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2007 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for CoPy of Death Recor~ PLEASE COMPLETE FORM AND ENCLOSE FEE ~ ~ :II :lI: II> ~ ;;l o II' ~ ~ II' ~ o ~ ~ ~ 8 FEE: 510.00 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 K Ift!';- I;;. S:.h (Ve \ c\.ev -oe.c . zec. 2004- First Middle Last Name of Father of Deceased Social Security Number of Deceased Ri c ho;.rc\ "Sc: v.. n-e ,- d -e. r o \ 8 - ILl - 9 5 -=?-9 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death EYY"IVY"Io-- D~v-o Oc-r . ~) \qz \ 80 First Middle Last Month Day Year Place of Death GZ- ~X~\\ D\"~ \.^JO-~'~ ~-t-.c..~~ss Name of Hospit or Street Address Villaqe.~ Ci y County Purpose for Which Record is Required ~nc\ a+ L J'e.. A~ivs What was your ~elationship to the deceased? _hAV\e.~ \ 1::::1 '(' c-c..--\-cc- In what capacity are you acting? oV'\ ~ hO- \ -f-' o-r~ fuMI\j If attorney. name and relationship of your client to deceased Signature of APPlicanttu . ~ - Date \Z-3'-~ Address of Applicant FbB0 \3\ _ c:::::, , \L-.b1 b I W \-. N" COMPLETE FOR DEATHS OCCURRING AS OF JANUAR l::Lil Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death DEe 3 1 2007 TOWN CLERK PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code DOH-294A (6/98) - _.. 1:'"'\ 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. Name of Deceased Henry John First Middle Name of Father of Deceased William First Middle Maiden Name of Mother of Deceased Marie First Middle Place of Death 1668 Route 9, Apt. 4-F Name of Hos ital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Leske December 26, 2007 Last Leske Last Social Security Number of Deceased 106-26-8168 Bickhardt Last Date of Birth of Deceased 5 22 1934 Month Da Year Age at Death 73 Wappingers Falls Villa e, Town or Cit 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' C. C . ~ Address of Applicant Date December 28, 2007. COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 5 -1 i 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 IVED - DOH-294A (6/2000) DEe 282007 TOWN CLERK NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for CoPY of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE ~ i ,0: '" il ; o m i ~ m ~ o ." 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 -.:I;"h r"\ t----\ d \0 ~t\- I \}r . 'Qc- 20 I zc:x::t:T First Middle Last Name of Father of Deceased Social Security Number of Deceased '~hn f'-{ ^\? PY?\H I Sr. \ 21- tCo - \-=J-S", First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death '~\A-th -ria ,)h+- 1:>ec ~I, 19Z,S- 9/ irst Middle l Last Month Day Year Place of Death E:lo.nt . CAT Wo..JX:::,\e~ S \\co Na.f'F\~\~fn\\,:::> '~ic:\-te..~S Name of Hospital or Street A ~s r Villa(fe:',Town or City County Purpose for Which Record is Required t:hd o<-P L-R- A~\~ What was your (elationship to the deceased? \ \Anc (Z'Jl... \ t:::r (" e c:-\or In what capacity are you acting? on loe.\r\ a. \ ~. C3~ ~VY'\1 Ij If attorney. name and relationship of your client to deceased Signature of APPlican;7~ . ~ Date i ""2 - 2.. \ -cr=:, Address of Applicant 1=b ~ C~I d ~~, ~''i \C:::.~6 , ~ ~ 8 _ Number of copies requested without confidential cause of death ECE\VEO ~ PLEASE PRINT NAME A DRESS WHERE RECORD SHOULD BE SENT TOWN CLERK COMPLETE FOR DEATHS OCCURRING AS OF JANUAR \f1- Number of copies requested with confidential cause of death ..J Name Address City State Zip Code DOH-294A (6/98) - _.. ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for Co,?y of Death Recor2 PLEASE COMPLETE FORM AND ENCLOSE FEE Name of Deceased WJ<::) 4 hI.. t--..\ . First Middle Name of Father of Deceased '---Thecr6r~ PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search ~ _ 20, 2 c:>c:r::t- t ~ :II lli (/) ; ; o III ~ i: m ~ o .., FEE: 510,00 per copy or No Record Certification. Please do not send cash or stamps. '"Ba.rr c:. 11 Last Social Security Number of Deceased ~ ~ 8 First Middle Maiden Name of Mother of Deceased ~ ~€- ( Not kna~(\ ) First Middle Last Place~f D~ ss --PQ?\d Name of Has ital or Street Address Purpose for Which Record is Required \ ~hc1 of Lrk- Afk,r-s Ej"r \~ r""' Last O-=( '=1 - 09 - 559 1 Date of Birth of Deceased 0:::1 . :3 \ ,1420 Month Da Age at Death 8""::J Year 'l::::u-trv~s Coun What was your ~elationship to the deceased? FUfrV'YZl-l .""Dt r c- c~ I n what capacity are you acting? c::lt"'\ ~ n~ \-t' c::sf' ~ m, ~ If attorney. name and relationship of your client to deceased Signalure of APPlican~ ,,-\~~ _ Dale Address of Applicant ~ ~~ F, ~i-\ zS10 12-2\-cr.::} PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHO COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 .10- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .... Name Address City State Zip Code DOH-294A (6/98) - -.. ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar 'for COe.>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased -'S\., ~ h U.' First Middle Name of Father of Deceased s:' " .f- . ~ '10' U Last Date of Death or Period to be Covered by Search J c /~ '1/(jf- Social Security Number of Deceased First ~i1 yV ~..;" Middle Maiden Name of Mother of Deceased .(1-.",(,,,,.,. Last First Place of Death Last (~I~jt ~c!. I Date of Birth of Deceas~ nO. 2 ~ OJ Month Da Year Age at Death Middle C Lei ~ t'::.1 (: 2 i'" ~ ,~ -l~ J. wit (l1';f;,-.v C c(L r n JIJ .IV 't n j 'JC' Name of Hos ital or Street Address Purpose for Which Record is Required Villa e, Town or Cit - /wlldr>rJul'- l::,...l i"C II c ./..1' Count /'v'f S r J hV[j r What was your relationship to the deceased? In what capacity are you acting? Iv 7 J ? If attorney, name and relationship of your client to deceased Signature of Applicant ~ v -tI [~~- Address of Applicant Date 12/r Ie-'f- . , ..,.,....."."........,',.',...--....'.'..,............,...'".........'...........'........'...........................................,..........................,................-'....,....................,.........................'..---............-. eOMPt..~l'eFoADEA'tHSbCeoRRlNGA$bFJANUARy119aa) _ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .....S$'WHEA.I$$EQO!$t:)$!i()Ul...QII$$ENT Name Address City TOWN CLERK State Zip Code DOH-294A (6/2000) ~JEW VORK ::T.A,TE DEPARTMENT OF HEALTH Vital Records Section . Application to Local Reg istrar for Co of Death Record PLEASE COMPLETEFORMANDENCLOSEFEE LFEE $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Je,~eased 'PLEASEPR1NTORTYPE Date of Death or Period to be Covered by Search Car 1 J. Bryson First Middle Name of Fa':her of Deceased James First Middle Maiden Name 01 Mothet' of Deceased Nov. 30, 2007 Last Social Security Numbel' of Deceased Bryson Cast 126-22-7606 i Date of Birth 01 Deceased \ Dec. 11, 1930 ,Month Day. Age at Death Theresa -prrst Middle Debt~ck Year 76 Place of Death 5 Fenmore Drive !\lame of Yospital or Strl:let Addrf,ss Purpose for Which Record is Required To settle estate Town of Wappinger Village. Town or City Dutchesst Counv RECE\VED' O~ 2007 _-,- I TOWN ctERK Wnat was YJur relationship to the deceased? __!!IDeral Director In Wh3t capa.city are you acting? same If attorney, 1l3me and relationship of YO'Jr client to deceased Signature 0-: App!icaot _~.t2 ~_ Date~ - 3- 07---. Addre's of Applicant. 64 E. >lam st.....- Wappi.Dgm;s Fans, N.Y. -.-.-- --- j ____-8 I \ \ __ N'JIT.ber of copies requested without confidential cause of death 1_-,-- --- ------- t ...J ~ I~~~-:- PLEASEPRINTNAJIIlEANPADDHESSWHEREHECORI: iiHOi]'LDBESENT.. ..... ___ a'"-____---.o..-.a---------..'- \ Name _- I Addr'3ss L= q ----.---.. ---'-.- _-+----c--- -- --- -.--------- - ~--- State _ _---- Zip Code ---..---- nn H- ?qLLA iFl/?OOO\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PLEASE COMPLETE>FORM.ANDENCLOSE.FEE... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Helen M. First Middle Name of Father of Deceased Frank Long First Middle Last Maiden Name of Mother of Deceased PLEASEPRJNT:ORTYPE .... Date of Death or Period to be Covered by Search Rooec?~ Nov. 26, 2007 Social Security Number of Deceased 118-09-7922 Date of Birth of Deceased Age at Death Ev~ Ferris First Middle Last Place of Death 26 N. RE"..msenAve. Name of Hospital or Street Address Purpose for Which Record is Required March 26 b 1922 Month ay. 85 Year Wappingers Falls Viii ag e, T -oWf"H*" Liiy Dutchess County RECE\\JEO To settle estate What was your relationship to the deceased? Funeral Director In what capacity are you acting? same If attorney, name and relationship of your client to deceased ,.OWN CLERK Signature of Applicant . ~ a.. ~ . Date II -;?? -0 7 Address of Appli~ant Delehanty Funeral Home .6I'E. Main st.. Waooinqers Falls, N.Y. ..:COMPLETEFORDEAT'HSOCCUR8INGAS OF.JANlJABY.1198S. -2- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE..PRINTNAME..ANIl..ADDRESSWHERERECQRO/SHOULO.SESENT.:........... -.. Name Address - City State Zip Code nnl-J-?Q4.A IR/?OOO\ 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 Alfredo Pires Coelho November 24, 2007 First Middle Last Name of Father of Deceased Social Security Number of Deceased Joao Coelho 097-34-5694 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Maria Alice Pires 5 10 1943 64 First Middle Last Month Day Year Place of Death 2 Briar Lane Wappinger 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? R"(~'" \I L . .) If attorney, name and relationship of your client to deceased ~In\l") . ...'" .. Signature afApplicant ~ ~ Date Novembe ;~ ;' Address of Applicant 1028 Main Street, Fishkill, NY 1 524 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 10 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) 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. Name of Deceased June Ann First Middle Name of Father of Deceased Anthony First Middle Maiden Name of Mother of Deceased Filomena First Middle Place of Death 21 Carroll Drive Name of Hos ital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Michelin November 21, 2007 Last Mattiaccio Social Security Number of Deceased 082-44-6223 Last Panzardi Last Date of Birth of Deceased 1 2 1952 Month Da Year Age at Death 55 Wappingers Falls Villa e, Town or Cit 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..... i Address of Applicant 1028 Main Street, Fishkill, NY 12524 Date November 23, 2007 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 RECEIVED NOV 21 2007 N CLERK PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased tv tjf DA 11A GAfft3 -r1letJ1/A-f2 LS First Middle Last Name of Father of Deceased Fa'-fVAJJPO f.,.- Pu EU-r t3 First Middle Last Maiden Name of Mother of Deceased M( L/t(3~()5 lJetAltl u c-r First Middle Last Place of Death '7) \. ~0 Keff-'VlC,/ V,IV<::'- Name of Has Ital or-Btreet Address Purpose for Which Record is Required Date of Death or Period to be Covered by Search II ~ ( /z-o C/ r- Social Security Number of Deceased /0'5" '-Z6 - 23 8" S- Date of Birth of Deceased t'2- tf?- Itf3L Month Da Year Age at Death ~ DA7~S~ Count lAJA-fP ( f\JC 612- What was your relationship to the deceased? In what capacity are you acting? roV1tr/tl'-1 J1'r~ NOV 2 1 2007 If attorney, name and relationship of your client to deceased TOI/'~_ ~ ~ I< Signature of Applicant ~ ~~ Dale (U'l.~ r- Address of ApplicantM 4f-,u L p:t/-. IfJC- r ~kS 72fc. ~ 2/ ttrf71(., Jf' (( d:- '/ Ai:! ( 2..)"33 ..."'............',',.,......-.....---.........-.-..........-....................,'......................'.......-...................-............"'...."".....................-................................--............... ....,',..,'....".--. -.-.-...--.-----....-........................................ '-'..- -....... -- '........-............."'.'.'..............,.,.-..-.........."'..,.,.".............-..-............. ....... ...eOMP-l..stEFOA[)EA'tFl$oe.eoRAINQA$OFJANUARV1W1~$$... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ..PUeA$ePAIH'1":NAMe.ANQAOpae$S..WHERt;AEOP'AQ..Sl-iOUl..p..$e.SEN1'...<...... Name Address City State Zip Code DOH-294A (6/2000) ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record ..PI..J;J:\$E..CQMPl..I;TeFQfitM4,.,PJ;NPl..l)$I;FJ;e....... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. First ~hM."'" Middle f} Name of Father of Deceased Last So fir Date of Death or Period to be Covered by Search II) ~ JIJ '7 RECEIVED Social Security Number of Deceased NOV 2 1 2007 Name of Deceased First ()",V\ ,...... Middle Maiden Name of Mother of Deceased Last S, l.r Date of Birth of Deceased First Lvc....~~, Middle Place of Death Last ~ Month )... Da 5 (,1 Year I.flfl Name of Hos ital or Street Address . Purpose for Which Record is Required IV TSt' Pc '\\\..A... ~('- 0- . (.)r Villa e, Town or Ci ')'- What was your relationship to the deceased? I n what capacity are you acting? ~ ~.... \... Po \,~ +Yv< :;.\-I ( lA ~ ur " If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant :.;;;r;~ v -;;l~ 4.( J-< ~ -- Date )) 1:J) )/J'7 . I h /,'1,'~ t..(..t. 'h.'.J.... ~ l.}')(),p''''o-' ;.. Pc. 1/$ .Iv',- /;) $-..) ,) .....................COMPLETE.r#oaDEATHsOCCURRING..ASOF,JANUARYjJ...198ai..........i................................... ... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . .....pl..eJ:\$J;paII"ftNAMJ;4~PAUPfn;$$'Wl-Ieal;aeQQfitP.