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2005 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For COe)' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search Robert Manning Reuter May 20, 2005 First Middle Last Name of Father of Deceased Social Security Number of Deceased O. Robert Reuter 150-26-1436 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Cathrine "Kit" Manning 9 10 1934 70 First Middle Last Month Dav Year Place of Death 28 Sky Top Drive Wappingers Falls Dutchess Name of Hosoital or Street Address Villaae, Town or City Countv Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement ofthe deceased What was your relationship to the deceased? Mortician I In what capacity are you acting? Professional If attorney, name and relatiO#lient to deceased Signature of Applicant. ~ Date May 23, 2005 ~ Address of Applicant Fishkill, NY COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 ~ Number of copies requested with confidential cause of death l'l v _ Number of copies requested without confidential cause of death t' .1> ,S i PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Cindy Reuter Address City Maybrook State NY Zip Code DOH-294A (6/2000) December 28, 2005 Ms. Sandra Kosakowski PO Box 324 20 Middlebush Road Wappingers Falls, New York 12590 Hello- Enclosed: State Copy of death certificate for decedent, David Sung, District #1368, Dutchess Register # 36 County Department ~ of Health . William R. Steinhaus ~ County Executlve . Lucia Mitchell Michael C. Caldwell, MD,MPH Dutchess County Department of Health Commissioner 387 Main Street - 4th Floor 387 Main Street Poughkeepsie, New York 12601 Poughkeepsie Phone: 845-486-3412 New York 12601 Fax: 845-486-3561 (845) 486-3400 '1 1 . h 11@ d h Fax (845) 486-3447 E-maI: mIte e co. ute ess.ny.us NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PLEASE COMPLETE FORM. AND ENCLOSE' FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased '~'..J-.~ I8P~A1~ <-J First ~Midd~ I - ~ Name of Father of Deceased I ~J PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search Last 1-10 -~(p ~J Social Security Number of Deceased Irst Middle Last Maiden Name of Mother of Deceased ~ First Middle Last Place of Death flvds::on a r V'\. tleq. (io.. (e. Date of Birth of Deceased IIf Age at Death Month 11,5)', Year -'lei D"fO ~L Name of Hospital or Street Address Purpose for Which Record is Required Village, Town or City County \0 ho..\'-~ 40 What was your relationship to the deceased? In what capacity are you acting? Sid e l If attorney, name and relationship of your client to deceased _ Number of copies requested with confidential cause of death (j ,~ Lf\~ " \ Signature of Applicant Address of Applicant Date 1-/7-00 COMPLETE FOR DEATHS OCCURRING AS . OFJANl.JARY1 1988 _ Number of copies requested without confidential cause of death 'Ii >/ ~~ \I ''\ PLEASE...PRINTNAME ANO.,'ADDRESS.WHERERECORO.SHOULDBE...SENT... . Name Address City State Zip Code DOH-294A (6/2000) ----- -~-- T /(~ ,/ ~T !~TP 1 " 1_ FJ<. - 1-~ .,~ ~ I c~mt'~~~f:j V~~I~ l7'~""lr '\ ""'1 >.PCATln~ r A. rrr~ I, . _u...':J ..l,i.f.'1'_....~ ::'~.__ - ,-,.;,_.~ ~ ! , I , L DOB;09..()1-34-' DUHANEV,MVaTLE,V 457JMPLE ST,206B , , POUGHKJ;;EPS,IE"NYJ126~ , ......~ ,~~X: FEY':B1t'B!:~:,iCLA1S: ID . L~ . ISSU~D: ltI,2SH)s 'EXPIRES:09-Oj"13:.~ ,... . ,',. J ~~~. ~;;! _,_~"",_""_,,_~~,_,,~_,_,^,,.=.,'J . . ~ CARL P. BARONE ATTORNEY AT LAW 1003 MAIN STREET FISHKILL, NEW YORK 12524 FAX: (845) 897 -3796 (845) 897 -2210 December 30, 2005 Town of Wappingers Attn: Town Clerk 20 Middlebush Road Wappingers Falls, NY 12590 Re: Request of Death Certificate for Edward E. Florence To Whom It May Concern: Enclosed please find a check in the amount of $20.00 for two (2) certified copies of the death certificate for Edward E. Florence. I represent the family with regard to the sale of Mr. Florence's home located at 16 North Street in Chelsea. The title company is requiring a certified copy of the death certificate. Mr. Florence died on December 30, 1978. If you require any further information, please do not hesitate to contact my office. Very truly yours, CnAlQ.b~~ CARL P. BARONE CPBacm enclosure \\ 6\0/,:/ } ,/ "" /,/ 1',/ (I'MIIl 0''''') Eaw.rd A. Diana County executive' 255-275 Main Street Goshen, NY 10824-1889 (&48) 291-4750 - FAX (845) 291-47Se VNIW,OI'Ingeoountygov.c:om Victoria C...y Prob'~Dn,Director II facsimile transmittal 1'0: DATI; 10/31/0~ Sandy, Town Clerk AIJDB'IIII Town of WlI)J)inam Falla ftOM1 L~ Williford PI Jeffrey Howard Riemer Date of death: 8/30/0' TOTAL.AGEI ~ 0DWa' ")I 1 I'AX~ 298-1478 . . . . . . . . . . . . . . Ik Dear Sandy: As we discussed earlier today by phone, we are requestina the death certificate of the above named. His DOB is 2/11170; Social Security is 077-56..2014 and addreal was 1~S8 Rt. 9D. HugbaoDville, NY 12537. 1baDka you for your cooperation In this matter. Approved. ~ iUiford Probation Officer (845) 291-4769 '~ 'Probation suPervisor TBIS MEMO IS INTENDED roll TBI INDIVIDtTAL OR INTlTY TO WJIlCB IT IS ADDUSSED. AND MAY CONTAIN INFORMATION TlL\T IS PllIVlLBGED, CONI'IDENTIAL. 01. U'll'll'KWISE EXEMPT nOM DlSCL()8UIlE t]NDD APPUCABLB LAW. II' YOU ARE NOT THE lNTBNDBD RECIPIENT Olll1lE BMPLOUB 01. AGENT USPONSIBLB FOR DEUVERlNG 'l'8B MESSAGE TO TBB INI'ENDED UCIPIENT, YOU ARE ~8Y Nu"1....ur.D THAT -'NY DISSEMINATION, DI8TJIB1JTlON, OR COPYING 01' TIDS coMMl1N1CA'I10N IS STJUCTLY PlloJUJdTlD. U' yOU HAVE UCE1VBD TBJS C0MM1JN1CA'l10N IN DllOIl, PLEASE NOTIFY VS IMMIDIATlLY BY TBLIPBONl AND RBTtJRN TBI OIUGINAL MESSAGE TO VS AT TBE ABOVE ADDUSS. ,'I'IIAS'YOU. lQ'd 9S: Sl SOO~ ~ ^DN 68Lv16~sv8:xe~ NOll~aO~d 0) 39N~~ I 2...;2 :2 -0'<; ,~u~ - NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coey of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE n 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 Covered by Search :" _:'. -', /,\.1 C I (\ fV' {. (1 fL, 'i L-CI pVU f' - L-/-- CJ ')" First Middle Last Name of Father of Deceased Social Security Number of Deceased r:- fl ~1f'I V(" P1 (c () ftH tfCl;c First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death \< (I. A,v f-(. 5> ~U7 4v '3 '2-/ Z' 7r First Middle Last Month Day Year Place of Death I \ t L;~ <;. S 91- Name of Hospital or Street Address Villaqe, Town or City VVAfJjJ//U(,fn County ) rJ TCII;:5( Purpose for Which Record is Required What was your relationship to the deceased? \JVSbqV1/ In what capacity are you acting? L fFe \.rr(/l If attorney, name and relationship of your client to deceased . 1\ ,- 1!,rv1 ( (' '51A let U tA/'-- , -"2-"2.-_.11 Signature of Applicant ~1 'h" Date Address of Applicant I I R "I;; 5 pJ vW ""11/71 lilt) ~I-S F.1 (IJ ;J";- I 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 ADDRESS'WHERERECORDSHOULD BE SENT Name Address City State Zip Code DOH-294A (6/2000) /' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section /2 -;;2.1- 05- rei ?II () .- Application to Local Registr;rll for COe.>' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE . FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. f' PLEASE PRINTOR TYPE Date of Death or Period to be Covered by Search Na~ of Dec~ased '/ () S ef' H / Il.R. First Middle Name of Father of Deceased voSepl1 First Middle Maiden Name of Mother of Deceased ~/jlleelll2-~ f)el1l1~e First Middle Last Place of Death /J 14 [) S r,' /I.) ;/ R j4!/tJ Name of Hospital or Street Address Purpose for Which Record is Required RiL ev Last r4l~ #1/11/0 Last Social Security Number of Deceased Month '3 If Day Z/ Year Age at Death pi! )/, V filf tel'/' 60unty Date of Birth of Deceased Lv4fpl)f.-''fces.' l,L4u5 Village, Ibwn or City CLtJ_\jA; 6- 0 tJ fleeelJSeiJ /10ftJe.. What was your relationship to the deceased? ...rO" A./ In what capacity are you acting? /J. 0, A .. If attorney, name and relation Signature of Applicant ;~-L a .eA Date/:<./~.d.lp S- Address of Applicant / 5 - ('Ii '" I(C' ~ :r I. I(/'4 ~jJ. ;:--,,; L--I-S'. )./ f. , / 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 PLEASEPRINTNAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City State Zip Code DOH-294A (6/2000) TOWN OF WAPPINGER TOWN CLERK CHRIS MASTERSON SUPERVISOR JOSEPH RUGGIERO TOWN COUNCIL VINtENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI ROBERT L. VALDATI TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 (B45) 297-5771 FAX: (B45) 29B-147B The Following Fax Message Consists of J Including Cover Sheet pages FAX TELEPHONE NUMBER (845) 298-1478 DATE .1(1~L--L ? / ~t7tJS' TO .... .. . dI~ - J~ cLh~'<L.J //lJIOIEtd I ~ I !) , FROM / ~ t:~ '!Ji~ REFERENCE Ja~ Cdj/~ - Kif#iI50trtE';) IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CONTACT SENDER IMMEDIATELY. Sender: d~~ - ilrf f;~LL ******************************************************************************************tttttttttt t t * TRANSACTION REPORT * * DEC-08-2005 THU 03:02 PM * * * * FOR: WAPP, TOWN-CLERK 8452981478 * * * * SEND (M) * * * * DATE START RECE I VER PAGES T I ME NOTE M# * * * * DEC-08 03: 01 PM 17329357509 3 l' 42" OK 98 * * * **************************************************************************************************** Dee 07 05 ,11: 3~a Gatewa~ Care Center 7329357509 p. 1 Accredited by Joint Commission 1UI Mc:edir,'lon 0' H"nhl,1'e O/JDnll'"DIIf FAX TRANSMITTAL SHEET TO: FROM: /clulkP DATE: # OF PAGES: FAX NUMBER 732-935-7509 The information contained in this message .is legally privileged and is intended only for the use of the individual(s) named above. If the reader of this message is not the intended recipient or an agent of the intended recipient with responsibility for delivering the mes..s;age to the addressee, you are hereby notified that any review, dissemination, distribution or cop of this message and its contents is strictly prohibited. Uyou have received this message in error, please notify us by telephone and delete or destroy the original message and any copies immediately. Thank you.. NOTES/COMMENTS I . .Its jYZ/ CVr- of/scuS-SjCYl, r,;ZcVl.cfim ;1ACvuor-; }1roe-.hS I't..ue. /s VN 1/ul-hdx;:#D/(JlhV .!ftJU I1-e.ecl h .5vfply fn-e tul-ft-J . Cf ccp..y c:f }1CU. ion.J /"lk~:S WqfrJ C/.Af. Ple~ '-,{;ux oIIreC#y 12 .~ 732---9 ~-1SCJ1 . /Ji-!n. /Je/er; - Sou.'cJ r ~1/'-1 ~ ' 139 GRANT AVENUE. ~~VV~tM~drt)l~itiiUm2W. rAX V;j~) Sl;jo-lbU~ ~~j! Dee 07 05 rl:35~ Gatewa~ Care Center 7329357509 p.2 I F" Motor:Vehic/e .', NEW JERSEY ~ Services ' - . ' , d'. ,( ~,'"' , . ,ll , r uf., I ~ .. OPERATOR Lie. K7522 51961 54194 CLASS D AUTO ENDR: RESTR: OOB EXPIRES 04-30-1111 02-28-2008 MARION A KROEHS 1 OAKDALE DR MIDDLETOWN NJ 07748-2148 SEX F EYES ILU HT 5-03 ISSUED 12-12-2001 RP2oo1341188SOoo1 REN 11.00 O"PIIIES 06-30-20'0'7 /" .-#" Dee 07 05 11:35.a Gatewa~ Care Center 7329357509 Prepared by: /:' ~/ ?:f4~ ff- Arthur H. Sorensen Attorney at Law 98 First Avenue Atlantic Highlands, NJ 07716 GENERAL DURABLE POWER OF AT~l'ORNEY KNOW ALL MEN BY THESE PRESENTS: That I, MARION T. KROEHS, of 1 Oakdale Drive, Apt. 3N, Middletown, New Jersey, referred to herein as PRINCIPAL, designate MICHELE PFAFF, of 75 Grant Avenue, Eatontown, New Jersey, (Phone: S~2-6(55),to be my attorney in fact and agent (hereinafter called ".AGENT"), in the event that the person named above for any reason sn~ll fail to act or continue as my attorney in fact, I constitute and appoint EDWARD PFAFF, of 75 Grant Avenue, Eatontown, New ~~rsey,(Phone: 542-6(55), to act as my attorney in fact., 1. General Grant of Power. To exercise or perform any act, power, duty, right or obligation whatsoever that I now have or may ~~~e~(~~racquire, relating to any person, matter, transaction or tif~pe:rty,# real or personal, tangible or in'tangible, now owned or "h~~~Cif~~~." acquired by me, including, wi'thout limitation, the : '.l::'" :.5l;,~P~Q~fically enumerated powers. I grant to my agent full ", '.~~p~.~~:Y;}J:o ". do everything necessary. in exercising any ,?f ,'./.el,:!li:granted as fully as I ml.ght or could do lf "', :~;;!~~'+~ power of substitution or revocation, . ,,' .....~,J;r1UJ..ng all that my .agent shall lawfully do ,.~;.'.../:"~ ,.:,;by virtue of this pow1ar of attorney and the ,'~;:~1Pt.qranted : ,.; . Powers of Collection and payment. To forgive, request, d~and, due for, recover, collect, receive, hold all such sums of money! debts,' dues, 'commercial paper, chel=ks, drafts, accounts, depo~l.ts, legacies, bequests, devises, nCltes, interests, stock cert~ficates, bonds, dividends, certificates of deposit, annuities, penS1ons, profit sharing, retirement, social security, insurance andc::>ther contractuaf benefits and proceeds;, all intangible and, tangl.ble property r1:ghts, and demands whatsoever, liquidated or ",.' unliquida~ed, now or h7reaf~er owned by me or due, owing, p~ya.:~~;~>~)':.' or belong1nq to me or 1n Wh1Ch I have or may hereafter 'acqu1-~~\!B':2.> interest; to have, use and take all lawful 11.\eans and equitab_l~;~~~/ ' .., .~s~.:~r~.?j:: /' p.3 Dee 07 05 1- 1 : 35,a Gatewa~ Care Center 7329357509 ~r legal remedies and proceedings in my name fClr the collection and recovery thereof, and to adjust, sell, compI~omise, and agree for the same, and to execute and deliver for me, on my behalf, and in my name, all endorsements, releases, receipts, or other sufficient discharges for the same; b. Power to ACqJlire and Sell. Tel acquire, purchase, exchange, grant options to sellon such terns as my agent deems proper; to convey real or personal prc,perty, tangible or intangible, or interests therein, on such terms and conditions as my agent shall deem proper; c. Management Powers. To maintain, repair, improve, invest, manage, insure, rent, lease, encumber, and in any manner deal with any real or personal property, tangible Ole intangible, or any interest therein, that I now own or may her,eafter acquire, in my name and for my benefit, upon such terms and conditions as my agent shall deem proper; d. Banking Powers. To conduct bankin9 transactions as set forth in Sec. 2 of P.L. 1991, c95 (N.J.S.A. 46:2B:11); e. Power to Borrow and Give Security. 