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2006 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record <..................~l...eASECOMPCE'J"E...FQRl\IlAND..eNCL()SEFee........ ... - ---....,.......-..........,.............,'."....-..."..........-................--......---........................... FEE: $10.00 per copy or No Record Certification, Please do not send cash or stamps, Name of Deceased ~ . \ \1\' \J (7 First Middle Naf"\le of father of Deceased ~t ~ -S Oo-n First Middle Maidfn ~ame of ~o~rer ,?f Deceased ~~@l. r\ L.~ \\ ~ \ ~ First Middle Place of Death \ . \\ lCl. \ "11 +\\\ ~\J~ c;;" \~\ I ",Q Name of Hos ital or Street Address Purpose for Which Record is Required ~~" Last Date of Death or Period to be Covered by Search i~/{8fOb \<.. \Q \\\ Last V\cL\t\ Last Social Security Number of Deceased ( y Ll - ~() .- q)...1L.J o~ Date of Birth of Deceased o ~ I L{ I Cf4 8 Month Da Year W()~~~ Q \ ~U\ ~ Villa e, Town or Ci Age at Death 5'51 tlJ\k<(; Count What was your relationship to the deceased? lv \ ~ L In what capacity are you acting? W ~--S ~ r-; If attorney, name and relationship of your client to deceased ~ ~ Signature of Applicant 'S(\/'Q) Is:Q ~ 'T ':;" Date 1'J.j ~ q /0 fa Address of Applicant '11 1\\\ (\;~(Cl" /--iLl \ IS ~ lvC\~IJ ~ if<; >tQ If, I ~ ,y PJ..5"f<:3 <;d'.......... . .... ..................,.....................................-............................................-........-..........................................................................-...............-.......'....................... . ..-.-..................-- ......-......--.......-.........................................-.-..............-......-................-......--.................................-.........-....-.......-........--.-.......--.. .............,...i"\:M....P......eTl:!:l:!:i"\:R....D.EATH....S...~,..n:R..aIN.nAS......O....e>IAN.........:iI..ov..j.........1"''Oi!ii . ""V . .,.;;.liiirv . <.. .~........~""w....=n .. ~...~. ........FQ~. ~M..>./~W>.. ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ............................<.....><PUl;A$E...ealN"tN.eANOAQQRE$$..'WMEREREOQRO$APQI$UaE$EIIl"t<<. Name Address City State Zip Code DOH-294A (6/2000) . ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coey of Death Record ~t.EA$ep(:)MPt..eTEPQl'n\IlANPENCI..Q$$FEe>' ....... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased rn ~(\ First Middle Name of Father of Deceased "3' 'S { ()Jj First Middle Maiden Name of Mother of Deceased {)o.. :) ~ ~ Un ~V\ 0 ()J f\ First Middle Last Place of Death 5 3 ~€(,. D\(,-~b ~\' \ D_ \ Name of Hos ital 0 treet Aadress \. ~.1 Purpose for Which Record is Required R a <,hbz. Date of Death or Period to be Covered by Search Last N \ i\ e.VS--\-e'l ~ Last Social Security Number of Deceased () , ~ - 6 '/ - \ Date of Birth of Deceased Age at Death Cfp Month '2- Da q /907 Year Villa < ,..~ T own or Cit l" :"'\" ..., U(/ c S . v It./V ..,,-- Count \OWl, ' What was your relationship to the deceased? In what capacity are you acting? ~OJ,Cl~ \'\::110(,' >:rr If attorney, name and relatiol1ship of your client to deyeased :~;r:~:~o~:~:::t '~b' \ )~~ :J:.j; ~4 k;.1; Iz-Jzttjo6 I)Y' I ................-......-...........,............................................................................,..........--...................................................... .................-..........-...........".".'.. . ... --,........--.......-. ."'............ ..........................-.....-..-...........- .........-.........-....".......... -.......--..... ...-..-......-..,...................'.'..............-.........,...... ................ ..0....0.. 'M.. ..P.W...ET......E.......F...O..R........D...E....A....l'.. .H..S...OC........O....u....a....FJ....I..N...S.....A...S...Q...F.....J......A,......N... 'U"'AR' .... .Y.....1.........1...9....sa......................................... ......--,. ""'-.. "'. .. ..' ..... .. . ... . .. . ..... ..... . ..-.. ,.............. ...........-...... . ",,,,, <>>.<:".."., .' >: "" ':.:: ::' :<:: ,:,..".. : <: ".. ':".." :..,: :.' ::'.':....,':.,..,:...,'.....' :...... <.:..:....<:"" <<:' .....' . ".," . ::'>J~> :'" .. .<<:::::::'::::::::::':':' ":""".,.",, . 3- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ... ......,.....~l,;eA$$PFnN"l"'N.EANQ.APQa$$$rw...Eaef(Ep(:)aQ$apUt.,Q$E$ENT" Name Address City State Zip Code DOH-294A (6/2000) NEW YORK SlATE DEPARTMENT OF HEAL TH Vital Reoords Seotion Application to Local Registrar for Coe.y of Death Record i'!}i!'\+ - "F;:::,:.:p:=:eA::::::::s_.:::::::r:s:m~':'!' L-___.__-_. :__ ':c'..," " . "'1 :~ ' ':" ::~::::,:' ,;. ~::: :::: ' : ":: ~::; .:: -:':: ::" ::: ..::' ':: :" ,~. ~ :~>';;.'~., ,- ,,":>;:::' >: ..::':'.;.:~':,,~':,:::; ~:::':::::,,; ,::",~, ::::::!::. :':~.:.'i:~:: ,~ ,;:.}i'.~:/:~:~ ':,::'\::..:;.. ~;::,: \i.'::::'Pl#Ai,e"PRII~fi) 08.:J"~PE.\".' '.,:. ...:.. . .', ", :'.:r...:.' ... . ,........ ".C['::'" :/... i ';':.."':1 Date of Death or Period to be Covered by Search Name of Deceased Robert L First Middle Name of Father ot Deceased Paul J. First Middle -- -- Maiden Na.me of Mother of Deceased Margaret Clark First Middle Last Pla.ce of Death 2264 Route 9D Wappinger _~me ~_t::!~..e!.~_~r Stre~ Addr~!_~_____ Villa[e, Town or City Purpose for Which Record is Required Amended copies requested following autopsy report Kadlec Last Kadlec Last November 25, 2006 .__.._---------_._---------_._-_._--_._---------_._~~ Social Security Number o~ Deceased 058-44-0675 - ----- Date of Birth 01 :>~ceasod 03 05 1952 Month Dav Vear Age at Death 54 -- Dutchess __-----_____~ounty _ Funeral Director What wa<; your relationship to the deceased? 1/1 what capacity are you acting" 1<'1 lnpr,q 1 D; rl'>r tor !f attorn~y. n~nle and relationship of your client to deceased Slgr.lur.OfApplican:-~-~~ 1d= ----._=~~::e_-:W6~~6 -------- Address of Applicant 91 tiorth Br~d\:Va~rrytown 1 NY 10591 .___ ___________ 1". 7.... ~.:.;! :..,..'!'.T::....""..:.. ::' <.. :': }:J:'" '~ili" (.. , .' ..<.E:.i.~nQ:Q~CUj,l;RI'...AS'!f.FJ.:.. iAfiU',..:mil.. ..{.:~:i!O;~. ... L:::.... .:. ....: '::' .......,....::..., ..:'..... ,COM,P .: ..'<FOR....D""..':M"ilI. . 'Ii;; n;.. NU!,,,, .... .. _;.'I.,.,.~._... I__i Number of copies requested with confidential cause of death I 1_ Number of copies requested without confidential cause of death l ..-....;-. ;' .::.~t?}..:~.::~:,~.,.:"... .' ,.,..,.w:"!'.,.,. . ". -', ",. ';: ~ .,..':.(,.;:;;.:;'::::::::::-P.LQSEiPAlNI:,NAMe7AND;~ORe.i!/_HE~'A'I9AO; HOO.ttWSe:'$s1m0.TJT?UTrr?TT7;;CI\ Name ____.____.___.___~r. Paul--=!. Kadlec Address _______ 31 Elizabeth Street City __._~~si~_ing___ State NY _ Zip Code 10562 DOH.294A (6/2000) ((offe!' jf unerar J!.Jome. 3Jnc. Ninety-One North Broadway Tarrytown, New York 10591 914-631-0983 Fax 914-631-9412 Town of Wappinger Town Clerk 20 Middlebush Road Wappingers Falls, NY 12590 December 26, 2006 Enclosed is an application for copies of the death certificate of Robert L. Kadlec along with a check for $60. I am requesting these copies on behalf of the informant, Paul J. Kadlec, brother of the deceased. Thank you, {t.~ Nancy co~ j//'/ LFD#00762 RECEIVED DEe 2 9 2006 TOWN CLERK .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record Rr..EA$elZOMaUI$1'Efo-aMANPENeUQ$eFEEH FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. N~~ o~ Deceased 7770n1tUJ First Middle Last N~;;;;f Decease~~~ First MidJ~ Last Maiden Name of Mother of Deceased r//IHI/lJfl V~ First Middle Last Place of))eath J I / tlll/~ ~ W~ Name of Hos ita I or ~treet Address Purpose for Which Record is Required J.12~ Va (e/)+ / Y)-e.- Date of Death or Period to be Covered by Search 4-/1/7 V Social Security Number of Deceased Date of Birth of Deceased Age at Death Month Da Year 'l~ Villa e, Town or Cit Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant 8 ~~ ~ Address of Applicant I 3 6- A- fZ. f) E IV ~ r . C 0 J d g p It..., ',J j Date I:) 1.1 0 /0 t.- ivY I () r-I t I HcoMPLETEFoabtiA....Hso.ecuRRINGASOFJANUARv1J1io< - Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . . ............ .....................<...........PU!iA$Eat1IN'tN.EAHtlAQPRe$$MlHEAI$..aEOOaQ$HQUr..P..fJE$EN.....................<........ Name Address City (~) j\~ State Zip Code DOH-294A (6/2000) ," DEC-19-2005 16: 00 ~i':lfn: ATTORNEY FLAGELLO 18454408765 To: 914265'3350 F', 1'1 CENOVI!:FFA FLAGEI~LO AUomey At Law 1076 Main Street, Suite 201 Pishkill, New York 12524 TEL: (~45) 440-8815 fA..-\':': (R45) 440-8765 Dccemb~r 19. 2006 CounLY Clerk Town of Wappinger Falls, New Ynrk RE: Ucuth Certltlcat(' Deal' Sir or Madam: We are rt=tlucsting a ct'rtitied copy of a Jeath ccrtitlG!ttc that we believe you have 011 record filr Thomas Yalt:nlint), died on April 'I, 1974. My client Carol Valentine will pick it up on Wcclnesday, De,ccmbcI 20, 2006 she will pay you for the cCltified copies at time (I f l')ick-up. We arc in n~t'd of the death cerliHcatc to clear n real property title issue. If you have any questions pleas~ do not hesitate tu contact me. Very truly yours. /G~~ GF:tm Cc: C. Valentine Fax # 845-265-9350 . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COe>' of Death Recorg PLEASE COMPLETE FORM AND ENCLOSE FEE N CLERk ~ ~ " :Ill In i: ;a o III ~ i III ! o ~ FEE: $10.00 per copy or No Record Certification. Please do not send cs.ECf~YE Name of Deceased 'n.br~ A. First Middle Name of Father of Deceased EdV\1O\.rJ First Middle Maiden Name of Mother of Deceased H eo\. '1=>V'I~ First Middle tal;t P~e~\ Be:> J3.--c:,-1\riex-o ~o~c:J Name of Hos ital or Street Address Purpose for Which Record is Required t::y-,d <=' +" L \ k PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search .~. \ "=I ,200("0 L- der-. Last Social Security Number of Deceased ~ ~ 8 0<02 - '2 Z .~ Co 3-=1L.\ Date of Birth of Deceased Age at Death Month Da Year ~~~-==- Coun A~k\"$ What was your ~elationship to the deceased? In what capacity are you acting? on If attorney. name and relationship of your client to deceased Signature of APPIiC~L> 0'-'-<>, :.-"} . \-1 ~ Address of Applicant Fb ~ 13\ I Y\10\..~ ~e6 ~l\:5J ~~\ 'P,ree-+U- 'o.=-hO\,.' ~ o>~,.~ kV"Y""\, '~ Date ~..c.. ,~ I "2oO'b N-j \~Q COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 b 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) . ..11'")/' ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for eoI!)' of Death Record f:)t.EASf$OOMPUI;TEFOAMANPENQI..