$HPQl..p$e$e~'t>.................... . Name Address City State Zip Code DOH-294A (6/2000) _3'RO(lP,"~K~' -SP-wA--FPINGER __ _ . RCIlJNIT 18 Middlebush 8.4. WappingersFalls, NY 12590 Proudly Serving Since 1917 To Whom It May Concern: My name is Scott Hurley and I am an Investigator with the New York State Police. I am conducting an investigation into the death of the following person and am requested a copy of the signed death certificate from your office. Richard Briccio 05/01/32 68 Pine Ridge Dr Wappinger Fall NY 12590 If you have any questions please contact me at 845-298-0952. Thank You, Inv Scott Hurley **** NOTICE **** The information contained in this message is privilege and confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly forbidden. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the above address via the United States Postal Service. TROOP "~~ -SP~---P-PING-E~ u-=--RCIUNfT -- 18 Middlebush Rd. WappillgersFalls, NY 12590 ~, ~.-=''''~ Proudly Serving Since 1917 11/21/07 To Whom It May Concern: My name is Todd Kara and I am an Investigator with the New York State Police. I am conducting an investigation of an Unattended Death that occurred on 11/8/07. The deceased information is: Sharon A. Soper 2/5/61 7 Onondaga Dr Wappingers Falls, NY 12590 I am formally requesting a copy of the Death Certificate filed with your office. If you have any questions please contact me at 845-298-0952. Thank You, ~~,L Inv Todd Kara **** NOTICE **** The information contained in this message is privilege and confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly forbidden. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the above address via the United States Postal Service. NEW YORK ST ATE OEPARTMEN' onlEAL TH Vital Records Section APplication to Local Registrar for Co of Death Record FEE: $10.00 per copy or No Record certification. Please do not send cash or stamPS. ::::y_~Ili~.~t:l1iIl'i_-~,,~"i"t;" rlI._ Date 01 oeath or Period to be covered by Search IV '" CL^,,"" Ii ( - - LaSt / / 'J {/ /, Social Security Number 01 Deceased Name 01 Deceased First\}Os(' Middle Maiden Name 01 other 01 Deceased Last Date 01 Birth 01 Deceased Age at Death onth L~ Da - Name at Has ital or Street AddresS f' 1&11/ t jVO(S/t'i purpose 10r Which Record is Required cilia; What ",as your relationship to the deceased? In what capacity are 'Iou acting'? 11 attorney, name and relationship 01 your client to deceased RECE\\lEO ~ Signature 01 APplican Address 01 APplicant "H'";__FptIt_"i\i:!li;QQ_\~'A$'6F\J~:Y;l;;_;;"";;;;nnn//: a Number at copies requested ",ith comidential cause 0\ death _ Number 01 copies requested ",ithout confIdential cause at death ,Y~la;"_!_~!.__~~~~tQ')'lti;lW State _______ Name Address City ..-",nn.\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Cop 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. Name of Deceased Sharon Ann First Middle Name of Father of Deceased Daniel First Middle Maiden Name of Mother of Deceased Loretta First Place of Death 7 Onondaga Drive Name of Has ital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlef\e.~8~ea. PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search November 8, 2007 Soper Last Soper Last Social Security Number of Deceased 092-56-0391 Last Date of Birth of Deceased 2 5 Month Da 1961 Age at Death 46 Mancini Middle Year Wappingers Falls Villa e, Town or Cit Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? 3 2007 If attorney, name and relationship of your client to deceased ~~7 ~cJv~ocL1 1028 Main Street, Fishkill. NY 12524/ Signature of Applicant Address of Applicant Date November 9, 2007 ., COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 5 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 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coe.v of Death Record .PI...EASEPQl\I1f.'(..e1"ef'QFll\l1..4NP..ENOUQSE..fEe.......... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~(~A PIS N:6(J., , Middle Last Name of Father of Deceased 'JoSepH First Middle Maiden Name of Mother of Deceased AtJG.'.WA As-t~. First Middle Last Place of Death ~~"AJ' ..r W~,.,"""S Name of Hos ital or Street Address Date of Death or Period to be CoveredtoiflJ<6LE 1//4 :2407 RK Social Security Number of Deceased 07.3 --01- f.l. J ,-- r-PlaJUIlS Fi4f,u Age at Death 'j- ~'" T Date of Birth of Deceased " 'I "/2.- Month Da Year , Town or Cit Coun Purpose for Which Record is Required a-",~ A(:f/hA4 '- What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your clie I. ", Signature of Applicant Address of Applicant . -..."'....-..."........-.-............................................................,...........-................................................... ... --.............,......... . -. .--.................,.....--..........-..........................................................................--..-..........-....................... ....... .............'".".. ...............<<...eOMPI..E'tEFQADSATA$.OCeOAAINQ.ASOFJANOARV1 .'''88).......>........ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .. ..............f.'UEASEf.'alH1TJ'44MEA..OAOQQ,;S$Wae$l$ft$PQftO.$HQQWPIIE$e..... Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for CoPY of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE NafAe)~f~c:ased A. V\JV\ fTC.-' Ja.V1V\!ew,cz... First Middle Last Nal1l.apLfather of Deceased ---r- Social Security Number of Deceased :\::::~':'f'" Cl.. rYl i Yl A, -..J at v1.V( \e V\..H 'c c... v H <t1 - ~tt ~ 22:80 First Middle Last Maiden Name of Mother of Decea~ .' \la lerie.- V1 ~\ First Middle Last Place of Death ~ . T::::>r d ~ Nc f4"{1 q 1 \m"Ye. ~ \Ii .. Name of Hos ital or Street Address ilia e. own or Cl Purpose for Which Record is Required \ ' E=hCf ~.{-" L~Q A~ \ <=:::. What was your ~elationship to the deceased? v1~ \ .( ('ee--\:::.( . In what capacity are you acting? OV\ .behoo.,-p cP-P .~Q......:~ If attorney, name ~nShiP of your client to deceased . ~. J,. \ ~ \ 0 ,- 2& --cr.:t- Signature of Applicant - '--- -- ~ Date Address of Applicant 1=C> J~~I' \~I ~~ .h;(~\~, ~1 I "Z-~6 PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search <J::"t. Z6, 2cc:q ~ ~ :II ~ '" ~ iil c j m = o ." :: ~ ~ 8 FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. Date of Birth of Deceased Z8t t'1~ Da Year Age at Death bz re:::.~ \ ~ ~~~ Coun COMPLETE FOR DEATHS OCCURRING AS OF JANUARY" 1988 ~ Number of copies requested with confidential cause of death l-{ t:.1_ t-: ~ \1 t- I ' _ Number of copies requested without confidential cause of death OCT I ~ 2007 - I VVVI'I '-'.......... II PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code DOH-294A (6/98) - -.. /."'\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.)' of Death Record ..Pti;A$E;PQMPue..,.E.FQAM..AND..ENPUQ$e..FEe FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased }4ST)C&- 11 First Middle Name of Father of Deceased 5t8/?TO..s First Middle Maiden Name of Mother of Deceased C'Nd< ).5///Y~ J<LD--V First Middle Last Place of Death i, ~ C/-j 1':--(3 r:- .R j PG-c- Ptf(? Name of Hos ital or Street Address Purpose for Which R~cord is Required Date of Death or Period to be Covered by Search sqr; 774- t2 t Last /0 -..:::('-1-07 Social Security Number of Deceased S (/,JtO 7/d7 C-a Last /30 -9,/-~~41/ Date of Birth of Deceased PEe ;z 9 2oo.s- Month Da Year Age at Death J wt/9 ?i:?'; IV C-I:-d'? F 19 L ~S ... p w 7C,;j C .f~ Villa e, Town or Cit I ~ t. C.'f::". J ~I t- I 'Count OCT 2 ~ 2007 h8/?;J/L' REQWc-:5T What was your relationship to the deceased? In what capacity are you acting? A-c-?d2G" St;:-7y7B7 ~ V'c-- CoLon.; ~--qoRJ?6l1.. /.;/O./'7c- If attorney, name and relationship of your client to deceased Signature of Applicant LO ~ ::?-k~ Date / 0 ~ 6,.-0 :7 Address of Applicant :5 00) RT 9 it/So 147/,;1 /Yc-N C-p//ypSO~, //"Y/-<.6-:.s-t3 ...............COMPI..ETEFQRDEATHS..ocCURRINGASOFJANUARV..1 .190............................................ . 2- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PI..!;A$E;P$IN'I"NAMEANQAQQSE;$$WHEA.eAEOOAb$I..O:)Ut,;O$I;$EIiA't Name Address City State Zip Code DOH-294A (6/2000) . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Reg istrar for COE!)' of Death Record ..... .......... ...........PLEA,$EPQMPCI$'I'EFPAMANPENPUQ$Sf::EE ........... .... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of Death or Period to be Covered by Search First ~ ') Middle Name of Father of Deceased Last CL,ero Ie; /~ /0 '7 Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Place of Death Middle 5 FrCJ\ '/0111 Last Month 7 1>r.: c,../~pr""~(lr$r.# rr Da ~~ Year~ ~ Name of Has ital or Street Address Purpose for Which Record is Required Villa e, Town or Cit Count What was your relationship to the deceased? In what capacity are you acting? Lc....~ E:n ;:O;ce,'Yt~..AT If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant "'2" v" >0-/ f> >~~. is MI.111~~OS~ Rt. ~r- "'1 1<-)10 Date ./'0/// /0 '( . ......., ,. ,.. __................". ..._..__..__ ..d.....' .... ..................................................., .........,. ................._.............,., 'H ,....." ...., ... .... . ...... ....... ...... . ............'.., :-:'"';.- . - .:::::::::UU:::/:::::::(U::UJZOM~PLETEjF08UDEATH:S~~jObCOR:RINGtls:::OFYJANUAFtVY1:: 1:III:CUi<<>>:/:::::::::::::::::::>'; ","-", -. --1- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .. ..)...PUEASE..PRINl'..NAMEANO.AODRESSWHEREAECPAD$HOOLO.SESEN.................................. ,.--, .'....,'................,..............................., ..................................-..-.-......................................,.......,....,.,..................................... Name Address City Zip Code DOH-294A (6/2000) .. TROOP "K" -SP WAPPINGER Bel UNIT 18 Middlebush Rd. Wappingers Falls, NY 12590 Phone: 845-298-0952 Fax: 845-298-1961 Proudly Serving Since 1917 FAX COVER SHEET TO: T/Wappingers T/Clerk 10/11/07 From: Inv. Daniel Smith Pages: : Including cover sheet Fax#: Note: Request for Certificate of Death for JOSEPH MATERa d.o.d 10/09/07 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for CoPY of Death Recor2 PLEASE COMPLETE FORM AND ENCLOSE FEE Name of Deceased -c:6~ First Middle Name of Father Deceased A \\en 5". First Middle Maiden Name of Mother of Deceased E"-..Je.! ~ -er First Middle Last Place of Death 1:=5 I---leeiew- ^"eVUAe... Name of Hos ital or Street Address Purpose for Which Record is Required . ~J-o-P L-\~ M-G.\~ What was your ~elationship to the deceased? ~~~\ ~~r --\t:.r . In what capacity are you acting? OV) ~ hq ,p ~ -the. ~lN\i ~ If attorney. name and relationship of your client to deceased 0 Signature of APPlican~ . Address of Applicant 1=0 ~ "Brbq PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search ~ ~ " :Ill III ~ ; o ", ~ m ~ o " FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. Last Cct. 1 0, -z.o::, 1- ~ ~ 8 -:8qlbnJ Last Social Security Number of Deceased O~l- zo .. o=TLfL-\ Date of Birth of Deceased ~QJIl. \ ~l \9'Z-~ Month Da Year Age at Death ca~ ~o.Ft~ ~\\o ~ Coun COMPLETE FOR DEATHS OCCURRING AS OF JANUAR. ~ Number of copies requested with confidential cause of death --i\/r' _ Number of copies requested without confidential cause of death OC f 1 0 2D07 TOWN CLERK . . PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT oJ Name Address City State Zip Code DOH-294A (6/98) _ _.. /."'t .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Reg istrar for COe>' of Death Record PLEASE COMPLETE FORM.ANDENCLOSEFEE.. ... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased :J CLm e-:3 ::J First Middle Name of Father of Deceased PLEASEPRINTORTYPE Date of Death or Period to be Covered by Search J11~ C!an(l Last M(1/( ~ ;L7 /1 ?J;L- Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Last Date of Birth of Deceased If) '1 c; I'll) Day "- .( Year Age at Death -; ~ F~ Village. Town or City County ;tJ~ ~ 'DCU~tzAL 11 What was your relationship to the deceased? In what capacity are you acting? If attorney. name and relationship of your client to deceased Signature of Applicant Address of Applicant Date JtJ'/9/o7 { I COM PLETEFOft DEATHS OCCURRING AS OFJANUA Y1.1988 _ Number of copies requested with confidential cause of death k Number of copies requested without confidential cause of death ............... ............... ... .... PLEASEPRINTNAME AN 0 ADDRESS WHERE RECORD SHOULDBESENT ..> Name Address City State Zip Code DOH-294A (6/2000) to . ; I ;$JI'AT.E ~f :NEW YOR'K ~R1r.MEN.J OF MIAL;TH - ~ ..-- - - , . :CERH:liNCAllGN OF, ,;BJR'jf\M ; NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar forCoe..x of Death Record Pl.EASECOMPl..ETEFORM ANDe:N~LO$E FeE . FEE: $10,00 per copy or No Aecord Certification Please do not send cash or stamps o r> .-1 :0-.... iT1 -- \ " Name 01 Deceased vJ illfP-~ First Middle I Name oi Fatherof Deceased 1 :Jo~ VI ~(/\ c::.s i FlrSI Middle Last I Mal9,en Name pf Mother of Decease~ I ~c /1 k t c;/r<=- <;. I First Middle Last Place 01 Death I ~ '3 50 Vi'>- ~. Name 01 Hos Ital or Street Address Purpose for Which Recor,d is Required ;1. S{v1A ~S Last pl.-eASE PRINTORTYpe., Date of Doath or Period to be Covered by 81tarch~ m C) ::D ~ at:?.. ~ Social Security Number 1 Deceased T Ot,?'1--- 3'1 - cr'1ucj Date of Birth of Deceased f I .q Month Da /q'i;; Year Age al De,,:' t1 ~~~~ Count' i WII"I was your relationship to the deceased? _-______ i 111 what capacity are you acting? FtI I(y,{"J 1)IY"Cv k.r- lit attorney, name and relationship of your client \0 deceased S'gnalure ~I APPllCa:b ^ ~ ~:u Address 01 Appllcanl '" "-~ ~.-. . 2- - - 1..