'ro borrow from time to time such sums of money upon such termsasl my agent shall deem appropriate for, or in relation to, any of the purposes or objects described herein, upon the security of anyctf my property whether real or personal, or otherwise, and for stich purposes to give, execute, deliver and acknowledge mortgages with such powers and provisions as my agent may think proper, and also such notes or bonds as may be necessary or proper in connE!ction therewith; f. Motor Vehicles. To apply for a Certificate of Title upon, and endorse and transfer title thereto, for elny automobile, truck, pickup, van, motorcycle or other motor vehicle, and to represent in such transfer assignment that the title to said motor vehicle is free and clear of all liens and encum:brances except those specifically set forth in such transfer assignment; g. Bus iness Inter~sts. To conduct or participate in any lawful business of whatever nature for me and in my name; execute partnership agreements and amendments t:hereto ; incorporate, reorganize, merge, consolidate, recapitalize, sell, liquidate or dissolve any business; elect or employ officers, directors and agents; carry out the provisions of any agreement for the sale of any business interest or stock therein; and t3xercise voting rights with respect to stock, either in person or lby proxy, and exercise stock options; h. Gifts and Tax Powers.. To make gifts to individuals (including my attorney-in-fact) and charities;, to prepare, ~ign and file j oint or separate income tax returns or, declarat.1.ons . of estimated tax for any year or years; to prepclre, S1.gn and f1.le g1ft tax returns with respect to gifts made by me for any year or years; to consent to any gift and to utilize any gift-splitting provision p.4 Dec 07 05 1'1: 36a Gatewa~ Care Center 7329357509 p.5 or other tax election, and to pay gift taxes, but only if in furtherance of my estate plan or of my desire to minimize death taxes; and to prepare, sign and file any claims for refund of any tax; i. Safe Deposit Boxes. To have access at any time or times to any safe deposit box rented by me, wheresoever located, and to remove all or any part of the contents thereof, and to surrender or relinquish said safe deposit box, and any ins1:itution in which any such safe deposit box may be located shall not incur any liability to me or my estate as a result of permitting my agent to exercise this power; and j. Transfers to Revocable Trusts. To transfer any or all assets of mine to any revocable trust which I may have created during my lifetime. k. Medical Treatment. To act as my health care representative. My Health Care Representative may make binding decisions concerning my medical treatment, including the power: to place me in a nursing home and/or other extended care facility: to give consent to or approval for the perfOrI11anCe of any type of medical procedure or examination, including but not limited to medication of any type, surgical procedures, Dledical examinations, or physical or psychological therapy; to grant: releases to medical personnel; to employ and discharge medical personnel; to have access to and to disclose medical records and other personal information of mine; to expend or withhold ft.+nds necessary to carry out my medical treatment; and to terminate life sustaining treatment. 2. Interpretation and Governinq Law. ~~his instrument is to be construed and interpreted as a general durable power of attorney. The enumeration of specific pClwers herein is not intended to, nor does it, limit or restrict the general powers herein granted to my agent. This instrum,ent is executed and delivered in the state of New Jersey, and the laws of the state of New Jersey shall govern all questions as to the validity of this power and the construction of its provisions. 3. Third-Party Reliance. Third partiE~s may rely upon the representations of my agent as to all matters :relating to any power granted to my agent, and no person who may act in reliance upon the representations of my agent shall incur any liability to me or my estate as a result of permitting my agent to exercise any power. Any third party may rely on a duly executed counterpart of this instrument, or a copy certified by my agent to be a true copy of the original hereof, as fully and completely a::; if such third party had received the original of this instrument. 4. Disability of Principal. The prclvisions of N.J.S.A. 46: 2b-8 authorize me to provide that this po~'er of attorney shall not be affected by my disability as principal, and I do hereby so provide, it being my intention that all powers conferred upon my Dee 07 05 1):36~ Gatewa~ Care Center 7329357509 p.6 attorney in fact herein or any substitute dl:!signated by me shall remain at all times in full force and effect, notwithstanding my incapacity or disability, or any uncertainty with regard thereto. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ d day of September, 1998. ~ 7-f/J - ' 11,.-- echIA'-f._V MARION T~., L.S. STATE OF NEW JERSEY) ) SS. COUNTY OF MONMOUTH ) ~/ 5~tm b.or- Al- BE IT REMEMBERED, that on this rz?- - day of ~ 1998, cP before me, the subscriber, a Notary Public of the State of New /~ Jersey, personally appeared MARION T. KROEHS, who I am satisfied, ') is the person named in and who executed the foregoing Instrument, / and thereupon she acknowledged that she signed, sealed and delivered the same as her voluntary act and deed, for the uses and purposes therein expressed. _~ nL- L. ....' .4-L /~~ NOTARY PUBLIC OF NEW JERSEY .,t't'rHU:t H. ~C~~]SrN ~(;21~' ?.!'clln C"l Ne?\i~ ~:t.~::!~'J Ml' C.;:,,:(., ~L~i;1afl U. i;;lL Dee 07 05 11 :.37a Gatewa~ Care Center 7329357509 p.7 MONMOUTH COUNTY DIVISION OF SOCIAL SERVICES P,O, Box 3000 Freehold, NJ 07728 TEL: (732) 431-6000 TOO: (732) 294-5462 Worker: Pratt, M Pt,one Number: (732) 431-7996 Fax Number: MARION KROEHS, GATEWAY CARE CTR 139 GRANT AVE, EA TONTOWN. NJ 07724 #Error Thursday. December 01. 200 Case #: App. Date: 12/1/2005 Dear MARION KROEHS, In order for us to make a determination regarding your Adult Mew';:;aid Only case, please provide the following information: . Marriage/Divorce/Separation Papers! Support Agl'e,ement/Restraining Order SPOUSE'S DEATH CERTIFICATE . Benefit Check J ~art'l SSI, Social Security, VA, Pension, Military Allotment, General Assistance \h\('-1- ory! ....,.... ~FROM SOCIAL SECURITY OFFICE SHOWING GROSS BENEFITS 0. V' ~ { REC'D AND ACTUAL BIRTH DATE . Savings/Checking Account Balance Histury balance on date of application 12/2002 AND 1212005 CHECKING ACcr STATEMENTS . Other Verification P A-4 & NEUROLOGICAL FORMS COMPLETED BY DOCTOR AND RETURNED . Other VeriUcation PLEASE PROVIDE ANY ADDITIONAL INFORMATION AS REQUESTED BY PROCESSING WORKER IN ADULT MEDICAL UNIT 420. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record P.LEASE COMPLETE FORM AND ENCLOSE FEE' FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased !,hrJ ( ,_,U 'First Middle Name of Father of Deceased F R f1=fr\~ PLEASEPRINTOR<TYPE Date of Death or Period to be Covered by Search tvfohvt Last J 0- ;21- q 0 Social Security Number of Deceased Middle MohV' Last I i 'd- - ;;2 4 - H 1?JCd - 1/ Maiden Name of Mother of Deceased 0eLrJ Fi~t Middle Place of Death IJ .:2. --;.. G- ALp I',.} -e .v r Name of Hospital or Street Address Purpose for Which Record is Required Date of Birth of Deceased Age at Death 8tt~ L-e JA Month Day Year Wft-ffINCf-er F~ Village. Town or City 'tJj County Signature of Applicant ~ /10 p A") ~ 1n ofl;J Address of Applicant , I i i \ / \. / \ , \ \ What was your relationship to the deceased? In what capacity are you acting? If attorney. name and relationship of your client to deceased ~e COMPLETE FOR DEATHS OCCURRING AS OF. JANUARY,', _ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE..,PRIN,....NAME _AND..'AODRESS,WHERJ;:.RECORO>SHOULD .BE.,.SENT. , Name Address City State Zip Code DOH-294A (6/2000) Dutchess County Department of Mental Hygiene William R. Steinhaus County Executive Kenneth M. Glatt, Ph.D. Commissioner Chemical Dependency Services 82 Washington Street Poughkeepsie New York 12601 (845)486-3790 Fax (845)486-3799 October 13,2005 Mr. Chris Masterson Town of Wappinger Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590 Re: Diane Donovan Date of Birth: 2/21/1958 Date of Death: 10/6/2005 Social Security #: 110-52-8846 Dear Mr. Masterson: Section 45.19 of the Mental Hygiene Law requests the reporting of all deaths of patients in mental hygiene institutions and facilities with operating certificates from the Office of Mental Health, such as this department. In order to the complete the investigation and reporting of the death ofpiane Donovan, residing at Chelsea Ridge Apartments, Wappingers Falls, NY, and a registered patient of this department, would you send a copy of the verified transcript and the long form death certificate, stating the cause of death of the deceased immediately. Thank you for your cooperation. RECEIVED OCT 2 4 2005 TOWN CLERK J!!~ John Sarris, MD Medical Director JS/kf I ~ /I '0j' Dutchess County Department of Mental Hygiene William R. Steinhaus County Executive Kenneth M. Glatt, Ph.D. Conunissioner Chemical Dependency Services 82 Washington Street Poughkeepsie New York 12601 (845)486-3790 Fax (845)486-3799 October 13,2005 Mr. Chris Masterson Town of Wappinger Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590 Re: Diane Donovan Date of Birth: 2/21/1958 "'. Date of Death: 1 0/6/2005 Social Security #: 110-52-8846 Dear Mr. Masterson: Section 45.19 of the Mental Hygiene Law requests the reporting of all deaths of patients in mental hygiene institutions and facilities with operating certificates from the Office of Mental Health, such as this department. In order to the complete the investigation and reporting of the death of_Diane Donovan, residing at Chelsea Ridge Apartments, Wappingers Falls, NY, and a registered patient of this department, would you send a copy of the verified transcript and the long form death certificate, stating the cause of death of the deceased immediately. Thank you for your cooperation. RECEIVED OCT 2 ~ 2005 TOWN CLERK 10/6/2005 1!~ John Sarris, MD Medical Director DIANE DONOVAN - Date of Death: We have no record of her death in our records. JS/kf If she was transported to one of the local hospitals and declared dead at a hospital, they would have ~he record. For Vassar Hospital, check with City of Poughkeepsie Registrar, Dept. of Vital Statistics PO Box 300, Poughkeepsie, NY 12602. For St. Francis Hospital, check with Town of ~ Town Clerk, 1 Overocker Road, Poughkeepsie, NY 12603 .}lt~ It/;./~ 5 hU.]?: \ \ 'i<vww.dutchessny.gov Adams- Cordovano Funeral Home 15 Church Street Carmel, New York 10512 (845) 225-2144 phone (845) 225-2708 fax October 24, 2005 20 Middlebush Road Wappinger Falls, New York 12590 Dear Sandra: Enclosed you will find a check for 2 certified copies of death certificate (with cause of death) for Thomas Montana. He passed away August 29,2005. Please send in the envelope enclosed. If we can be any further assistance to you at any time please do not hesitate to call us. -- ~ / \O~ \\\~\ l1 , j 1(;)/. f.Q{1 .:y' V 4, 't-~ . ~ ~ Robin Harris Office Manager October 12,2005 Wappingers Falls Town Hall 20 Middle Bush Rd. Wappingers Falls, NY 12590 Attention: Sandra Dear Sandra: Could you please send me 15 death certificates with raised seal for Mr. Martin J. Ostuni. His date of death was May 5, 2005. Per instructions from your office, I am enclosing a check in the amount of$150.00 ($10.00 per certificate). Please send the certificates to Mr. Kenneth J. Cotty, Executor of the Estate of Martin J. Ostuni 124 Dartmouth St. Rockville Centre, NY 11570 (S/t) (, 78'-31/4 - ~ Very truly yours, ~ Kenneth J. Cotty Executor 1 <: .10 / dJ/'i~M_____.. (!a, , ~.r.__ f &df'J_.' .__~",,-,-,,"~'_'" _ .~,,,,... ......__._,..._.--.c_'''''..~''"''''''''''~.,'--'c.._,~'''"''_.~~~.__~ . 7( .- -!~---=:-~ - -~_._..,-,_.~,",,_._..._---_.__.__...._..... ....._.", ..,___.,....,.__............_~""~A.~_~....~..'.,""""'-=..........,......,,_~_,~,__ .._.;~>'._"~.,""....,_'~n._"_._, ~~~reiLjJ.l..~~__.'._....... .... .~~r-U!L- --- - ~ ~ . ._,________.___..__._.m..___.~__~__........._.____. ~.~ &~~--~~=_._=-=-=~~==~-~~==~=_..=~~ - of ,<11 \ /"- ~1XTH: I hereby nominate, constitute, and appoint ~ENNETH COTTY to be Trustee and Executor of this, my Last Will and Testament, to serve without bond; that in the event of his inability to act for whatever reason, then, I nominate NEIL COTTY to be the Executor/Trustee, also to serve without bond. , IN WITNESS WHEREOF, I have hereunto set my hand and seal this / J day of December, 1988. /~~;) ~ MARTIN J. OSTUNI The foregoing instrument was subscribed, sealed, published and declared by MARTIN J. OSTUNI, the Testator above named, as and for his Last Will and Testament, in our presence . and in the presence of each of us, and we, at the same time, at his request, and in his presence, and in the presence of each other, hereunto subscribed our names and residences as attesting wi tnes ses, this /5" day of December, 1988. a. .~~ residing at 1!,Ro!,~ j?" %I-IJ '":({-'l<f -llifb-OrtM1 Uj't~ 1';J? /2 \" (~ f /~, ~ ~1. ~~J.! {r1-uAJ~/~p residing at ~ tf~ /Lei Cer::/S:;::: 1:.,b j;ft/;~(C?( 7l L/ ! z--s~~ V . II V r-: (0 MEMORANDUM TO: Fa--' I (lh r i S (Y) C'lSt-e,vS ()h Town Clerk or City Registrar I lAJ~pi n 3 e V S I Office of the DC Medical Examiner, Ann Smith 111a-3105 Decedent: So..sCiYl (Y)iC-lueJ Pa;esflO.- DOD: ID/;)-7/05 FROM: DATE: REGARDING: Attached is the NYS DOH Vital Records Section MedicallBurial Death Correction Report completed and signed by Kari Reiber, MD, Chief Medical Examiner of Dutchess County for the above named decedent. Please forward a copy of the final Death Certificate to our office after you have amended the original at the following address: RECEIVED Dutchess County Medical Examiner 387 Main Street Poughkeepsie, NY 12601 NOV 2 8 TOWN CLERK Thank you in advance for your assistance. V 1/' I / 10" . ~/"Y \1\jV \).Y',npss / / \I\~} . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N.Y. 12237-0023 Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Philip A. Marandola First Middle Name of Father of Deceased Last November 10, 2005 Social Security Number of Deceased Anthony Marandola First Middle Last Maiden Name of Mother of Deceased 058-62-8616 Date of Birth of Deceased Age at Death Joyce Hults Middle Last August 8, 1962 43 86 Smithtown Road Name of Hos ital or Street Address Purpose for Which Record is Required Fishkill Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant r:fC (/j .A-' (tV)/) Lt::l{,/ / Address of Applicant 895 Route 82 , P.O. Box A Hopewell Date II - 1<1 -oS- o Junction, NY 12533 Name McHoul Funeral Home Inc. Add~ss 895 Route 82, P.O. Box A City Hopewell Junction State New York Zip Code 12533 DOH-294-A (7/92) VS-34D November 9,2005 Town ofWappingers Falls 20 Middlebush Rd. Wappingers Falls, N.Y. 12590 Dear Sandy Enclosed please find a copy of a letter I recently received requiring me to provide the New York State Retirement System with a copy of Edward Bulloss's death certificate. I am also enclosing a copy of my driver's license and a check for $10..00 payable to the Town ofWappingers Falls. Please send it to Linda Bulloss, 122 Collins Ave. Williston Park, N.Y. '11596. Thank~you for your assistance. Sincerely, I~~ Linda Bulloss j \1\ I~'QS '6Ql>t \ II' * 0 dO'; o()/ f\~ A. D' 9f\ Linda E Bulloss 122 Collins Ave Willistonpk NY 11596-1612 ~ovemDer J, ~VVJ In reply refer to Reg No: 14023832 Ret No: 085866510 SSN: 094302287 Unit C: Pensioner Services Dear Ms. Bulloss: We are sorry to learn of the death of Edward G Bulloss. You are a beneficiary of Edward G Bulloss, a deceased pensioner of this Retirement System. It is necessary that we are provided with a certified copy of the pensioner I s death certificate. This document is required before we can determine the amount payable. Please disregard this request if you have recently submitted the certificate. A photocopy or facsimile (FAX) of the death certificate is not acceptable. If a payment is received from the Retirement System after the pensioner's death, it is void and must be recovered by this System. Checks received at the pensioner I s home should be promptly returned to the address shown on the envelope. Please be aware that stop payments have been placed on all outstanding checks. If any checks are payable to the pensioner's estate because they are dated prior to the month in which the pensioner died, further instruction will be sent under separate cover. If funds were forwarded to the pensioner I s financial institution after death, the Retirement System will contact them directly for reimbursement. Please note, however, that the pensioner's account should not be closed or depleted if reclamation is required. If you have any questions, please feel free to call (518) 474-5424. Very truly yours, / /.7~. _ .-' l,l:........~.-Jc...(_~_. f.)>-?fJ;.i- r.1;I-- Linda Doherty Employees' Retirement System Examiner IV Pensioner Services Section LD/RT557 r\b'" ;bi; (~Prt fit" . NEW YORK STATE ~PARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coe..v of Death Record - ... PLEASECOMPLETEFORM.ANDENCLOSEFEE. FEE: $10,00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased C. Y/.J,.~(A tV1 First Middle Name of Father of Deceased el'--~p &. First Middle Maiden Name of Mother of Deceased C LA-W L CJ(,I\GU;.. yt(l- First Middle Last Place of Death 1/9 \2"f,w..J5,utJ LAM.;:;' PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search III e/ 07 C6vJ~ Last Social Security Number of Deceased rb~L-~ Last ~ Month l~~) II Day (p( Year Age at Death 4-3 Date of Birth of Deceased Name of Hospital or Street Address Purpose for Which Record is Required Village. Town or City County i TLA~~,--fl.,. I/ZA ~ ' ~l!J. 'so IV t;..->~rc::- What was your relationship to the deceased? ~~f5A,-J{) In what capacity are you acting? If attorney. name and relationship of your client to deceased ~-e J"l1 /f'&":71";.sW ~N~ Date II /1/ I)!;) (.;Jpry!I'IN(ttL ~ IwA/ /2,r?(./ Signature of Applicant Address of Applicant 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 : .... .....PLEASEPRINTNAMEANDADDRESSWHERERECOROSHOULDBESENT . Name Address City State Zip Code DOH-294A (6/2000) . RECEIVED OCT 1 1 2005 TOWN CLERK MEMORANDUM TO: ~ City Registrar I ~Ofpi f19{0:, t!h (is f'nasi-' vScYJ Office of the DC Medical Examiner, Ann Smith 10) (p IDS Decedent: 1h15n1~ !-ray (YJt5iJftJ.naDOD: "6'/(;)9/05 FROM: DATE: REGARDING: Attached is the NYS DOH Vital Records Section MedicallBurial Death Correction Report completed and signed by Kari Reiber, MD, Chief Medical Examiner of Dutchess County for the above named decedent. Please forward a copy of the final Death Certificate to our office after you have amended the original at the following address: Dutchess County Medical Examiner 387 Main Street Poughkeepsie, NY 12601 Thank you in advance for your assistance. / \"v.~~ \\)\ William R. Steinhaus County Executive Michael C. Caldwell, MD, MPH Commissioner Kari Reiber, MD Chief Medical Examiner TO: FROM: DATE: REGARDlNG: Dutchess County Department of Health ute MEMORANDUM Office of the Medical Examiner 387 Main Street Poughkeepsie New York ]260] (845) 486-34]4 Fax (845) 486-3579 Attached is the NYS DOH Vital Records Section MedicallBurial Death Correction Report completed and signed by Kari Reiber, MD, Chief Medical Examiner of Dutchess County for the above named decedent. Town Clerk or City Registrar Jane LaLone, Administrator, Office of the DC Medical Examiner ~ Decedent:~ ~ DOD: '-/ /~ ) /2.\90/ Please forward a copy of the final Death Certificate to our office after you have amended the original at the following address: Dutchess County Medical Examiner 387 Main Street Poughkeepsie, NY 12601 Thank you in advance for your assistance. RECE\VEO ,,~._'i'-"l: ,~ JUN 0 7" · TOWN CLERV NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N,Y. 12237-0023 Application to Local Registrar for Coey of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification, Please do not send cash or stamps. Name of Deceased Uarr-te-+- F TT f',rst Middle Name of Father of Deceased ............................ PLEASE PRtNTORTYPE Date of Death or Period to be Covered by Search .,- J 2-"!? z.o~S- ()56ke.-- Last Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased .LL..rn~ G fb0'\^-uJ~~ 2- 2-1 I 'Fj;:st Middle Last Month Da paCe;Dyh M (,*J.le.bu..~ ;J N Name of Hos ital or Street Address W~iJIt=: TOW~ ~ Cit ~ Purpose for Which Record is Required re('C'M~ What was your relationship to the deceased? c\~~ In what capacity are you acting? ~ If attorney, name and relationship of your client to deceas . -- Age at Death ~!ar '1Lf ( .2 S-C:CcS" y'-<- Signature of Applicant Address of Applicant PlEASEPRINTNAMEAND ADDRESS WHERE RECORD SHOULD BESENT< . - -------- Name -------_ Address City ---------- ----Sfan~ ") Zip Code JOH-294A (7/92) ....\p ~ lb' (~-) Ii \ I I\) 't> l) r', ~ 't:JTJ ,x ~\ ~Q, ( \;~\ :; 'j\l . ~ VS-34D NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased fl (~2. f'1 0 First Middle Name of Father of Deceased . <PlEASEPRINT:ORTYPE... , Date of Death or Period to be Covered by Search bSTJr.Jt Last J(G 05 Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last 107 -- /~ ~ 7770 Date of Birth of Deceased Age at Death First Middle Place of Death ~ W jl.) Last Month o p W&PPI ;..;::zel2.. 3 Day ( Y~ 2;0 Name of Hospital or Street Address Purpose for Which Record is Required Villa e, Town or Cit Count rv4.. ~JHg (J;2.0C-f2e1); fb(Z C3i7f71. ~ /-l21Jt What was your relationship to the deceased? (../. In what capacity are you acting? A::s. A-J'i'OG2~y If attorney. name and relationship Of;-O"r c~t to d~ed . ~r"t2.- p r C5 Tln"~ f)g.) Co7lY Signature of Applicant ~~~ Date /&j'/#05 Address of Appli~ant :lfio C/2t$TItt.-. t2v1Y t20tw,-. 11'/)pkrJMJJ D y 101 '1'0 ....COMPLETEFOR:..DEATHS.OCCURRING..AS OF.JANUARY119.SS. ~ 1J~ \ 'V ~ CI I .t\\ ~ . <>\\ \)' \ t b _ Number of copies requested with confidential cause of death /1 --2- Number of copies requested without confidential cause of death :........ .......i>...... ... PLEASE<PRINTNAMEANDADORESSWHERERECOROSHOULOBESENT.. ...:. Name Address City State Zip Code DOH-294A (6/2000) DOWNEY, HAAS & MURPHY PLLC Attorneys-At -Law One Smith Court- P.O. BoxZ Millerton, NY 12546 (518) 789-3613 (518) 789-4442 Facsimile (518) 789-3968 E-mail dhmlawoffices@taconic.net Edward E. Downey* Michele W. Haab** Gary L. Murphy * Also Certified Financial Planner™ ** Also Admitted in Connecticut October 5, 2005 Town Clerk Wappinger Town Hall 20 Middlebush Road Wappingers Falls, NY 12590 RE: Alfred Mann - dod August 21, 1996 Dear Town Clerk: Please forward our office one certified death certificate for the above. I am enclosing a check in the amount of $5.00 to cover the fee and a self-addressed stamp envelope for your convenience. Thank you for your help. Sincerely, DOWNEY, HAAS & MURPHY PLLC by G,-a-~ of: . TY\ lL. p~ 1Y'<1\0- Gary L. Murphy GLM:mla Encs. We have no record of Alfred Mann's death in our 1996 records. Please check with the local hospital vital records dept. Vassar Hospital - (845) 451-4202 (City of Poughkeepsie Registrar) St. Francis Hosp. (845) 485-8583 (Town of Poughkeepsie Registrar) Sorry we could not be of help. P. S . We are returning your check. The fee for a certified copy of death iR $10. 1!r.' ""-,,,.. """----.. ' -, '''MA~'' . ~ ,-,'... . .".' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application for~.e~-~ of Certificate of Death Deceased \SQ......~" .('\ ~ f\. v...'-".."::> ") District Number Date of Death ;).. :J.-'-\ 1 ~ Register Number Place of Death \J \ \.\.l-'\ <V- \..-\Jc_ pe' ~"- '-\. J. State Number v See Reverse Side for Instructions I, ~tN ~,,("\ ~~ 0, <- (name of applicant) of \1 {"'\ 0 r i'"""\ ~ Q,-. ~~~"'-r'''-, ~'\ \J-~~g (address of applicant) request that the following information amend the certificate of death identified above: ITEM IN ERROR (or omitted) AS IT APPEARS AS IT SHOULD BE Documentary evidence submitted herewith in support of this application includes: Explain reason for error or omission: .....L:.::..::::..::,':!:,:::::::::.::::::::i::::::.:::.:}:.irp:':~~:qg!~~j@P:~M:.g~:m~~..~::::'::::'.:::'::::::::::::::~:::::::.':.:::::.:'" .. . .. .... ........... .................... . . . . . . . . . . . . . . . . . . . .. .... . . - . . . . . . . . . . . . . . . .................. . . . . . . . . . . . . . . . . . . .................. .. -........... '... .................. .................. .................. .................................... .................. .................. . . . . . . . . . . . . . . . . . . ............... . Under the penalties of pe~ury. I hereby affirm that the statements made herein are true and correct to the best of my knowledge, t< aAJ,,,,,, (V'\. ~.,.-<.-u-- Signature of Applicant ~~rVC"'~~~~ Relationship to Deceased q\~-:\\o<( Date The above information has been added to the local record of death on file in this office. :::i:::::i:::::::::::::::::::::::,:,':':':::,:::::::::::::':':.:::::i:::i:.:j':j::li:::I":::_iim:::.~::I._::.::1[81::1:11111$::,::::::::::::::::,:::::::::1:':':::':.:'::":':1:::::::::::::::::::.:::::::::::::::::::::::::::::":':':'::'H Signature of Registrar District Number Date DOH-299 (3/93) Page 1 of 2 VS-64 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record PLEASE COMPLETE FORM. AND .ENCLOSEFEE. . ..... .. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ... / ................. . .................. ..PLEASE..PRINT.ORTYPE ... ........... di<.. .....< .... ... .... .. Name of Deceased Date of Death or Period to be Covered by Search ~/)~[TA Lu.J~\<- hh.~\ \:."4"'~ q,.R-o~ 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 Day Year Place of Death Name of Hospital or Street Address Village, Town or City County Purpose for Which Record is Required What was your relationship to the deceased? s:: 0 .-- In what capacity are you acting? :i:::::~:~~:::'i~~tre9.;jJjif Date q-il(~ f"' /-.H /?.S);; l~ tJJ 'if!' l..A~ Address of Applicant . COMPLETEFORDEATHSOCCURBINGAS OF. JANUARY 1 1988 1\ %~~ _ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . ....PLEASEPRINTNAMEANDADDRESSiWHERERECORD/SHOULDBESENTi. Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record . PL.EASE CQMPLETE FORM AND 'ENCLOSEFEE. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased J' fI/l/1 ?( c.._ First Middle Name of Father of Deceased /1# p;eEw L, First Middle Maiden Name of Mother of Deceased PLEASE.PRINT<OR.TVPE /1Z. Date of Death or Period to be Covered by Search (/> Jf' B 7 1j=c ..es.- 9-J/-CJS- Last Last Social Security Number of Deceased 08/?'- LjtJ- {;cy/ 8 RbrlEl.eS Date of Birth of Deceased Age at Death JS/f~?{LZ First Middle Place of Death 19 ~~/lH C~C'9>/~ t:f2-.2:>. Name of Hospital or Street Address Purpose for Which Record is Required T4/ T Last Month 7' Day y Year S7f (/ /} r / / F1-:6 E4- Villag~ or City pI,.