()Sf$r::EE> FEE: $10.00 per copy or No Record Certification. Please do not send cash o~EIVED 4 2006 Name of Deceased Anllft- First Middle Name of Father of Deceased 01-1/'" h. Last Date of Death or Period to be Covered by Search rz/ rz./o G:, Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Last (."' til:L-'"'> '" Date of Birth of Deceased 10 LL IS Month Da Age at Death First Place of Death Middle 7- 6 ""5h. t~~c J Year 73 Name of Hos ital or Street Address Purpose for Which Record is Required YoLcL- -::C\-\\X--~"G"Sf\ b: What was your relationship to the deceased? Y\:J~t:'"' 1~CC.fL -- tJeV\J YOll~ ~~'t<: P6LICe.... In what capacity are you acting? O(tKh/d :Lv'\~~r.Jntf.'\. If attorney, name and relationship of your client to deceased W~?pjv\.5LJL- Villa e, Town or Cit "'uJ1,-~ Count Signature of Applicant Address of Applicant ;G. ) 'fI-L,~ Date (Z J~ /ch I I ................................-..................-....-..... ,.....................................,...................."....................................................,......................................,.,...............-..... cOMPLETEFOaDeAl"HSOCCURRINGASOFJANtl1.\SV1J19SS> ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ... . ..."..'..".'p.iil:tAs..e...pol.UT.IA..e....'A:N.'. ri'::a:rio....a....e...S...S.mH...e....a....e.......R....e"",n:RriS. ..HAU..triS....e......s.e. ...N....T ......................... .. ':-'<":::::::::::::>\>4~.-.'..:.. :":\...::::0.. :~~::~:>:~:~~" :':)~ .';'. ~~:~. :.,;.. ::.:. :.::..:...~.. ..)~~~ '::'" .':': .-:..: .':':/ .::-.-. .');~~~vi .:: :~r....::. ::. .~..,: ..~~~:::~. :""" :':\:""'" ":':..-:: ::~t?~~>:}........ 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 Ann First Middle Name of Father of Deceased John First Middle Maiden Name of Mother of Deceased Anne First Middle Place of Death 7B Sherwood Forest 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 Walsh December 12,2006 Last Pasternak Last Social Security Number of Deceased 067-01-7234 Kunda Last Date of Birth of Deceased 10 22 1913 Month Da Year Age at Death 93 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 Address of Applicant ate December 13, 2006 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 6 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) (" RECEIVED DEe 1 3 2006 TOWN CLERK NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record PL.EASEOOMPCe1CftFOAMANOENCUOSEf:EIS ...............................-- -.. ,.,,_... .....----............."'....--............--...-----...---. --. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ArYlI{Y First Middle Name of Father of Deceased H OI.Vl\S d First Middle Maiden Name of Mother of Deceased 1J.ess i .e First Place of Death qB Ct<..rY'tihy Stree\ Name of Hos ita I or Street Address Purpose for Which Record is Required A T/;. r YI e.r Last Date 01 Dejth or Period to be Covered by Search I J-I 3 ,;1.00 b iU rY\ e r- Last Social Security Number of Deceased t J... (;. -- J-.c. .- 6205 Middle L-c /A {- Last Date of Birth of Deceased if 10 ,Q33 Month Da Year Age at Death 7 3~(:5, l' \ ~ cd A-fr~qi?rS FeJl~ "ilia e,~own or Cit iJ '( I'). or; q () b...~.J1."S Coun .~, 1 e (...J.xz.- \--jy\ ~\ What was your relationship to the deceased? ~I" -c. t" ~ D i'''~(,..f-r, t- In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant O~ Q ~. - . Address of APPlican~ 5ty~e -r- FisJ,/c,/1 ) Date 1;2/1/ k6 N r I ;l5' ;;;1..I/-- .................... "............".."..-....-..--..--.......-.-.-........................................................-...-..............--.................. ... ............""......'..".""-.......-..---.-.-.-......,-........._.... -,...,.......................... .............-.. ......-....-....-.... COMPL.srs FOR. OftA'tHSoeCOAAINGASOPJANUARVY1 ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death DEe - ~ 2006 ERK ............Pl..eASEPfUN"tNAMEANOAtlQSESS'W...E8.i!AEOCAOiSHOUl.,.I)$E.SftN"t....../............................................... Name Address City State Zip Code DOH-294A (6/2000) frL. (~J- (]V --- General Information and Application For Genealogical Services NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section, Genealogy Unit P.O. Box 2602 Albany, New York 12220-2602 j;d ie2-/JfJo~ VITAL RECORDS COPIES CANNOTBE PROVIDED FOR COMMERCIAL PURPOSES. 1. FEE - $22.00 includes search and uncertified copy or notifiaation of no record. 2. Original records of births and marriages for the entire sta~ begin with 1881, deaths begin with 1880, EXCEPT for records filed in Albany, Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office. 3. The New York State Department of Health does not have New York City records except for births occurring in Queens and Richmond counties for the years 1881 through 1897. 4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical research. To insure a complete search, provide as much information as possible. Please complete the applicable section for each type of record requested: birth, death or marriage. Name at Birth Name at Birth Slale File Stale File .c Date of Birth Number .c Date of Birth Number ~ Place of Birth 1:: Place of Birth_, BECEVJEo I. I. m III Father's Name Father's Name DEe - 4 2000 ~~~(~ Mai~n Name- Mother's Maiden Name -= WN CLERK Name of Bride 1'1 I I ! NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section, Genealogy Unit P.O. Box 2602 Albany, New York 12220-2602 pd. . (r:J;;J- €N --- General I nformation and Application For Genealogical Services ~d I e2../ Jj JOe, VITAL RECORDS COPIES CANNOTBE PROVIDED FOR COMMERCIAL PURPOSES. 1. FEE - $22.00 includes search and uncertified copy or notifiaation of no record. 2. Original records of births and marriages for the entire sta~ begin with 1881, deaths begin with 1880, EXCEPT for records filed in Albany, Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office. 3. The New York State Department of Health does not have New York City records except for births occurring in Queens and Richmond counties for the years 1881 through 1897. 4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical research. To insure a complete search, provide as much information as possible. Please complete the applicable section for each type of record requested: birth, death or marriage. Name at Birth Name at Birth State File .t: Date of Birth Number .t: Date of Birth 't Place of Birth 't Place of Birth__ "" 1- m co Father's Name Father's Nanie Mother's Maiden Name Mother's Maiden Name GJ Name of Bride GJ Name of Bride en I! Name of Groom fa Name of Groom I- I. State File I. .. Date of Marriage .. Date of Marriage fa Number fa Z Place of Marriage Z Place of Marriage and/or License and/or License Name at Death Lil ~W~ Name at Death Date of Death /).f) ~A[ IW?L Age at Death Date of Death .t: . .t: 1a Place of Death ~ .... Place of Death fa GJ GJ Q Names of Parents Q Names of Parents State File Number BECE1\Let) DEe - 4 2000 WN CLEAK State File Number Age at Death Name of Spouse State File Number Name of Spouse State File Number For what purpose is information required? ~c1~~ ... rJ ~.,,"J,?~J-/q;,~ . Send record to: (please print) Name rJlJUES ~ ~M!!Jt- Address /9tJ MtiPt.,+ ~ City (j1f~NA-l(., State 11 Zip Code /2'10 DOH-1562(p) (09/2004) If requesting birth and marriage records, please sign the following statement: To the best of my knowledge, the person(s) named in the application are deceased. x 1.03 In what capacity are you acting? SIGNATURE OF APPLICANT Page 2 of 2 6.0 ~....' ~..",'i . 4 3 ....3 ~; ....~ 1] CDO'~'."")' ~i 1\0) 2. '. Z~.f. ~e.'.' lli .... .... _......!~ .. . .' .~ '..n... '.' ..._'".'....'timl'... fJJ..t)!' .0.....0...... ....,...;. '0'.' ..,.... ~~; ,'=::m,.m 0 :1::0, "-I · ,.... ..,,~'... ~......., '!'" \r., .&t:ffl""Z~' ""'".,.,~"S~:c."".'..' ,'. ~'""""'" .,....C"o./P..7;:I.':z.~ ....0.::....... .c.... '.' . .... '..," , ""'." ~ ~ c.,. .....'.., ...... tt:/.~~\;.;;-~ ...:::..~/:,< :.~ . .... ~J({); /~~~'"',~;;::., ..' .."..> ., II .'" ~1D"~:m'." \ .~" .,.' ", (~ht.~r~I~}~ ...J~'~b~... . ,~,~~ .< -1 ~~"liC: " ;::.'>'1:. . C'> I ;'':i\~';; i\~~ , ~~' , .... .....c........'.. It.~. ~ J \ .:;. .. ~,,\o!?>c::,:ct.o;;. ;-"'J""::l' , . ~_~'= "" ; /l.l:'iL4 ~. f~\ .' / . >~;VI'''(::?'~; ',I i:~!;.:;;~):>' 1 ',' .,~ ., "~.",. ..;i",-~/ / .~ ~ I' . ;"'V....--- ,.. ' / ... or....... -' .:,.;.. ~'I"''''''' :. ':;::=::..~, :0;,'" ~'.v",.m.>..":-.> ,> . '0 .. h' trj'" " ,,", ~., 7 \-C:t' c=--::c./d /~~ <j~ .. "FOR GENEALOGICAL PURPOSES ONLY" A Verified Transcript from the Register of Deaths a :II G> m z m )> 5 G> o )> r- "'1J c :II ." o fJ) m en o z !< Date of Death..~.~X. .2?~~,.. .~~~~..... ........ Registered No.... .76.0.... ....... .......... Place of Death..... .~.~Pl?~.n$~.~.l?.. .:f.~+J~.?. .~~~. .x~~~... .......... ,........... ............ Name of Deceased .... \\T.~.~.1.~.~~..~:...~~~~~~~~:r:..................... ......... ............ Age, ..... .~.?:........ ......Y ears, ........................ ..Months, ................. .... ..Days Sex.. ..... ..~................... Color or Race...... ..Pn~nqwp,........ .... ........................ Single, Married, Widowed or Divorced...........W~~~Vl.l?d................................. Full Name of Husband or Wife.................~~~~~~?...................................... ............................................................................................................................ Date of Birth.. :rJ.1)..~.W;).~..... .............. Birthplace..... ~.::!-pgl?.t.<?.~ ,..J~~w. .XPf;'~ Citizen of what Country...... y?~................. ...... ........ ................................. ..... How;ong } Here .......................... ...................................................... ........ Resident In U. S. if foreign ........... ............... ........ ................. ................... Occupation.......~.~.l?9.~. ............. ............. S. S. No. .............................. .......... Father's Name .... ...~~~~~~~.. ~~!':~~~.~.~F............................................... ...... Mother's Maiden Name .... ...~!'!-~h~!'!-J.....(~.~.t.Q.E:!,1)....+.c;u~ t..llnk.nQwnl.. ............ If Veteran, Name of War....... ........... ...... ........ .............. .......... .......... .............. Cause of } Immediate Cause .........~.~?-.~~~.I?~.~.?~..?~..~~~~~...................... Death Due to: ............................................................................ .......... Time Dr. in Attendance} ............ ............ ................. ..... ...................... ..... ..... till Death .............................. .... .................... ......... ..... ..... ..... Medical Attendant or other Attestant ... .'.!'.l}.C;>~~l? ..~~~?~..~ .',p. ......................... Place of Burial ... ..~~?? ~~~~?:.~.. ~~.~.~.~.~.. ~.~~. ..~.?:::~ ......... ....... .................... Undertaker ...................... ,.......... ............................ .................................. ..... I Hereby Solemnly Attest, That this is a true Transcript from the Public Register of Deaths as kept in the ........ ..+.<?~ ..9.LW~p.p.;i,ng.~L............ ...... .... .. . . ...... .. .... .... .... .. . .. .. .. .. .. .. .. .. .. .. .. . . .. .. .. .. .... .. .. .. .. . .. . . . . .. .. .. . .. . .. . ... . . .. .. .. ...... . .. . .. ... . .. . . . .. . . .. . . ........ ~ . .. . ... . .. . . . .. . . . . . ... .. . . . .. .. . . . . . . . . . County of .... ??~.~.~.e.~.s................... ....................... ........., State of New York Dated at ...... ........!J.~.P.pJ.~g~r.~..f.gU~..................................,...., N.Y. the .... .~.~.~............:.............. day of . ...r>~c::~~~~':r........ ...... .-:-f<j-' ?O.o6 .(Signed) ...... . .... .. .......... ............................................. ..... ..... Official Title Town .Cle.~k.-:..~e.g;~~~!~.:r:................... . .. NEW YORK STATE DEPARTMENT OF HEALTH Vllal Records Section Appncation to Local Registrar "for Coexof .Death Record .. . ". . " PLEAS .... :EF'Ee Name ot Deceased ~O\oev--\- L. First Middle Name of Father of Deceased ~o..~\ ' ""J., (<"~cll1c. S,V First Middle Last I Marder. Name of Mother of Deceased' Dn^nQvcl ~ r 'F'i';;( ~I Middle Last Place of Death 'Z,Utf e+ q D Name 01 Hos ital or Street Address Purpose tor Which Recor,d is Required kouivc Last LSA$EPRINTBTYPE:> ... Date of Duath or Period to be Covered by FEE: $10,00 per copy or No Record Certification, 11- l..-S -O~ Social Security Number of Deceased OS'<6 - Y L{ - 0 <.0 tY- Date of Birth of Deceased 3/ s:J.s 2- Month Da Year Age at De(1ll: S'I WQ{1:J1 nt}t-y Villa e, Town or Cit j)L^-~ Count WI1at was your relationship to the deceased? ___ Iln what capacity are you acting? ~ ~ U I vr c--lt- If attorney, name and relationship of your client to deceased Srgnalura ~f Applicanf ~ ~ Address of Applicant ~ ~ Date / { / 'Z-gtao , J ' 4---r,YY\..fJ ~C F' RRI --fQ. Numb~r of copies requested with confidential cause of death I ------;- Number of copies requested without confidential cause of death I ' PL~A. PRlNTNAMA OAPDRESS WHERERE:ORO<.SHOUW'.BES'ENT Name t Address Clly 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 Social Security Number of Deceased ~ a :II :ll: Ul il1 ; o ", ~ l ", 3 o ." : ~ ~ 8 FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~ vtv1A^ First · vv ) Middle Name of Father of Deceased ~t\;: <;htVVl First Middle Last Maiden Name of Mother of Deceased _ Date of Birth of Deceased S ~ S\U{~W-< 1-- ~l First Middle Last Month Da Pl\~at\~Vt ~ 0-u~ ~ ~'1~ Name of Hos ital or Street Address Ita Purpose for Which Record is Required S~\t\v PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search 1\ - ,QJ-o~ Last I d4 -J-LP -- M34 J- 11~; Year Age at Death -=t-3 ~ Coun What was your ~elationship to the deceased? ~\tG..l ~ In what capacity are you acting? If attorney. name and relationship of your client to deceased Signature of AP~ ~ ~ , Address of Applicant "7; e. ~ <2k-. \0~~~~ RECEIVED 2 TOWN CLERK Date ~ \ l...-~ -0l1 COMPLETE FOR DEATHS OCCURRiNG AS OF JANUARY 1 1988 ~ Number of copies requested with confidential cause of death --2(. Number of copies requested without confidential cause of death PLEASE PR1NTNAMEANDADDRESS 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 Co of Death Record . . .......~t.EA$e.eQMPt.E;'TE..f:P;$MANP..Ef,l:QJ4Q$eFEE/........................... . FEE: $10.00 per copy or No Record Certification. Please do not send cash or stJAQ,~. 2'( 2006 Name of Deceased Lou 1Jt; 111 First Middle Nam.i2';L#~ of Deceased First Middle Maiden Name of Mother of Deceased fVI ~ ;11 (J Y} k-Urt First Middle Last Place of Death {/ J /1 t/ tI\J ) () fYl ,;(L r< c{ Name of Hos ital or Street Address Purpose for Whi?Cord is Required /~1f~~ J iJ&~L Last Date of Death or Period to be Covered by Search / /-d-'&'- 0 b vJ A I 1Ps; Last Social Security Number of Deceased I rb-- rl-Y- JJ-'-/(/ Date of Birth of Deceased Age at Death Month :] Da VYear 7 ;}It::-f~jJ Count Wt/I1#I)C~ Villa e, Town or Cit What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relati hip of your client to deceased Signature of Applicant Address of Applicant . . . .................................../i../>COMPL.ETEf:'ORDEATHsoeeuRRINGAsot#JANuARv1. ..,90./........<.......<>...................>.... -&.- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . . ........>.........................................PUeA$ePFUNT..NAMEANQAQQae$$WHEae$EPO$O.$APQCP$e$EN,.............. Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PI..EA$E;PPM~"'E;"fE€()-l::tM4NPENQI1.Q$E'€EJ$> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. N.ame of De~ased -Lj\~t:.- First Middle Name of Father of Deceased Date of Death or Period to be Covered by Search c. lJ2tLKctZ Last ID /60(0 Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased D11~NE e First Middle Place of Death l-Ho (0ENU,S0 -rER . Name of Hos ital or Street Address Purpose for Which Record is Required Last Ojl l <5.oh Last Date of Birth of Deceased 10 2-l Month Da Age at Death \q<o 1- Year 4~ ~d\QS~ Count (}jf\()YP''({Q.(S fA. uS N '-\ Villa e, Town or Cit \ \ \. IV\S l~ ~YS6rQ.l What was your relationship to the deceased? ~-t 8L In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant j~ !LJ~ Address of Applicant /351- LDrcJ VIe-uJ ~ Date I ;);'Ijo ~ f-P/)r~~ IO's100 eOMPl..E':t"E FQR DEATHS OCCURRING AS QFJANUARY 11198$ if Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death Pt.;!;A$E~fOI'fl"NAMEAt4Q.Da.E;$$'WHEI'lE;l::tEPQl::tJ)$AQQI..p.$E$$l\It> Name ---rE:\C.J f\ LN'A-LK 8Z Addr~ We-n\\':;- I?SL~"tQLu ~ City . ( \ State -N L Zip Code 1 ~ ~ DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record Pl...EA$EqOMP(.I5'1'"~f()FJMANQeNQI..O$SlFeJ;Y.. . 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 ~ ~ w&../rJ First Middle Name of Father of Deceased /3rJwwd. J &1'00 lA..(.. ') First Middle Maiden Name of Mother of Deceased ~ V\e.-.. S~,,+ H First Middle Last Place of Death 2 1?,.~~ U \ Name of Hos ital or Street Address Purpose for Which Record is Required '2. LJlf\vL-- Last t.~""'t.;'" Last Social Security Number of Deceased SS- 2- - 'f Z- - ~rs"fS- Date of Birth of Deceased Age at Death Month Da Year 1)~5 Count What was your relationship to the deceased? In what capacity are you acting? ~fMvp....1 ~\/"~-~ If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant .. -.--....---.-.........-,.".,...-.......................,..............-....................-........................................-...............-....................................-......-................-.........,...... .. . ..--- ..., ',"-- ,",'" .-.........-."........... ........ -..,...... .................................,.......................................-........- ......--......-......................"'...'.... UCOMPUemSFOADEAl'HSOOOORAlNQASOFJANOARYU1ElUU -Lt2 Number of copies requested with confidential cause of death >U:J310 NMOl _ Number of copies requested without confidential cause of death ....................p..I...EJ\....s....e.....p..a.. ..I.NT........N..A;...U.....e...A;....N.O.......AD..... .0....8... .e..S...5..W. ....H...e.. .a....e....R.e. ...CO.........R...O...s.....a...o....U. ............-.....-. .... .. ..... ..... ..' .... ... .. . . ,. ...---..,.---.....-. .. ... ..... . . ." .. ..... ..... .... ..... ...,... ..".... .... '--::::::::::::-:<::::<< -::::" :-::, ::: ..:-.":-. ..;..: :.\.-::::. .::.) ,::}. ~:~:::. :" "'';'''''' ...:: >..:. :"-:" ,':,,'::: .':-.. '-:"" ''..:'' ::. :..' ::,,: ":" ....>. .:.) ,::..-..: :"-:" ~.::{ .::....: :..':':::'.:::.,: .::-.'. .'>>. ..::, ::. .":::..:-. :...:.... 900l E \ AON l::I 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 Robert T. Hughes November 8, 2006 First Middle Last Name of Father of Deceased Social Security Number of Deceased George Hughes 059-07-8001 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Helen Sands 4 1 1913 93 First Middle Last Month Dav Year Place of Death 14 Fieldstone Blvd. Wappingers Falls Dutchess Name of Hospital or Street Address Village, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant C# ------ Date November 9, 2006 Address of Applicant 1028 Main St., Fishkill, NY 12524 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 6 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 D HOV .. 9 2006 TOWN CLERK DOH-294A (6/2000) N~-Ol-2006 WED 10:48 AM WAPP. TOWN-CLERK 8452981478 p, 01 Name of Deceased ANNA- First Middle Name of Father of Deceased Jo+f,J 1(. First Middle Maiden Name of Mother of Deceased AM ~L-,A- W. ScffELL. First Middle ' Last Place of Death Cl:if(/(AL p~TCt-ft-<>5 ,jrA.U(~a Name of Has ital or Street Address Purpose for Which Record is Required cS7'tt7tFfu R..f/)s~3. f.. h(Ll-E~ Last Appli atian to LOCil1 Registrar f r Co of Delath Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section :~~~;!;:;~:~r:;:r~;~:i;:::~~T~;i~!~!f~:~\:;~:~;!: \i~:;~)~;!\~~:~;i~1!;~~:!;~ \i;;:r:!!:~l;~~m~;~~)::~\m]i;]:~~m~~~!~1!mj!~1~~:~~t.~ ~. ,. ..~, FEE; $10.00 per copy or No Record Certification. Please d' not send cash or stamps. :;:~\j:\~~~~~~~!~~~ ;;~\1;~~!;;\~~: ~;1~~:\!~~\;l;~,;1~1~!;~~~j~\;~\;~~\~~~~!\;r:~;!~:~\i1;\~Ylt\~jf~\;\1i~\~~ij~~!\f:~~;~;\\~~1:; ~f~\~\~fl\;\\'~l!;~ff,~~~~~;?~~~~~~~i.~m~~~ .;.; ::;1; , " ~ ~1:~;~;,;~~~;~:~~;~;~!f:~~~~~iti}.~~i~fi~~i~ i.~~~~~;~:~f;! ~;~;j~~;;~ ~;:~!;~;m~~ii;~~~;~:~t~;~~i;i~!;~:~~;i~;~;~!\~~\;~ ~~\~1~~~~:: i1~~;~~:1~!\;;:~~f~i~ MIUGZ Last Social Security OJ],. 2;-- R-s3 7 Oate of 'Birth of ('2- Month ~~e eceased I~ (fa I a Year Age at Death 9'2- 1> I.{/C- tf~ Coun What was your relatiol'\$hip to the deceased? In what capacity are you acting? 0 11 attorney, name and relationship of your client to dec ased E LA, _ Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death , .: ~;!~~im1~~~l~~!~~~~~~~~j:~~~:~!:!n~~::~!~~i~:~;[:1;: ~\;~ji~~:~lE eu~ 'J ~p..) Address I!.. K e"'f City YO tLC,H KE-~- jJ7 S r f.- ~Q. ~.