< ~ . ( oalef {t'Tn :::2f, , (? s:- 72 I ' " COMP~ETEFqR~~AT8~ '99CURRI NG AS OFJA~UiRY 1 ,1 ~6& I -1-(;) Number of copies requested with confidential cause of death I I I _._ Number of caples requested without conlidential cause 01 death I ' PLEASEPRlNT NAMg AND ADDRESS WHEREAaCORD<SHOUL.b8E SENT i I I I i Name __ Address Clly State Zip Code DOH 294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COf?Y of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE ~ ~ :II :oil en ~ ;a c m ! m ~ o " 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 ----r- Apple~~r. ....Johl""'\ A. Apn \ ll,2CX!>1' First Middle Last Name of Father of Deceased Social Security Number of Deceased ~~~ A. A-pplc-h::n I Sc--. \03> - 2Co - 2-9<0 D First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death ~~ S. EV'I~"",~ -J LA V)e. 2'1. lct.o~ ~ First Middle Last Month Day Year Place of Death 1N~..r ~;-C:lrl e.~S:. 8' .=rdit 1=:::h'" €- Name of Hospital or Street Address Villaqe. w City CQ~ Purpose for Which Record is Required ~ \" ' e-nj l ,--re. c ,,' o-f ~ ~\ ~ \ '}.\\\\1 ",n "'I What was your ,elalionship to the deceased? . ~ne=-" Dre.<>- ~ , ~ C'~~~ In what capacity are you acting? c::::n ~. ha.. t .f=' O'-P ~vnl If attorney. name and relationship of your client to deceased Signature of APPIiCa11t~ ~o ~ ~ Date ~ - 2-Cc -cr;==t- . Address of Applicant ~ ~ \~l . \~() , ~ ~ 8 COMPLETE FOR DEATHS OCCURRING 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 J Name Address City State Zip Code DOH-294A (6/98) ....."," t:> NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for Copy of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE A. First Middle Name of Father of Deceased Social Security Number of Deceased 098 - '22~Seor z ~ ~ " :ol II> ~ ;;j o m i ... i: m ~ o .., :: ~ ~ 8 FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~okl R'e?he..tt~ Last PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search ~+, Z-6'.2C:Or ~ ~bdeo..u. First Middle Last Maiden Name of Mother of Deceased L-"Ili' o...V) Va... n' V1 First Middle Last Place of Death 9 I A.--d m::JV""e...."D-. Name of Hospital or Street Address Purpose for Which Record is Required Date of Birth of Deceased ~lA(Y \'"2, \C}a" Month Day Year Age at Death -=j, =T ~ r-r.., 1\'1 e.r Village~brI City ~~~ County t:=~ c-t f ,-fe.. O;.~rs What was your ~elationship to the deceased? F}\~\ ~V-~ .k:c- I n what capacity are you acting? i"'V'\ ~ ~ I ..p ~ '-k. '1'\"\ \ l.j If attorney, name an~ relatirShiP of your c1::deceased Signature of Applicant ~ ~ --;:: Date Address of Applicant l=c ~ ~ ~ (, -- ~~ \ '2.SC1 0 9 - Z& 7::.A- COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1- 1988 1- Number of copies requested with confidential cause of death R E C F: ~ \f 1-1 J SEP 1 6 2007 _ Number of copies requested without confidential cause of death TOWN CLERK PLEASE PRINTNAMEANDAODRESS WHERERECOROSHOULD BE "t-'V.I-I . .,I Name SEP 1 6 2007 Address City State TOWN CU::HK Zip Code DOH-294A (6/98) " ......, 1")/ I Q 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 Florence E. Silvestri First Middle Name of Father of Deceased Frank First Middle Maiden Name of Mother of Deceased Mae First Place of Death 17 West St. Name of Hospital or Street Address Purpose for Which Record is Required To settle husbands estate .PLEASEPRINTORTYPE ...... Date of Death or Period to be Covered, by Search Last Dec. 18, 1989 Social Security Number of Deceased Fusaro Last 118-30-9892 Middle Blacher Last Date of Birth of Deceased Sept. 24, 1939 Month Day Age at Death 50 Year Wappinqers Falls ~ 'Village. ~ or -t piE.CE-"/ \- ~ 'LOU? Dutchess County What was your relationship to the deceased? Funeral Director In what capacity are you acting? same If attorney, name and relationship of your client to deceased ,OWN CLE.RK Signature of Applicant ~ a .Ai),P'J.....{.-..~ . Address of Appli~ant 64 E. Main St. , Wappi. crers Frlll c:: , Date 9-26 07 N.Y. 12590 COMPLETEPORDEATHsOCCURBINGAS. OF. JANlJAHY1198S.... ---1- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASEPRINTNAMEANDAOORESSWHERERECOBDSHOULDBESENT.. . .. ..d Name Address City State Zip Code nnH_?q4A {R/:JOOOl NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PLEASE. COMPLETE FORM. AND ENCLOSE. PEE .. FEE: $10,00 per copyor No Record Certification. Please do not send cash or stamps. Name of Deceased FI?AN{',4 R. First Middle Name of Father of Deceased FRqAlc./S ((. First Middle Maiden Name of Mother of Deceased M!1,ey I}, CoR.C6RIJIo/ First Middle Last Place of Death 3 Cj PI?~5I'c('T sT. Name of Hospital or Street Address Purpose tor Which Record is Required ..PLEASEPRINTORTYPE Date of Death or Period to be Covered by Search /RAVIS I :re. Last S Ef'7. :;A.3.. :AD 0 7 7/(4 '! IS. 51? Last Social Security Number of Deceased DrJd -:It.- ~'1t.S- Date of Birth of Deceased .PE~. ~3, /93:L Month Day Year Age at Death '74 WfJPf';AI6T,e:/?S FIlLL~, Vi lIage. rown-oF-Btty .j) U7c:..1-I~S S- County -TD SETTLE ;;STA7r What was your relationship to the deceased? p, J.A!pR-I/L J> I K EC.7 0 L In what capacity are you acting? SAM F If attorney, name and relationship of your client to deceased Signature of Applicant ' ~-",-', . d LJ-?Ldtfl' '" 1- Date Address of APpli~ant ~ 4 E. fJ1.tJ,A/ S7. Ij/"J~pr/f)(;FI?<:; F/9a~. 1/[. y l3.EC.E V 1-1 J SEp 1 ~ 2007 . TOWN CLERK 9 - ;?~ -0'/ ...COMPLETEFOROEAT'l-IS0cCUFt:RINGAS .OF. JANlJARY1 1985i -'!2- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .. . ..........PLEASEPRINTNAMEANPAODRESSWHERERECOROSHOULDBESENT<. ............. State Zip Code Name Address City nnH.?Cl4.A lFi/?OOO\ .. TROOP "K" -SP WAPPINGER Bel UNIT 18 Middlebush Rd. Wappingers Falls, NY 12590 Proudly Serving Since 1917 DATE: 09/16/07 TO: Town ofWappineer Clerk FROM: Inv. Scott Hurlev Fax Number: Direct Number: Emergency Number: Email Address: (845) 298-1961 (845) 298-0952 (845) 298-0398 SHurley@troopers.state.ny.us NOTE: Re: SP Wappinger BCI Cases, Unattended Deaths Writer requests Death Certificates for the following unattended deaths that occurred in the Town of Wappinger: Rachel Walters (05/31/64), Date of Death 09/08/07 Barbara Stevens (09/07/40), Date of Death 09/16/07 If you have any questions please contact me at the above numbers. Thank You, Inv Scott Hurley **** NOTICE **** The information contained in this facsimile message is privilege and confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly forbidden. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the above address via the United States Postal Service. . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.>' of Death Record UPI.IEA$I$PQMPt.l$mEPQ1AMANI'.)$NCUO$I$FEE> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. First} Middle Name of Father of Deceased Date of Death or Period to be Covered by Search ~~~ Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Decea.sed ~)/ Month '{ Daf i Age at Death Year V First Middle Last Place of Death l~U'1~'l,J~rL- Name of Hos ital or Street Address Purpose for Which Record is Required Villa e, Town or Ci Count C\-JlNI 11'1 1\ { rYl vt: 5 What was your relationship to the deceased? In what capacity are you acting? ?~'i If attorney, name and relationship of your client to deceased Signature of Applicant .a-~ 7 ~~ Address of Applicant )1\ sl ;& Jl1lo~t,<;~~ Pcdta-- DI!~ / ~ Date WJ\(1f1/ y~ ~~fL- '9/17/4 / / ~ Number of copies requested with confidential cause of death "'*M<~'~E?~BR<..<....D........E........~j..H.......S..........~C>lii...R......R.......I...N...... hXS..........". F.......... jiN.......U/~. /DHM1U1...li..~i!i......... U<....... .............. ........yy ..r:;,","::.::: ..F:Y,.. _ ":';:,. ...v~. .v.. . .. ~.M. Y. .~"... .MO;:l;:.... ... ~~... - Number of copies requested without confidential cause of death P....~$EP$U""tN.IE.*N$AOQRI$$$iW"ERI$AEP<>AQ$apUl;.paE$EfiI,.U Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Copy of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send cash or stamps. Name of Deceased Barbara Jean First Middle Name of Father of Deceased Franklin First Middle Maiden Name of Mother of Deceased Esther First Middle Place of Death 49 Marlorville Rd. Name of Hospital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Stevens September 16, 2007 Last Pepper Last Social Security Number of Deceased 130-34-0169 Rose Last Date of Birth of Deceased 9 7 1940 Month Dav Year Age at Death 67 Wappingers Falls Villaae, Town or City Dutchess County 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 ~~ e Z!"'. cZ. ~ - Address of Applicant 1028 Main Street, Fishkill, ~2524 Date September 18, 2007 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 5 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) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for Cory of Death Recorg PLEASE COMPLETE FORM AND ENCLOSE FEE ~ ~ :II ,0: (Il ~ ;;1 C III ~ III ~ o ." ::: ~ ~ FEE: S 10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased \fe~ce ~ Date of Death or Period to be Covered by Search ~~.-::::::.Y'\ -p ~'i. \0.20c/:r First I I . Middle Last t I Name of Father of Deceased \Ie ~C-C.- Social Security Number of Deceased ~n~c..c> 'e>9- 2-~ -9-+01- First Middle Last Maiden Name r Mother of Deceased Date of Birth of Deceased Age at Death "-1 ern \c ~ ~{I c'-t~ Fe-b. 2-5 I \93~ T-<-i First Middle Last Month Dav Year Place of Death ke.~M~v--'n 1<.~ v~~ .~-\-C-~ (0(0 Name of Hospital or Street Address I County Purpose for Which Record is Required =t::::{,,\J of ~ A~~,~ r-. What was your ,elationship to the deceas~? _~If' ",,-fc "-\.~k.n '~ !J- In what capacity are you acting? ~'-~ ~ (""~C'~ If attorney. name and relationship of your client to deceased Signature of Applicant ~.~ Date '9 -IT -oT Address of Applicant \"2::\ ~~~.~\~ ~7 1 C$ o COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 JQ.cl Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death I PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code DOH-294A (6/98) . .. -,nt' ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record ...........................................PliJ5J,\SEQPI\IlPt.;.E;1"Ef'tlAMANP.eNc:UCi)SEFee.........../> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. I Name of Father of Deceased 111 c /, If 1;./ First Middle Maiden Name of Mother of Deceased S;?I(c2A First Place of Death Z 0 ~ ~ h r Date of Death or Period to be Covered by Search ~f''td / I~st U I'-f ?... (JJ to - (;J ~ Social Security Number of Deceased /3::2/(/j Middle Last O~hq)lfrj6- Date of Birth of Deceased J.f 3~ If If Month Da Year Age at Death Name of Hos ital or Street Address Purpose for Which Record is Required ,- Ir/zJfjJ ;/'{'IU<$ 7.015 III Villa e, Town or Cit ~~ ;?i/;;he-~s County What was your relationship to the deceased? )-/ (" S h "2 1'1 /- /' In what capacity are you acting? . , If attorney, name and relationship of your client to deceased '" Signature of Applicant Address of Applicant ...<.U.....:......<.............U.......UUCH,COMPLETEFOa.:DEATHSOCCURFIlNGASOF.4ANuARv1198s.C......<<(i<.................... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ at.:l;A$J:EeaH'm~J5ANP.Qae$$Ml:aEaE;AEQPAP$aPQ#Pf;le$EN$< Name Address City State Zip Code DOH-294A (6/2000) -"/--"t~! ;"\ ~ d-~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Col!)' of Death Record >pl.8e;.AS~PPfJlJ?I.J;"tI$F:()l=ll\llAN[)aN:QU()$ef'l;e> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Namen.. of .DEf.ce'f. ed ""'-f- I ^ l~ (\AQ : ~ ' ()J a.. ('t't'fS First Middle Last Name oLFather of t;>eceas~_d r IT) \ ri 1 t ! l"{i'{}/ J I ~(.f VIMt>'l,J <'i. .: (eN r- ,t~. Vi'I'.}) " ~ First, Middle Last i Maiden Name of Mother of Deceased Vlr'7 ( N (~- . First Date of Death or Period to be Covered by Search q~g- OT Social Security Number of Deceased 69:::; - 0).- 75"?-j Middle rJ2.u~ tr Last Date of Birth of Deceased tJ~, 51 Month IiJ1 Da {)JAe Pi ~J1e( . , Town or . Age at Death 19C'I- Year '13 Place of D~th I' 'r'. . I <Z ~ ~\ 4 \ -e V {"'~ J~ Name of Hos ital or Street Address Purpose for Which Record is Required (l.~ p /."7') : 1'17'\ DJ'( ~ V ,"- vl '" County Or rr) . f v:...e..ot I" V'-... What was your relationship to the deceased? jL/ (/L-....-^.. I n what capacity are you acting? r;;,V(J veJ! i) t.( ec:/...n If attorney, name and relationship.. of your client to deceased . , /~'2J/1 Signature of APPli6ant"'~A~ &U.::.- Address of Applicant l/..3 'Tf ("VI ~ ~ Q Date 7-/3-d? ;JY ('20~" ( / >>/>HCOMPLETE':POFfbEATHSOCCURRlNGASQFJANUARY:11>19SS> ! .' .~ ~. Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ <iPt.-I$.A$I;J?alNl"NAMI;ANQ.l)$e$$:WHl$ft~l=lI$P()I:;U)$aQQl.8tlEU:.$eN""'< Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for eoI!)' of Death Record . .Pl..I;Tft.f'ORlIIIANOENCUQ$Efl;f5./............... ... FEE: $10.00 per copy or No R~C8r~ G~r!ific:qtign. Please do not send cash or stamps. Lpst Date of Death or Period to be Covered by Search ~(30\0/ Nam e of Deceased _ Co lee n ~J::>. First Middle Name of Father of Deceased E I Y)U)( First Middle Maiden Name of Mother of Deceased CR~ ~ COA/~n-Cfvv First Middle l,.ast Place of Death /7 Cf Vovv-My ~ Name of Hos ital or Street Address Purpose for Which Record is Required }Jt t Il-h' rpy I U Lets t Social Security Number of Deceased 0-7(;,- 5b-S~3~ ~/;;lr7~ Villa e, Town or Cit Age at Death 52- '])u.;I chi u Coun Date of Birth of Deceased 9/2-0;/5;<-; Month Da Year What was your relationship to the deceased? _~ In what capacity are you acting? ~. r-aL. VI yec:kv . ',', If attorney, name and relationship of your client t9 deceased Signature of Applicant A ac~~... .... ._.. _. ...