{ TC/jESS County I~'F &;:::: OF~:T// What was your relationship to the deceased? r~/'TC-. In what capacity are you acting? If attorney, name and relationship of your client to deceased ---7')) D/R-Ec7~~ Signature of Applicant Address of Applicant S- s;- Date 9~ I-C -c:J g- t--vTJr'/ /4C(" s ~y / c J7'o COMPLETEFORDEATHSOCCURAINGAS OF. JANUARY1 1988 ~Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death PLEASEPRINTNAME AND ADDRESS WHERE. RECORD SHOULD BE SENT Name Address City State Zip Code DOH-294A (6/2000) untitled sept. 2, 2005 Roland L. Manzi 485 washington Rd woodbury, Ct 06798 Town clerk Town of wappinger Falls 10 Middlebush Rd wappingers Falls, N.Y. 12590 Attention: chris, Town clerk Re: Martin J. Ostuni 375 old Hopewell Rd., wappingers Falls, NY. 12590 Deceased May, 6, 2005 Dear sir: per our telephone conversation of this date, enclosed please find my check in the amount of $10.00. for a certified copy of Martin J. ostuni's death certificate. John Hancock Financial services requires the certified death certificate to satisfy the payment of the Annuity to me. A copy of the quarterly annuity statement showing me as the primary beneficiary and a copy of the latest confirmation statement is also enclosed. For your convenience, I have enclosed a stamped self-adressed envelope. Your prompt attention would be greatly appreciated. Thank you. ~z~~ 0 Ro~and L. Manz; '(1 ~ Page 1 SEP-01-2005 01:50 PM . .. P.05 CONFIRMA TION ST If TEMENT AUIIIst 19, 2~ Puticipant(1 ): Annuitult(a): Certiftcate Number: Product: IlIut: Date: Plan Type: Firm: R.epreaentatil'l!: ItARTIN J. OSTUNI ItARTIN J. OSTUNl QP0731aa09 IIlA C""u Jww 20, 2002 Mon-eu-U UMI HSlC SeCURITIES INC. CLAUDIA IAltIIMl MARTIN J. OSTUNI 375 OLD HOPEWELL RD. WAPPINGERS FALLS, NV 12590 ... . Your IIInuity value 1M of AulJ!8C 19. ZOOS "II $105.000.08 TraMa<<lon SUIIIIIW'Y OIIte GUIlI'llntee Period TrUlDCtiOD Don... AmOUDt Matiarlij---- -. -- ~. OIIte Rate 0809/2005 5 Yea: Fixed FJcctronic Funds Withdrl\wal $ S 306.50 N/A N/A Total 306.50 Acdwty Summmoy Guarantee Period Premiwns YTD/PTn $0.00/$]05,000.00 Witlllll'llwals YTD/PTD 52.406.24 1$11.782.00 Annuity Value 5 Year Fixed S 105.000.08 08/19/2005 Total Annuity VlIlue S 105,000.08 Should you have any questions please feel free to contact one of our Service Representatives at 1-800-824-0335 Monda. thro Frida between 8:00 AM and 6:00 PM Eastern time. J()hn Hancock SenmnC Calm P.O. 8~x 55106 BOROn, MA 0220S-5106 1-800-824-0]]5 For "..""'"., IhIlNrl<<3 ONLY, John H.neock ADDwi)' h....1C Op_hODi 601 Conan- 5t Bolton, MA O:t:Uo-2805 John Han~O(;k Life m'l!ltance Company. John HancO<;k Var1:able Llf. Inl\ll'anec Company (not licensed In New York), John Hall(()(.k Ful'Ids, Sirnator Investors 111<:., member N^SD, SIPC, Borton, MA 02117 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Coer of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search Barbara Dunn August 24, 2005 First Middle Last Name of Father of Deceased Social Security Number of Deceased Walter Shimansky 110-46-2980 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Cathrine A. Hicks 12 6 1953 51 First Middle Last Month Day Year Place of Death 18 Mina Drive Wappingers Falls Dutchess Name of Hospital or Street Address Village, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signalure of APPlicaJ~.L- Date AueDst 26, 2005 Address of Applicant COMPLETE FOR DEATHS OCCURING 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 ADDRESS WHERE RECORD SHOULD BE SENT Name Auchmoodv Funeral Homes, Inc Address 1028 Main Street City Fishkill State NY Zip Code 12524 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Copy of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search Scott Robert Thompson August 8, 2005 First Middle Last Name of Father of Deceased Social Security Number of Deceased Robert Thompson 090-64-0208 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Gail Sunde 10 12 1975 29 First Middle Last Month Day Year Place of Death 7 Craig Place Wappingers Falls Dutchess Name of Hospital or Street Address Village, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? Mortician In what capacity are you acting? Professional If attorney, name and relationship of your client to deceased Signature of Applicant Date Aue:ust 9, 2005 Address of Applicant 900 Route 82, Hopewell Jet., NY COMPLETE FOR DEATHS OCCURING 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 ADDRESS WHERE RECORD SHOULD BE SENT Name Robert Thompson Address 7 Craie: Place City Wappin2ers Falls State NY Zip Code 12590 DOH-294A (6/2000) '\ JOHN J. DARWAK Attorney and Counselor at Law Kingston Office 42 Crown Street Kingston, New York 12401 (845)338-4500 Shokan Office 3136 Route 28 P. O. Box 240 Shokan,NY12481 (845)657 -2000 fax:657 -2086 Please respond to: Shokan Office Town of Wappinger Town Hall 20 Middlebush Road Wappingers Falls, New York 12590 Attn: Town Clerk August I, 2005 RE: Your - Death Certificate - ALAN W 0 'DELL My: Estate of Georgiana S. O'Dell My: File No. DOS-811.1 Dear Sir/Madam: Please be advised that I represent the Court appointed (Surrogate's Court, Ulster County) Co-executors of the estate ofthe late Georgiana S. O'Dell who died on September 10,2004 being at the time of her decease a resident of Ulster County, New York. The said Georgiana S. O'Dell, at the time of her decease, was the owner of a life insurance policy which said life insurance policy named her three children, Jean Susan Mackey, Ricky Lee O'Dell and Alan William O'Dell as beneficiaries thereof. The said Alan William O'Dell died on March 31, 1999 being at the time of his decease a resident ofWappingers Falls, New York. In order for the estate to process the life insurance claim it is necessary to present to the life insurance company an original death certificate for Alan William O'Dell. Enclosed for your convenience in this regard is a stamped self-addressed envelope. Should you have any questions or comments, please feel free to contact me. JJD:vmd Enclosure ~~~ ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Copy of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search William H. Owen July 28,2005 First Middle Last Name of Father of Deceased Social Security Number of Deceased Claude Owen 090-16-3864 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Mae Perry 11 13 1923 81 First Middle Last Month Day Year Place of Death 4 Card Road Wappingers Falls Dutchess Name of Hospital or Street Address Villaae, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? Wife In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Date July 29, 2005 Address of Applicant 4 Card Road, Waooineer Falls, NY 12590 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 -.!L Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Lillian Owen Address 4 Card Road City Wappin2er Falls State NY Zip Code 12590 DOH-294A (6/2000) . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last I Sex William H. Owen Male Date of Death I Age If Veteran of U.S. Armed Forces, July 28, 2005 81 War or Dates World War II I- Place of Death Town of Wappinger Hospital, Institution or 4 Card Road Z City, Town or Village Street Address W Manner of Death D Natural Cause D Accident D Homicide D Suicide D Undetermined D Pending Q W Circumstances InvestiQation 0 Medical Certifier Name Title W Thomas Robinson Q Address 21 Springside A venue, Poughkeepsie, NY Death Certificate Filed District Number I Register Number City, Town or Village Town Of Wappinger 181 Date Cemetery or Crematory Burial 8/1/2005 Fishkill Rural Cemeterv D Cremation Address Fishkill, NY D Date Place Removed Z Removal and/or Held 0 and/or Address l::: Hold U) Date Point of 0 0.. D Transportation Shipment U) by Common Destination 5 Carrier D Date Cemetery Address Disinterment D Date Cemetery Address Reinterment Permit Issued to I Registration Number Name of Funeral Home Robert H. Auchmoody Funeral Homes, Inc. 01569 Address 1028 Main Street, Fishkill, NY 12524 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shiooed If Other than Above i Address 0:: W Permission is hereby granted to dispose of the human remains described above as indicated. 0.. Date Issued Registrar of Vital Statistics (signature) District Number Place Town Of Wappinger I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- Place of Disposition Z Date of Disposition W (address) :IE W U) (section) (lot number) (grave number) 0:: 0 Name of Sexton or Person in Charge of Premises C (please print) Z W Signature Title DOH-1555 (10/89) p. 1 of2 VS-61 TOWN OF WAPPINGER TOWN CLERK GLORIA J. MORSE SUPERVISOR JOSEPH RUGGIERO TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590-0324 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI ROBERT L. VALDATI / The Following Fax Message Consists of Including Cover Sheet :z. pages FAX TELEPHONE NUMBER (845) 298-1478 DATE /Q~I 1/ II I ~ () 0.:;- TO FROMoL7 -~ ejd~ j)i!~ REFERENCE J)1!..:iL (' u1:/~- -~4 J~ l/ IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CONTACT SENDER Th1MEDIATEL Y. Sender: J~7 ;( - f2/~7 NEW YORK STATE j DEPARTMENT OF HEALTH CERTIFICATE OF DEATH I 4B. IF FACILITY, I DATE ADMITTED: o g I I 4D. LOCALITY: (Check one end specify) I CITY OF VilLAGE OF TOWN OF i 10 0 ~~ngerl I 4G. WAS DECEDENT TRANSFERRED FROM ANOTHER INSTITUTION? (If yes, specify Institution name, city or town, county and statal I NO YES 1 ~ 0 6. AGE: I IF UNDER 1 YEAR : months I 75yrs.1 1 9. RACE: (Black; White, etc.) 16A. RESIDENCE. STATE: 1168. COUNTY: New York : Dutchess 16D. STREET AND NUM8ER OF RESIDENCE: 17 Dogwood Hills Road, Wappingers Fal.ls IN. Y. RECORDED DISTRICT 1368 REGISTF.R NUMBER 38 Betty MIDDLE W. RESIDENCE 4A. PLACE OF DEATH: HOSPITAL HOSPITA'. (Check only ons) OOA ER OUTPATIENT o 1 02 0 3 4C. NAME OF FACILITY: (If not facility give address) 17 Dogwood Hills Road NCHS 4F. MEDICAL RECORD NO. 4C YEAR 7A Whi te 132-09-6186 78 15A. USUAL OCCUPATION: (Do not enter retired) Artist 9 10 17. NAME OF FATHER: FIRST Kurtzpreot SI 19A. NAME OF INFORMANT: Mr. William J. Walbr LOvAL Ht:\:ill:> I tv\" vvr 1 LAST Walker I 3B. HOUR: m HOSPITAL INPATIENT 04 NURSING HOME daYs IF UNDER 1 DAY I 7A. ';ITY AND STATE OF BIRTH: (Country 178. IF AGE UNDER 1 YEAR. NAME OF houlll mln_ I If not U.S.A.) I HOSPITAL OF BIRTH: -1 I I CATCN51//L.t.e I'1I1Ayl-l't-/lILJ I I , I 10. HISPANIC ORIGIN? (If yes, specify) 11. DECEDENT'S EDUCATION (Specify only highest grada completed) NO YES []C 0 Elementary/Secondary (D-12) 12 COllege (1-4 Dr 5+) NEVER MARRIED OR MARRIED SEPARATED W100WED DIVORCED 01 ~2 03 04 I 15B. KIND OF BUSINESS OR INDUSTRY: : Art William J. Walker ,15C. NAME AND LOCALITY OF COMPANY OR FIRM: : self 16F. IF CITY OR VILLAGE, IS : RESIDENCE WITHIN CITY OR 1 VILLAGE LIMITS? [J YES [J NO IF 1-00, SPECIFY TOWN: 116C. LOCALITY: (Check onsand spaclfy) I CITY OF VilLAGE OF TOWN OF I 0 0 ~ Wappinger r16E. ZIP CODE: : 12590 FIRST Jessie MI LAST M. Beers MI LAST Wilson 18. MAIDEN NAME OF MOTHER: 1198. MAILING ADDRESS: (Include zjp code) : 17 Dogwood Bills Rd. I Wappingers Falls, N.Y. 12590 I 2DC. LOCATION: (City or town and statal 1 I 1208. 6!fH~ ?fts~~~m6~:REMATION. REMOVAL OR 1 Newt.own Village Cemetery 21A. NAME AND ADDRESS OF FUNERAL HOME: Delehanty Funeral Hale 64 E. Main St., Wappingers Falls, 25 30 31 318 OR as aCOD Newtown, CT. . 21B. REGISTRATION NUMBER: : 00508 N.Y. I22C. REGISTRATION NUMBER: 1 . 01216 I 24B. DATE I ISSUED: I YEAR 25A. ON THE BASIS OF INVESTIGATION AND SUCH EXAMINATIONS. AS I FELT NECESSARY, IN MY OPINIOIll DEATH OCCURRED AT THE TIME, DATE AND PLACE AND DUE TO THE CAUSES STATED. ~~t~~~~~ ~ 258. PRONOUNCED DEAD YEAR I 25C. HOUR: I I o CORONER o ~~~~~~~S o ~i2~~~R I 250. DATE SIGNED: I I MONTH DAY YEAR /4 () "; 26.1t!E A.~87f~s ?~~E2'Z~~ ~HO SIGNED~ ~ I..) 27. MANNER OF DEATH: UNDETERMINED PENDING NATURAL CAUSE ACCIDENT HOMICIDE SUICIDE CIRCUMSTANCES INVESTIGATION 02 03 04 05 06 .NO 0, YES CONf'IDENTIAI. 'SEE INSTRUCTION SHEET FOR COMPLETING CAUSE OF DEATH CANCER I I \, ~ '2--'-1- 29A. AUTOPSY? I 29B. IF YES, WERE FINDINGS USED NO YES I TO DETERMINE CAUSE OF DEATH? '0 0 1. 0 0 NO 0 1 YES CONFIDENTIAL APPROXIMATE INTERVAL BETWEEN ONSET AND DEATH 30. DEATH WAS C^USED BY: (ENTER ONLY ONE CAUSi: PER LINE FOR (A), (8), AND (C).) PART I. IMMI;DlAI= q-USE: A L-i-\i,; D!0 i~e:-.r' e~ Tv/l'-1 DUE TO OR AS A CONSEQUENCE OF: ., B Hf;TA<:"Tn'TIG i'.,J2eACT DUE TO OR AS A CONSEQUENCE OF: l:: .g " .., 1D E ~~ ~~ ':. ~ W-" oc. u.~ 0" w'" ::;" ~.f C . PART II. OTHER ~IGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO CAUSI; GIVE~'P.~RT I (A): ,~,~: I HOUR: J-ltl Yf:-S I c.J'H? (! I(\.;(.; fIA A ~l (,: "( A Q/l(,,!( Tv 1~,w6S. L Y~IPIf-(..lfLt Ii i 3~ B. LOCALITY: (City or town and county and stale) I ml 32. WAS DECEDENT HOSPITALIZED IN LAST 2 MONTiiS? NO YES o 01 ; 31C. DESCRiBE HOW INJURY OCCURRED: I.' .' I 33A. iF FEMALE, WA~ DECEDENT PREGNANT IN LAST NO YES 6 MONTHS? DO 0 1 YEAR I 33B. DATE OF I DELIVERY: I VS.60 Jul 11 05 01:45p Riok MoNul~~ . JUL \11- 2005 MON 01: 47 PM . \.IAPP ~ TOWN-CLERK W'.. f/p,.(J4. !"1f. ,t.d A ~. flf,j~;'1r-I'I7Y ~" Application to Local Registrar "\ \ y. . ~=~~&J~ePAATMeNT OF HEAt..TH f~ CollY of Death Record 203-426-6841 8452981418 p. 1 P. OZ " PLEASE F.EE , , ' FEE: S10.00 p.r copy Of' No RecDrd CcartJfication. Please do nDt send oash Df &ramps. (tJ/j,I-I~ J Na",. of 0ec8l!lsed BFrT")' /J., {pAt-/tG'- Frst Middle Last k Name of F1lher of 0eceN8d ~ ' J Sacill15eourlty Number gf DecNS.d Ku.rTz:. ,.,reo, td/~S&JN 'F~8t MlddlD I..ast (' MIi98D Name of.Mot/'ler of Pec8~' Date of Birth of PeeNSed, 4. q f- c..Je.sSI~ MaY"'Tro.llee,($ , I 1//, F ,st Middle Last Mo Veat . Place of Oeldh . , A ... " .. 1 ,. 17 ~~ ,If.lt.t". ':/J"../ "",r. , NIIM of H . 01' StIweI Addrat \Ii rpo$O for WI\tCI'I Rlilaard Is Aequ..od Re lei. -fOr tforncEqu/ Age at Ceattl . Line o{C.r~'.T Co Wl'tal WI5 your relation,hip to the dec.~? In whet capacitY 11/'8 you acting? _ . If at1ome)'. name and relationshiP of your cl*'!1O dec..e<l_ ", . Signaue of .Apl'licati AddrIJU of Applic .~. . ~,.;' '; f.' ',' .~,:Y~Il":~: .:', :.~~. . .', ... " ., g'OCCURRfNQ,AS'OP'';' .. ,:"..a~~~. .~'l':IIII/;:j1;'::'~'1 ,_ Number ofcopies requBltod wl'm con1ldentil!l Cat.M of d.ath ~ Number of copies requested ~ eo~tial cau.. of decaU\ . .:,......'. ' '.a5iSI!Nf:..~',:,,: '.