security Number of Deceased First Middle Last Maiden Name of.Mother of .Deceased Date of Birth of Deceased Age at Death rz ~~ ~~ First Middle Last Month Da Year Plane of Death ~ ~ ~~ p J/(/ I l ~ ~ ~`~W ~6~~e/`-~`~~`~,- v2.v'(' I /c?c~D~ Coun Name of Hos ital or Street Address, .Villa e, Town or C Purpose for Which Record is Required What was your relationship to the deceased? ~ / ` In what. capacity are you acting? ~ ~ C~ ~"'' If attorney, name and relationship of your client to deceased Signature of Applicant P~""~ ate ~ / ~ ~ Address of Applicant ,.. ... ~.,}, .......... y. v::::~-~::w:.;..i: ii'fii\•: f::.n......vv. •;r ;. -.~., 'f~ •: }:•..: rfi. :.....:::...:. ` r. • . ~ vv Number of copies requested with confider#ial cause of death Number of copies requested without confidential cause of death ::.,:::. _ , ., '•`. •. ::. ::::.:: y ., .. . y> Name " ~ - Address Ci ~ State Zip Code ty DOH-294A (6/2000) y Application to Local ,Registrar NEW YORK STATE DEPARTMENT OF HEALTH fOr COpV ~# Depth R:eCOrC~ FEE: $10.00 per copy or No Record Cert'rfication. Please do not send cash or stamps. ..... ~. .. Name of Deceased ,/~ n Date of -Death or Period to be Covered by Search ~~o-~~•y M dle T~~~~t~k ~~~30~~~ First l Name of Father of Deceased Social Sacurity Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of-Birth of Deceased Age at Death a~ 3~ ~ Y First Middle Last Month Da Year ~''') 11 Place of Death ~/G-'7r~ c S f Name of Hos ital or Street Address Villa e, Town or Ci Coun Purpose for Which Record is Required QV ~ S P Two s~rg~-~~ ~r What was your relationship to the deceased? i In what capacity are you acting? L. 4 w Fn ~er~ ~ a.- 'f If attorney, name and relationship of your client to deceased ~-~' ~ /~o~ Sr ~~C/ Signature of Applicant r l ~~~ Date Address of Applicant • •.:::.::. •X•ii:.j;iiii, ~ :: ; :;:: •ii:'':Yi ii}}i+•:::.: :r.:..~ ..:. ~.. v. ~ •r;. :v' .Xv Number of copies requested wit#~ confidential cause of death Number of copies requested without confidential cause of death ., .:' . . :, .. :: .::. :. ::.;;~? Name Address City. State ~ Zip Code DOH-294A (6/2000)