~ State Zip Code 12-(,0 J DOH-294A (6/2000) DANIEL F. CURTIN Attorney at Law 606 Druid Road East Clearwater, Florida 33756 Phone: (72 7) 449-1090 Fax: (727) 441-8048 90 Market Street Poughkeepsie, NY 12601 Phone: (845) 452-4353 Fax: (845)471-5148 E-Mail: curtinlaw((~comcast.nct Member of Florida & New York Bar November 1, 2006 Clerk Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 Re: Estate of Roberta Miller Dear Sir or Madam: We represent Elaine Mattson who has been appointed Executrix ofthe Estate of Roberta C. Miller. Ms. Miller died on August 30, 2006. She and her sister, Anna Miller, had savings bonds and made each other the beneficiaries oflife insurance policies. Anna is also deceased and we enclose a copy of her death certificate. Weare now trying to gather the assets belonging to the estate and are required by the govemment( for the savings bonds) and by the insurance companies to submit certified copies of Anna's death certificate. Enclosed please find our check in the sum of$30 for three copies of Anna's death certificate along with form DOH 294A. If you have any questions, please call this office. Thank you. ~ Vera Goodm / NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar , for Co of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE I ~ ::D :0: (/l i: ~ o ", ~ l ", = 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 ~)\Yl~ . S~~i-c::.r Oc."\ . "3\ I :2 00 eo Firtt Middle Last Name of Father of Deceased Social Security Number of Deceased :A0e1c::t Rnt'l\ALC; I 2"2. - '39 -9 '-\~~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death HCA.~ '8lA.~ \ \ -:s- o..V) . Z <-{ , \ ct L-\- 1- S~ First Middle Last Month Day Year Place of Death lli""kh~> Z0S'~ ~e~\ N~\Y) 31- ~~P\~~ ,~\~ Name of Hospital or Street Address ~Townor :ity County Purpose for Which Record is Required t:' ~r"\ d <::). -f" L ..-~e. A \~,r"::::. What was your ~elationship to the deceased? -~ "" en- \ d \v~c'-k.r, In what capacity are you acting? CJVl \o....a..- he.- \ f+- => {" '~v-r-.. \ ~ If attorney. name 7 of your client to deceased Signature of Applicant . ~ ~can.~ Date 1\ - 2 -0 C9 Address of Applicant 1=b~ / 2...'1 \ 2. 5C)S COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1. 1988 -L Number of copies requested with confidential cause of death ~c j'c..... t ~I \ 'c. e..~ _ Number of copies requested without confidential cause of death PLEASE PR1NTNAME 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 Co of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE z ~ ~ :II :0: /Jl ; nl o "' ~ l "' = o ." : ~ ~ 8 FEE: 510.00 per copy or No Record Certification. Please do not send cash or staij,~CEIVED PLEASE PRINT OR TYPE Name of Deceased I--(cM~~ Date of Death or Period to be Covered by Search .l~e. C. Cc-\ . 251 -z.OOG:. . First Middle Name of Father of Deceased Mo,,~r~~ Social Security Number of Deceased ~....sto-..vrt-i h~ o~<Q - \,-\ - 0 8><.n L\ First Middle Las Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Y=-\r\ 0\.01'o-\-cA.. Re~ '.s t--JcN' . "::> I \~L""1... <&-~ First Middle st Month Day Year Place of Death W~~\~~ \5 N \'c.o\c.. ~...r-el '~i-c-~~ Name of Hospital or Street Address Villaqe ow 0 ity County Purpose for Which Record is Required e- V""'I d c.~ L\~ ~,-r~ What was your ~elationship to the deceased?~' AI vc..c.~ In what capacity are you acting? 0'("". ~\~ c:;:) .~ ~\~ If attorney, name and relationship of your client to deceased Signature of APPlica~ . ~\, ~ Date \0'2.-=\--0<0 Address of Applicant Po ~ \=-\, No.W\~~ ~\\os.j~ 12~6 TOWN CLERK COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 \2 ~ I. 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) . ...., rH' Q PETER C. MCGINNIS Attorney and Counselor at Law 515 Haight Avenue poughkeepsie, New York 12603 Tel: (845) 471-5721 Fax: (845) 559-0068 E-Mail: pmcgin1@aol.com Kelley M. Enderley Counsel October 25, 2006 Town Clerk Town ofWappingers Falls 20 Middlebush Road Wappingers Falls, NY 12590 Re: Barbara Dunn Dear Sir/Madam: Enclosed please find my check in payment of a certified copy of a death certificate which is needed for a real estate transaction. The following is the pertinent information: Name: Date of Death: Serial No.: Barbara Dunn August 24, 2005 23 Please forward the certificate to the above address. Thank you for your assistance in this matter. Y~rs truly, ,;~ I Yl~~~ 'Peter C. McGinnIs ~fJ "t\ ~ Q . } <v\'l-"\~~C/ ~ \ \1) · PCM/dl Enclosure ". PAY TO THE ORDER OF 'J:lIe1ll'r"_'I'lItolIlM;:I"II".:.I:II~IIIl:::l'.'l".Iol:l:tMllIf'._:t::f'l.illl~,,=-::.;r":.I::t:a1.11111;.ll,lrl'l:l.l:.l:U..II.:t'.:I.]:tlJ::t= PETER C. McGINNIS ATTORNEY AT LAW 515 HAIGHT AVE. POUGHKEEPSIE, NY 12603-2468 PHONE: (845) 471'5721 dJlJYJ.R1tl!.~I.JW~ 11-13 GARDEN STREET POUGHKEEPSIE, NEW YORK 12601 10/25/2006 7224 $ **10.00 Ten and 00/1 00***** **** *********** *** ***** ** ** **** **** ** **** ** * *** ************** **** ** ********* *** ** ***** **** ******** * 50-1134/219 Town ofWappingers Falls MEMO ... GENERAL ACCOUNT Town ofWappingers Falls Town Clerk 20 Middlebush Road Wappingers Falls, NY 12590 .0)...... (..V1h. d .:IJ......I.IMlll1ll:l....M.Ii>.'.'Ii'J....:I::f.........::Ii'I.......n.'I=-I~I:__I.l.IIol:..l:.:.I..:h.~...:I:::I:I=--:I::t..I\II',U1=-.11....,..':.l::.l:f.'.~...ll'~.,:.:I:;f... II. 0 0 7 2 2... III 1 : 0 2 . 9 . . ;1 ... ;11: III 0 . 20 0...... b III r- DOLLARS 6-0~~~(' r.,{:.<;;j<~&1'<, J.1..<: ,:>ltT I.: <"c."..,.....,,;;;;'*" 4,1'() '-J."r... -4.: NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record . ......................................................<........eUeA$I$QPMPWemSPOAMANOENPUP$I$FEen<</<V}..>.....>..................................... ... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ~A{2.L ef7 C!... N A1-~(L Last Date of Death or Period to be Covered by Search IO(lolo~ Name of Deceased C. First Middle Name of Father of Deceased Lu.Ro 1 First Middle Maiden Name of Mother of Deceased ALu:e... First Place of Death L{ (p ~ f) [..( S S {t2..ML Name of Hos ita I or Street Address Purpose for Which Record is Required Social Security Number of Deceased w (LSCV'\ Last or S'- - (p 0 -- &&1 0 ( Middle 3"cYle~ Last Date of Birth of Deceased ! () .)1 cOOL Month Da Year Age at Death 43 Wm/~s All), Villa e, Town or Cit tvnJ-./eSJ Count Signature of Applicant Address of Applicant What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relatio ship of your client to deceased <<..eOI\1lPUEtEFQRDEATflSobCURRING.ASQEllANOARYdW19SS::... l']r Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death <...PUliiA$EPrUNmNAMEAN$.J.U)Pf1.I$$$V'tllsaefOSPQ.AO.$APPi;;Q$E$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 Co of Death Record ..... ..........>.PCEASECOMPUETEPOFtM. ANO:ENCtiOSE.fEE)i...i{.................................................>>......................... . . ... .....-.........".--.........,......"....................-.....-,... .......-....-...... -....... .",- .... ........ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased t?ol~i2~r "PATRICK First Middle Name of Father of Deceased Date of Death or Period to be Covered by Search fv1 ole II ,j Last 10 /0/0' Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Middle Last Place of Death II CIU~'I3Af'fJ~e C'auRr . or Street Address Purpose for Which Record is Required Month Da Year WAPPI AJtiaR... ~tATCH&SS' Count Villa What was your relationship to the deceased? F U All! Q n L. In what capacity are you acting? F U M(LJ:lA L- If attorney, name and relationship of your client to deceased Signature of Applicant ~ f! 1f1.zJ ~ Date Address of Applicant S 5 13 /fJ 1-11 Al S'T; WRJI1PnJt5JL/f. F,fJ4t-s 'D 112.12 C 'T'Z' If! "'D I fUi. crOR. Ie /1.2, It:!, , , N.Y. 12 S"90 .>..eOMPLemE.FORDEATHSoCeuRRfNGAS'O'EJANOARY1~19S8..:. 10 -+ I Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death >>.eueASEe'nN'tNAMe:ANQ.paJ$s$WHEAI$.RE~at)$flPUl.ipaE$ENT> 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 . ....... ....... .....................................//i.)..PCEASSeOMPLeTER. O$l\IIANbENOCOSSISEJ;).i>..i../..........................>........... . 'H" ... .....-............................. "............., .,- ..... ... ... ." ..-"... .... ....... ...... . ..... ....... .. 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!JKrI!u IL Middle L Name of Father of Deceased First 6H,J Middle Maiden Name of Mother of Deceased 05b.~O/-O 31 Age at Death First PAuL I NY Middle Place of Death fiI I~ MY / '/ Ii ,qc /it-.rN.5 A C fL 1-16~' g 9 . , I or Street Address Purpose for Which Record is Required --- H S '/1) SohM l-r A c..Jq'1 So J- f .7JJc- smlL ldelft en, m-x {t(/3A17? 1# 1'1 What was your relationship to the deceased? 011/'1 0 Ad6'!-I7t:?'L -1- CHI L. P In what capacit y are you acting? t1S A O/+tJ6lffls-'?t- lJl.~ 0i-/J1IiS 1J,e/.Jr/i.Is.~ ';1'/17<; /-l~L /5///S If attorney, name and relationship of your client to deceased ~ tJ&rJIUi:~ Last Month $11.-- J q I{ Year t7 Town or . _ Number of copies requested without confidential cause of death . . . . . . , . - . . . . . . . . . - . . . . ....... ............'... ....................... ... ..... ...........-.... ..... ................ ........ ...........,.... ...................... Signature of Applicant Address of Applicant / ..<<...n'COMPuemEFORDEATHSOGCURRINGAS.o.FJANUARV11988. ~ Number of copies requested with confidential cause of death .eueA$SPSlfftNAMEANQAQQSI$$$'WHeal$:'ae.OO$Q$APUCpal$$eNl'.ni Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Col!)' of Death Record .pI..$A$etQMeCl;TEF<>iAMANPENQI$Q$eFEE<........ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of yJyed BF~st Middle Name of Father of Deceased M/lD e e. Last Date of Death or Period to be Covered by Search First Middle Maiden Name of Mother of Deceased Last First Middle Place of Death / ~ . /t{ 5c(Cr8o ~c... Mame of Hos ital or Street Address Purpose for Which Record is Required Last Date of Birth of Deceased Age at Death M~tth ~L( / ?iar f W/f ,)/>/1'1 6et2 l ,h;t j f\ Y JJ vt {CV( f-SS Villa e, Town or Cit Count Jott C. [ .J /lVeSJ7 67'1-770 rt What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to Signature of Applicant Address of Applicant Date rpyot .................................eOMPI..Ets.FORDeATHsoecuRRINGASOFaiNuiRv1. ..1988.............U................................... -i- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death Pl$eASEPAINTNAMEANDAtU)leS$WliIESEAEOOAtfSHOOl...QSesENt> ",........ ................................,...........,..............................,......................................... ...................................,.,......................-_... 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 .... ... .