--- . Nlurlo ,. Addr~ss . City' s.. ZiP Code OO"'"294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For CoPY of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search Alfred Scott July 19,2005 First Middle Last Name of Father of Deceased Social Security Number of Deceased Jens Scott 056-03-1678 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Helen Jorgensen 11 25 1915 89 First Middle Last Month Dav Year Place of Death 314 Chelsea Cay Wappinger Falls Dutchess Name of Hosoital or Street Address VillaQe, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? In what capacity are you acting? Funeral Director If attorney, name and relationship of your client to deceased Signature of Applicant Date July 19,2005 Address of Applicant 1028 Main Street Fishkill, NY 12524 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 12 Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Marcia A. Pullar Address 11 Spruce Ride;e Drive City Fishkill State NY Zip Code 12524 DOH-294A (6/2000) e--- ~ ,~ () I IA( "go.. UV' VI ./ ~l...V Kcrv \4 0~ CROWNE Pl HOTELS 8< RESQ ~ Oft>< ~~ ~ ~ anq f201~~ .~~ T~I r~ of (vtil !-Ilf; t:oJ), (~~ \1)Jl , ...f (jdA ~)ff~MLt{ un1f., l~ 1n k:.rl~1 iB i'VJt~ t ~ fx giofAI ~ (5) ee-pt~? ~ ~ m.wl , ~ $~ (/UI/)~-C/ ~V /j1jLJI7e:. .. ~ ~ STATE and LODGE STREETS .ALBANY, NEW YORK 12207 (518) 462-6611. FAX (518) 462-8192 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased CLI1C€ ,4. First Middle Name of Father of Deceased PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search g;t.E/V1JLI#'E "7 /tJ ~5 Last /, ;/l/ Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last First Place of Death Last Date of Birth of Deceased /~ ~:3 Month Da /937 Year Age at Death Middle &.5 Name of Hos ita I or Street Address Purpose for Which Record is Required Villa e. Town or Ci Count ~f' X ~ I -* What was your relationship to the deceased? ~'C\ I h ~f' ':f::: In what capacity are you acting? ..5 ~ Y"'\ . If attorney. name and relationship of your client to deceased *., Signature of Applicant (l,...J..rr- '-t= ~ 1./1') ~ . '* Address of Applicant 1.5 {)~V J ~ .Dr'1 V 0 "-.l f'I Pf"1 f\ '"' Q.r ~1-13-~.s f AllY "'1 I d...59'~ COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 1988 ~ ~\fJ. ~ ~ ,,\';. ~~.. ~ O~~ _ Number of copies requested with confidential cause of death V Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD-SHOULD BE SENT Name Address City State Zip Code DOH-294A (6/2000) .. !' I, ' NY 1251d:\' .i~ :'1;-:.:f'l. C LASS./jJ.. )'.r~'.~".,~. .... %. '''<! ~;!_lAES: 09-22- ',) '. .' "'::;' .,.... ../.' N .' ..~'~: "'.)i!;"":' 4' . ~ -- .'~' ~".'-- /.1', .....y..'.....- '.' . ''1'''' '.. .' : .... . -.: _ _.._.:..._r.~...:_. ..- : ..,....Ii"'~.~..y..:..:~ 1.004 'f ID:903 377 261 JOHNF. BASHER 15 DAVIES DRIVE 914-298-8707 WAPPINGERS FALLS, NY 12590 ~ Pill' TO THE ~ .,; ORDEROF I '" " i .. " HUDSON VALLEY FEDERAC" POUGHKEEPSIE, NY 12601 914-483-3011 FOR .: .2 2. g ?g j b 11:b JOO 2 g bOO glle c..~O!\,11\1E. RCl"AI 1) R ! , I R r J C r " ~. 1 D08:09-22-65 BASHER,JOHN,F 15 DAVIES DR WAPPINGERS FLS NY 12590 SEX M EYES HA HT 5-11 CLASS A E NWR: ISSUED 09-01-04 EXPIRES 09-22-12 ~--r-~ 65244410 1004 50-7936/2219 DATE l-i3~ $ ~ 0 /:)0 DOLLARS m =.::' M' ARnSTlCCHECK~.1.8OQ.o224.7621 -HACEDAY NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINTOR TYPE . Name of Deceased V ~ V.;t'fV 4,'s Date of Death or Period to be Covered by Search , . _lA ( t-j ;JZ..... ( '( 7 2-.. 0 (./ () First Middle Last ( Name ofpther of Deceased fJ (I I'k I e'1 Social Security Number of Deceased l ~"'W1. ILf!: {)7{, -1(,- /30( First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death {l,(C\..... !3tJ/ ~L (if /2- I I 2.2.. 77 First Middle Last Month Day . Year Place of Death 8- ( "'- '-<Ar c~ !; I-r ~e. F~l(f" D ~ I-d..J ~ I- UJCi-fltVlr<r -S Name of Hospital or Street Address Village, Town or City County Purpose for Which Record is Required 13 (} a,f Tf-ll~ (' (~-( What was your relationship to the deceased? 8m In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of APp'icar=Y,"'---ocL U~Y{/~' Date .J c.A. (1 S' 1 G'O)' I Address of Applicant / 12 t 4.--Y1 (;) b"v-L V (--h. cyt.. t ......J.. ?1...-vJ /l.5'2~ ,;/ ( f' COMPLETE FOR DEATHS OCCURRING AS OF JANUARY.t, 1988 - Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City State Zip Code DOH-294A (6/2000) ..,. . (! -z.. "r.xS- .:,,</. . .., ....----........ ..........-.-...... _ ....--' .-' ......-......... X;;~cJ~~~ --- - .-0 --.-.~- Ni~-- g~~~~;:~ .-- 01, - Y-'/'d'.-1;-.. ~_~r~-- ~\'__.~~ - ~: T) - " --_.~-~~~~. - &~-~~-~ ~~~L#~ thr:{';~. ..~~~ d0-- ~#~~-~.." - -_.__.:.--~;-_:... -~ .- ..~~-~~~- __..1~ .. .__--- ~:tz~~ ...-~ _-.---- it-ff't--0tf: i..... .. .. ~. Z _ .---.... _.~~h~;;<--- ,- _----.---- <:k.~-l~~~- t;3~.-w~c1~ ,:I( ~~-------- _-- -.------r;;;-,k--~~~ J., NY... __-----(-6-.5--3:€s-- -----. .' , JOYCE S. EISNER JANET E. GARCIA 3005 ,.' ------ /" //:--t:i,;-.': 1-1081210 ,/ c0' .... /) , PAV ro THE ..' . v...!. - __.A '_ ORDER?F "'_zt-l7J ..:-/t- t. LL{)/>';''f:~Y2' i" ~ j ,i ' , ! "'./.., ~ L::r." .- \'\. ./:.........-L-z.-~_ ~ / DATE - ~' ,-/-;/ 'A t ~'.61," $ DOLLARS ffi Security Fulur.$ I 0...."., .", HSBC m HSBC Bank USA Mt Kisco, NY 10549-2399 J ,..j /. j...r. ) - FORLit.~k CeAJr(', ~j( ,,-:.:-,C~ 1:0 2 .00 .0881: ,,~ ~OO 5 ~ ~ bU- / .'].. ,/:1'i...,./ c.c:_~ ..j } -~Gj<L-'.l~ '''~-- I' ----f---I- '- '.. '-- :i no 5 M' ,F 08551 DATE &/30 /IJ 5' I , $\ 10 ~ DOLLARS FOR AMOUNT OF ACCOUNT THIS PAY CASH ~ CHECK o M.O, ~ l:J1umkc;yoo 1 ~ ' BY j.~-, ~~ I BALANCE DUE June 23,2005 Town Clerk Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 Attn: Sandy Re: Robert Reuter Dear Sandy: Cathleen M. Nettune 65 Squash Hollow Rd New Milford, CT 06776 (860) 350-4489 Thank you for forwarding the corrected death certificates. Enclosed you will find the old/incorrect death certificates. I understand from Auchmoody Funeral Home that you needed these returned. Sincerely, Cathleen Nettune CI AftD S hw; L410l\ i.J;btLl e ~ I~t~t !{UCA rrlocdL/ fuJLe/tli f/rJiflL 10 Z ~ YVlrJIA) i,~ t IlLLf h~'h/{{ II/IV ( f2-52Lj ~4t) gq & {J I {;& hleen M. Nettune Squash Hollow Rd r Milford, CT 06776 (860) 350-4489 e ..LJ''''''~ 1oJ.1..1.U.L.....1..1.V.1...... As we discussed yesterday, please find enclosed a copy of the divorce agreement between my parents. I'll look forward to the new death certificates for my father; Robert Reuter indicating they were divorced rather than separated. If you would forward the 15 corrected copies to my attention as soon as possible it would be most appreciated. Thank you for your help on this matter. S~ncerely, Ca'iArwn NtWzvnL CatWeen Nettune .. I \ ' ~\\ ~ \9 \' 008:07..14-82 W ,RE8ECCA,JO P 608. NEW PAL 12 NY 12561 SEX: F EYES: HA H1': 5-06 CLASS 0 E: R:. . ISSUED: 01-22-04 EXPIRES 07.1412 82096490 CURTISS, LEIBELL & SHILLING, P.C. Attorneys at Law 20 Church Street Carmel, New York 10512 (845) 225-5500 tel (845) 225-3635 fax Timothy J. Curtiss William A. Shilling, Jr. Vincent L. Leibell Of Counsel Jennifer M. Herodes Anthony R. Mole June 7, 2005 Town Clerk of Wappingers Falls 20 Middlebush Road Wappingers Falls, NY 12590 Re: Estate of Mary P. Baumler DOD: 02/22/1994 Dear Sir or Madam: Please be advised this law firm represents the above referenced estate. Would you please forward four (4) copies of the certified death certificate to our office so that we may conduct estate business. Enclosed is a check in the amount of $40.00 made payable to the Town of Wappingers Falls Town Clerk and a self-addressed, stamped envelope for your convenience. Should YO"Ll have any questions, please do not hesitate to contact me. VLL/sat encl. ~ qlJ \ 0\0 "6 Vi. u\' f ~ 1) l~/ RECEIVED JUN 0 9 2005 TOWN CLERK .. . .. JUllt 1 I 2 tJb5 D~V ~dr()) mil\ V\~ I~ ~he{~ WaJ~h' vYlU\ rtdNy ~\t1Vte-V1 JA. 0laJJh p'Cl(~ d OlvtJ a ttJn 1f7etu\ I ~ . l arYl. . vvvl-hn i7J ~1Jv.~ef: 1- ifnt U)~ f)~o.'U . d, (Y1(G\ cU'(J\./ Df ~ I) l)e.oJh Cyx-h6\ Lode . l VJDIJlcJ V1tll(y CtprV~ (;7i /Y1cu1 r- y ~ ~~~. Fe)JecCtL ~lS h , mLj C1c1Ovess. ~ \;.ual~h D.O. bU~ ~os V\evu pw,",tz- N~ 125l.o J 1111~ID' i/ II ~... .rml~~u~~ ~o.<<ovT!~ .Ab ~ 8594 'SEP-.el1-2005 01 :47 PM '1<OJ,..\-'/ S" ~ A6 e c; QUARTERLY STATEMENT hnllaTY 1.2005 - March 31. 2005 P.01 p:..ge . of 2 1 I I ! i I -~ - MARTIN J. OSTUNI 375 OLD HOPEWELL RD. WAPPINGERS FALLS, NY 12590 i: Annuity Valu~ u of March 311 2~ :~ Guarantee Period 5 Year Fixed Current Value $105,118.82 $105,118.82 .J ohn H am;ock Servicing Center for Ollf!rqlrl Del/~f!r'es ONLY.' P.O. Box 55106 John Hancock :BQ5tO~t M A 022M-5106 Annuity Ima~e OperalioDs 1-800-ii24.0335 6OrCongress St Boston, MA 02210-2805 ! INVEST BY MAIL , ADDRESS CHANGE [] Yes, 1 would like to invest by mail. My check for $ is enclosed. o Tax Year ORA Only) Pleas~ print any changes /0 your address be/ow. Please make checks payafJIe tQ: John Hancock C erti ficate: Participant: Address: GP()7318809 Martin J. Ostuni 375 Old Hopewell Rd. Wappingers l1al1s, NY 12S9Q V0062345 John Hancock L,fe Imuranc( Comp""", J(lhn lhocQcl< Van&ble Lllc InsuranGt ComJlB.!lY (not bccnstd In New York). SIl~na\Or tnveston, 111<:., member NASD, Sire, Bollton, MA 021 [7 - m 6'~ .~.& J'~ IZ/{J. ~.Ab#uu- -80 6'~ J'~ . · .... · . . ~ -'W /00/2-1;/06 PUTNAM 07-&0 6/2/2005 PAY TO THE ORDER OF W APPINGERS FALLS TOWN CLERK $ **40.00 Forty and 00/100******************************************** *********************************************************** W APPINGERS FALLS TOWN CLERK ~ ~ MEMO ESTATE OF BAUMLER 11100 B 5 11l.1I1 :,: 0 2 . 11 0 b BOB I: 20 8594 50-680/219 DOLLARS t M' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Yn 1'\ <R... \ 0 N First Middle Name of Father of Deceased OK-T-S, Last U). /... lJ ,it--i::.1L t-V . OlR.:l --S First Middle ast Maiden Name of Mother of Deceased First Middle Last Place of Death ;ff~/J1 e- ft}- OS&:~){v(/r 4.i....L ~fTb Name of Hospital or Street Address Purpose for Which Record is Required PLEASE. PRINTOR TYPE Date of Death or Period to be Covered by Search ~k: 62-. Social Security Number of Deceased Date of Birth of Deceased II Month Age at Death II Year t:y cfr 4) A ~-At 1-. S/ IV . Y Village, Town or City b () Tc... {{ E ~ Count 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 Date COMPLETE FOR DEATHS OCCURRING AS OF JANUARYt. 1988 - Number of copies requested with confidential cause of death -2- Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name L:L 4 (/VI; Address '5' Os 130 CityW~~/IJ(;fP DOH-294A (6/2000) CZo Zip Code I;J- ,C;-ci6 May 18, 2005 Wappingers Town Clerk 20 Middlebush Road Wappingers, N.Y. 12590 RE: Stephen Walsh Date of Birth: 9/12/59 Date of Death: 5/13/05 Section 45.19 of the Mental Hygiene Law requires the reporting of all deaths of patients in mental hygiene institutions and facilities with operating certificates from the Office of Mental Health, such as this Department. Dutchess County Department of Mental Hygiene In order to complete the investigation and reporting of the death of Stephen Walsh residing at 1611 Route 376, Apartment 29, Wappingers Falls, N.Y. and a registered patient of this Department, would you send me a copy of the verified transcription and the death certificate of the deceased immediately. William R. Steinhaus County Executive Thank you for your cooperation. Kenneth M. Glatt, Ph.D. Commissioner Sincerely, /J.~@ ,~~l/~rris, M.D. ~edical Director Dutchess County Department of Mental Hygiene 230 North Road poughkeepsie, N.Y. 12601 9 Mansion Street Poughkeepsie New York ]260] (845) 486-3700 Fax (845) 486-3727 JS/kf ------ "Cf; f\€.C€.\\I t..> '( ') ri . ~~; . ,1 10'J'JN CLf}f~~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased (( oberta.. First Middle Name of Father of Deceased Lieo rq e- Firsr Middle Maiden Name of Mother of Deceased r AJru"v f oeJ~ .. Last PLEASE PRINT ORTYPE Date of Death or Period to be Covered by Search r~b I~, ;;;'005" Kct b \' Y\ i3k\ Last Social Security Number of Deceased First Place of Death iO 13 c...he.\se.ct r<1'd,g e.. Vr. Name of Hos ital or Street Address Purpose for Which Record is Required Middle Last Date of Birth of Deceased 1 Month d-.d- Da /93 '7 Year Age at Death &7 /)J~.pp 'f\j1 et'S f~ II ).), 'I, Villa e. Town or Ci Duf~~~J Count YeA S/on a,V)d , Signature of Applicant Address of Applicant Q nr1 ~.:;fa.. t~ COMPLETEFORDEATHSOCCURRlNG AS OF JANUARY 1, ,t988' ~ Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death " ,,', PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BESENT Name f/~..Je-eVl \. Address ~~ ~~ ~ I City' r,';)'h In'l ( C- \J Q Y\ ?-e-I] G}e16Q!::Q ~d. -/-:'~~KJ-r State A./ -'I r Zip Code J;;:< fj-;;), c/ DOH-294A (6(2000) ~ -} 1-05' , ........... I /f~~)~/' 1)J-~v- -+t oJ.) "" ~:.L I P lt~ $~ "le 1M C ( f i'1.\. (r vI~tH- \ . ~N'1 ~ . ~Jlrtf- v \) ~ f'l1 f' fl. '! c rrf1 \ ~ '<crl C N A..... /u N) , -;::-r: ;J ., '? \ ,) ob · c:\,(b I~~I, ;f'~'/CJI:>OtV:> ~" p'O-...l~ 1'1 \<ltfS/C B..Ji ;;C" , 01 ~/f K,,~,l, II" I H ++J +CW~{ c V' C t /-If 7 ~ ~ t: IYli ~ ~ 5 ,'... y f' p, A/~ j I.. ( rrf'> 1tJ,^ C f+Jl'" P j ~ --D cl,.e b 1\"v'lY \1+ ) '" ",2 # ~ lJ.t. wilJ e,"" r..v . I 3 _~.?- _I i' q <>. !: M 1J141' I'" 'II/'~fI'tlHr J. ;:; ~ M /1"'1 ~h~' ~1) .99 t~.e1 r. .-\1'; . ,0 i) 'oj ~ fr..{"oV LoU · V\. ~n- () , 11 Friends OfW ~~t-il~~" f' e . ~"I~~....\.:,..\\t,,)\... .,:.0 ell ~i~~ ~~~~~ ~;Ylan "t'" (J' I "," Lantana. FL 33462 t -e r- '\- I t. \ t I>- y. '- Pt' po, 1" ',1 TOWN OF WAPPINGER TOWN CLERK GLORIA J. MORSE SUPERVISOR JOSEPH RUGGIERO April 26, 2005 . TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590-0324 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI ROBERT L. VALDATI Miss Elizabeth Moylan 6755 Paul Mar Drive Lantana, FL 33462 Subject: Birth Certificates - Family Members Dear Miss Moylan: Enclosed is a copy of the "original entry" for the death of Emily Silvernail who died March 29,1968. Since Gertrude Merit died in Poughkeepsie, we would not have the record recorded in the Town of Wappinger. Please write to: City of Poughkeepsie Dept. of Vital Statistics POBox 300 Poughkeepsie, NY 12602 Town of Poughkeepsie Town Clerk's Office 1 Overocker Road Poughkeepsie, NY 12603 I am returning your check in the amount of$20. The fee for one copy is $10.00. Please issue me a new check in the amount of$10.00 payable to Town of Wappinger. Sincerely, J~~1 Sandra Kosakowski and! or Deputy Registrar of Vital Statistics ELIZABETHM MOYLAN 6755 PAUL MAR DR LANTANA. FL 33462~3941 1522 i-1I~6 DATE ~)(} ..;--- $ ~t<j 51-701012111 BRANCH 38 PAYTO THE ORDER OF fD S'"'''' Fe.turn ; ,DOLLARS t 0"''''0" Back, WEBSTER BANK .ff ~'_"JA~"or-~'~ /J1~ ~,\.:...