~. '~.~_._' Address of Applicant ~ 130 x. . ct-r p.etAJLU Date JG1 ~/3! 107 ftLj _ Number of copies requested wlthO\.lt confidential cause of death ..Pl..EA$I;...PRI.NT..NAM'lA.NP.:~paeS$.:'WHf5aE..FlSQQFlQ..$HQOL.p..$E$f5N.P............... Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Copy of Death Record 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 Decea.sed Date of Death or Period to be covered by Search Jason Thomas Coyne July 9, 2007 First Middle Last Name of Father of Deceased Social Security Number of Deceased Thomas Coyne 089-68-3759 First, Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Janet Opuszenski 3 13 1981 26 First Middle Last Month Day Year Place of Death 16 Hackensack Heights 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? Funeral Director In what capacity are you acting? If attorney, name and relation,ShiP ~ deceased Signature of Applicant ~~ Date July 10,2007 Address of Appliyant 900 Rt. 82, Hopewell Junction, NY 12533 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 Address City EeE.'" """ \ I p.- - ~ 1\)\)( DOH-294A (6/2000) ~\\G 1 ,O'l'JN C\..E.f\K NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for eoI!)' of Death Record <PI..;)=J).$ISCPMPOSl'l$ffORlVlAN[)J:NCUQ$t;:F.EE: FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased R~J-i€L fII First Middle Name of Father of Deceased \It N f2t5N-1' First Middle Last Maide~me of Mother of Deceased "'J~/\JE LJvJ<.I\JDf-J,J First Middle Last Place of Death ./J._ Hv/j~/.J HAvE~ JCeI1A~ Name of Hos ital or Street Address Purpose for Which Record is Required ~ (!-l)LO Last Date of Death or Period to be Covered by Search lIu~ IdJ ~OD7 !y!lNU!4J Social Security Number of Deceased 07;2-05-'-1S~6 Date of Birth of Deceased 0";;' - 0..2 - ) t} I q Month Day Year Age at Death 0APP)N~.s 4LL5 <gq D~~E'$ S Count What was your relationship to the deceased? h),'\JERA<.., be&'&f1J1l In what capacity are you acting? 1CN6'lIJL. b0:5t!/PDi- If attorney, name and relationship f ur client to deceased <t-IL}-o? Signature of Applicant Date Address of Applicant ~/ Gbl'.)G'y lIiJ~. N€rJbulGll , NY /;2.SS-/) : COUFH,jETEFOR::OEATHSOCCURRING AsOI#JANUARV1J1985> ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ . ....:...:...:..............>..I?LI;J.\$J:Pfnf'fl"NAMJ:~NQAtlPat;$S)lllflI$$SRI$OPRQ$HPI.J:l...[)$I;$I$Nl?.......><>:i.::i.:.:.::::::::....... . Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section ~mP Q Applicatlf6"" to Local Registrar for Coey of Death Record .' .......................<.........\.../......pueA.$E:PQl\Ilal..!E:"TfEF. O. <....FlM....... ..\.4.......8. ..0.... ENCL. 0... SE.. 13ES.... <................ . .... ....-. ......."..., --- --- ,----..-...,-, .. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ~e of Deceased ~ rfJ. t (' ,. L Ie --' First Middle Name of Father of Deceased R oS C- Last Date of Death or Period to be Covered by Search oS -- Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased ~ i A /' ~ L /)'r/rv y~c.." First Middle Last Place of Death t/oM. ~ Name of Hos ital or Street Address Purpose for Which Record is Required o~ Month Date of Birth of Deceased ~ 25 Day ~(j Year Age at Death l)? .........................>....><...>i?LE;A.$e..afUN'T'NAII/lt;ANQ...... '.. What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client Signature of Applicant Address of Applican / </..:COMPWETE'f;oaOSATHS -L Number of copies requested with confidenti _ Number of copies requested without confide Name Address City DOH-294A (6/2000) Df;~RTM~N~ " HEA,-T~ CITY OF NEW YORK CERTlFICA TE OF BIRTH REGISTRA TlON Above is an exact copy' of a eertU'lca.te ,t_.l1. Ocn tbe da te indicated, in the Bureau of lteooJ'ds a.nd St&t1Stict-of ''tMD$pa.r1/lll:en't of Heal t[, in the borough in ..hich the birth occurred. ift isseQ1Itf'~thout cilar,:e, pursuant to the provisions of Section ~67-3,O of the Adm1u'istrtl.tlve Code of the City of New York. If the certificate contains any errors, return this copy with the corr"ct illformation to the Horough Registrar in tbe borough where tbe child W/iS borll, (See address below.) He will advise you how to proceed to have Le,,, record corrected. It is important to do this at once. ~ (;: '~<<---.\ ,It~ ~~ ".D. ~.j),' Cad rt. ~ \'IlYO" O:x.t,11 55 IOhE.R OF hE.Al TH 0 I RECTOR OF BUREAU ltA~HA TTA": THE BRO"X: 125 WORTH STREET ~ROOKLY": 295 FLAT8USH AVENUE EXTENSION 1826 ARTHUR AVENUE QUEENS: 90-37 PARSOHS BOULEYARD, JAMAICA R ICHNO"D: 51 STUYYESAMT PLACE, 51. GEORGE, 5.1. ' , . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record ... ............................................./.......pGE4SEyQMPl..r:TE.eQFJM..AN[)I2~QUQSe..FeeY>..... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of Death or Period to be Covered by Search First :~-h<"c 1'- Middle :r Name of Father of Deceased Last ')e l)O().1 /7'97 Social Security Number of Deceased First :kh,-...) Middle Last .~ -A..- Maiden Name of Mother of Deceased Date of Birth of Deceased First Middle Last Place of Death I t,rG{ c.. F:h;tJ~ Name of Has ital or Street Address Purpose for Which Record is Required M onth ~ Da cJ J ;r~o Year Age at Death 11 WC}fP; fo')~~ (''Iff') Villa e, Town or Cit ;V-f [) t!tc/",- ~ '") Count ~ ~~ What was your relationship to the deceased? t~ In what capacity are you acting? ~ ) If attorney, name and relationship of your client to d ceased 5' ~(.(~<.. Signature of APPlicant~ .J. ~ Address of Applicant 5" (~aI~ D ~ vJq/pJ'1~" r~ Date ?/ PIO '7 ;J. y 1.;l.j9o I .............................................. .....................-................................. _ Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death/ .pt.;eASEe$n'l.,.HNA'MI2ANQ-At')QaeS$VVHEAeFJEP<>FJQ$HPQ:G[)i.ElS$I5r'AX/ Name t?aRol/~ ~Rr--'e..I Address f! 0 130 -I- I 2. I City ~ e~ State );7 f / 2- V"L , t!d~ 911 - c;ioCj -~oJ?tJ DOH-294A (6/2000) 2007-08-06 14:07 HEINTZ 8454964684 >> (845)298-1478 P Vl General Information and Application For Genealogical Services NEW YOM STAle DEPAR'llIENT OF HBLIH v.... ..... SecIoft, Gen.tlf... '-'iI P.O."_ =:r. Nfw ,ark 12220-_ VITAl RECORDS COPIES CANNOT Be PROVIDED fOR COMMERCJAl ~POSES. , 1. FEE- ..idIdII..m......a.d aw ar .JA.-'l'kal.___ 2. cqM,..... fit......... _.................. ...1_........... 1-' EXCt:p, .......w it ............... Y~...-1It 1"4. ~..... tar................ ...,........ S. Tht.... Yon ... lJl.p-' I 101.......... nuI__.. YIWkc., r-.b ........ .... ~... .. QuMfts MIl f. .. .....U...tIIIU.... ---..., .,.....,. I .. nUL. 'u uAHJIIr a .......It"1III't.D ~~-...f.t ....v...."" tA.... .. ..... ,.......... ._.~... I .. . _ Please complete for type of record requested, birth, death OR marriage. ,.... ..... 0.". PIIa! "... r____J. .i...__ ............ -- . ....... ....~ ... af~ 0. "..... .~ NMIe II 08Ilh~ n p '~eJ) . , ,.~~ (n;\JI'l).~ ~";l..lp-c1.1r ~ of 0eIdI") . Age" o.n.-S"Q"> L. __ ~S Place aI DMh t,J ~ ~f' \ t")Cf' r~ 1-<.:1 H..s: NIlles at PIrtN& -n..,.......... ~ S...r .t="r~ re I<v \ J 'j MIIM .. s,c... rJ)A -..... DIll.. ... PIb ...... flllllR Name ........1IIIiIIIn .... ..... III .. ___.. ......... ..,.... _I~ ..... ..... Ut~ ......._ .......... 0." 0eIIt PIIct at 0MMt NIns (I P... NIIM.. SpautI ~.~ Age at DeItb OQH-1562 fD6l2OO8) $lIGNA"-"E OF APPUCAt1T (ove,., 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 or No Record Certification. Please do not send cash or stamps. -\ ~ Z C> ~ '.. . :0 iT' Q. , \ - " - ~ :II ~ en ~ ~ o m i i m ~ o ." % ~ ~ PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Secf3l5h -- -J ul 6', Zen-, Name of Deceased \ R\ \;?' EJ'Narc 91 i en k ~ First Middle Last Name of Father of Deceased t::"d V\.lC\ ~"H . Gj 1\ e V} Y''"~ First Middle Last Maiden Name of Mother of Deceased ~I'}e.. e Gt,' Il.e.ert First Middle Last Place of Death y:t -Helen t::::h",~ Name of Hos ital or Street Address Purpose for Which Record is Required j ~0'1 a-P L,.\; SocIal Securi umber of Deceased C$ o 6,1 - y ~ - 8Z-Y ~ Date of Birth of Deceased CSc-+ 22 J Iq::, ~ Month Da Year Age at Death S~ Dv-:'\c..\.te~ Coun A~l~ What was your ~elationship to the deceased? F1AV'le~\ '"Dre.c:. ib..r In what capacity are you acting? OV""l be:... ha. \ -r 0 -9 fuvV\\ \~ If attorney. name and relationship of your client to deceased Signature of APPlica~' ~ Date Address of Applicant --Po ~ , ~ j C ~ P- I '2-S') (j I '8 - 2.. -a '";f COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 l0 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 ..I Name Address City State Zip Code DOH-294A {6/98} . .. -,rH' Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for CoeV of Death Record PLEASE. CQMPLETEFORM.ANDENCLOSEFEE... Lu FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ^.- "..) .........+.Pi....... .' ...... . ... </PLEASEPRINT::ORTYPE.. .... H ........)P ......~ Name of Deceased Date of Death or Period to be Covered by Search JOHtJ f. ._5il..l/ff5TI2 I ..JULY First Middle Last 3 j. ~oD7 Name of Father of Deceased Social Security Number of Deceased JOSc:rH P. .5 i ~VES7r< I (j~7-d:J- 3/0~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death GLAD fS N) VE~ o~ ;;2.( Jq'd't 19 First Middle Last Month Day Year Place of Death 17 (,JEST 51. W/JPf7/NC::-ER.5 /~':;Lf..S. .z>{jTCH€~S Name of Hospital or Street Address Village, T~oi;...Cit.y County Purpose for Which Record is Required To 5 E7Tl.€ E ST4 Te What was your relationship to the deceased? t=v tJ~(2iH- J) , 12. GL7 a <<- In what capacity are you acting? SA/VI~ If attorney, name and relationship of your client to deceased Signature of Applicant -J}~~"<~ (1. ~b ~~ :;q~ Date 7-3/-(Y1 Address of Applicant Cq. E. M~/I\I T uJ I' N~EJ?S FJ9.LLS /If. y_ (;;2 S90 COMPLETEFORDEATrlSOCCURRINGAS OF.JANtJARY1198gd ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASEPRINT:NAMEANDADDRESSW;HERERECOROSHOL/LDBESENT. ....: · ... ".d) Name Address City State Zip Code nnl-l-':>Q4A IFl/?OOO\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Town/City Clerk for COe}' of Marriage Record :::::i:i..:::::::::::i:::::::::::::::::::::i:i:::::::::,:::.:::::::::::j:::j:::::::::i:::::l:::::::::::::::i:i:i:::::::::::i:::::::i:i:::::::::::~::::::::::1I111:l_::::1:1111:1:::1111111::::11111.:::1_1:::::::::::::::::::::::::::I:I:I:::::::::::::::::i:i:::::::i:::::i:::::::::I:i:l:l:j:::::::i:::::::i:i:::::::::::::::::i:i:::::::::::::::::::i:::i:i:::::::: Search and D Fee $1 0.00 Search and ~ Fee $1 Certification Certified Copy 0.00 per copy per copy A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occumng on the original record of the marriage. the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed information may be required such as: passports, veteran's benefits, court A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an est~-CE I 'f ~- ! I l::.~. .- . I ~ Aur; 0 1 2007 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::111:..:::_1111.::::1111::::111::::1:111:::151::::::::::::::::::::::::::::::::;:::::::::::;::::t::r;r:r::::::;::::::::::::::)!::'::::!:H:(;:::::::::i::::::::::::::::::::;:::' PLEASE PRINT OR TYPE Name (First) of Groom Groom's Age or Date of Birth Residence of Groom Date of Marriage or Period Covered by Search Place Where Ucense Was Issued (Middle) (Last) G Vf$ cr. (County) D l.JTQ.t4. LSS (State) Nlj I I T Wl\ff~ w Name of Bride Bride's Age or Date of Birth Residence of Bride If Bride Previously Married, State Name Used at That Time Place Where Marriage Was Performed (First) (Middle) y A0L;f()€' C . (Last) 1<\L 36 jO (County) ])U.rt,tt~ (State) N~ s . H. t\ R.~ \5 . CD ~ Ul~ F~.N~ For what purpose is information required? ~~~A uQ F~ In what capacity are you acting? S~ What is your relationship to person whose record is requested? If self, state "self." 3~ If attorney: Name and relationship of your client to persons whose marriage record is required. Signature of Applicant LJ Address of Applicant 5 I t.:. 3 'R 0 UTI.... <6 2- SALT 'Po l'".fT I !'Vi 125')cg DOH-301 (3/93) Date 8 I 0'7 Please print name d address where record is to be sent. cy; \173 (PLEASE SEE REVERSE SIDE) .--------,~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record .... ............>............< <..... eUEA$J$C:()l\IfflC15TI$...r()flM4 Nb..eNPt.;C>SEJ;l:e................... . FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of ~e/a{t: OIOP~iOd to be Covered by Search SOSE?ft']rJC ry"tf2.(jt1t-l-f Fle'";"1 T a/I 7 First Middle Last Name of Father of Deceased Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Middle Place of Death 1- {2 tit:,,,, Cy Name of Hos ital or Street Address Purpose for Which Record is Required Last Month t I Day DiJ;v't. I W jtfP:pvC~ l.r Yea~ rmlJ, ,v y 1'7 ItJr-,~ Villa e, Town or Cit Count D v TeN N rsr:> Xi'\ fI' t ~ r What was your relationship to the deceased? In what capacity are you acting? ~ y Sf> ~" 1/ t.) r If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant ~~ ~ (~ 5? w A P PrN G tf1I.... '" +t>Dl..L l! tJS t:I Date 7-/t- ""'/D ~ . lJ ~ "" IrI1 p F" . ............................................\/..U.>.cjoMRLETEFORDSATHSOCOORRINGASW;)f;:.JANUARVH1988\i...i....:......::..}>................................... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ pt.;$A$li5afUI\{1'"JiAl\lfIi5ANb:AUPSe$$M{tll$$15:flI$QQ$O$HPQl.;l)lal;$I;Jirtw><> Name Address City State Zip Code DOH-294A (6/2000) , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record ......................Pl..e:A$I$(;PMeCE;"tf:P,OFlMANoc:tiJCUoaEFEE<......