>pt..EA$eOQMPCeTEif'ORMUANPENOUQ$er;;EEn... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Last Date of Death or Period to be Covered by Search ~ [L~ O~ Nam~ of ~ceased ~ \ \O^<;o First Middle Name of Father of Deceased ~O~ First Middle Maid~ Name 9f Mother of Deceased Lcx-Vv' VYD. First Middle Place of Death L-~ NL'"'-.J \~~,-\~~<:t~k.. Name of Has ital or Street Address Purpose for Which Record is Required ~ ",^ ~V"... 'R.(J~~~ Last Social Security Number of Deceased :3 ~ l- - '?.- '-1 - <; f <:; 7... ~c::.", Last Date of Birth of Deceased ~nth ?a~ 3( Year Age at Death rL~ ..... WCl.~"\ "'<\!(.. (" Villa e, Town or Cit "+r- ~\.. Count L<2- Q.. \ What was your relationship to the deceased? ~ ~ In what capacity are you acting? L....e.. ~ '- \ If attorney, name and relationship of your client to deceased :;;r:;::~:~::~~t ~~ TL ~ ~ oat\." In 1O'-t ~"^- \\~\ .. ~{~)C::I \J\ .. , . ................................................................................................................................................................,........,.............................,",..............................,...",........... eOl\llpl,EtEFD.RDEA1'HSbCCORRINGASOFJANUARyjU1j8j> ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .............../...............................n...PLEASeUPRINl' NAME ANOADD9ESSYlHEREfitECOAOSHOU.J..OSE SEN.....Y..Y........ ........<<.................................. . . , . , . . . . - . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..... .................... ..... ...... - . . . . . . . . . . . . . . . . . . . . . . . . .. ........... Name Address City State Zip Code DOH-294A (6/2000) ; TOWN OF WAPPINGER ... TOWN CLERK CHRIS MASTERSON TOWN CLERK'S OFFICE 20 MIDDlEBUSH ROAD WAPPINGERS FALLS, NY 12590 (845) 297-5771 FAX: (845) 298-1478 August 17, 2006 Mr. Benjamin P. Roosa, Jr. 398 Main Street PO Box 468 Beacon, NY 12508 Re: Estate of William E. Dederer Dear Mr. Roosa: The death certificate that you have requested is not on file in our office. Deaths occurring at Vassar Hospital are filed with the City Clerk's Office in Poughkeepsie. Please send your request to: City of Poughkeepsie Dept. of Vital Statistics PO Box 300 Poughkeepsie, NY 12602 Very truly yours, J~ I!~' Sandra Kosakowski Deputy Town Clerk SUPERVISOR JOSEPH RUGGIERO TOWN COUNCIL VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOlONI ROBERT L. VAlDATI ~"n"'N"""~'" .;.".,~ 43748 Iii I; I~i' " I I .. - ROOSA &. ROOSA ATTORNEYS AND COUNSELORS AT LAW 39B MAIN STREET NANCY ROOSA HILSCHER COUNSEL BENJAMIN P. ROOSA 1903-1971 BENJAMIN P. ROOSA, .JR. P. O. BOX 46B BEACON.NYI250B (845) 831-0971 August 16, 2006 Registrar of Vital statistics Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 Re: Estate of William E. Dederer Dear Sir or Madam: We are handling the estate of the above named, and in that regard we require a long form death certificate for Frances L. Dederer, who died at Vassar Hospital on October 7, 1991. To enable you to forward that certificate to us, we enclose herewith our check in the sum of $10.00 together with a stamped, self-addressed envelope for your use in returning the same to us. Very truly yours, ROOSA & ROOSA vv or;Y / __~ .n" .'" .,. "':,.;;.~.;. ~ ""i)"" "M';''' ,,,,w,,,,",;..;,,.;.-, """"N''';;';'' ..... -' ~ "mn ..",C,', '~"i),,,",,""" ....,,~. ."n;~,_n....;.. . .",>iN' ""..i..... -,.,""";" ^,..\....;. j/ I v- ~ / 50-235559 !?r: I DATE 1&/0 (; 0~~~007618 PAY ,I 6~6~~OF .~Z~~~ ~1tJr~$/(17 ~~ ~~~ 0 _ ~~~ OO~~ THE BANKOF NEW YORK ::;~~rle;~8 By: r~~~ "--- ~ i I I I I I ROOSA & ROOSA ATTORNEYS AT LAW 11101.. :l ? ~ B III I: 0 2 . gO 2 3 5 21: "'027 ::ftt:/:;L?c# . - __- ~. ", __"_"'''VJ'';;;~;--'~'..~~~-;;;':'- :,' ',:";- ~.;_::~:"~~~~~~._ ~..,:-~'-,;iiu",- _'_<.;.,,'m'd'-""'" --=~. _"..~~... ""ni FOR ~-:--,,;;;;'E,-'~';r~_ _..."m';",;;";;~_-"~..,..."""".,,. __ '''''_~'''d'''''''' -.~ ., ',..,. ...,,, ,.."...~."..., .'.'~ , ,. i I I I i I I . I i~' JJ 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 Jane Elizabeth First Middle Name of Father of Deceased Sterling First Middle Maiden Name of Mother of Deceased Henrietta First Middle Place of Death 52 Osborne Hill Road Lot #32 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 PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search McIntosh September 20, 2006 Last Atkins Last Social Security Number of Deceased 077-54-9456 Last Date of Birth of Deceased 4 18 1958 Month Da Year Age at Death 48 Lewis Wappinger Villa e, Town or Cit Du"~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 ~~"-OJ Q( -{+~ Address of Applicant 1028 Main St., Fishkill, NY 12524 Date Se 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 for Correction of Certificate of Death Place of Death See Reverse Side for Instructions District Number Deceased Date of Death Register Number State Number I, Of~ ~f -f.t..JN(d~b6-$- 1 ~ ('J\, opw.{)-J ) H p-p. \.JJ ~ (:A.L.r. ,"tP..~-'1(J (address of applicant) request that the following information amend the certificate of death identified above: t-^\Gl~ -r. (1-otr- (name of applicant) IT~M IN ER~pR ,or omitted} AS IT APPEARS AS IT SHOU LD BE Documentary evidence submitted herewith in support of this application includes: Explain reason for error or omission: Under the penalties of pe~ury, I hereby affirm that the statements made herein are true and correct to the best of my knowledge. ~NJ ~~ ature of Applicant ~ y'~f J Nvc<n(J~<l. Relationship to Deceased Cft(ICf/ ,;L.O()~ Date The above information has been added to the local record of death on file in this office. Signature of Registrar District Number Date DOH-299 (6/99) Page 1 of 2 (OVER) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record . .. .al..IiU~$EGQMPCE'J'E...<>aM~NPENQJ...Q$EFeE)... ... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. \Nfme ~f D~ceased V1rj\l1( ~ First Middle Name of Father of Deceased /I1.e.rr; .J- + Last Date of Death or Period to be Covered by Search A-u UJ I 1. .)./} pi,. 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 ,J.I!./ J IA '" :c I\.A" err 1Jv{. I:J \I t1( Name of Hos iral or Street Address Purpose for Which Record is Required Last Month Da Year Wa.ffIYl5ers~/'5 jJ V ~ Villa e, Town or Ci What was your relationship to the deceased? In what capacity are you acting? II attorney, name and r~.1 lion.hip ~I your client to deceased Signature 01 Applicant. ~ Address of Applicant 1c1. t:.l IAl t) ,t/ L A r Dale ~ I''f/;' Ik~(' 1)14/( /1.)( ~ Jb ... ........-..............'.....................,........--...........................................................................-.......--....................................................--...... ..-...........................-........................... .. - ,""'.-. ......-.. ....- .................... ........ ......... ...... .................. .,......-........-...."..'.. ....... ..............................,....... .-,......--..........-...,.............--.......-..... ..................................>..COMl?Uer:E..FOAOEATHSPOCURAINGASOFJANUARY.1 .1I$&)i......................................./................... . of copies requested with confidential cause of death ber of copies requested without confidential cause of death ..................<...n...aCEA.SEPAJrittNAMEANOADDRESSWMEREREOOAO..SHOULbSESSNT).....<..................... . ......,.........,......................... .............................................................-...........................",........",.......................,....., ........................... Name t1 t1-z~ e;el tV b ;-h4-~ V d Address/2 ~fL)ovD jJLA-21 City I? n?-t:-o ,.) State Nt Zip Code )01 SlJP- DOH-294A (6/2000) STEPHEN R. HUNTER ATTORNEY AT LAW 140 MAIN STREET, P.O. BOX 808 GOSHEN, NEW YORK 10924 845-294-0776 Sept. 6, 2006 Town Clerk Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 Sirs: I represent the estate of Louise O. Schmiderer and the proposed executor. The Surrogate has asked for the death certificate of Louise's brother, Eugene Preston O'Neill. He died in Town of Wappinger on May 7, 1986. Enclosed is a copy of a letter from the Surrogate's Court asking for the death certificate and my check in the amount of $10.00. I thank you for your assistance in this matter. Very truly yours, ;2~( HUNTER srh;sw encls 4;'J L, tlU ~\\\\O ~ () to/ y ~/ ~\~'. STATE OF NEW YORK SURROGATE'S COURT OF ORANGE COUNTY 30 PARK PLACE GOSHEN, N.Y. 10924 TEL: (845) 291-2193 FAX: (845) 291-2196 ELAINE SLOBOD, SURROGATE JOY V. MORSE, CHIEF CLERK JEANNE M. SMITH, DEPUTY CHIEF CLERK August 16, 2006 Stephen R. Hunter, Esq. 140 Park Place P.O. Box 808 Goshen, NY 10924 SECOND NOTICE Re: ESTATE OF LOUISE SCHMIDERER File # 2006-412 Dear Mr. Hunter: Before we can complete the above proceeding we still need the following. 1. Need brothers and sisters listed on family tree and need photocopies of their death certificates. 2. Need an amended page 2, only distributees are listed under number 6. If you have any questions, please do not hesitate to call. V~:~~>_ruIIY yours'-;1t" ~ /C(~~~ Cheryl arina Senior Court Office Assistant . ., , ~ f..r~~ f~Y"", ~<)~~ ~ ~- , CJ uV~.\ '-L ()t~ -' - lvvt~ ' I 19-~~ ~; ~ ~ c..~K ~ vJ ~ d+ vJ~f(,",Jj~ ~ vV\ \ Jd.~ ~ v ~ l f\ d . vJ "'ff:..J l ~ f'A-LL ~ ,tJ-; I ~~lc) ;J~J ~ ~ 0 rJ A~ ....f' e;>< "" L J \ 0 ft.. ~ ~ f3rtaf -rt..rr- ~ .-r ~ \. e ,c.~c....., , c) << . eL. .J rJ ~ ,",11 L ~ I ~ h ~ ~L I;.J \ ~ ~~T,;.(~ 3) ~~ K~ ~"Q.4.CJ lc; ~~ CeltJ t::"\" ~ ~ v'4S') '. rJ '1 -.{ >oS ~,J~ ~;:;-r; ~ ( ~ ~,/, ~rc 'i) c..~K f'<>"- ~/O.- f4/r+-~k. --r:> ~...J '" d vJ.A.jO.:' oJ ~ ~ t( ~fl"f {)^~ 'e..z-r.~'''-.1-(~ ~ fl",-", - ~ i 1 - 5 tl ( '~,J dt- vJAft'N)~.l. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N.Y. 12237-0023 Application to Local Registrar for COI2Y of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Margaret B. Martin First Middle Name of Father of Deceased Last September 7, 2006 Social Security Number of Deceased Walker First Middle Last Maiden Name of Mother of Deceased 121-16-9843 Date of Birth of Deceased Age at Death Middle Last March 30, 1925 81 Hudson Haven Care Center Wappingers Falls Dutchess Name of Hos ital or Street Address Purpose for Which Record is Required Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant 895 Route offV-' ~4/ 82. P.o. Box A Hopewell Junction. NY 12533 Date 9/9!ob Name McHoul Funeral Home Inc. Address 895 Route 82. P.o. Box A City Hopewell Junction State New York Zip Code 12533 DOH-294-A (7/92) VS-34D NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record PCEASECOMPCE'tEF:OAl\Il4HQENCUQSEFES> ...............