~f,..,_,.",_","_"" '/",."""._":-,_:,,,_""'-',','-'-'_.',""-,:'. ... OR /Yt ~N~"'S-#J..Y~A'/#'- . ..,'.. .... . . . ... .... . . . '.'~M' ':21 J.1? o 16J.': 'lD .t.J. n'O 1 'it, (; 5'. -152.i!. ........ .. ... . .. .. Burial or Transit .~ - ~ '1\ c:-. Permit issued by........~~~..:\:~....~~~.................................. Date of issue.........~~.....;:.............19..f.ej:z NAME OF e. LENGTH OF ReglS'c:tered No / - HOSPITAL OR. P STAY IN TOWill, ..............~............................ INSTITUTION.............. ...iM;~.j;~;:pf~f;;;..j;;tit;;ti;;-;;:..gi~;..;t~~.t..;dd;;;~.-~~..i;;;;;;ti;;~).................................,CITY OR. VILLAGE .......\....l.'-1.r.~.............._.........._.................._.............._..._...._... 2. -U sua! residence \ I . 'i\.k I J " . City or of deceased: State........A;..e..I,M..~....R..~............ County.......:V.U.\.C!C>!?.;..s............ Town..;.u.J.~~;l.M...~.t:.<C........ Village........................................... Is residence within its corporate limits? YES 0 NO ~ STREET \J~ A I .. '- ~ ~ . ~, ADDRESS "- \-el, ~ "- Is residence on farm? YES 0 ..0 Ii:! " '- C\ fCt 4. DAT OF DEATH ~~~~ 8. IF MARRIED, WIDOWED OR DIVORCED, Nam. of Husb~.~~ r'"l \ C' \ . \ -Car) . lie- '--\..Q'(<2-\"\c,'Z. ...:::>, *.'CI'C"-\.. II. BIRTHPLACE (State or foreign country) /12. CITIZEN O.F WHAT II COUNTRY? Iv' cw t () ~ k u . s. ,n ' 13b. KIND OF BUSINESS OR INDUSTRY Q.. t- ~ 'fY\.~ 15. MOTHER'S MAIDEN NAME Clr-, '(\, : cZ.- S UJ 0... \. C\ 18. INFORMANT'S NAME C. \C\..'(e.y\C<L rr 'Si'v€-r /17. SOCIAL SECURITY NO. (3"'7;), lo 4~ 19. CAUSE OF DEATH (Enter only one cause on a line) PART I. DEATH WAS CAUSED BY: \" . t\ .' _ \ '--- \ IMMEDIATE .CAUSE Ca)...l V\.t one o..\r'A~_-\.... '(\. \\1 C'::i:~Q(\. .Conditions. if any, \,\., ~ A \) which ve rise to above gaimmediate DUE TO (b). ().( e.'( .:;c\e fn-\-' C. ~ Q(). \:2.<20...;<2.- cause (a), stating the underlying cause last. ~ ~ o r:: ~ ~ o ..J ~ M e 21d. INJURY OCCURRED \2Ia. PLACE OF INJURY (e.g., in or about /2If. WHERE DID City or town :;: While at 0 Not While 0 home, fann, factory, street. office bldg., etc.) IJ'fJURY OCCUR? ,eo Work at Work : 22. 1 hereby certify that 1 attended the deceased from............................, ........, c:r.::....3..-;.~:i.:..A..., 19 ..., that llast saw the deceased alive on.......-.;;::::::.............., 19......, and that. death occurred at.{;,~j!i/!vn., from the causes and on the date stated above. Da. SIGNATURE (Degree or title) I Db. ADDRESS IDe. DATE SIGNED t~'\e5\c.'1 ' G G \&\\\0 J ( ,\ \;J."So '3 _ ;)c. 19- ~ Y I 24b. DATE . SIG ATURE OF UNDERTAKER alI'- bQ Jt,,-v~f r, \ ~'fQ(\.\:: S C;3 'oe.,~ Jr. Pre, 3)y ~ ~. A RESS UNDERTAKIF' REG STRATION NO. 1264. :ATE FILED BY LOCAL REG'. IUb. SIGNATURE OF REGISTRAR f20 oe c-t,' -\ Ij "a,e-\--- ~ ,,^ e.. C. Y'\ I -::> 190 'if' (\" \ \" II U..J-~ 01 ; r\.."',",; ~ l..- C0l( ,;1.. 0 9 C' \ \'\.0. 'rc...n-> 0 .' ------'\ ~'-'L \'\ ~'1..J c-..~ ~~=itor ' Permit issued by..........U~.~...:;S.~"M.i.d..~............................ Date of issue.....~\.'<'s;.;h....~.S...........-19.~.~.. 3. NAME OF DECEASED t: \Y\ \\L\ S\\ \.l(~,<,\\~\\ I', CO. LO...R OR RACE 17. SINGLE, MARRIED, WIDOWED, , DIVORCED (Specif~) LL~~ Yn.C<--f" (" \ ~('}. I Ill. AGE,lIn years IIF UNDER I YEAR IIF UNDER 24 HRS. last birthday) Months I Days Hours I Min. ,.,,-, 13.. Us'uAL OCCUPATION CGive kind of work done during most of working life, even if l.. \ - retired) \S.\QJ\JjQUJ l te. 14. FATHER'S NAME Ge.Q(C\e. C~o..fn? 1'01\ ". WAS DECEASED EVER IN U. S. ARMED FORCES? (Yes, ::~r unknown) I Cll yes, give,::r or dates of service) 5. SEX t='e.v"', <<..~ 9. DATE OF BIRTH 0..ua, J..J. \ \is i 0 ,;" f. DUE TO Ce)___ (Day) CYear) 19 C:.c? ;;;).1 I NT AL BETWEEN ONS~ND DEATH .., . ..........~..M. '~.M.....___.._..._ .J,.l.l:J;,a_Q_':.!!..~ ..-...............................-......-- PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL CONDITION GIVEN IN PART ICa) 21a. ACCIDENT, SUICIDE, HOMICIDE (Specify). , I (j)0 21e. TIME OF Hour Month Day INJURY a. m. p.m. 2CI. AUTOPSY? YES 0 NO~ 21b. DESCRIBE HOW INJURY OCCURRED. (Enter uature of injury in Part I or Part n of item 19.) Year 2401. PLACE OF BURIAL, CREMATION OR ') OVAL County State TOWN OF WAPPINGER TOWN CLERK 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 APPLICATION FOR SEARCH OF DEATH RECORDS DATE: April 27, 2005 FULL NAME OF DECEASED: JEAN SWENSON DATE OF DEATH: AUGUST 6,2000 PLACE OF DEATH: 150 NEW HACKENSACK RD. APPLICANTS RELATIONSHIP TO DECEASED PERSON: ATTORNEY FOR ESTATE NUMBER OF COPIES REQUIRED: 10 (FEE FOR EACH COPY: $10.00) PURPOSE FOR WHICH RECORD IS REQUIRED: ESTATE ADMINISTRATION NOTE: PLEASE FORWARD THE LONG FORM CERTIFICATE. THANK YOU. SIGNATURE OF APPLICANT: THLEEN M. LUCY McCabe & Mack LLP P. O. Box 509 63 Washington Street Poughkeepsie, NY 12602 ADDRESS OF APPLICANT: ~ ~ f ~ ~ _.~ ~- ) y ~ // / ~\Ao , f\ECE\\}E(. APR 2 8 ::~5 ,OWN CLERK 04/25/2005 09:41 47134e16 FSI PAGE 01 TO: FAMU..Y SERVICES INC. MENTAL HEALTH SERVICES 230 NORTH ROAD POUGHKEEPSIE, NY 11601-1316 A~~NE: 845-48~1703 Est. 310 '-1?U)YI Cl tJ; (L. - FAX NUMBER; FROM: Alan Kraus. CSW - Executive Diredor of Mental Health Services DATE: t845l471~ D5 .~ RETURN FAX: IF YOU DO NOT RE IVE ALL OF THE CALL (845) 486-Z703 Ex-t. 310 R.J PAGES: RE: NSMITTAL SHEETS, PLEASE COMMENn:~~e- ~;~~ JTf: · CJ:lU. 5l ~ '~_ ~ II · / . ~O~ ~\ CONFIDENTIAL COMMUNICATlQN Thil trllDSmiutOD Is IIltendell. only fnr the iudlvielllal or ,..thy to whlc:lI Jt U lldUell.cd, aDd may conC8lJl hlforlu~o.. that I. pmilepd, COIlftdentllll, aDd Remp' m.. dUdOlare aDeler .ppllCllble J'edcn11Uld ate IllWL This Illt'onalltloa Dlay h.ave been dl.doaecl to you from J:'OCOrd. protected by I'odenl COJd'Identhlllty l'1I.IeI (42 CFR Part 2 aId tbe H..IQ. Inmranc. Pol1llbUIty and Acc:uunMbtlity Ad (HlPM)). TIle r.del"lll ralcs prohibit you from maid.. any f'Qrt'her eIi.do.ure of this iJlronaatlOD Qn1ll1 fttrtber disclolllre Is expressly permitted by the wrltteJl conRDt orthe p.nOll to whom It portllInl or a. othent~ permltMd by 42 CD Part:2 llBellor HJPAA. A F1erala1ltJlorludon for tile ........ of ..dictl Or other bdb....tlOD Is NO'l' .ulBdCDt for this purpo", 11Ic 'edenl t'UleI rutrlct I1IY 11'. of tile tnfol'lll.8tlon to crl~lJ,ally ill"~ or proseCUG IIIIY al~ol or drag abule patiebt If the "Ider of tll.. ~muniClltlO1l. b not the iDtendecl "el,1on" or Its emplO)'R or agent retpollstble for de1tverl."I c:mnmllDicatton to the intonded redplent, yoll arc notiSecl tllet lID)' dissemlnlltloJl, dlstrlbadon, or wpyiD~ oftht. communlcldoD Illltrlctly prohibited. If you h.an IKelml thlf commuDlcatlonlD e'lT'llr, p1c8" notify the NDde... jm1lledlatilly at the ~phone number l.t.telI above and ....m. the origi....l colftDl.lIDlcdon to liS at the .bove addres. by U.s. Postll) SOrvlce. Thank yon. . FSI PAGE 1112 1114/25/21111115 1119:41 471341116 (J 8eAc;:OW MENTAL HB/d.nt'C~.JMIC: 223 MIht SINd BeKoR..*-. York. 12S0I-2770 MSII~ FIX 14~/.n-491S 0, EASTBRN DU'TCHBSS ' MENTAL HEALTH CJJNIC 2 RtiIMr A\lCftUCl PO Box ~lS Dcm:r P\ai1\l, New Y.n I 2.S22-n 36 84S1f117-4loo 'FllIt.1451111-4112 ' Q MlL.LBltOOK MENT~L HBALTH C~C 1~.5 County NOUI8 RoMl POBa.51, MiJl'broolr., N.w York 12S45-fiJQ "'SI617.40~ Fax &4SI617--40,6 l:J POUOHK8aP$'('B MeNTAL HEALTH CU'NtC at Nord\ RClId ;130NortbRoed. Po"5~ie. New York \2601-1316 845'486-2103 Fax 1I451416-:.II65 T1'V 84S14t6-1U5 Cl RHlN!8BCK. MENTAL H'ML.'Jlf CLOOC 6529 9pri~A",,1I11l Rhn.,bocIk, 1IIcw Veri 11572-3109 14~1$76-~ FIlI.I45f876r2l73 a FAMILY smMCBS.1NC. 29 J\TclItb. ....1_ .. Poughblpll.. New ~ 12l1iOt-2s..1 1451-4$2-1110 Pax I4S/4S;Z-1Il9 { I !!t Family Servi-. 1M. _ MENTAL REAL'IH SERVICES. " Marcl't21 I 2005 Town Clerk's Office 20 Mlddteb...." Road Wspplhgers Falls, NY 12590 Re: Date Of Birth: Date of Death: Rita Cirino 09lO8I1954 03114105 Dear Sir or Madam: Section 45.19 of the Mental Hygiene LIW r1IqUi.... the reporting d all cteathS or peUents In mental hyQIene Institutions end facilitieS with apntlng certifa.tee from the Oftlce of Mentl!ll Health, such as this Agency. an order to complete the jnveltigation and reporting of the death of: SUP C\rino. resillna at 5313 Prince. Circlea W80Dinan ~ is a registered pBti8nt of this Agency, would you send me a copy of the Yerifltd transCription and the dUth c:erttftcate of the dlCealed immediately. Th.nk you for your cooperation. J .n ~.I LOS ExecutIVe 01 r, Mental Heelth Services AKI.rm. F~ ill ~ by ~ ~ OawIDIDlIDt NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coey of Death Record ..........................................................................PCI;A$eePMewsrEeoRMANP:eNOJ.;.()$efEE..n<).................. ,_H ".n....., .............................. ......................................-,............. . . - .......... - . . . . , . . . . . . . . . - . .. .. - . - . .... .......-,... ...........-....-.-........ . . . . .. - - . . . . . . . . . . . . . . . . . - . . . . . . . . . . ......-.-.............. . - - . . - . . - . . . . . . FEE: $10.00 per copy or No Record Certification. Please do not send cas.h or stam s. Name of Deceased 7?tD First Middle Name of Father.of Deceased ~ Last Date of Death or Period to be Covered by Search ---- S First Place of Death Middle Last Social Security Number of Deceased /02- 42 _2o;? Date of Birth of. Deceased ? ' 7~ Month Da ~ First Middle Maiden Name of Mother of Deceased Last Name of Hos ital or Street Address Purpose for Which Record is Required fM Villa e, Town or Ci Coun What was your relationship to the dec;;:ed? . ~ j'l/(S Jt;11c. In what capacity are you acting? z)yz/I{l4 If attorney, name and relationship of your client to deceased r j)/~~ C Signature of Applicant Address of Applicant ..>CQMPtETifFoa{OEATRS.OCCUBRI..........ASOEJANUARy::':.:iifU. .. ............ -. ........ . .......................... . ............ -....... -.. .................... n' o . . . . . . . . . . . _ . . . . . . . . .........."........ . ......................... ..... ....- -.............. ......... ............................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............................................................. er of copies requested with confidential cause of death e - /' ,/ fr ~ D / ,./:lr 4 V ~ \ >~/ ~vvr~'1f-~ / (} (\ / iJ _ Number of copies requested without confidential cause of death :..:PUe.A$EemHltNAMEAflQ4QQSe$$'W8E8.eSEQQ80$.t{QUlu>se$ENT.m:d Name Address City State Zip Code DOH-294A (6/2000) JOHN M. REED ATTORNEY AT LAW 17 COLLEGE VIEW AVENUE POUGHKEEPSIE, NEW YORK 12603 TEL: (845) 454-4340 FAX: (845) 454-7862 March 24, 2005 Town Clerk Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 RE: REQUEST FOR DEATH CERTIFICATES w/SEAL Dear Town Clerk: As the attorney for the Estates of David M. Alexander and Marie Alexander, I am requesting Death Certificates with Seals for the following: J DAVID M. ALEXANDER DATE OF DEATH: 10/09/93 PLACE: Town of Wappinger ~ MARIE ALEXANDER: DATE OF DEATH: 10/24/03 PLACE: Town of Wappinger Enclosed is my check in the amount of $20.00 to cover this cost and also a copy of a Certificate and Transcript of the above mentioned deceased. If there is anything further you may need, please let me know; thank you. JMR : j c Encls. RECE\VED MAR 2 8 2005 TOWN CLERK t\\~\~; I . I I J<9HN M REED, AITORNEY OFFICE ACCOUNT 17 COLLEGEVIEW AVE. POUGHKEEPSIE, NEW YORK 12603 PAY TO THE ORDER OF March 24, 2005 DATE Twenty and no/DO --------------------------- Town C1 erk, Town of Wappi nger --------------- $ 20.00 HSBC ~ Hsse Bank USA Poughkeepsie, NY 12603 FOR (2) Death r.prt 'A1exanders 11100 ~ 58 bill 1:0 2 .00 .0881: DOLLARS 4586 1-108/210 ~ Sncurily Faalufe! , ~~~lIs O~ NP ROBERT B. DIETZ THOMAS E. DIETZ DIETZ & DIETZ, LLP Attorneys At Law Two Cannon Street - Suite 207 Poughkeepsie, New York 12601-3224 Paralee:al Cannela E. Newman (845) 452-4000 Fax: (845) 454-4966 Lee:al Assistants Colleen C. Misner Michele A Macintyre March 28, 2005 Town of Wappinger Registrar of Vital Statistics 20 Middlebush Road Wappinger Falls, New York 12590 REQUEST FOR SEARCH OF DEATH RECORDS FULL NAME OF DECEASED: MAE ELIZABETH PHilLIPS DATE OF DEATH: May 24, 1990 PLACE OF DEATH: 11 Balfour Drive Town of Wappinger RELATIONSHIP TO DECEASED PERSON: Attorney for Estate of Floyd G. Phillips, Jr., deceased son of Mae Elizabeth Phillips Number of copies required: 1 (Fee for each copy: $10.00) Purpose for which transcript administration Signature of Applicant: _@ (JA~f-' ~/~ DIETZ & DIETZ, LLP 2 CANNON STREET - Suite 207 POUGHKEEPS~0~K 12601 OUR FILE # ~ \ o~ ~ q \ ~~\ 4} ~\ ~ ~ )~I RECE\VED MAR 2 9 2005 TOWN CLERK ESTATEOFFLOYDG PHILLIPS JR. JOHNJPHILI.IPS, EXECUTOR 33 KENS WAY HYDE PARK, NY 1~538 1021 DATE 21 z. <is 10:; 50-7936/2219 ~$ '()-- DOLLARS & :"'~~ OeIalI5()f1.~. \\~~~~~aw~~ I" A Hudson Yall~y ~~~;:~~~OBoq~~. PIP .~ March 5, 2005 Dear Mrs. Morse, Thank you for the time you spent with me over the phone with regards to my Grandmother, Helen Bush Jones, who passed away in her sleep in Feb. 1987 in Dr. Millers office (Dentist) laying on the coach. I call inquiring as to how I could receive a copy of her death certificate. You very helpful. Not to mention how much I appreciate you remembering her and our family. Please find enclosed a copy of my mothers obituary with a check for $10.00. This will also show you that I am who I said I was, Gwendolyn M. Graham. Also please mail the death certificate to my home address listed below. Or you may contact me at either number 678-895-6957 or 770-489-4650. Thank you once agmn. Home Address: 6356 New Gate Dr. Douglasville, GA 30134 JSincerely, ju.' I .. I / ~'~Mit en. L;;'" .I Gwendolyn M. Graham <, \ (\\0 0' ) t RECE\VED MAR 1 ~ 2005 TOWN CLERK ~) tr " ***PALLBE~~ERS*** ,,~' II FllIEfS ; ~ ****rJN APPREqJATION**** ", V'~" , . J The fall1;ilr would like t~ express their sincere ,;' , " thank,.