<............................... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. JUL 1 7 2007 Name of Deceased ~~S e p ~ <<.v<- First Middle Name of Father of Deceased rL.e~'P9 Last / Date of Death or Period to be ctOWN tG~filt(1 07 /lJ!:> 7 Social Security Number of Deceased t.v If" t,+G1,. First Middle Maiden Name of Mother of Deceased RQ~~ ~l~lSo~ -FIrst Middle Last P.Le.At/~ . Last /3 J -2-2 -?t.W Date of Birth of Deceased Age at Death Month II Da Ir 1'91 Year 7 Place of Death 7 R.~ceAlc." DJt..\V~ Name of R~spltal orlStreet Address Purpose for Which Record is Requi!ed WJ4 fJp:r NGe e. Villa e, Town or Cit .P GI+C ~e..r5 Count [);~roA- h~ --<-.r<r-.f 4Jt..eGrtl It(... LJ~hL- What was your relationship to the deceased? In what capacity are you acting? r"~ . If attorney, name and relationshi Signature of Applicant Address of Applican <i...CQMPLETEFORDEATHSOCCURRfNGASQF.JANUARv'11988<.< ..- ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ :PUI;:A$Eeall'iI'tNArilJEANIAQPRS$$.'Wl-If:ftl$:Rf$QPFlQ.SHQVl..OElI;$JENTi Name Address City State Zip Code DOH-294A (6/2000) 07/17/2007 11:03 8452974828 STRAUB FUNERAL HOME PAGE 01 III '11 Application to Local Registrar . for COe1 of Death Record .. NEW YORK STATE OEPARTMENT OF HEALTH Vital Records Section PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per <:opy or No Record Certification. Please do not send cash or stamps. N'~".d (L . ~c.~ First Middle last Narf of ~~t~e~~Q<>~~ C ~ Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased ~U, \.AJt~ ~ _ 4 - "3 l First Middle Last Month Da Place ot De~ (;) W~(" _ Name of Hos itaJ or Street Address~ Ilia e Purpose for Which Record is Required , ~~. PLEASE PRJNT OR TYPE Date of Death or PeriOd to be Covered by Search .::t - \ C) - 0 -1-- Social Security Numb$r of Deceued ?--L1'~ - 4. 4 .... Lf B l I.J Year Age at Daath =}S- ~ COI.m What W~ your (elationship to the deceased? ~~ ~ W dj re r:hJy- In what capacity are you acting? --- It attorney. name and relationship of your client to deceased . r. ~I.. I \>.... 0 ~ ^ filraub, Catalano -&.-Hflm SIgnature of AP~ l~ 5;:> casr -"lam &~t Address of Applicant P.O. 80)( 131 ~ .. Wbpplngel5 t'cws. N. y. 1<!S90 . --- '::} -- t3 --0 )--- COMtn ~ 11-. FOR DEATHS QCCURRlNG AS OF JANUARY 1.,1'M '7,,- Number of copies requested with confidentiaJ cause of death ~ Number of copies requQsted without confidential cause of death REC~'VFu JUL t 7 2007 IUWN CLERK - PLEASE PRIHTNAME-ANOADDRESS WHERE RECORD SHOULD BE SENT: .J Name Address City State Zip Code ntil4_~Q.r1.11. 1~/QRl \ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record <<eI.SEJ:\$Ey()Nlfll.iE;rEROal\ll.AN[)aNPUt)1iU~FJ;J;< FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Date of Death or Period to be Covered by Search Name of Deceased /7 {"cj.)v II \J M ~eEcV L- u~ J First Middle Last Name ~ather of Deceased C u~M6S (Af<-'2-\J First Middle Las Maiden Name of Mother of DecejJ1ed .-r 1'1 \. (''('vAG CON TV C> ) First Middle Last Place of Dqth ~ 0 d:$ tJ R lV\O \'-\, Name of Hos ital or Street Address Purpose for Which Record is Required o-=t Social Security Number of Deceased I ~ ~ 6-~S-SIj Age at Death r:t'L/ N""'-/ · 0 ~ Tvlv<:r Count l<'-J.j Date of Birth of Deceased lq~l\ Da 8q- Year lu~W/~6n Villa e, Town or Cit 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 fLY. I (; ~ ;; C)/)4 (" I Date 111 ;;~ Iv ~) <...CQMPLErEFoa.oEATH:sOCCURRINo..4soFaANuARY1U1988><>> L/ RE"FI\ --, -, Number of copies requested with confidential cause of death I _ \....'- > I t- ~ .' _ Number of copies requested without confidential cause of death/ JlILO 8 2007 -_. -.. --.- . . ."'L.l;;n~ . ...... ..... /....<............>PUeA$aflRIr(:tJ"'AMEANJ:l:1Qt)Pla$$'WaEf'r:-aeOPal)$HPUl...t)$I;Sef.ll...i...>...............>....................... Name Address City State Zip Code DOH-294A (6/2000) . 5t1"1l711. ~ C1MfL (~l()) (0) 1-\qq1- NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PLEASE COMPLETE FORM AND ENCLOSE.FEEp FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. .... t <I _ Ii ......... ........ ... . ... .. -/><----- ~... 'PLEASEPRINTORTYPS... ......,.... .,' --,cc. ~7....~ .........~~.. Name of Deceased Date of Death or Period to be <f6ered ~ Search Helena Bopp June 8, 2007 WN LERK First Middle Last Name of Father of Deceased Social Security Number of Deceased Michael Billie 097-14-0277 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Anna Dobrovolsky July 5, 1922 84 First Middle Last Month Day Year Place of Death Elant at Wappingers Falls Wappingers Falls Bgtchess Name of Hospital or Street Address Village,~eF-GH~ ounty Purpose for Which Record is Required To settle estate What was your relationship to the deceased? Funeral Director In what capacity are you acting? same If attorney, name and relationship of your client to deceased ... Signature oi Applicant ~ .a. 'ht':::~ . Date June 11 , 2007 Address of Applicant 64 E. Main st.. Wa in ers Falls, N_Y_ . .....i ......,COMPLETEFOR.DEATHSOCCURRINGAS OF.JANlJARY1198Il. ... -L- Number oi copies requested with confidential cause oi death _ Number of copies requested without confidential cause of death . ..PLEASE..PRINTNAME...ANIJ.ADDRESS.WHERE..RECORO..SHOULDBE...SENT..... ...., -... ,:, Name Address City State Zip Code nnl-l-?Q4.A IFl/?OOO\ (' i NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record <<>p:L..EA.SEPPMPl.iE;TEFOFtllJlANDSNCLOSEFSJ:: . -- . . .-" - _....- ......-.".......-.....--..... ,- ---.........--..........-....."....-....". FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Las Date of Death or Period to be Covered by Search '7/2.107 Name of Deceased First-rvlfMU Middle Name of Father of Deceased p bAN Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last First Place of Death Middle rtw~ f'fl "~(.r .1 Last Month Day Year Age at Death IECE'\/~(J JUN 2007 TOWI\tG Date of Birth of Deceased Name of Hos ital or Street Address Purpose for Which Record is Required Villa e, Town or Cit N'IS P IN" e .s -tt j d- .fwvI- What was your relationship to the deceased? I-./'IR >7"/ J A-7'V/2- In what capacity are you acting? I rJ 11"'& II~or~ If attorney, name and relationship of your client to deceased ~ ~___ /NV. ,1}1vl?#)I'\I/u;,^,~4J'.{I;tAQ Signature of Applicant - ,..../ Date 6 ! r /07 Address of Applicant /J1111dt.e..hvs;tt 4/" -r1fA../~r,P'-r.;..-r..y · < <<.....COMPillSEFORDEATHSOCCUBRINGASOFiaANUUY1ill198SH> _ Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death/ ..<...PUJ;A.SEattJfU':..(!.u,\fjll;AN$1U)PSE;S$WfilEFCE;F.lI$P()RP$!itQQ14b$I;$I$N1"y< Name Address City State Zip Code DOH-294A (6/2000) t' ,. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coey of Death Record < <Pl...i:J,\Si:yOl\llpt.;Erref'()FU\ilANDENCUQSEFEE .. -... ..... .- ,..."""-.....".,,,------... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Date of Death or Period to be Covered by Search - First Ih....' Middle Name of Father of Deceased p Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Place of Death Middle Last Month Da Year Name of Hos ita I or Street Address Villa e, Town or Cit Purpose for Which Record is Required ~'e :r-N~.. Count What was your relationship to the deceased? In what capacity are you acting? N1$P If attorney, name and relationship of your client to deceased L~-:r-. A.~~ Signature of Appliean · _ ' ---= _ Date II Address of Applicant 4"'D& M ~ 'L "., <COMPLETEFORDEATHsocdt..hlRINGAs:Q.e.:JANuARvHJ19ss>> L Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ ...........:./...:::..:..:.:.:...:.:.:::...::....:..<...:::.:.......:./....:f;,Ue.ASi:...eaJNmNANli:4NUA.QPI$S$.'WflI$Ai:..aI$OOFtP$f:1QI.:J:l...P$S$I$N$)<........:.....:...................... . 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 . .......................................................>....P:l...I2.A.$eOQl\Ilel...lSTsJ;.-Qfill\ll.A,NDf5NQLP$lSFf5JS>..<........>....../............... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamF. R EC~.' \f "") MAY 2 l 2007 Nb:e~~ +r~ased ~ r}-y First / Middle Lcfut Of) 7 Name Of) ~a~her of Deceased ) . I L WI" I) q'rr) R b ~ e tTe I J First Middle Last t; s7 - tJ -) () '1 0 M~i~en ~ame of Mother of Deceased .) ) Date of Birt.h of Deceased H ~ Ie h ReJ '! )'1CiJ'-el1';-;} 1) 3 First Middle Last Month Day Year PI~\o! De~th Waf. f/ h1~ Y' j ~ '1 .s&, J!J e.5 t!/,~ v~ ;:; jC( 11/ q )11/ _ . ~ 5 fq/ )5/ ) v. 7, )).. J 70 Name of Hos ital or Street Address f II q D } )1 t'YVilla e, Town or City Purpose f.or W.hiCh Recor~ IS Requ. ired r: Y) ~ ~q) fJ I> I11'C Age at Death 1i /) wf~. A e S S Count ome t'W .....................,-...-.-,..-...._..'.....'....,................-.......',.....................,.......................,..........:-'.....................'........,......;.......'....,'.'.......;.-,..-..............,.................,.....,..;,..........:.'............................,....................'...;...;.........:-.-:...'...........:..........................,..................'. ....................-...-..-...'.............-..--.... .COMPUerSPQA:OSATHsoeOOABINCA;SOl#J,J.A.NtJARYd19U) ) tJ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ .. ..............<.....L.......>.....<)...<........eUSA$eeRIN1"NAMI2A;NQAQPae$S'W'''''SalS.filS~Rf)$HPtf#pElI2~SNT)..............><........................................ Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Copy of Death Record 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 Carl Swenson May 8, 2007 First Middle Last Name of Father of Deceased Social Security Number of Deceased Carl Swenson 079-18-2706 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Maude Amato 1 9 1924 83 First Middle Last Month Dav Year Place of Death 158 New Hackensack Road Wappinger 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 Signature of APPlicantDi\ 8 "'- Date Mav 15, 2007 Address of Applicant 1028 Main St., Fishkill, NY 12524 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 16 Number of copies requested with confidential cause of death Ft) MAY 1 ti 2007 TOWN CLERK Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City 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 ~ ~ :a :0: en ; ii1 lii ~ i m ~ o ." % ~ ~ 8 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 W\ \ t', tu"vL ------- r~~lln~ \ S - \~- 2.--O0~ First Middle Las Name of Father of Deceased Social Security Number of Deceased CCe~ S. ~tUS(J)lS r~2--\ B- 9<al43 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death f1,e.VI-e V\.eve ~~~ll ), - 17 - Iq 2-~ gl First Middle Last Month Day Year Place of Death G R..cL lLhrp~ 2- 2A-1 ~ ~V\..Us.\ ~kiM Name of Hospital or Street Address Vi"age.~r City County Purpose for Which Record is Required "tY'- \ae\tW~D-\' ~V\M 10 RECF:"J.... 11 What was your ~elationship to the deceased? ~\\.R, vaQ riiv~ . MAY 1 5 2007 In what capacity are you acting? - TO'NN ClER,< If attorney. name and relationship of your client to deceased - Signature of APPliC~0 ~ Date $"-\:S --0'+ - , \~D Address of Applicant S'5 e. ~ "Sk-. .I u ~~\.S ,~ COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 .1988 ')-0+ I . - Number of copies requested with confidential cause of death 1 Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE. SENT ..I Name Address City State Zip Code DOH-294A (6/SS) . .. ...,n,' ti) 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. Name of Deceased Carl First Middle Name of Father of Deceased Carl First Middle Maiden Name of Mother of Deceased Maude First Place of Death 158 New Hackensack Road Wappinger Dutchess Name of Hos ital or Street Address Villa e, Town or Cit Count Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and properF~L}<J;1el deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search May 8, 2007 Swenson Last Swenson Last Social Security Number of Deceased 079-18-2706 Middle Amato Last Date of Birth of Deceased 1 9 Month Da 1924 Age at Death 83 Year 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 MAY Signature of Applicant Address of Applicant Date Ma 9,2007 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 Address City DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COe)' of Death Recorg PLEASE COMPLETE FORM AND ENCLOSE FEE <s - 2--0+ z ~ g :II :00: III il ri1 o m ~ ~ m !i o .., : ~ ~ 8 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Na~ ^D.~c"e~se~ ~i~S~~V\tV) ~I~ ~. ~Dece~ed , First ~ddle~la~ . Maiden Name of Mother of Deceased ~~e \~ Place of Death . I . ^. \ . j. J} 1\ ~ \J..QMJ ~~ ~. Name of Hos ital or Street Address Purpose for Which Record is Required ~~' PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search Social Security Number of Deceased o s-4-'i~-2-~~ Villa e.~~ Age at Death 3~ y~ Date of Birth of Deceased '5 - \-::r- - lo~ Month Da Year Coun What was your ~elationship to the deceased? In what capacity are you acting? If attorney. name and relationship of your client to deceased SignatureofAPPli~\\~ C ~ Date S-~-o:r Address of Applicant s-s-e, ~ Sb-. ) \i~~ Wls. ~ r:~..~O - COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1. 1988 S Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death PLEASE PRtNTNAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code DOH-294A (6/98) . ..