--.......................-................................. ...... ..... ....... ...... ..... ...... ......... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. / I' I -' NameJ:5~s~ J2- First Middle Name of Father of Deceased Cj,~$r;r /~. First Middle Maiden Name of Mother of Deceased c!..ea..veA- r First Middle Place of Death JY1 ol5c... Last Date of Death or Period to be Covered by Search M oll~e. Last ~~~;c Last 9- 0--0 t, Social Security Number of Deceased {)t, 0 - ~~- J?7'IJ 1- Month (f:t J? Age at Death 5~ Date of Birth of Deceased Name of Hos ital or Street Address Purpose for Which Record is Required Villa e, Town or Ci Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant 0#~ Address of Applicant S f-l71~P I::: 1/. tv. IV ~ (!.;'}.( rD UJeec/07'-- Date ?- K- 06 UtL L-4iVd jJ,y >..CQMPLSEFoaDEATHsbCeURRINGAsioF'iaANUARyj}198i<i /VNumber of copies requested with confidential cause of death . . .. .... .... _ Number of copies requested without confidential cause of death .. . ........ ...>/PUf$A$EPRIN$N4MiANOAQOSS$$'W'HeleAeQQAO$HOQl.,O$e$EN't<.... . Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N.Y. 12237-0023 Application to Local Registrar for COPY of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ~ ~ 2 c. ::D m () m - < m o Hannah B. Grotzer First Middle Name of Father of Deceased Last September 4, 2006 Social Security Number of Deceased Joseph Clairmont First Middle Last Maiden Name of Mother of Deceased 021-28-3939 Date of Birth of Deceased Age at Death Margaret DeCoff Middle Last July 24, 1938 68 62 DeGarmo Hills Road Name of Hos ita I or Street Address Purpose for Which Record is Required Wappingers Falls 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 oCo J.. ra~ Address of Applicant 895 Route 82 , P . O. Box A Hopewell Date ql)1~ , Junction, NY 12533 Name McHoul Funeral Home Inc. Address 895 Route 82 , P.O. Box A City Hopewell Junction State New York Zip Code 12533 DOH-294-A (7/92) VS-34D NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for COe.>' of Death Recorg PLEASE COMPLETE FORM AND ENCLOSE FEE b\\::>.'o Last Social Security Number of Deceased ~ ~ 21 :Il CIl i01 ;;! o m i l m ~ o ... ::: ~ ~ 8 FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased '~-ffi e- \C\ First Middle Name of Father of Deceased \ "~n~ First Middle Maiden Name of Mother of Deceased Ch \'5Dnq Lo...\~ First Middle Last Place of Death Z =1- 'B~\ V\ l..-a..~ Name of Hos ital or Street Address Purpose for Which Record is Required , C~ a-+ L,-ge- l\\\~\~ c. A Ydr i o...c.h PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search A 2-31 2...cd Co Last 096 - \ L - \"Z{a. \ Date of Birth of Deceased . I Ap-' \ '20 I \q 2-,- Month Da Year Age at Death 8'2.... '"'"'D ,^-T-c..~~ Coun What was your ~elationship to the deceased?\--tAne..VCA \ 1:::\ ~ In what capacity are you acting? O'A ~\.(" ci ~~ \::J If attorney. name and relationship of your client to deceased Signature of APPlicant~\ . ~~~ Address of Applicant \~ - --- Date ~0 2..S · '2.co <0 N \""2..5"'\ D _ 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) . .....,nt' Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record ..... >PLEA.SEOQMP...ETEFGAMANOENCUQSEFEE>:........ . . .......................-.......-......................."..............",...............................................-.... 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 tJ Middle L Name of Father of Deceased ,J 6 H rJ First Middle Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death f' AiJ"/ nJ t.1 tJ eNT 2LefL , '11( (7? First Middle Last Month 01 Da I 7 Year 0 Place of Death /J-vt11e /Y/!Flc/LtJ11J.slfu(. PU/-c~e.r:s Name of Hos ital or Street Address Villa Co un Purpose for Which Re_cord is Required A c.- "'/V!1'<J --rt?" It W I-M rn { <l.. I'll 7 r A tz ~,...--t'~ ~ ./~-z;-...:ov /,f~ t'''h...L.~ ......., ,;:;<'-.~t7T/LAoIlJj (liVld'7 What was your relationship to th~ Cleceased? '7J Au G # rex. In what capacity are you acting? HI'; O/ta:;Hll"-n. 1n/9/IJG C;f.fZ.~ 6f7H/4f 6"'..J' If attorney, name and relationship of your client to deceased - ~ 05~;e11... Last Date1rU,"' J!) } ,~ ~ / _ Number of copies requested without confidential cause of death \) ~OV }IJ ' <t'r"a .".:":" .,-.:.:.:...:....,..-.:.:.....:.....:.:...................:.:.:...:-'-.................,......:..................................,.,:...:...........:................,.,'.....................:.................-............,.......-:...........................'...........................:........................................................................... ....-......',...........,...................,................-.-_......'............ ..CQMP].,;E'teF'OROENH$o.aeoAAII\IQA$OFJA.Ho.AlY11~sa ...2---Number of copies requested with confidential cause of death ...............<....<............>>..........Pl..ieASE.PRINT'HAMEANP..QBE$SWHEAI$AE.A.SAOt.JO...ESENX............<<............................... Name ::To A nJ P Zft5M.- <'PI (/(U( 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 Lucy First Middle Name of Father of Deceased Andrew First Middle Maiden Name of Mother of Deceased Pauline First Middle Place of Death 384 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 CLE.R" Rosmilso August 18, 2006 10WN Last Renovitch Last Social Security Number of Deceased 058-18-7223 Wenchko Last Date of Birth of Deceased 11 7 1922 Month Da Year Age at Death 83 Wappinger Villa e, Town or Cit Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? Fune I Director r client to deceased Signature of Applicant Address of Applicant Date Au ust 20, 2006 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) ROOSA & ROOSA ATTORNEYS AND COUNSELORS AT LAW 398 MAIN STREET BENJAMIN P. ROOSA 1903-1971 BENJAMIN P. ROOSA. JR. P. O. BOX 468 BEACON,NYI2508 (845) 831-0971 August 18, 2006 Registrar of Vital statistics Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 Re: Estate of William E. Dederer Dear Sir or Madam: NANCY ROOSA HILSCHER COUNSEL We are handling the estate of the above named, and in that regard we require a long form death certificate for Frances L. Dederer, who died at Route 9D, Town of Wappinger on October 7, 1991. To enable you to forward that certificate to us, we enclose herewith our check in the sum of $10.00 together with a stamped, self-addressed envelope for your use in returning the same to us. Very truly yours, ROOSA & ROOSA ~ ,;11 4\\ /. BPRJR/jm Enclosures , \,. ./' ~-~..... qq C\~ ~ t \p II ~}\~/I NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N.Y. 12237-0023 Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Ralph J. DiCostanzo First Middle Name of Father of Deceased Last August 19, 2006 Social Security Number of Deceased Antonio DiCostanzo 113-01-7240 Date of Birth of Deceased Age at Death First Middle Last Maiden Name of Mother of Deceased Nicoletta DiCostanzo Middle Last March 28, 1919 87 Hudson Haven Care Center Wappingers Falls Villa e,Town or Cit Dutchess Name of Hos ita I or Street Address Purpose for Which Record is Required Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant c/iJ J. -~/~ Address of Applicant 895 Route 82. P.O. Box Hopewell Date (j: /21 ! U- Junction. NY 12533 RECEIVED AUG 2 1 2006 Name McHoul Funeral Home Inc. Address 895 Route 82. P.o. Box A City Hopewell Junction State New York Zip Code 12533 DOH-294-A (7/92) VS-34D NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record ..... ................>PJ...IU~.$J;\PQM~J,..IS'tEfQAM.4N[)..ENQI4'Q$J;f:EE/..../....n................................ .. . FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased gff11 JOSe{/N/tJE First Middle LIt;J J)r;. Last ,y Date of Death or Period to be Covered by Search /(0 r;.. "I 0' Name of Father of Deceased .j0.5 e--f;-{ 1'1 G'PI AlIr First Middle Last Maiden Name of Mother of Deceased Wlc'7V MfrR-1Ijli;L First Middle Last Place of Death Ho fVl t Name of Hos ital or Street Address Purpose for Which Record is Required Social Security Number of Deceased o ~3 -).-;). -1;)../0 Date of Birth of Deceased Age at Death Month /1;J Year 7~ Coun IIJS What was your relationship to the deceased? In what capacity are you acting? II attorney, name and relationship ;{ client 10 deceased Signature 01 Applicanl ~ B;; [~ ' Address of Applicant / q c. ~ L, HU56f+tv D Date -!!: ;;2/ / 0 f, ~ r IN Iff 11 AI Gjt::--,e ~ . (' rJ 0 \ .....,.......................-...............,......,.......................................................,....................-............................................................... .. ........................................... . ........<C:OMP)JETEFORDEA...HSOCCURRlNGASOEJANUARYd198i>> .. Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death ...PI$!;A$EPAUftNAMEANO-4QQaJ;$$.W'aESISAEGQAI:)$HPUt.,.Q$E$Et\l1">..... . Name /1 Address City ~LRllJtJ LA- 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 stamp~Ut, 1 1 ;. CLERk PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search Wallace A. Empleton August 12, 2006 First Middle Last Name of Father of Deceased Social Security Number of Deceased Walter Empleton 111-22-4572 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Marie Crow 11 7 1910 95 First Middle Last Month Dav Year Place of Death 11 VanDerwater Drive Wappingers Falls Dutchess Name of Hospital or Street Address VillaQe, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement ofth" 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 Applicant Date AUl!ust 14,2006 Address of Applicant 1028 Main St., Fishkill, NY 12524 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 6 tl 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 Co of Death Record .....................................Pt.eA$I;CQMPl...eTePQRMANQI;NQI..l)$l;pl;eH..........<............. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Mn.r:J D. First Middle Name of Father of Deceased ~i!S~ ~ d M~le Maiden Name of Mother of Deceased rJ'eA.h'e 5rf),'+h First Middle Last Place of Death I 5 D Co..rn CLb ~ 5+ Name of Hos ital or Street Address A + kin 5 Last Date of Death or Period to be Covered by Search '8 J~JOl.o DJ'XDn Last Social Security Number of Deceased OQ8 -31.0 - 33JD Date of Birth of Deceased q ld, aa I '-1'-/ Month Da Year Age at Death ~I Villa Purpose for Which Record is Required Re ues+ed b +am; I What was your relationship to the deceasea? FlJn_~l)) In what capacity are you acting? On b..p h(], I L Q.f If attorney, name and relationship of your client to deceased J-I () rn e. F'unPfo...) /+ om e-- Signature of Applicant Address of Applicant .......