- and gratitude -ro~~ all kindness and ." 'h' ,tl I \ ,;,' ,j T' , e~p~ess:J.ons of sTlI1pathT!;in th~ir hotlr o-r need. .f ,/*******J**************....~************************* 1 ,;' \, I '.J" ; 'j\ '~;,.,:JA,Jte. _ .J , I . ~ .~ ,., .....:...,.,;~ --..:''t- ~ "f' ' · . NT Children, do no~ -rorget 1I1T ~eachil'Jg. . . Keep lI1T'coll1ll1~nds in .ind then you will live a longtillle. ,[) . . .. ~ .!\~' .,' JJOft" t ever stop be!in.g kind ,and -eruthful. Let k:tndness abd truth {!1bow i'Ii all your.' do.. 'J. Rell1ell1b'er t~"'r. Lord (in everything You do and . t <. ~e will give T~~' ~stlcce4s. " . ~' i' In Re.elllbrance o-r :Jur ooHo'ther Helen )Bf,lsb ~borpeX , 1 , I Love, ," I' I 1 " '1 \ t-l,... Your phildren ~" .f' -". ..... ;/ " \ ""-.. ," ~.\ 1 I FUNE~;orBVICES HELEN L i THORPE ;I I ~.~_.~,..- '~~') '\ :\ l' i j I I ! i ;( .. ..... ,I .. "J... .'1 .. . -.. ' ' , ,'~::' I " t'''l \to j 1 1 . ,) 1 ~ ~-, I .. .iI I :,~'\1: .' .:l HARCH 4. ,'1935 - SEPT.,pw11E'R , 01:1. 23" 1992 . ~, 1 1 " HONDAY SEPTEHBER 28, 1992 1: 00 ,:P.M. BEULAH BAPTl'~T CHURCH 92 CATHERJNE STREET POUGHKEI;PSI~~ NEW YORK 126()1 REV · JESSE l(. ' lJOTTOHS J J'R., PASTQl/f / I J -' I oBl'J'lJ'ARY \ . ,., HELEN "L. THORP/p 5 ~. A 30- YEAR CITY OF POUGHKEEPSIE RESIDENT. :I>IED WEDNESDAY AT ST. FRANCIS HOSPITAL ,.INPOVGHKEEPSIE. \' P/l;!gR TO J.lESIDING iIN THE POUGHKEEPSIE AREA. MRS. TIlQRPEWAS A RESl4ENT OF HARRISBURG. PA. " . .~! I SHE HAD "(ORKED FO#l14 YEARS AS A FOOD SERVICE WORKER AT THE HUDSON RllVER PSYCHIATRIC CENTER RETIRING IN 1986. 'I" ' · . 1 ,BORN MABCH 4. 1935) IN' CHELSEA. SHE WAS THE DAUdllTER OF THE LATE NAtHANIgL C. BUSH AND HELEN L ~I HALLORY BUSH JONES. : / '. SURVIVORS INCLUDE HER TWO SONS. SaT. JESSE THORP~JR. INTH~ U. S. ~MY RESERVE. OF POUGHKEEPSIE. AND Al.,FREl11j HINES, JR. OF BEACON: ~~~~~t! D~~OHTERS, r~E~OR~1t:. .'!'HORJ?F;'" G~ENDOL'YN .( . '-"'"".~ _~...1HAM" A.f,~ ~.tlAl';"':~~"'.:J A. THo.RPE, AL'L Of. , .~., POUGHKEEPSIE;, TH>>EE,lJRD'PHER,$, CL.ARENCE BliSH'AND ~ "ROBERTf. B~lI, BOTH"OF POUGHKEEPSIE. AND NATHAN1EIl. T. BUSH OF TULSA, OKLA;TWO SISTERS,. GLADYS ,THOMPSON AND ELEANOR HA~' 0 BUXTON ,BOTH OF " POUGHKEEPSIE; A GRANDSO, MARK A. LUNSFORD, JR. OF POUGHKEEPstE, WHO RESID 'D WITH' HER: 10 ADDITIoNAL GRANDCHl/JdREN; SEVERAL NIECES AND NEPHEWS AND AN UNCLE AND AN AUNT. " ,- , SHE WAS PREDECEASE1 BY A SON,' REG:rNALD. E. THORPE AND A BROTHER, R kPH BUSH. ... '. . . . ( SadlY Missed, I The Family ARRANG 'HENTS BY FLOYD J. GILM RE FUNERAL HOME 19 COTTA 'E STREET POUGHKEEPSIE. EW YORK 12601 /\ O' ORDER OF "~~VICE I " \ PRELUDE.................~.. .SIS. DOR()THY CARPE1\1'EB ',. \ , \ PROCESSIONAL. . . . . . . . . . . . ~ . . . . . . . . . . . . .' . . THE FAM LY' . \. \,' ' HYM~. . . . . . . . ... . . . . . . . . . . .'. . . . . . . ..... . . . CONPREGATIOA,AL' , I \;.. , ., "JUST A CLOSER JrlA~K WITH THEE".. .' THE SCRI;RES \.'( Ii OLD TESTAHEN~PRAYER OF C~Nso~::o:ESTAHENT \ \ .~. ~ (J \ ,t I ACKNOWLEDGEMENTS I /1' ~. \1.>J AND OB!TURARY .,' ... . . '. . . .(~. . 'E NEI:.S9t!-' (lfJAl.::'Nt!' ~ \~t^~'~ 1ff,.,..~~t'J.~.i~'~~'<1". /: -\-:: ~~..~/ ":7"~' i-.:t ~ >~~ ~:Jl al. . .,~..' "1:.'; J . I THIB.riTE.;.. '............. ;,';:\i 'e~~~".". .... ..... ..l)EBORAH '.Ti10~PE.I. ... . 'SGT. JESSE THORPE, J,'R , '~.~ RE,1tA, RKS ~.. . . . . . . . . . . . . . . \' . . '. . . .' . . .. . . J" . ..',HINISTeRs SOLO. . . . _.,. . . ... . . . . . . . . . . . J... II II .. .- . iii . . LORRAINE LARRY . ' . "HA Y THE WORK I:;VE Dd 'E SPEAK FOR 'ME" "~.........~:>~ r ."'\ ':,"\, \ \ t.. ,_. ." , Ii: " EULOGy:..~.......................REV. ADELE'JOHNSON ;;..., RECESSIONAL........................."I'LL FLY AWAY~' \ INTERH+T FISHKILL RURAL CEMETERY j ,~ 'I I ,I / ,/ /' ./ / ,r' ~ 10~" C~~;~GE.R 10~" O~\.:US~~~~~ t2f>90 20 ~~,,\.\.S, N ~"p~tlGE.~ / "t Oco01S rl..t# OP.\E.~ $~ OOL'-"P,S r--- 0" N .. McHOUL FUNERAL HOME, INC. ROUTE 82. P.O. BOX A HOPEWELL JUNCTION. NEW YORK 12533 TELEPHONE: ~221-2000 8yS ORDER FOR CERTIFIED COPIES OF DEATH CERTIFICATE Date Ordered 1;Z}~~- Piease prepare _. 2-. Copy(ies) of the death certificate of the below-named. To kJ f\~~-lDtA.l""J aJ==eJ! --2-.0 M l \:)'D[ E"g(-t,StJ 12 \'). t-. J!tPPflvGEIZ S F4t-'- ~ / N / I ::ZS-e:rO Total Cost $ "'7 0 - g..paid Herewith D Charge C COD. 01 Z Name of Decedent CA-f.4 1?.L E. S < T . S ~A.f'DF e " Date of Death Nov. ,I 4./ 2J;::XI"-I County j:Zt7('.-fII.?~ S D Call When Readv 0 Hold ~ail To: E. M MAr:;;. I "B 13 So Address J f7tJ 6'. ;2.1 C1 s +-. / 15 -gc/\..\)< r ('\.17 /fjl-l~6 A 'PT - ""1 '"D .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N.Y. 12237-0023 Application to Local Registrar for COe)' of Death Record \~~ N~\~ \ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Charles J. Saunders Jr. First Middle Last Name of Father of Deceased UNic~ow 10 First Middle Last Maiden Name of Mother of Deceased ELL E)..j S f'~WJ\)ER-~ Middle Last November 19, 2004 Social Security Number of Deceased 125-24-0244 Date of Birth of Deceased Age at Death June 6, 1933 71 \ b 1t1 R-\-e. S 70> N r Street Address Purpose for Which Record is Required Wappinger :fown or Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant <" ~ ~ Address of Applicant 895 Route 8 , P.O. Box A Hopewell Date l \ ( Z-c,- ( 0--1 Junction, NY 12533 Name McHoul Funeral Home Inc. Address 895 Route 82, P.o. Box A City Hopewell Junction State New York Zip Code 12533 DOH-294-A (7/92) VS-34D January 31, 2005 Gloria J. Morse, Town Clerk's Office - Genealogy 20 Middlebush Road Wappingers Falls, NY 12590 RE: Death Record - Townsend Van Voorhis - Born 1843 Died - April 10, 1905 (per family bible) Marriage Record - Townsend Van Voorhis to Lydia Johnson Probably around 1895 - 1897 Ms Morse, First, thank you for the prompt reply to my earlier requests. I am still working on my family genealogy, here are the latest records I am looking for. 1. Townsend Van Voorhis was born around 1843, and I believe he married Lydia Johnson toward the end of the 19th century. 2. Marriage Record for the above couple. They are in Wappinger Falls in the 1900 census, I think they were married there 3 - 4 years earlier. I may not be spelling the last name correctly, it may be Van Vorhis or Van Voorhees. I hope this death record will tell me how he spelled it. I enclose $20.00 for the searches. I do not need a certified copy, just a photo copy if possible. If you come across a death record for Lydia Van Voorhis, I would happily send you another $10.00. I think she may have died in Pennsylvania, but I am not sure.... Thank you in advance. Sincerely, -D ~ 1\. ~~~ Mary Johnson ~ 145 North Highland Avenue Wellsville, NY 14895 rbrhod@adelphia.net TOWN OF WAPPINGER TOWN CLERK GLORIA J. MORSE SUPERVISOR JOSEPH RUGGIERO February 10, 2005 TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590-0324 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI ROBERT L. VALDATI Mary Johnson Rhodes 145 North Highland Avenue Wellsville, NY 14895 RE: Death Record - Townsend Van Voorhis Marriage Record - Townsend Van Voorhis to Lydia Johnson Enclosed is a death record for Townsend Van Voorhis who died June 30, 1905. Also enclosed is a copy of the original entry that was recorded back in 1905. Your family bible and our village record book seem to have different dates of death. (see copy enclosed) I was unable to locate any record of marriage for Townsend Van Voorhis to Lydia Johnson. I even went back a few years and ahead a few years in my search. I found other Van Voorhis' but not Townsend. The onIy "Lydia Johnson" in the marriage records was married Nov. 28,1907 to James Ireland. (see copy enclosed). Please destroy this copy if no relationship to your family exists. I did not charge you for this copy. Also, while skimming through records, I came across a marriage record for Rich S. Van Voorhis, married on June 28, 1885, age 23, to Mary M. Mullen. His father is listed as "Townsend VanVoorhis" but his mother is listed as "Caroline Knight". I thought you might find this interesting. Could Townsend Van Voorhis have been married prior to Lydia Johnson? Rich Van Voorhis would have been born around 1862 which would make Townsend about 20 yrs. of age when Rich Van Voorhis was born. I found no death information on Lydia Van Voorhis. Do you have a date of death for her? I hope the information enclosed will be of help to you. If I can be of any further assistance, please let me know. ~C(~ Sandra Kosakowski Registrar of Vital Statistics RECORD OF MARR.IAG.ES /yq ,TERED NO......................................... MARRIAGE LICENSE ............................................................ ................ .................................... ......................... of........... ............................................................................................................ ..............i n the cou nty of..................................................................... ,te of .New York, and ................................................................................................................................................................... of ......................................................................................................................................in the county of ;;~~;:;;;;::.:'.~:~~.. Y." .t_........._.......::h;::~:~m~l.:~: [SEAL] .............................:.....~.......................................................................................,.Clerk The following is a full and true abstr the facts disclosed by the ,above-named applicants in to me upon their applications for the above license: \CE ~d - -];;[~:=:~:"!C~::.. _.3+ 1!Jr ~~~ff;~~~~~~~ WHEN AND WHERE.......................... NO. OF MARRIAGE..:...{:~;". I bave not to my knowledge been infected witb any venereal dieease, or if I bave beeo so infected witbin live years I have had a laboratory test within tbat period which shows tbat I am now free from infection from any such illsease. FORMER WIFE OR WIVES LIVING OR DEAD.......... ~CE . ~'a/; -........... --.-V'..O'vyUL, N"J?7l..------m.--.....--...--....--....---....-- Wi UJ, 4~ ....23; ......--.......----..........m__=::::m_________...'.....__.__m__m_.__........... ~~~~~t.~.~.~~:..~~~~~:;~~ ~vr ~ ----- _~___________n__________________n__. M IDI!:N NAME OF'.--~--n....-......--....u_u-..---___-__-...----- NO. OF MARRIAGE ,,__..l........ I have not to my knowledge been in. fected wltb any venereal disease, or if I have been so infected within IIv. years I bave had a laboratory test wltbin tbat period whicb sbows tll:lt I am now free from infection from nny stich dlscnae. FORMER HUSBAND OR HUS- BANDS LIVING OR DEAD.............. DIVORCED ..................................... DIVORCED ............................................. WHEN AND WHERE.................. AGAINST WHOM ...................... AGAINST WHOM ............................... , . '.. OIU . ~ARRIAGE CERTIFICA!~ . / Ne~..~~;~..~.~..~.~.;~~~..~~,~;;..~;;.;;;;..:;;:~.::::2.'l:;&~:;f.~;;;:~ :~d'"1.....(j..z.:Zd:::"&;;Z::::::~...~~.~..7:~e o:.~.~.~.~. ;;~~ fe of New York. SOlemn~:~~b~mat on betwe .. .....................................~....................... ......:..~~..................................................7,.._j9.the ~ntJ' oL...::....,....................................... 'e of New. York and.......~r;;............. .... ........................ .. ......................................................... of ......................... .........~............................In the county of.....~~.and State of New York . STATE OF NEW YORK } ~~..:.............~...:~ ...::::::::::=:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: . . . ..........................................;...;..................................... ....................... groom, and ................._................................ ...........................;....;.............................................................bride, applicants for a license for marriage, ;~~;~.il~..~~~orn, depose. and say. that to the best of their knowledge and belief the statement respectively signed by them is true, and that no legal impediment exists as to the right of the rs to enter into the marriage state. AFFIDAVIT .FOR LICENSE TO MARRY No................,....................................... "....c............ ................................... ......................................................................................... Groom ................,.-........................................................................................................................., Bride, .d and sworn to before me this......................................................day of....................................................................................................193........ .............................................................;..........................................Clerk CERTIFICATE OF CONSENT is to certify th aL-.....c.... , who have hereto subscribed...,.................name. do hereby consent that I This is to certify that............, who have hereto subscrib,,'! "':a.....a .J-. J...__......... ______.1. .LL_.I. "FOR GENEALOGICAL PURPOSES ONLY" A Verified Tf'~nscri~t from the Register of Deaths Date of Deatll.....Jl1~e. .39).. }~q~............. Registered No...... 1.7.1.~ ...... ........ Place of Death . .YUJCl.g~.. .~f.. "\~?:p.p. ~~g~r.~. .f.~.~.~.~.~. ..~~~..X ~;r:L.... ....... ..... Name oi Deceased .... .... T.~~~~~n4.Y~nY~.C?!h.~.~........................ ................... Age, ......R~........ ......years, ..........................Months, ....... ......... ......Days Sex........ .!'1~.~~.. ........... Color or Race.......... ............... .... .... ...... ................ Single, Married, Widowed or Divorced.............M~Tr~~q.............................. Full Name of Husband or Wife Date of Birtll.... ................................ Birthplace. .Rp:tGb.~.~.~.. .C.9.l),nty.