--,nl' Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COe)' of Death Recor2 PLEASE COMPLETE FORM AND ENCLOSE FEE ~ a :II :0: III i:. ~ o I'l 'Il ~ I'l ~ o .., ~ ~ 8 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 C3'\~v\.Q ~\\VJb 5-\ - J--oD~ First Middle Last Name of Father of Deceased Social Security Number of Deceased ~a.y- 0:>~ bS4- b~~lc;D41 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Le~CL ~ 7~ \'1- ,... l tl. 0<6 Cfg First Middle Last Month Day Year Place of Death WID \r)~j \I I"\l"", A. \\0 ~.e\~ ~ ~\YUJ,5 v;~(J_ . Name of Hospital or Street Address Villaqe Town r City County Purpose for Which Record is Required 1M.-~\P ~~;\~ What was your ~elationship to the deceased? ~vz0- 6-~(".e~ In what capacity are you acting? --- If attorney. name and relationship of your client to deceased - Signature of APPlick.~ ~ Date 5' - ;)... ~ J--001- Address of Applicant S-b' t::. ~ "St . } \D~ ~\sl ~ \~~D COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 \ 0 Number of copies requested with confidential cause of death 1 Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code DOH-294A (6/98) . .....,rH/Q :. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record . .. ....<<...F>l.J::A;$E;PQfJ\PloieTJ;fQF,fl\ll.ANPI:NCLiliP$e'ffEJ:<.>........... FEE: $10.00 per copy or No Record Certification. Please do n~~\fr~An'lps. ""1;.'" 'c. Name of Deceased (-;-kP~ Y\ \=irst Middle Name of Father of Deceased VVl~ First Middle Maiden Name of Mother of Deceased 1 h{tflll~t-.. &J~V'- First Middle Last Place of Death lto~ \ Rte 3/(0 M-\- it- c9C) Name of Hos ita I or Street Address Purpose for Which Record is Required WoJSh Last Date of Death or Period to be Covered by Search 51\Sld~D5 W t0lc;lA.. Last Social Security Number of Deceased /oq - 525- q, \5 Date of Birth of Deceased q Month Age at Death (J- Day l C) ~~ Year ~'5 l.UJ 0 f I Vl f1UV'S Villclbe, To~n or City l)u~C;-S Count QJ(. What was your relationship to the deceased? l)MJ~ ~ In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant ~ ~~ ~ Address of Applicant . O. 6 (p . 1>f~ Date~~ W'i \ ~~lo I .............cOMPliliEtfE.FQR:DEATHSOCCURRINGASOFJANUARY:1J<1988u.n.> ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ ..../PU!:A$E5P$'NmNAMi:4NIAPI.E;.$$/W'tilJ;RJ::F,fJ;PQF,fQ$HP(JJ.,.()]:lI:$J;Nmn G) , 1."\ 1. Name ~ecc 0... V'.JU i'6V'-. Address V ,C), r-y-.:;.W La ()~ City \I~ '\)~ State ~ Zip Code \Z S Co \ DOH-294A (6/2000) '" -~ ... JOSEPH T. GEMMATI ATTORNEY AND COUNSELOR AT LAw 30 MANCHESTER ROAD POUGHKEEPSIE, NEW YORK 12603-2412 JTGESQ@AOL.COM PHONE: 845-454-6920 FAX: 845-454-2542 PARALEGAL E-MAIL ADDRESS: MATILDE R. WAYNE PAULA A. GA TTINE April 18, 2007 VIA FAX AND MAIL (845) 298-1478 Wappinger Town Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590 Attn: Chris Re: Estate of Gregory Lokuta RECE'V"" J APR 1 9 2007 TOWN CLERK Dear Chris: Enclosed please find Application to Local Registrar for Copy of Death Record regarding the above matter, along with check in the amount of $30.00 for fee. Please forward death certificates at your earliest convenience. Thank you, and please feel free to contact me should you require additional information. Very truly yours, ~fJIL dX:i~t:r Joseph T. Gemmati 7(/ JTG/dmf Enclosures MAR-~2-2007 10:23A FRoM:ToWN CLERK (845)298-1478 TO: 4542542 P.2 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record ".,..QMllET-E*6()flM;:ANO:EflGe' :St:/Feet::'h/r:~:WNf::i'FiAW\:g,.::rlnn? . '. FEE: $10.00 per copy or No Record Certification, Please do not send cash or stamps. '}f{rp:.fW:fHIh'.{{:'i::;~:::~;i:n:~imM:;tu:m%:m).~.t)%'~W@:{:P::USI$E}PA'm::~8fr~(PEiWK~:@~'5't:':/r<';?:{:r,:,g1@f\iH@%~;..~:f::':$.\~.'::~ii.;'.i...." Name of Deceased Date of Death or Period to be Covered by Search 0r-ejoru L-oKLt.+~ r:eb"rllfi~ ..:')'1 O?OO.-1 First ~ Middle Last rt 1 (A..-U-- < ex 0( 7 f Name of Father of Deceased Social Security Number of Deceased .:::\~~::::r:': .:.:;";_:,:0:.'.. First Middle Maiden Name of Mother of Deceased Last t <X> ~ - 50.- f5 d l.P g First Middle Place of Death Last Date of Birth of Oeceased q 0:1 d3 ,Q5 Month Da Year Age at Death Name of Hos ital or Street Address Purpose for Which Record is Required lOwn D,r \J-.Ja.ppirljer Villa e, Town or Ci 1-/'1 'IvJChLSS Coun pe.'-r\f1on '\Dr LeJ-'\-efs Df Adrl\'\ ni.s+rcrl1on Signature of Appliean Address of Applicant ' _ Number of copies requested without confidential eause of death' :::::,,;:,::;,j'::;:i:',,\,::::':,:t;:;::i:<;et..$e!.RR Nt;,. :. e:~_D8eS\WlileF.te,;:Be"" 't)::$H()Q.eOiSE'lS ,NT4'i&::::W:ili!::'@i\;)~~}gtA'~ ::~~'.LC:; "~C1? _ ~f' JD,~~~ 6efi\Jf\ft~ Address \.3 D Mon.cJll s-t-e.J" R ri ' City Thltj b Yiil.psi (' State j,jj Zip Code J ;;>(00 3 DOH-294A (6{2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record ';';':::.':::P.;LEASSPPMPCSrEFOFtMANDEfifCC()SSFE... E.........i .......... ..____ - __ _. ."..".,..._..."'............._.... d.'" ....._....."".,.,.,....... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Nam~eceased~ -{IOt~c First Middle Nam7#~t Deceased M~t Middle Maiden Name of Mother of Deceased ~/;2A ~/loe(" First Middle Las Pla~e of D a. th ) / /f.-- 4// ~o,v ~6V L-./ftc (;ft- Na e 0 Hos ital or $tr~et Address Purpose for Which Record is Required O+OLub Last /~Q/V Last Date of Death or Period to be Covered by Search ~--/-7- /007 Social Security Number of Deceased :; -;; ,- .- IS 1--5 Date of Birth of Deceased L~ ?: /~r g~~eK 5 Villa e, Town or Cit Age at Death '2)~k)S Count ~./M ff/ UJj I ><--t/-5 What was your relationship to the deceased? /~{7I'A 'Pi ec-h t( In what capacity are you acting? I ( If attorney, name and relationship of your crent to d~ /' /' Signature of Applicant Address of Applicant ......:::::::;:..:.....:.:.<..<.'/i:.:...i.)COMPWETE..FQa.DEATHSOCCURRINGASOF.JANUARvHU19S8))):::>>::: 2 Number of copies requested with confidential cause of death ...". --..........-..."..".. ..... .--......-....--......... ....... '-'-. .......... .-... ,.. .......... ................... .......-.-.-............"". ......................."".... ............-.-........."".. ...................... ... ... ...... _ Number of copies requested without confidential cause of death/ RECE'\/~' ) APR 1 8 2007 CLERK ...PC~$SI?$Iffl"N~J;~N$A$~:t$e$$.:'WliI::Jil.:al::(J():Ft.$ap(Jwp$J;$.Sti,lm> Name Address City State Zip Code DOH-294A (6/2000) APR-18-2007 WED 11:22 AM ARLINGTON LAW CENTER I i I i I E-MAIL ADDRESS: JTGESQ@AOU"OM FAX NO, 8454542542 ! i ! JOSEPH T. GEMMATI I , A TTORN~Y AND COUN~ELOR AT LAW 3~ MANCHESTER ROAD POUGHKEElPS/E, NEW YORK 12603-2412 i i I ----: I ; RHONE: 845-454-6920 I , fAX: 845-454-~542 I ; J To: Wappinger Town Clerk's Office~ Attn. Chris Fax No.: (845) 298-1478 i From: Oanielle I Re: Estate of Gregory Lokuta 'I Date: April 18, 2007 I I I I > --..-..-. . "'W"-'~'_Ul.' ,.' _____ , I I I , DOCUMENTS Letter P. 01 PARAl.t'fiAf, MAIILDf. R. WAYN1: f'AUL/\ 1\, GATflNE RECEIVI-IJ APR 1 8 2007 TOWN CLERK .-.... . NUMBER OF PAGES, _f~ing F<u.. <<;ovcr Sh~~t I I APR-18-2007 WED 11:22 AM ARLINGTON LAW CENTER I I i I -, I , JOSkPH T. GIOMMATI A TTOR EY AND COUNSSlOR AT LAw o MANCHESTE~ ROAD POUGHK PSIE, NEW YO~K 12603-2412 1 ---_ I I HONE: 845-45"-6920 i rAX: 845-454-j542 I April 18, 2~07 VIA FAX AND MAIL (845) 298-14181 'j Wappinger Town Clerk's Office !i 20 Middlebush Road I ! Wappingers Falls, NY 12590 i Attn:Chris I i Re: Estate of Gregrny LO~uta I I I Dear Chris: ! Enclosed please find Appli tion to Localfe9istrar for Copy of Death Record regarding the above matter, along ith check in e amount of $30.00 for fee. Please forward death certificates at your e rnest conven nee. I i Thank you, and please feel1.ree to contact me should you require additional information. I I 1 I I i 1 ry truly your$, d~ I I I i I I i FAX NO. 8454542542 p, 02 E"M.AlI. ADDRESS: PARAlEGAL JTGESQ@AoL.COM MATllOl!! R. WAYNe PAUu\A. GATTlNE JTG/dmf Enclosures FOR APR-18-2007 WED 11:23 AM ARLINGTON LAW CENTER FAX NO, 8454542542 ~-i-':-"-~I' 'ifA,,"..1-l1"'l LIMI....hH'~A.i ....,.r:::::r::::Jv f_ - (845)298-11478 TO: 454Q.4i= I ! ~pplication to Local Registrar ! for COe>' of Death Record I' I p, 03 r-'.';: DATE 11-/3 -0 1':/' .~flME:'.,. ~ ..... . Whil~ You WeteOftf"" '.C M ~fLL--r-:-z .' '" . ",1~J"Jru ~..., PHONE AAEACODC~~'f"~~ EX1ENSK>N .. ;ertincation, !Please 00 not send cash or stamps. I r c..., III Ui 1 What was your relationship to th8 deceased? I In what capacity are you acting? 8..:: It attorney, name and relations . ~ Signature of Appliean ... /. Address of AppUcant t, Date Death or Period to be Covered by Search (A. ~b rt.W--(J dO() O?OOr-t Soci~ Seculity Number of Oeceased l~d- 5D- DalPg Ot:lle 1>1 Birth of Deceased q __q OJ? 6> 3 J Q._ ManU; Da Year LDn otf ~O-ppi'rJer ViII , Town or - AdH\lnl.5-h-a:f1on. Age at OBath t-J'7 I:u.. + Ch.e.SS Count N<UT1e Lcu:0 Om(g, O~ t 6envn~+J AOd'_ ~ ~S~ r ' City '1'l) I ~ ' .'. . . $1&+ -..N'l Zip Code J ;;> (0 () 3 DOH-294A (6/2000) Ii. I. I I' , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for ColD' of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE Name of Deceased -.j c;:>~n A First Middle Name of Father of Deceased ~ohh A. First Middle Maiden Name of Mother of Deceased l?v\th S. E V'JehS First Middle Last Place of Death <0 5:0,+ PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search AWe--6nJ-::rr. Aprl~ \\, Zoo1- Last \ ~ ~ :II :0: l/l i: !;l o j m ~ o ." :I: ~ ~ 8 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps.RECE'VFI Social Security Number of Deceased AWe-6\1 Last 163 - 2<0 - z..~<OG Date of Birth of Deceased ~Y>e. 2-~, 113<0 Month Da Year Age at Death -=t-. 0 "t:::ri-.fe. ( Name of Hos ital or Street Address Purpose for Which Record is Required ~h~~= Villa Coun cY\.J 0-\ L-,k A~\~ What was your (elationship to the deceased? t=V.Vle~\ Df~e.c-kr In what capacity are you acting? . on be-hq \ +' c---r +a.VY1\ \~ If attorney. name and relationship of your client to deceased ~.~ Signature of Applicant Address of Applicant Po COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 2-- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE. SENT -' Name Address City State Zip Code DOH-294A (6/98) . .. -,,.,,/' Q MAR-22-2007 10:23A FRDM:TDNN CLERK " "" C845 )298-1478 TO: 4542542 P.2 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for CollY of Death Record .....,:t:..:.:>1,;./:ti'...t:)t?:Ii?:;fHt..;{{:!...,....'?P~'$E<':QMeJ.ie.'F.efnQllNtANQ:ENot.O:SeiEeef::I:''':) .J::;#?:: ",.,'-(}':'(i;' ", V"," :'".- ...... ...',.....;-:.:..-.... '-' -"~ ... ..::::::::~_: :~~<::~;:;::::5~'~. :f~:~ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. .{i.::.):.;InWtf:{K:::W;::t;@inMH.@;::;U::.i:%H;A~i.t.t::::.r<}%@.I:a:t;Eil.\$l;JPAtN{~$i:_e=mi1{%~:jN?::*{m:tl!.::.:ii1@#:~Ft@1\{i@i.:~i;~'1%i.1..:',:' '.. . Na~e of Deceased L 0 K t.L +0... Date of Death or Period to be Covered by Search Qr~~orj Middle Last ttb(l/lCL~ dd) dCfY1 Name of Father of Deceased Social Security Number of Deceased . -,.:: ':':<"~ - '~ First Middle Maiden Name of Mother of Deceased Last Id~- 5D - 5;Xv<g Date of Birth of Deceased j Cf5Cf Age at Death /Own Month DO< Da <13 Df \NO--pp\ nje_\ Viii e, Town or Ci Year L/t '1) u.+cJ.-l,e. s 5 First Place of Death Middle Last Name of Has ital or Street Address Purpose for Which Record is Required 7e.-\-, t\on ~'r ~e_JtifS Coun 0.[ A~l(l'\l()i~trcA-'hOt1 What was your relationship to the deceased? In what capacity are you acting? tttto( ne.!J . ' If attorney, name and relationship of r c' nt to deceased ~ICL ,./ . --'-7 ,- ----..- ,~...."... /"".-' Signature of APplica~.. ,/' / Address of Applica /c. / '11 . ~~nm~:l~~t~~~~~~~~wjr~~~~:mr~t~]j~}~1riiJ~f:;"~ ;:';:~::.~':~',~:::':?""-~':'~.~."':.r':: LOl1u,Jtl) e-x--wlfi 1-J/cX/Dr] 03 _ Number of copies requested with confidential cause of death L Number of copies requested without confidential cause of death/ APR - ~ 2007 TOWN CLERK "W."i'i,)..:.:t>!"t;:%t:;':':Q;~met;.$liPRJJ(t;l.' . ~~;A1)QBe; . ..$1l<<aeae41eCQJlt1)~8Qm;tt..... .1$1S8'f:)%QW.:rN::i1.@i:nmtWY}.i Name J05~ -r GrernfY\O-.-t\) tS~, Address 3D ~I\ o.rc..'rrLf;V Rd. City FbL~5~~l~ State N"/ Zip Code J ;>lo 03 DOH.294A (6/2000) .. JOSEPH T. GEMMATI ATTORNEY AND COUNSELOR AT LAw 30 MANCHESTER ROAD POUGHKEEPSIE, NEW YORK 12603-2412 JTGESQ@AOL.COM PHONE: 845-454-6920 FAX: 845-454-2542 PARALEGAL E-MAIL ADDRESS: MATILDE R. WAYNE PAULA A. GATTINE April 2, 2007 VIA FAX AND MAIL (845) 298-1478 V'/appinger Town Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590 Attn: Chris RECE,v~r) APR - 4 2007 TOWN CLERK Re: Estate of Gregory Lokuta Dear Chris: Enclosed please find Application to Local Registrar for Copy of Death Record, regarding the above matter. Also enclosed please find check in the amount of $30.00, as fee for death certificates. I am writing this letter on behalf my client, Cynthia Lokuta, who is the ex-wife of Decedent Gregory Lokuta, and also the mother of Gregory's children, who are the beneficiaries of Decedent's estate. My client is applying to the Dutchess County Surrogate's Court to become administratrix of Decedent's estate, and therefore requests copies of Decedent's death certificate. The name of father of Deceased and maiden name of mother of Deceased have been left blank; please advise if you need such information or can process the request without it. Thank you. Very truly yours, ~J~~. Joseph T. Gemmati k}r}o1 JTG/dmf Enclosure APR-02-2007 MON 10:39 AM ARLINGTON LAW CENTER .. FAX NO, 8454542542 p, 01 JOSEPH T. GEMMATI ATTORNEY AND COUNSELOR AT LAW 30 MANCHESTER ROAD POUGHKEEPSIE, NEW YORK 12603~2412 E"MA1L ADDRESS: JTGESQ@AOL.COM PHONE; 845-454-6920 FAX: 845-454-2542 PARALEGAL MAilUJE R. WAYNE I'Al.!tA A. (J/ITrINE To: Town of Wappinger Clerk's Office; Attn. Chris Fax No.: (845) 298-1478 From: Danielle Re: Estate of Gregory Lokuta Date: April 2, 2007 'DOCUMENTS --.