-........................................................................................................................,........................................................... .. .................................................... ......... .................................................eOMPL.E'tEFQRDEATHSoeCURRINGASQFJiNUARVj .1988H......./3/.<<.................................. --UL Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . ............................................/UPI..1t4$I;PA~ltU".AMI;ANO...e$$'WHeaeReP<>$O$A.UU.$I;$eNl.....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 Co of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE ~ FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. ~ :II ;ll: III i:. i;I :ll ~ i = o .., :: ~ ~ 8 PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be Covered by Search V'~If'itL Ne.rrift A...;) '=J I 'Z.cO G::> Fi Middle Last Name of Father of Deceased Social Security Number of Deceased 'Nill\€.. +hc~ Z'tZ-. S4- - ce,(a I First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death --::J:t'\n\' €- tJo..rro IN c:ec. "', 14 C::8 6=1- First Middle Last Month Day Year Place of Death "'pi z-ZO"\ ~'l1";:r~ ~ II=. (l,Go ":t:'rY"'~r-ic:"'- , .:e~ ~ . I Name of Hospital or Street Address (\7ill~Town City County Purpose for Which Record is Required E~ ~ L,Q ~\r~ What was your ~elationship to the deceased? ~ V1f" xo-\ U~-\::.r In what capacity are you acting? c:::n beho\.~ ~ .~~'.\~ If attorney. name and relationship of your client to deceased Signalure of APPIiC~ ~ · ~ ~ ~---> Date e, -9 -0 G" Address of Applicant 'fb~~ B\. \,... ~ \,' l\~~ t-c:t \l~ ( ~ 'f \ Z..::5'"\ 0 . COMPLETE FOR DEATHS OCCURRtNG 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) . ....., nl' Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PLEASE COMPLETEFOHM..ANDENCLOSEFEE. FEE: $10.00 per copyor No Record Certification. Please do not send cash or stamps. Name of Deceased .JO.5 O'H ;+. First Middle Name of Father of Deceased .JA t\.iE.5 R~ii\J( First Middle Maiden Name of Mother of Deceased 4111 ZEt First Place of Death 7:1. IM~cRI4'l I3LVJJ. .PLEASEPRINTOR..TYPE. Date of Death or Period to be Covered by Search S~M5o,J Last fJ () 6. 5, ;;JoD (, 5AM5~,J Last Social Security Number of Deceased lit - .:19- 5'78'7 Middle (!Jlt<7EfL Last Date of Birth of Deceased ..Jolli[ AI, /Cj3! Month Day Year Age at Death c,&" Name of Hospital or Street Address Purpose for Which Record is Required W III'PIIIi6€'/25. P",t)LI...S \[ILt-ft(;.C ~T~ .DUTc. H€.5S County It) s6rn..f 6S'lATE' What was your relationship to the deceased? r: () /lJc(2 In .t)/ RECTo tt-c In what capacity are you acting? .5'AM~ If attorney, name and relationship of your client to deceased Signature oj APPlicant1(..~:- ri iI')'~~ . Date AuG, -7, 2~()? Address of Applicant t;. E. M 4".} ST WrJp/,{if~8!S FA lL$. /If.1./. I;J.:)'fb .. ........ .. .....COMPLETEFOa.OEATHSOCCUR:RINGAS .OFJANUAR?t1 1981l. ..... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . .............P.CEASE.PHINTNAMEANDADPHESS\MHERERECOROSHOu:LDBESENT<'. .... ....-? State Zip Code ~ Name Address City nnl-1-~Q4A IR/?OOO\ " Application to Local Registrar for Co of Death Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section .. .............f1t.EA$E;tPMa...I$'11EFQfitMANPnli:MOI.!.Q$E;.fli:EU.......<......<.....<............................. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased iJ!<.SU01t 8uR/?oUbtfS First Middle Name of Father of Deceased J ULI ArJ First Middle Maiden Name of Mother of Deceased GM/ L- '-/ .b () B 0 I S mftC-K If'l First Middle Last LO V C- Last Date of Death or Period to be Covered by Search JO-() B~, Iqq~ f)uRRoub-HS Last Social Security Number of Deceased 057 - 3 8 ~ 7/07 Date of Birth of Deceased I J!I /90~ Month Da Year Age at Death 97) Place of Death Cc,v,(?flL '~T' LIe'::.';, rVJR?/lV(., Hl9lvllz Name of Hos ital or Street Address Purpose for Which Record is Required ES1CZTe.. bJi"cf;(-t"- So ~ Count What was your relationship to the deceased? -# aIQ d-da I:Y,b.-{t',v In what capacity are you acting? fl'f/'f+ (J ~ { n If attorney, name and relationship of your client to deceased t.J (fit . Signature of Applicant \)~ f. ~\ --tMIU . Date. 0 <? /07 /f) ~ Address of Applicant I~ C/to/(IV7)y K Pdt Po goy 7t;, 1;.)fX::t PArk- t' (}cj /~Jj 95 .........................................U..COMPt.Ei'EFORDEATHSOCCURRINGASOFJANUARY.11981.UU...u....<<......<....... <................................. -L Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .................<.....n>>f1tleA$li:aalNl'NAMli:4NOAQQAE;$$'WHEAI$AEQQfitO$liPUI..Oali:.$ENmU........<.....<................................. ... Name ,,-)0 An C. &n" (V\ Address P. D Boy 7 ~ City L'\Je.~-t ?~vK State n \..J I Zip Code J..d..Y- 9 ~ DOH-294A (6/2000) John Burke Chamberlin * NEW YORK STATE DEPARTMENT OF HEALTH OFFICE OF VITAL STATISTICS ALBANY CERTI FICA TE OF 81 RTH REGISTRATION This is to certify that a birth certificate has been filed for DARCY JOAN CHAMBERLJN Born on May 106 1954 , at Kingston. New york rM# Dau..fJhter of and (name of father) Date Filed NJ.RY 14. 1954 Kin~ston. New york ADDRESS [9 - ~ I I THIS CERTIFICATE IS EVIDENCE OF AGE, PARENTAGE AND PLACE OF BIRTH AND SHOULD BE CAREFULLY PRESERVED When the child is vaccinated against smallpox and inoculated against dip htheria or any other disease, ask the physician or clinic to fill. in the spaces below. - .~ '--'--" '- Date Physician or clinic Vaccinated against smallpoy Inoculated against diphtheria Inoculated against whooping cougl1 Inoculated against tetanus tl1t-'~~':";;:~JI. :is . . ..... l'ci,:u~..' . ~"T'" ." ..~ <i'\'~J.)'" ,t':aCLt'V'~.:.L.V. _ ..,..'....".. ...'M-.......- \~'2.:.i:~__~_..,.~~"'''"'~~ ' .~ 696 9VS 1.-=01 'yo., o':N.ap!I(EV\JOIOV'jOI~~ DA/':'i ". Off.ia. ne. ""'Y (Piling Pee Paid . ) ( oertel . ) (t BaDd, Pee: . ) (Receipt )1ot 1101 ) DO m!' La_ .um ~ ... SlJRROGATB'S COURT OF THB STATE OF I1IIIYOH COUIITY 0' _________________________________________X ADUR1S'1'RATIOlI PROCBBDUG, Bstate of uR.~UL.A. L. c.HAm~\...ltJ a/k/a h_~ Deeea.ed. _________________________________________X PBTITIOlI POR LB'1"'l'BRS OF I [ ) Adal;Lnietration [)(J Limited Admini.tratioll [ ) Admilli.tratiClll with Limitations ~ Temporary Admin18tration Pile No. ...-.-" TO THB SURROGATB' S COURT, county of It i. respectfully alleged: 1. The name, domicile and interest in this proceeding of the petitioner, who is of full age, i. a. follows: .ame;~ JOAN CH/H..tBeRLltJ GRlM. Domicile: i lo tHAMS'B( S Rb. we~T PA-R.K (Street Address) (City/Town/Village) ~~a~?eK. (Z~(93 (~f~~~~O Mailing addre8S 18: Pi 0 BC'}( (~S-difi~~~~~~i1C'''J'. 12Y.Q ~ Citizenship (check one): [Xl U.S.A. [ ] Other (specify) l) ~~ leR... (COUIlty) Interest of Petitioner (check one): . [ ] Distributee of decedent (~tate relatiansb.1p) [;>(:1 Other (specify) SrJ)A .~..notJ.'OOI.FOI,..l....OWa.lb-' ~tJUe6.il~"IDtJ (1.'/ R,:;:.Falt:;;:. , Is propoeed AdD~ nistrat~r _ attorney? [ ) Yes [)() 110 [If yes, submit statement pursuant to 22 BYCRR 207.16(e)p ...a180 207.52 (Aacountiue of attorney-fiduciary).] 2. The name, domicile, date and place of death, and natioDal citizenllh1p of the above- named ciecedant are .. follows I l'fbe :DeatllOe&'t:Uiaa. _t::be filed .U:b. tIlte pncsaedi... If the decedent'e domicile 18 different frail that ebga on eM death certificate, check box [ 1 and attach an affidavit apla1niDgthe reuClll for thiei.nc0D8i8tenc:y.) __I URSlJL.A L r~~ AMlSEI< L J N Domicile: {nq (sM2.~ n~~) VI e1V ~OA-~ity.:~tr.~~~~ AJ00 YDRK Ja5a~ (State) . (Zip Code} '1'OWIUIhip of: PI S H K / l.{ _' county of: h 0 ~r j...ff: So ~ Date of neath: 5? J 1/00 place of Deathl(Pq /fJ()(Y1fo il1/};.euJf!}..!0cJ,hll O.y. I I Citizenship: (oheclt one) I t><l U.S.A. t ] Other (epecify) A-1 (12/98) -1- [Rote I POl' It_ 3. through CI Do not includa any ....t. that are jointly held, h.ld in trust for UlOther, or have . n...d beneficiary.] 3. (a) The estimated gross value of the decedent I s personal property passing by intestacy is less than . $ 7- ,(JOO,O()(), '-. I ' (b) The estimated gross value of the decedent I s real property, in this state, which is [X] improved, [ ] unimproved, passing by intestacy is less than $:3/ ()O Of aOo. -. A bdef. d~s~riptionof each parcel :j.s as follows:CIJ-~Y~lnieredln R'\I-ev~,IJ1++VraJfd- ~fn BOffOUj liS) hcmd.bvllf NII-tiona../ Lttrdnn*-, r;trme. hoVs~ In west Pfl/Z.I<.., W.Y. {lI.J/DePT. oF' mrEIi!JoR. N H L (JP.OIJZ€ PJRC,CjUe..)ON ";g,Ip hUtS ON HUbsolJ RIVGii(.; [ilJ-2 PAJ{,C,et- /-HlmPTof'lS VA<.ATION BG~t+ PRCJyGill)' WITH z.. I-!O\)SE S e>N JoPLIowlJ LI/JG Rbi '5~~~ Pvn,} I c., 50llTHA-m PTO"';, ,.,;,y) 5 TE:.t..ePHDkJE PO/..eS ?Rot1'l TJ-Ig- oceAt.J. (e) The estimated gross rent for a period of eighteen (18) months i~the.sum of ( Rlv6/2.e,"{ L>1V~e IJTA-T3I.E AT TJ4IS "n Tn~, Be,'K,11 PP.oP~12T'-I: rnA..'1-t-(YlA'1 -i:Jo~~Uov:J$ /57.)} 000 ,- (d}- In addition- to the va-lue-of the personal p~r~y _s.t~ in paragraph (3) the following right of action existed on behalf of the-decedent and survived his/her death, or is granted to the administrator of the decedent by special proVision of law, and it is impractical .to give a bond sufficient to cover the probable amount to be recovered therein: [write ..... or .t.t. briefly the a.u.. of aetioa. aD4 the par.oa. ...iDBt whoa it exi.t., :l.De1.u4iDg n.... ~ carrier] . N'I S SuPf2.BW1G" c.OVf2...T j(}/)~~ ~ ~OO~ / ~fo71 : THIS Pt;IIiIDtJ ~R... (DPQcYJDA-tJUf-AmBteutJ (,e1(Yl\ prKeR . Pl.-AIIJ"fF Y. JoHtV ~. CtlAm~~L,(1\l 61 AL (IH-G^l:>ISil2.l~ole{;:S L1S"1eb % 70...,. b~ THIS PETlIIDrJ,'Ti+e CftlJSE Or AcnvrJ IS \..71'\1>\)6 lNPl..venc...G" A6fH)JST '"'fi..l.E 1)El-GOen'T, AS blSC.(NER'f PRo(.EebS,l"HER.E j....{,4.""1 BE ~ol2€ (.A-uSES +>.nb ~IH2.TI8S AbbE'D. (e) If decedent is survived by a spouse and a parent, or parents but no issuei and there is a claim for wrongful death, check here [ ) and furnish names (s) and address (es) of parent (s) in paragraph 7. See EPTL 5-4.4. 