~...NX. Citizen of what Country............ ..................... ................. ................................ How LOng} Here .......... ..~.O.. .Y.TS. ..... OUg..... Q;f. Jv.q.PP.,.. .F~Us. ~.. .NY).. ....... Resfdent In U. S. if foreign ...................................................................... OccupatiDn.......~~J:?.Q.r.~.r.. .......... ........ ...... S. S. No. ................. ... '" ... .............. Father's Name ..... .I.U..~h~nl.. V ~nV RRA'b.i.s... ..I?9.:r.l).;.... .P.V.ts:;hR,s.S.. C.QP-nt.y.... .NY Mother's Maiden Name CQ:rn~.lia.. W.e.y........ .B.o.r.n;... ..Dut~h.e.s.s. ..Go.un t.y: ~...NY If Veteran, Name of War.............................................. ... ............. .... .......... .... Cause of } Immediate Cause ........ .I?J?J?~J~.?... ..................... ..... .............. .... Death Due to: . -.......... ........................................... ............................... Time Dr. in Attendance} .............................. .... ... .... .... ................ ............ ..... till Death ................................................ ..... ....... ...... ........ .... Medical Attendant or other Attestant ... ..~~~!.g.~..~.: ...Y. ~~~?:g~~r......... ........ Place of Burial ........ ~.Cl.ppJ~g~!.?.. f.?:~.~~ .'.. .~~~.. X.9.~~....... .......................... Undertaker ......................,............. ..... .......... .......... ....................................... I Hereby Solemnly Attest, That this is. a true Transcript from the Public Register of Deaths as kept in the y.q.)..age...9.:f..W~p.p.~ng~;r~..p.q..:U..~............ .... ...... ........ ........... ..p.~~ 'J::r.i.c;..t..tt. ..:!-.:?l4...... .......... .......,... ............ ............ ...... County of ................ P.ut.c.l.W??...... ...... ..................... ....., State of New York Dated at .. .)Q!\1~qqJ,.~J?~.~.h. ..Ro.~~,.. .W?-pp.~ng~r~...I:.q.JJ~........ ..,....., N. Y. the .. . ....... ..4.th....:............... day of . ,....f. ~ 'Rr.w:P;y...... ....... .x:W' ).0.05 (Signed)J~f~'p ..... ..... Official Title DeputY.R.~g~s t:r~:r.. .oJ.. .Y.H.?J ..?~?:tJ!:> 1:Jc:? ~... ~:.. (' I 1&f:~ -r@1li 3968 -\ I ROBIN B. RHODES MARY J. RHODES 145 N. HIGHLAND AVE. PH. 585-593-1965 WELLSVILLE, NY 14895-1315 50-278/223 ~ 0256030016 ~\.-3C>-OS . dJ!!!l,%h--~ G . .~ --.\ ' 9"!!!€~" ~ n/L...I. DA 0'\...1) ~ Cu.. ~ C' Ooill ~ dc> \ !\.. <-:r:: &.1,J> 00 !S 'c::C:> ---1...., STEUB;$ Wellsville Office (j) ~ TRUST 475 N. Highland Ave. P.O. Box 664 COMPANY Wellsville, NY 14895-0664 co $~O- ~(D ~~~~~ FealUfti' o..lallion liad ~Jf) 1:022302 ?BI;I: . ~'~. 0251;0300.1;". 3ql; ..... - ----- TOWN CLERK TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NEW YORK 12590 RECEIVEDFRDM ~ f.t~ ...t~- ~d~ FOR 08~~O DATE~ $1 ~t1 @] DOLLARS BALANCE DUE D CASH ~ CHECK D M.O. ~~~ AMOUNT OF ACCOUNT THIS PAYMENT NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased f3E'NEDEffD Date of Death or Period to be Covered by Search ':!r~1fJ I!. Middle Last Name of Father of Deceased Social Security Number of Deceased STEFftNO }),' /fJIUf!.. () /JIP -:- -3~ -48 SiP First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death fji~EfTft , fJ1/LCtl 1 ~(; /1;.3 f/ First Middle Last Month Day Year Place of Death Idl! fJPliJELS ;::AI/S N'1 Id.-S,/c ])U.Tt! tltSoS If !-116ft Sr,e€Et Name of Hospital or Street Address Villaqe. Town or City County Purpose for Which Record is Required r; \5 tlj) 111 /; I~ iNs tLlUi AI e E €. b m 1'/113 What was your relationship to the deceased? dlltLJh felL In what capacity are you acting? . Fx e..(!l( r6te.. If attorney. name and relationship of your client to deceased Signature of Applicant 1JUi.~ ~, J.:L1u-<<NJV Date / /e2. 7 /os , , Address of Applicant 1f,2, /(1..:111 @1fff-,J;ziVc I AtLJAl:eus Ie N,y IUd>/ .~ I --- -------------~- ---'-"- ~ ---...- Ii \\Y AS OF JANUARY 1. 1988 ~. y, <t\\) ./ ~ :'. " @ 3th I \\Q~ 1~1 - death ~ ~\, ~U ~-1!k ~ l ' .~ . -.- -~ . ~'-~~'--~"=.".~..~~~""""-==~. '" \ ./,/ ERE RECORO.SHOUbI) BESEN~ _n=--~~",,,_~t1!!'/5,~fdfllL.=.){A Ie a tJ t~"" -,,~ ~~;, GtfTc J)RIIfC All-tl < ~, .'_. ~~-- ~;;.W,; fJ61J&i;1~tt ~ S !E.. N't I~ol Zip Code _~ -'~7.'~ , ....~"""'-"""<A~~~.~>-=.~ . [--- nt-~ rr- - - ~--~~-- ----.--.---.-- .,.....,.-._---~._----------..,-_.~---~---_._.._.. ;'-'\i; !] 1\1 n"" '~r>, .u-(~ :"."TlI'.:;;r;"H .Iifl'hl!"<"!iICli':' 10:550491 759 "'''f [JRIVER LrCEi~SF 008:11-14-46 KRAKOWER,MARYBETH 42 S GATE DR POUGHKEEPSIE NY 12601 ' SEX:F EYES': SR HT: 5-00 CLASS: 0 END: REST: S ISSUED: 1()..15-01 EXPIRESll-14..Q9 . /Ju.~,~/ ,:a,,,-~.......-<\ '1 46486190 .I."~"'~;,,~. ~~, g-~, ~~, ~ &: PA ATTORNEYS AND COUNSELORS AT LAW ~ BARRY B. SILVER (N.Y. & FL. BARS) MICHAEL H. FORRESTER RICHARD SCHISANO SOL LESSER SARAH ROSENBLATT DREYER (N.Y. & CT. BARS) DARRYL.J. DREYER 3250 ROUTE 9W NEW WINDSOR. NEW YORK 12553 (845) 562-9020 (845) 562-7570 (845) 1561-4441 18001 736-8556 FAX: C84!5) 562-9025 REFER TO FILE # January 7, 2005 Registrar Town of Wappinger 20 Middlebush Road Wappingers Falls, New York 12590 Re: Couwenberg, Elisabeth Date of Death: October 1, 2004 Dear Madam: Please be advised that I represent the Estate of Elisabeth Couwenberg, who passed away on October 1, 2004. Would you kindly provide the undersigned with one (1) certified copy of the death certificate of Elisabeth Couwenberg. Enclosed is my check, in the sum of $10.00, representing payment in full of YOUl fee. Thank you for your kind cooperation in this matter. Very truly yours, ~ ;:;\I~ ~ o f 8 \\ N RICHARD SCHISANO /ss enclosure ~IJlloj RECEIVED JAN 11 2005 TOWN CLERK NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N.Y. 12237-0023 Application to Local Registrar for COe)' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased .- m A~ A7e-O Date of Death or Period to be Covered by Search fJN77Jl'i) () J. 1/17/6:5 First Middle Last Name of Fatber of Deceased Social Security Number of Deceased ftlICr/EZe /V!,ASS/t-;eD 13/- o 7 - (9 r d-~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death CltKm UA F-e7Cf..DtJ E MO~/ //1;;; ~~ First Middle Last Year Pace of Death ~ WIrPfJ. /flt /J50A! iW/::-N CM~ Ce:NrEt!- ) 6IAfCH Name of Hospital or ::>treel Address Villa~e, Town or City County Purpose for Which Record is Required L,EG;I1L What was your relationship to the deceased? Ii7lY?TJ CI /f7\J In what capacity are you acting? If attorney. name and relationship of your client to deceased Signature of Applicant ~ ;8 t(;Ll1Lflfl1 Date I ho / uS-- /' cj m - ~-l, 10I7MU / / Address of Applicant /0;; (,. OJ-^-' ( ( ~ wi tffuse -r I lie T ) (hM ~ Yb'K / PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City State Zip Code DOH-294A (7/92) VS-34D ~ ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.)' of Death Record . PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT ORTYPE Name of Deceased Date of Death or Period to be Covered by Search 12~jJ1~/l/IC~ !/ r ~# First Middle Last NamZP'6;,Peceased ~ ~# First Middle Last Maide2J;!.a!JJe:Jlf Mother of D~e~ed 'A A/.I Date of Birth of Deceased. /1l/7;L-1/' j/Ct:.L>/'/F'/v,Y'" ? Zc -C.b First Middle Last Month Da Year Place of Death r9 / ?> ;:t'.t?~';r&~ r Name of Hos ital or Street Address /-7--oS- Social Security Number of Deceased {t)S--;s,- JLJ r-€lzyo Age at Death rf?i-v>> Villa e /M/J/~~ ~73 ?f;Z-~ Purpose for Which Record is Required /~~r ?5~ Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your clien vF~/// ;z=-~~C V /4Fc-;7.er/C Signature of Applicant Address of Applicant > .s- ~ CQMPLETEFORDEATHSOCCURRING AS OF JANUARY 1 .t988. Number of copies requested with confidential cause of death / t\fh ~ S\ ()" ;{'l~ ,0 I Number of copies requested without confidential cause of death .'. .... PLEASEPRINTNAMEANOAODRESS WHERE RECORD SHOULD BE SENT Name Address City' " I, I State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COe;' of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE ~ ~ ::D ~ en i: r;j ~ ~ i m ~ o ." :: ~ ~ g FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of D~cea~p.d ~/vCf.77/1 PI. First Middle Name of Father of Deceased Social Security Number of Deceased f /J TS '/ )/rl/V A/CZ:- /' C. , First Middle Last Maiden Name of Moth.er of Deceased /.' $ ~fi/ I r pC":> LI /It .4(./;f First Middle Last Place of Death :? j3 L /lc~ 7".,y CJ"e' ~ ~ ..~~ Name of Hos ital or Street Address Purpose for Which Record is Required rr~~r ~F ;bF>~/~,7;/ PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search :rE rF/i"ez'y Last DEC" .36, ?o~ y Date of Birth of Deceased '7 --:s I /9Zc Month Da Year Age at Death .?-'C.- 1A//1/Y:;.t/ 6.F ~ j)~/ r ~<s Coun H/~Wc- P,/:/2..,>~~ /c. , Signature of Applican Address of Applicant COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 '-7 ~ Number of copies requested with confidential cause of death ? _ Number of copies requested without confidential cause of death ~o 0:/ ~ . it lJO' 113'0 PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code ^ 1\ ~~~ \ DOH-294A (6/98) . .. -'1")1' t;) MAR, 7. 2005 3: 39PM CLEVELAND SVC CTR NO.2 9 2 p, 2 ~ 11..._......... New York. Ute I1lmnuIee Compelii)' P.O. Box 6916 Clevelmd, OH 44101 l..ao~9S.9873 ~.INMI)'Drkl~.com March 7, 2005 .qentlRepresentlltlve: Kevin 1 Mulqueen CLU CFP CHFC (845) 569-82.00 ESTATE OF CHARLES SAUNDERS CIO YUSON HAM 13900 FIJl WAY APT 308 MARlNA DL REV CA 90292-6921 lns1n'ed(s): YUSOll Ham Policy(s): 36 949 152 Dear Ms. Ham: I received your request for bU'ormation on the above policy. 1be Insured on the above policy is Yuson Ham with a date of birth of 03/2211972. The cmrent owner, Charles Saunders is deceased. If you have any questions, please contact me at the toll.free number above. Sinocrely, ' ~ Customer Service Representative cc: Kevin J Mulqueeo. CLU CFP CHFC V74 For polley InCormaUoD anel online service, please Visit us at --> www.newyorklife.tomlvst 03/07/05 MON 11:29 FAX 310 8231843 Canon Multipass ~004 ,I; t' ~ ( ..,Ai(.1r"A JERALD FIEDELHOLTZ. R C. ATTORNEY AND COUNSEL.L.OR AT L.AW POST OF'F'ICE BOX 4088 270 QUASSAICK AVENUE ~ ~~ ~ ~ f.t$~-()(),f,f 18451 56Z-4e:JO FA" (845) 562.7880 FOR TR"NSMISSION OF CORRESPONDENCE ONL.Y February 23, 2005 P"R"L.EG"L. "'ANICE SUCHOWIECKI Kyong Sook Ham 514 S. Adams Street, #.} Glendale, CA 91205 Re: Last Will and Testament - Charles Saunders, Jr. Dear Ms_ Ham: Pursuant to my conversation this morning with your daughter, I am enclosing herewith a fully executed copy of the Last Will and Testament for Charles Saunders, Jr. As I advised her this morning, it would be in your best interest to contact an attorney in L.A. to discuss this matter with you. If he wishes to contact me I will be more than happy to accommodate him in any way I can. Very truly yours, -lE" /kp enc: PURSUANT TO CPL.R SZI03Ib) ISI THIS OfFICE REVOKES AND RESCINDS THE AUTHORIZATION PROVIDING F'OF! SERVICE OF' PAPERS VIA EL.ECTRONIC MEANS. ~ Sunny Ivanyi (AKA Yuson Ham) 13900 Fiji Way #308 Marina Del Rey, CA 90292 March 4, 2005 Sandra Kosakowski Town Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590 RE: Death Certificate for Charles J. Saunders Dear Ms. Kosakowski: Not too long ago, I had send a letter to your office requesting the copies of the death certificate for Charles J. Saunders along with proof of beneficiary, military photo ID of Yuson Ham, and a money order of $20.00. I have not heard from you since and wanted to follow up on this matter. I tried phoning you today and last Friday, but was told that you were not in and that I need to speak with you since you were handling this case. I was also told that you need a copy of the death certificate of Kihwa Saunders, and that there was confusion of my current name (Sunny Ivanyi) and my previous name before I got married (Yuson Ham - listed as the beneficiary on the insurance policy. I have changed my name over the years from Yuson Ham to Sunny Yuson Lee to Sunny Y. Ivanyi, my married last name. I am also enclosing several additional items as proof of name changes, along with my marriage certificate. Hopefully, this will be enough for the death certificate to be sent as I need them as soon as possible. If you have any questions, Please call me at 310-740-2094. Sincerely, ~ Sunny Ivanyi (AKA Yuson Ham) ,>..~-'... .--. . /"'~/. --- ~--'- ---~ Yuson Ham 13900 Fiji Way #308 Marina Del Rey, CA 90292 February 7,2005 Town Clerk's Office Town of Wappingers 20 Middlebush Road Wappingers Falls, NY 12590 Dear Sir or Madam: RECEIVED FEB 1 1 2005 TOWN CLERK I would like to request to (2) official copies of the death certificate of Charles J. Saunders. He died on November 14, 2004 (reg. #34). I am listed as a beneficiary on his life insurance polices. Enclosed are the copies of his insurance policy, $20 fee for each copy, and 10. If you have any questions or need me to fax anything, please feel free to contact me at (310)740-2094 or my fax # @ (310)-823-1893. Sincerely, ~ 1!{}/YrL- Yuson Ham TOWN OF WAPPINGER TOWN CLERK GLORIA J. MORSE SUPERVISOR JOSEPH RUGGIERO TOWN COUNCIL VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI ROBERT L. VALDATI TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590-0324 (845) 297-5771 FAX: (845) 298-1478 February 2, 2005 Sunny Ivanyi 13900 Fiji Way #308 Marina Del Rey, CA 90292 Dear Ms. Ivanyi: We have received your request for a copy of a death certificate for your grandfather, Charles J. Saunders. Under the Vital Records Section of New York State Dept. of Health rules, a copy of your grandfather's death certificate cannot be issued to a granddaughter or a stepdaughter. Please read the enclosed literature issued by the State of New York on the issuance of death certificates. In this case, you must accompany your request with supporting documents establishing a legal right or claim to obtain a certified copy of a death certificate. We are returning your postal money order in the amount of $10.00 since we cannot issue the document you requested. Very truly y~urs, ~.(~ Sandra Kosakowski Deputy Registrar of Vital Statistics