-.__.___...___.___..H_._.._ - -.....-..-.-----u.-.!NUMB.iiR:-op PAGES, -- .. '" .." ..- "........---.......-..-..-.______.-.L Inc1~i~_F~Cove~~hee!_H._. Letter & Application to Locat-Registrar for Copy of 3 , Death Record . ~:: TOWN OF WAPPINGER TOWN CLERK CHRIS MASTERSON SUPERVISOR JOSEPH RUGGIERO TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL WILLIAM H. BEALE VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI April 4, 2007 Joseph T. Gemmati, Esq. Attorney And Counselor At Law 30 Manchester Road Poughkeepsie, New York 12603 Re: Gregory Paul Lokuto Dear Mr. Gemmati: As per your request, I have attached 3 certified copies of the New York State Certificate of Death for Gregory Paul Lokuto. I have also attached a receipt in the amount of $30.00 for your check #10058. Please feel free to contact this office at 845-297-5771 should you have any further questions. Sincerely, r-~ Application to Local Registrar for Co of Death Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section ............../.,.,.....<".<>....P. L.E'.. ...):\SEeOMPCETftFORM.ANDESCLOSEFEftJ.CH.......>>.,......'..,."....,.,....,...,>...........,.....,.................. .. ...- ............---...,...."......................-.....'''....... .......--...--....-.....-...'......."'.... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of D~ceased . r PI {("r H()([ '11 First Middle N~e?fFa~.t erofDecea~ed V<'O '0 ~( j-/ First Middle Maiden Name of Mother of Deceased 1((/1 r//j Last Date of Death or Period to be Covered by Search 7fl fJv~J Last Social Security Number of Deceased Month / / Z Da Age at Death Y3- l)!-{ tic~ 55 Count Date of Birth of Deceased First Middle Last Place of Death , C'e/l-t $,.01 ;l J t S VV1q &-( ~ Name of Hos ita I or Street Address Purpose for Which Record is Required 1<1 ~ar W'~~r/'/~/( ~r&' Vflla e, Town or Cit f/11 {d I2IJ;VU Ut y / f?A f;:m What was your relationship to the de/ceased? tj ~ ~;1f {) ~ e>"Yt In what capacity are you acting? /120 ~t:J(} ( '4 ~ U .Pe&G(Y/Z .,. If attorney, name and relationship of your cfient to deceased ' :~;r:~;e:~::~~:t17!J~~;~:!JltrtL-;vZ> FI D{a)~~f7 RECEfVt"') APR - TOWN CLERK . ..............................,.,......".".<<<\/.6011IIpl,jETEFOR:OEATHSOCCUFdobNGASOF':.UANUARY1W:198S.<.W.....JJ.<<<..<<.<< ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ ..........pp!;:ASS,P9.NTNAMEANQAQPSES$WlilEae.:REOCRt:I$l-iQUl;;(.)$E$EtiI$> Name Address City State Zip Code DOH-294A (6/2000) ....... ~- MetLife PO Box 990020 Hartford CT 06199-0020 t' // February 17, 200"1 ESTATE OF ARTHUR W TRAVIS C/O DAVID VANDEWATER 28 VESTAL HILLS DR KINGSTON NY 12401 Insured: Arthur W Travis Policy Number: 1 NW25873 MetUfe Insurance Company of Connecticut O"1te of Dea1h: Unknown Dear Mr. Vandewater: We at MetUfe offer our sincerest condolences to the family on the loss of Mr. Travis. We are committed to assisting you in the processing of this claim as promptly as possible. The face amount of the policy is $2403.00. Any indebtedness to the Company, unearned premium or unearned loan interest due the beneficiary may alter the total death benefits payable. The proceeds are payable to the Executor, Administrator or Assigns of the Insured's Estate. Enclosed is the Statement of Claim Form as well as a "How to File Your Claim" tip sheet designed to help you complete the claim quickly and easily. This form should be completed and signed by the Executor or Administrator of the Estate. Please read the instructions, complete the requested information, and return the signed form and a copy of the death certificate indicating the cause of death and a certified copy of the Court Appointment papers so we can complete the processing of your claim. A return envelope is enclosed for your convenience. If no Estate was formally probated, we have enclosed a copy of the Claimant's Affidavit. The next of kin of the Mr. Travis should complete and return the Affidavit. It should also be notarized. We have enclosed a return envelope for your convenience in replying. Should you have any questions, or need any help in completing this form, please contact our office at 1- 800-334-4298 or me directly at 1-860-308-6825. With deepest sympathy, ?agud- iro Raquel Lopez Ufe Claims Approver Individual Life and Maturity Claims Encs. ': ~. ...~ 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. Name of Deceased Ftita T. First Middle Name of Father of Deceased Ralph First Middle Maiden Name of Mother of Deceased Elvira First Middle Place of Death 334 Cedar Hill Road Name of Hos ital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Hafner April 9, 2007 Last Sapere Last Social Security Number of Deceased 068-24-2671 Vitolo Last Date of Birth of Deceased 8 14 1930 Month Da Year Age at Death 76 Wappingers Falls Villa e, Town or Cit Dut~hess 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 ~(jQ Date A ril10,2007 1028 Main St., Fishkill, NY 12524 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 Address City REGE'VI-' .. APR 1 1 2001 DOH-294A (6/2000) TOWN CLERK NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record ........PUSASECOMPclS'teFORMANbENOUOSEFES/> .----....,................... .".."...,-' .................................-.. . -. -.- ..-- ,-- " ,- .-".- .... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Nami9:::L:1 (Jt:h~tt First Middle Last Nam~Fathe.r of Deceased J? VA~~ r' " J.,:;:k~ J AM Ii) /~ !-' First Middle Last Maiden~:tt: Mother of Deceas/c:::A.p.l ~ Middle Last Place of Deat~ j) dL ~ /o,L- /uo- Name of Hos ital or Street Address Purpose for Which Record is Required Date of Death or Period to be Covered by Search Social Security Number of Deceased It) 9 - ~'I - prf7P Date of Birth of Deceased I~ Da Age at Death I Month 193<( Year 73 7)JCk~ ~/I' IIJ r t:-,t.-- Count What was your relationship to the deceased? ".- In what capacity are you acting? //'u.~.eI2.t9L. If attorney, name and r~hiP of your client to deceased Signature of Applicant ~Jcl ~ ~ Address of Applicant IVI.LL~ r, Ji. ~7( IJtJoke4 f}J-t:- ............:COMPWerE:FOa:OSATHS.:OCCUBRINGASQft.JANUARY:1198S/> /D l' ( . '"d . I Number of caples requested with confl entia cause of death _ Number of copies requested without confidential cause of death/ RECE\\J....'J APR \ \ 2007 TOWN CLERK . .' ........................:.:....:.:.<</PUeA$ePtlJfi;ti~AMeAfitlAPQRe$$V(I1J$AeaSOP$Q$f;tQUWt)$e$J$N$/:..<<><.>::.......... Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar , for Co of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE Name of Deceased -Sb~ First Middle Name of Father of Deceased ~ 0\4,- 1\. . First Middle Maiden Name of Mother of Deceased (Lwtv\. S. Ccw'1.Av' First Middle Last f\. V>vru.,~,- Last PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Sea m l1-U~())- ~ I ~ 21 :l': en ~ o I m ~ o ." : ~ ~ 8 FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. \~pGlh\~, )() Last Social Security Number of Dee.eased IO'~ --2\Jl- L-8~ 0 Place of Death < '\t-.....- V'v.., 'WJ.... - ca.:.::> CL)\,-t 'UY\A,r-t. Name of Hos ital or Street Address Purpose for Which Record is Required, C\'- ~1 \ u / lU0fPC~ Age at Death 'l-V -\)Ld~~ Coun Date of Birth of Deceased Lv-~'" "3lP Month Da Year . wi... tl\ (~.~ What was your ~elationship to the deceased? In what capacity are you acting? If attorney. name and relationship of your client to deceased Signature of APPIi~t ~L~~ C. kl ~ Address of APplicant"'---<S e. \\~ ....::;,t, i \j )[1 'f'P ~ .~ - Date r.-: 'l<', ~ .') J if - 1"2 ... o-l- lU1 \2YU) 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 WHERE RECORD SHOULD BE, SENT J Name Address City State Zip Code DOH-294A (6/98) . ....., 1")1' ~ NEW YORK STATE DEPARTMENT OF HEALTH, Vital Records Section Application to Local Registrar for Co~ of Death Record 'pl.EASECOMPl.stEFORflIlANO ENCL.OSEFEE . FEE: $10.00 per ~~or No Record Certification. Please do not send cash or stamps. tfr=Ce'VEt , MAR 2 6 2007 NamJieceased . JlJA r; ).,;J2,; / r / . . s1/ Middle Name of FiTter of Deceased {> /'_ P ^ U2u II CM1l Middle ~t Maide~n~her of D7!:eV:eJ/; - /1:1:(11 Middle rl L.:ast Place o1tjan-f 0-/ M Name of Hos ital or Street Address Purpose for Which Record is Required ........ pLEASE.PRINTORtVPE Date of Deilh~tlJ"Jllj;;; Social se7~~b: ~e::t;~ Di?Ja:th of ,ritJ?q t< ?J/eath Month ry Da Year 1JdcitM Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship f ,/ Signature of Applicant Address of Applicant .'. ..,.____.. ....".,....... .,d_..... "" "..., ,. '." ...., ___d__"_ ...... ... _ .,_.. ........ """..."........" _",_" ...... COMPL.ETEFOR DEATHS. ()CCURRING AS OF JANUARY 1. 1985 ...... _"7 - Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ..... .... ... PLEASEPRIWtNAMEANO,AO[)RE$SWHERE;RECC>FlPSHOULo>BESENT" Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record . ........... .......................eJ2EA.$I$PQMAlJE:':[J;.FOaM*N[)ENQC~$E:t:::f:J;...............{............................................ .... FEE: $10.00 per copy or No Record Certification. Please do not send cash or sta~CE' V t: l J TOWN CLERK Name of Deceased 'Jl/ciro.rcf ~"h'-'/ First Middle Name of Father of Deceased tA,0c<-~ First Middle Maiden Name of Mother of Deceased i-I e le;v' First Place of Death 7 L v( f/( Ni/( Or' vC Name of Has ital or Street Address Purpose for Which Record is Required 11 () i/ ; n,;/ c:..) J ~ f/ f.;., {,;</ ,- p(' CI ............... Date of Death or Period to be Covered by Search 5c./tt-<Cc.1z- Last b/ J. / <j;2.. Social Security Number of Deceased .5-c hl"(~ /2 Last Middle Last '-1/ ,l.. - ;]0 - Y..2 7 / Date of Birth of Deceased H~';/ ;;; 7 Monttr Da / '7:7 f Year Age at Death {,I vVrr?(""-;,l~-.J ;=;;, I(S Villa e, Town or Cit PIA. +c hc-J J Count What was your relationship to the deceased? .56.17<- -<...> e In what capacity are you acting? w r' p( '" V<--"" If attorney, name and relationship of your client to deceased ~/fi U / .. " (17/707 SignalureofApplicanl 1/( dA/i:q:~ ~ Dale ~/ / . Address of Applicant 7 eel',;, ~ fir I ( JP-, vC , W'..:,p/"r '?~..y /IC /Cr. .rVo- 7"<- - K 1:2..::>- t' c- . / ... ......coMPwerEFQRiDEATHSOCOORR1Ns.AisOF:.aANuAftv;1W198i. _ Number of copies requested with confidential cause of death __, Number of copies requested without confidential cause of death/ .................P:UEA.$EPalN'tNAME~NQAt>Qa.E:$$.MlHJ;aE:aJE.PQap$H()QJ2[).$I;$J;N1':{ 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 Recorg PLEASE COMPLETE FORM AND ENCLOSE FEE TOWN ~ ~ " ~ Ul ; ~ o m ~ m ~ o .., ::: ~ ~ 8 FEE: $10.00 per copy or No Record Certification. Please do not send cash or s.tr., 9 2007 Name of Deceased H g~ Middle ~V1 ~~ Name of Father of Deceased f\~\O ~~ ien First Middle Last Maider1iame of Mother of Deceased . f'-Ap..hCU-H"'~ ~ l6-tre;~ First Middle Last Place of Death 53> ~\e-r CT. Name of Hos ital or Street Address Purpose for Which Record is Required . (\ -e-Y'C"\ o-\'. L\ ~ PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search ~rch \1. ."2-c:O=t Social Security Number of Deceased c>cr=t - \6 -'103 \ Date of Birth of Deceased 'l - \ L-\ - 1975 Month Da Year Age at Death B\ ~~ Coun A\U.\~ What was your (elations hip to the deceased? In what capacity are you acting? Ch bdra\~ If attorney. name and nship of your client to deceased fYl t \~ Signature of Applicant Address of Applicant \3\ ~~ Date 3-\9 -c 9 COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 '9'-\-\ 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 oJ Name Address City State Zip Code DOH-294A (6/98) . ......, f") " t;:j) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PLEASE CQMPLETEFORM .ANDENGLOSEFEE<< FEE: $10.00 per copy. or No Record Certification. Please do not send cash or stamps. Name of Deceased .J t:..,vNlf First Middle Name of Father of Deceased --1 AM':;s First Middle Maiden Name of Mother of Deceased T~ E'({e S ~ C. cJ (4 Il,\)OQ:.,J ') First Middle Last Place of Death 5~ LANe GATE" RD. Name of Hospital or Street Address Purpose for Which Record is Required -;0 se7Tl,..~ ~$ fA Tc PLEASEPR1NTORTYPE' .. Date of Death or Period to be Covered by Search .J> I r:/L f ffD Last M~t<. J~. ~oo'l Social Security Number of Deceased po~Tt Last 052-03- /7"~b Date of Birth of Deceased flee. /'1, /etl(.- Month Day Year Age at Death 9D WA PP'NG~eS 'PnL.L~> ~,Town or~ J} 1J701E~S County What was your relationship to the deceased? F' () Ne f(4<. In R eL7CS'- In what capacity are you acting? ~J4t1.f[ If attorney, name and relationship of your client to deceased Signature oj Applicant ~~.,d) ..1/ 1.>"'7 . Address of Applicant t if ; ~~ H. lA)n NJAJrUA Date 3 - /3 -0'1 .::J",J/LL -no ;r I ~S-9() ....COMPLETE.POR...OEAl''HSOCCURBING.AS..OF.JANUARY11988... S Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ......... PLEASEPRINTNAMEANPADDRESS WHERE RECORD SHOULD BE SENTH< Name Address City flEeElVtl.J State MAR 1 3 2007 Zip Code - nnl-l-?Cl4A IFl/?OOO\ NE'N YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COei' of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search 3- -, . o-::t- ~ ~ :D :lI: '" ~ iii o m i i m ~ o ." FEE: $10.00 per copy or No Record Certification. Please do not send cash or staflilf- " f...~Ct.:1 V ~ l j "'AR 1 2 2007 Name of Deceased L..oi~ A, ~ 1:b ~ First Middle Last Name of Father of Deceased ~ne>&;- ~ '"Bo""E:. First Middle Last Maiden Name of Mother of Deceased \. J ";...h~"'Z-e\ "",,om' ~ First Middle Last Place of Death b I~V\T ~ WQ.'R==-'~~ Name of Hos ital or Street Add~es~ Purpose for Which Record is Required ~do~ Social Security Number of Deceased ~ ~ 8 o T 'Z. - '0- E:l54"=t Date of Birth of Deceased ~-8 - 'Z-o Da Year Age at Death a~ Month ~;-~ODS Coun ~~i~ What was your relabonship to the deceased? 1=W,,,,,,,,~ In what capacity are you acting? 0""\ ~ ~ If attorney, name and relationship of your client to deceased Signature of APPlica~~~ --- Date AddressofAPPlicanR~~~J ~. ~ I N'i L-z=.--=J(', .3 - rL -a -i COMPLETE FOR DEATHS OCCURRING 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 Address City State Zip Code DOH-294A (6/98) . .. "''')1/ Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COe)' of Death Recorg PLEASE COMPLETE FORM AND ENCLOSE FEE MAR 1 ~ ~ 21 :ol en i:: ~ o '" ~ i '" ~ o ... FEE: $10.00 per copy or No Record Certification. Please do not se.tt!N~ll Name of Deceased - ~ \j, ~t'\-t First Middle Last Name of Father of Deceased ~_ V;~ L-f'\m First Middle ~ Mair4~Nam....;:::,other of Deceas~ First Middle Last q~ PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search 3- .-0"7 Social Security Number of Deceased \-z.ct - ,~ ..Oiz-=r ~ ~ 8 Date of Birth of Deceased b- {o- Z--G, Da Year Age at Death S\ Month Place of Death \ L' \\~\ -==f5~~~' ,~. C- Name of Hos ital or Street Address Villa e. ow Purpose for Which Record is Required~ ( ('. . ('\ J"LC'\O . , ~ cT Ll"l!...~I~ ~+c.t.,~s Coun What was your (elationship to the deceased? ~1I'le.rral-c::::t'l""'~~ In what capacity are you acting? oV"\ ~ If' -" ~:~ if attorney. name and relationShi~ur~ient to deceased - Signature of APP~ . · <=-<,. Address of Applicant ~ ~ t3-1, V\l F;" ~'/ (~O ~ Date B- \"Z-~=}. COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 11988 :::J.11 Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code DOH-294A (6/98) . .. -,rlfl Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for eoI!)' of Death Record .. . .................................................<<.i...PliE#$l;PPMaUI;$$FOf:lMANPENP4(>$I;:ffel$..><........ FEE: $10.00 per copy or No Record Certification. Please do not send casRW.;s~ V ,.~ Li uAD. ')i'irO Name of Deceased WI 11(1\<<1 First Middle Name of Father of Deceased {h:1C Wlc L \")E N~ ~ First Middle Maiden Name of Mother of Deceased "J:; I i 1'\ P Av'XC K:. First Middle Place of Death .J 0 f1/l A (.JYl rvs ;{ L.~ Name of Hos ita I or Street Address Purpose for Which Record is Required p p{ rlJ: iC Last Date of Death or Period to be Covered by Search 2/ cloT Social Security Number of Deceased Last Last Date of Birth of Deceased t i"{. Month Da Age at Death '70 Year Cc LN A PfD-J G t: ,'- Villa e, Town or Ci b v Ie 4+ County /'JyJP What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant ~" 7() /I--c/~ Address of Applicant j'J Y S?- s:a W'l111:pv&t'F- Date 3;;~+- , . )~..:.coMPillETEFoRbEATHsOCCURFdNGAsQFnjANuiRyd~198Ef...q -+- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death/ .eU~$Eaal:Ny.NJ.\l\ItEANIAQtfal;$$"'ti;I$A:I;...f:leppf:lJ)$HO(J:lil):$I;$eNJ".. Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Copy of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send cash or stamps. Name of Deceased Jack A. First Middle Name of Father of Deceased Dominick First Middle Maiden Name of Mother of Deceased Mary First Middle Place of Death Hudson Haven Care Center Name of Has ital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement ofthe deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Dema February 26, 2007 Last Dema Last Social Security Number of Deceased 094-14-5290 Garaguso Last Date of Birth of Deceased 4 7 1922 Month Da Year Age at Death 84 Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant Date Februa 27,2007 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 12 +1 Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City DOH-294A (6/2000) RECE\VED FEB 'l - 2007 TOWN CLERK .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record .. .. '<<:P,(;E.A;$I$QQM~UEJ;eFQAlIJlA.ND:ENOUOSS:F=:EE. ......./:<>.... . ....,- .--,-....".-... ....".............. ---_.-.-.......-.----.",'-.,.....-..--... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased f. \ \ s o..~ Q.. ~ \-,. First Middle Name of Father of Deceased <:-a~~<lr'~ Last Date of Death or Period to be Covered by Search 10-01-04 Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased ~\~S~~Q~~ First Place of Death \.0().~'P\{',3Q('S, F-c.\\S ~~~ V:,O-~Q.""o...t'<'. ~O'UJh RJ. Name of Hospital or Street Address Villa e, Town or City Purpose for Which Record is Required Last Middle s ~ Q.\AC.\~ \ Last Date of Birth of Deceased Age at Death Month Day Year -}) 0--\Q..~QSS Count '\ O...:j. 0 ~~; ~ What was your relationship to the deceased? J.C'\. \ \..~ "'),.Q (' In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant 4SL ~ 0 A1 (L. d /j:l1:)A~'/'-- Address of Applicant J- ~:). L\ \(.(\ c: ~ Ck~ ~ au:J(\ (.!.... d \ Date. ~~. - A J -.07 \D~~ \--~\\s N l1 \ <.CQM:RUETEFORDEATHSOCCURRINGASQF.JANUARyH~i988:<< ~ Number of copies requested with confidential cause of death i Number of copies requested without confidential cause of death/ >PI1:l;A$I$:~auwt:N.EAt\lPAPQSS$$)I'(HSal$'FISOP:AU$aQl.':O;fl;)aa$SN$: Name Address City State Zip Code DOH-294A (6/2000) .. . .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coer of Death Record >PtSA$E;OQMeUE;1T:EflO:AM.j,.,.Oi:NQUC)$EFE:E> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased !(oC (0 First Middle Name of Father of Deceased . -"? ~ t<..,,-,,', "(.1'". Last Date of Death or Period to be Covered by Search . I t]l f Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Middle Place of Death L) ~Oc{15 P/'tL( Name of Hospital or Street Address Purpose for Which Record is Required Vf'\ c. (c\'ifY'\<(A fvr/j Last Month Day Year ~~6' l~J~.C s S Count 'vvctl~r,~ S1~ J ~,( , S Villa e, Town or Cit o fire ( 0) J- L.~ L'i)~ -nll...r 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 "'-/4 3/1/r:w Id"-L{t("';-J<e/( }?,} 9.rN-t SG^- - Date 'Z /z. 1 /0.7 A~~~~'1 W'~, I Z 60 J ....,............. ................. . . . . . . . . . . . . . . . . . . .................. .................... ................... . . . . . . . . . . . . . . . . . . :..COMPUErs.Foa:DsATHSOCCURRtNGASOf%JANUARY'1198a _ Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death/" eUSAi$E:eaUly:NAMi::8NO:AQoae$S::"fiJEa:E;;:AEPO:AO$HQUtQ:aESENT> Name Address City State Zip Code DOH-294A (6/2000) THOMAS P. DiNAPOLI STATE COMPTROLLER 11 0 STATE STREET ALBANY, NEW YORK 12236 STATE OF NEW YORK OFFICE OF THE STATE COMPTROLLER February 20,2007 RANIERI Lincoln Life & Annuity Reference # 10372504 Patrick Ranieri 2143 New Hackensack Road Poughkeepsie, NY 12603 Dear Mr. Ranieri: This is in reply to your correspondence concerning the abandoned property detailed below. We have thproughly searched our records and have located the following property in the name of Rocco Ranieri: , A. Lincoln Life & Annuity Company of New York endowment policy number 1515918 in the amount of $5,022.00. In order to further process your claim this Office requires the following: 1. A copy of the death certificate of Rocco Ranieri. 2. Proof that your father maintained or purchased Lincoln Life & Annuity Company of New York endowment policy number 1515918. 3. A currently dated certificate of letters testamentary or letters of administration for the Estate of Rocco Ranieri. Such certificate must be dated within the past six months. If no executor, administrator or fiduciary of the Estate of Rocco Ranieri has qualified or been appointed, the attached Next bf Kin Affidavit must be submitted. 4. If an ~xecutor or administrator was appointed, the brief written statement of claim of the person appointed, sworn to before a notary public, setting forth the estate's entitlement to the property. Reference: 10372504 February 20, 200? 5. If no executor, administrator or fiduciary of the Estate of Rocco Ranieri has qualified or been appointed and you are claiming using the Next of Kin Affidavit, you must complete the enclosed Table of Heirs Affidavit listing all his children and children of any deceased children whether or not you know their present address and providing proof of your relationship (copy of birth certificate or like document). 6. The actual outstanding policy. If this is unavailable, the person claiming must explain its unavailability in a sworn notarized statement and include the following: "In consideration of the payment of this claim without the surrender of the outstanding policy, the Estate of Rocco Ranieri will save harmless the Comptroller and the State of New York from loss due to such payment." We will continue to process this claim when we receive the above requested documents. If I can be of any further assistance, please do not hesitate to call. If you wish to correspond by mail, send all correspondence, using the above captioned reference number, to the undersigned at the following address: Office of the State Comptroller Legal Services Division P.O. Box 10337 Albany, NY 12201-533 rey Pesnel gal Assistant (518) 473-6920 '~~ . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record Pl..EA$EOQMPitl$'1]$FQfitMANP ENCI...Q$iS FEE > FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased A ~in ~ Name of Father of Deceased 'n fl . ~ W u...u.(i/YYl s:;. . First (~iddle Maiden Name of Mother of Deceased CtJiu fJ~ First Middle Last Place of Deat~ j9,- f3 <JC-~6h ~a./Y\.L Name of Has ital~; St~e~t Addr;q~ - Purpose for Which Record is Required (?J o-6v.:tfl, Last Date of Death or Period to be Covered by Search F ebAv- ~c9 ~OOr-; J O(o-JJUtr.L Social Security Number of Deceased Last I ~ ~ - 50 - 6-Q G, 0 ~ Month Date of Birth of Deceased /959 Year Age at Death d3 Da 4'7 [) u.t. cJLWO Count . _ Ct/Yld bu-~ What was your relationship to the deceased? IYl...OYLL In what capacity are you acting? (Yh ~~ 0:tJ -+ lrY1Mf~ ~ If attorney, name and relationship of your client to deceased COMPl..ETEFQRDEATHsOCCURR1NGASOFJANUARY11iii ~ Number of copies requested with confidential cause of death oj Signature of Applicant h Address of Applicant 3 _ Number of copies requested without confidential cause of death FEB 2j 20 TOWN CLERK . ..............................pl...~$EPaIN't'NAMEANO..AOpaiS$$NVHEaiS fitEPOfitO$APt.Jl..U..'E $ENX...... <.. <................... Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record Rl.I;A$e~QMPI..i1;"TI$f'OAMANPeNPI..Q$eFEE< FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Nam~.of. Deceased . Ii.' Ii : '~.' :n\. r.JC.-7 F' ~;/l.. iv' '. I First . Middle Name of Father of Deceased Ed /;()Qr-d }-.e' First Middle...... Maiden Name of Mother of Deceased ~VAY "j)V~"'er First. Middle ~ U Last Place of Death.--., [ (' . . , ~()I~Y c3l-M-e V'<) P ck Name of Hos ital or Street Address Purpose for Which Record is Required <.. .... k j n LL't~~ C ~~''''.:>T/1T'z.:.. I~\\..{\l' c..' .::> What was your relationship to the deceaSed?'PL'l. ("IC(.R:+e f.-- I n what capacity are you acting? C''::7 x: ~ c: VI+C1 '("'\J If attorney, name and relationship of your client to deceased N JYi1/jj Ie..-. !\e~ Last Date of Death or Plriod to be Covered by Search I :2. \ 11 or;" Social Security Number of Deceased Age at Death I.?, Month ,~) Da 7(c ....J)cC d\FSS Count G.J~ Of (I', q e t<;: Rs Villa e, town 'hdCit Signature of Applicant Address of Applicant . "...... - . . . . . . - - . - . . . . . - - - - . . - . - .. '.. - - . . . . . . . . . . . . . . . . . . . . , . . . , . - , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . , - . . . . . . . . . . . - . . . . . - , . . . . . . . . . . . . . . . . . . . .....-..-.-...-....,-....------........................",.................................. ...................... -...........-....-.-.......,.............. .................c..O.....M.....P....L..EJ'.....E....F...O....S......D....E....A....T...H..S.....OC........c....u...Q.....R...'..N...O.......,A.....s...O....F...J....A..N....U....ARj.....y.....1'. .......... ..- .. ... ..... .. . ... ... ..... .. . ".............. ... "... ....... .... ... ... . .... .. . . .. .. .... .. ... . . ........... .... . .. -, .. .. ... ............. ... ... .... .. ... .....--_.. --. ............... .......... . ....... .. .. . .... ...--..--- .. .... .... ....... ........ ...... .. --.... ... ... .......--.. . ... ,...... ... ..... , . . .... ... .... :"-"'_-'-_"'---'" --.... ....-.. .'.'. ........... ......... .',. ....'.', ...... .... .... ... .......... ...... ......, ...... ........... .'. .. . .'. ..... ....... .J- Number of copies requested with confidential cause of death A Number of copies requested without confidential cause of death ................... ........................ 1iss/'" ~~~~ JJ FEB 2 6 2007 ) BY: __ ,,,,,,,,,,,,,,,,,,, ''>P. .... L........EASE PRINl' NAME ANOAODRESSW'HEAE RSOQROSHOOL.DSESENt .. .....-,.-..,......,-.. .----..-_.......................,..........,........,....................--......................... .............-............."......................,..... Name Address City State Zip Code DOH-294A (6/2000) ----------'--- /