4. A diligent "earch and inquiry, including a search of any safe deposit box, has been made for a will of the decedent and none has been found. petitioner.t;16 (has) .Qta.e) been unable to obtain any information concerning any will of the decedent and therefore a11ege(s), upon information and belief, that the decedent died without leaving any last will. 5. A search of the records of this Court shows that no application has ever been made for letters of administration upon the estate of the decedent or for the probate of a will of the decedent, and your petitioner is informed and verily believes that no such application ever has been made to the surrogate's Court of any other county of this state. 6. The decedent left surviving the following who would inherit his/her estate pursuant to EPTL 4-1.1 and 4-1.2: a. [I ] Spouse (husband~. b. [~] Child or children or descendants of predeceased child or children. [Mu.t include marital, n=-rital, and adoptecS] . c. [X] Any issue of the decedent adopted by persons related to the decedent (DRL Section 117) . d. [>(J Mother/Father. e. [;<] Sisters or brothers, either of whole or half blood, and issue of predeceased sisters or brothers. f. [X] Grandmother/Grandfather. g. [X] Aunts or uncles, and children of predeceased aunts and uncles (first cousins) . h. [Xl First cousins once removed (children of first cousins) . [Infonnation is required only as to those cla88es of surviving relatives who woulg take the property of decedent pursuant to EPTL 4-1.1. State .nu.bar. of survivors in each class. Insert .Ro. in all prior classes. Insert .X. in all subsequent classe8] . -2- 7. The decedent left surviving the following distributee., or other necessary parties, whose names, degrees of relationship, domiciles, post office addresses and citizenship are as follows: [Rota. IhcJIr claarly bow each plIZ'.cm i. ralated to 4ace4aat.. If ralat.icmahip h through an aaaa.tor no i. 4acaaaad., .i... ~, data of ~t.Il, aDd nlat.imaahip of tile anca.tor to the ,,*,ad8Dt. u.a ridar ab8at. if apaca in paragraph (7) i. DOt. aufficiat.. Saa Unifora aula. 207.1&(})). If ay paraaD li.t.ad. ill Paragraph (7) 18 a D~":1t.al plIZ'lIOIl, or 4a.ceD4a4 frca a DOlllla:r:it.al parsem, . at.t.ack a oopy of the order of filiation or Schedula A. If allY per.on list.eel ill paragraph (.,) wa. ulopt.ad. by ay par.ona ralat.ed. by blooi! or man'iap to 4aca4aDt or 4a~caD4e4 fr~ such parsODa, at.tach 8cba4ula B]. 7a. The following are of full age and under no disability: [If nonmarital or adopted-out person, so indicate by attaching Schedule A and/or 91 Name Relationship Domicile and Mailing Address John~.G\H$\'\P.>02L-\N S?OVSc loCi ~Ol:)rtT~r..HhelN~b/rlSflk..Lu... ""I \2.52-'-/ ~~JoA...,c.\.\Am"E/2.I-I~ beIlV\$ItU6~rT~R. l(oC-~AmP"e,2S ~b/~D~l:1-l1~ WH>Tp~n.". tZ,-\q3 W\l,UJrVu\. ..jA~ CW\-fI\~eQ,lI JJ SDN loq !-.lOUO'P\-l ~ 'Jlf'l,I.)12D1 HsH$ll.L...n.'1. \'2.s:-2'-\ '3'0\'\\..) Sl.OiT QVrYVI~EI2..L-11\1 So 1'J IoC(MOIJnTAn) VH:WZ$, t='I~KILL,n~r Ig1..'1 PPr\JL 8:>fY')\)f)btt+~UtJ-llGe.eA$'b So~ bG MOOt1Tkl tJ 'V lewQ.b. FI5~"Iu... n.'/. 11Sl-~ b.o.'!), IJJ2ID~;i>V1'C.,l-I~S> (.{)Ol'\~ SUgRDf:,A~ {.Of.:)~1 F'L.~ InbE'f~q4ISg/0b Citizenship USk- uSA- USk USk Us.~ 7b. The following are infants and/or persons under disability: [Attach applicable Schedule A, S, C and/or D] Name Relationship Domicile and Mailing Address tJ/A- 0( ~+ fcM.(J\A.J Citizenship 8. There are no outstanding debts or funeral expenses, except: [Write "NONE" or state same~995.On P1Hb -ro Ro~r J+. AVU//..IOb"b'1 FUIJEf2AI-U01Y1es,JnC. PoR CJ~eM.\:llo~ b if I rlrt (u,h ed -3- 9. There are no other persons interested in this proceeding other than those hereinbefore mentioned. WHEREFORE, your petitioner respectfully prays that: [Check and complete all relief requested] a. process issue to all necessary parties to show cause why letters should not be issued as requested, b. an order be granted dispensing with service of process upon those persons named in paragraph (7) who have a right to letters prior or equal to that of the person nominated, and who are non-domiciliaries or whose names or whereabouts are unknown and cannot be ascertained; c. a decree award Letters of: 1><J [ ] Administration to . 0mJ\-JJ~&E fHG /,...;f ~~n,,qt.. PRoP€f2T'! TO "[)(;PPO(2. r II-IERIUEfLljY LAnj)tnII~t::' fROP6' (2. 19 Limi ted Administration to~ Rl3wIJ ER. fl{Z71~S oF LJ;4Jrc-( THflT Wt:?!U O(,OlJeC By Ii-! t 'beu;l>/;}JTAnb ft1'15~LF fl5, /eNAIJ15-OJ-l.0I11fYlOAl AS ~e[~ (0/Y7f24L7 46ea:mGf,j/ of /Q,5'. Administration with Limitation to [;><] Temporary Administration to ImrneblA-TI:>>{ 6el;IN f<~-rRIl:3.vJ}Jb- (U2;,1t-Le5 oFLEbftC'/ tHAI wEJ2{; SOL-1> of< E5/PTa I LL.EbIJ./,L'i , or to such other person or persons having a prior right as may be entitled thereto, and; ) d. That the authority of the representative under the foregoing Letters be limited with respect to the prosecution or enforcement of a caus. .of action on behalf of the estate, a8 follows: the adm1nistrator(s) may not enforce a judgment or receive any fund8 without further order of the surrogate. e. That the authority of the representative under the foregoing Letters be limited. as follows: ' .L f(f%PELTPvu..y M~'t Ti+1t-T TIfE ~L,f?R.06rf7E" /lYlme'bIIt.TEt'-l PtffO/(I)t A REPeR-EE It> J::r\l\JESTH:lATG" FU(...j,,'1iHE bET~IL.S -rl-+A-T SUj;?RDOVlb 11+E:" bEA-iHS cf' rYl"f MOTIt€R. 'Tl-+t" b~81'" jIJ IHI'S PET/TID,.), A-nb HER. SO~lPA-()L e::bMVI'I.tlc..~AmB€12.L"IIJI P,c..;:5~g,~Db{f1r:4S WUI2..T PILE" (10, qZ.j{gSJC5". m'{ L>GC..I2IlSE'b 132oTrlcR- .p/WL../I~ AL-Sl> f+ LO-1>eFe1J'J:>PtIolT ItJ TITI: N'/S suPReme LOiJeT of 1>u1"l.Ift.SS c..OlJrrT'j, tOVlZ..T PILe J(lbE~ no, z..ooY./~b71, IF Anb WJ1e1J II IS 7:>G'TBZ.ml/vEJ:::. 6'i ,HIS lOI.)I'2.:r; It"b A-(l't o'fI-tl?12- wue-rS InVOL..v~b( To &€ ftPPRDPR,J/f1EJ :r WISH -rD -n+Et-J 'SVSJ-il-r -n-+t;; PETrlloN poP.. --n-ft: L-/l'Vll,r;;:)) It'PI111NIS.TR/F'TJoJJ or::: rn'l .fVf,OTl-fee~ €:STitt e ,q.s i-/5Tet> fiBt;lJ~ , / I ::c J1L.SD WI S H 10 l./.s~ ~ ASSETS of my MOTH-EflS fi$T.tTl3 TO PRo VI bG" It- MO~l)ME,JT FoR HeR. I]V I~e W;IWS/,OTT C-GI---\F;-Tk/2..,/ 6UeLA-L. PLOT -rHIr, SI-lE OwllV> /,J TI+t: 7lJV;N OF eAST HltmP-rorJ, 1.1''1'/ whev-e... ::sM_ LJkn-re:b'To Be: t3vJ2.it?"b' . r>O f. [State any other relief requested]. Dated: \) () 1412, I, 200 Ie, I 1. DnA tt ~Urr.Ul &1M kuJM,( ahA~ (Signature of petitilane~) 2. (Signature of Petitioner) ))A-RC>~ JOA-N CHArv\l~E7Gj....I,J &R.\tJ\ (Print Name) (Print Name) -4- I" ....,.. .... .. ,"' . . .".. . 1__1:; 1ITm USA !lIlJ5 01<9-00 LO.SFOll6482M ..' <C :.,,'~.'" ~ 126 MaiD StnlIt FiIbIdI1. NY 1252A (914) 896-6166 P.O. Box 43-Roum 12 Hopewell J1IDcIiaD. NY 12.533 'o/5"a5 c. fi.~ (91<4) 221-9234 'f -;:2i) Number is" dd C if Livery . ~~ l.."'-m................................. ,.... =of=:;/_~.l~~~ JJI" FJ:~id ~=,""'" .......................... ,... ITEMIZATION OF FUNERAL SERVICES AND 2.. Flower vehicle ... . . . . . . . .. . ....... . .. . . . . . . ... $........... MERCHANDISE SELECIED 3. Limousine(s). .. .. .. .. . . . . .. .. . .. .. . . . . . .. . .. .. $........... The following are the charges for the services, merchandise, and livery you have select- (Specify Dumber: _ @ $ _/limousine) ed. You will Dot be charged for any item you do Dot choose unless it is necessary because of other selections you have made. Any such charges are explainlld below. 4. Passenger car(s) .. . .. . . .. .. . .. . . . .. . . . . . . .. . ." $...... .... (Specify number: _ @ $ _/car) __t ROBERT H. AUCHMOODY FUNERAL HOMES, Inc. IlIIIbliabed 1929 16 0nDd AveAvc PaaF'-lp'iI>. NY 12603 (914) 4.5z,,161O I FUNERAL HOME CHARGES (Indicate N/A for items of service and/or merchandise that are not provided.) A. ~=v~:= ....... ... ....... .... ..... ...... $...'l9~~ 2. Direct Burial. ................................... $....11.1. ;~.. B. Transfer of remains totbe funeral establishment including personnel, equipmenund vehicle. . . . . . . . . . . . . . . . . . .... $...... C. Preparation of Remains 1. Embalming (iDcluding use of preparation room) .. . . . . .. $..... If you select a funeral for which this firm requires embalming such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you do not approve if you select arrangements- sucb.asdirect cremation or direct bur- ial. If we charge for embalming, we will explain why below. 2. Other Preparation (including use of preparation room but excluding embalming) a. TopicalDisinfcction... ..... . .. . . . ... .. .. . . .. . . . .. $ ... b. Custodial Care . .. .. .. . .. . .. .. .. .. .. . .. .. . .., $... c. Dressing/Casketing .......................... $ .;. d. Cosmetology............................... $... e. .Restoration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ .,. f. Omcr (specify) $ ... D. Arrangements Basic arrangements: including funeral director, other staff, equipment and facilities to respond to initial request for service, the arrangement conference, secur- ing of necessary authorizations and coordination of ser- vice plans with parties involved in the final disposition of the deceased. ,jJ( $.....1.... $..... ....... $. ..tJ/It.... E. . Supervision ffuneraldircctor and staff) I. Supervision for visitation.... . .... .. .... . ., .. .. . ., 2. SupervisioA-fOl' funeraIserYi<<. . . . . . . . . . . . . . . . . . . . . 3. 0U1cr supen-ision(specify) 0111l18AP-47 . F. Use of the facilities 1. Use of1he facilities for visitation. . . . . . . . . . . . . . . . . . 2. Use of facilities for funeral service ..... . . . . . .. .. .. $..... 3. Other use of facilities (specify) $ . . . . . H. Merchandise 1. Casket or alternative container . . . . . . .. . .. .. . .. .. .. $...... .... a. Supplier b. Model name or number c. Material: Species of wood or kind of metal weight or gauge or alternative container (describe) d. Interior 2; Outer lDterment Receptacle .. . . . . . .. . .. . . .. . .. . .. $...... .... a. Supplier b. Modelnameor number c. Material I, Additional Services and Merchandise Se1ected(Describe and sbowprice) 1. Memorial Cards............. ....... ... ......... $....... .2. Acknowledgement.Cards... .. .... . .., . . ..- ... ... $....... 3; Casket Plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $....... 4. Crucifix/Cross... ........... .. ................ .. $....... 5. Hairdressing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $.......G 6. Flowers......... ..... .. .., .. .., . .. . . . .... . . ., $....... 7. Clothing or Burial Ganncnt&. ... ... ...... ..- ..... $....... S-. Register Book. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S....... 9; Death Notices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $....... 10. ........................................... $....... 11. ........................................... $....... .,. 12. . . . ....... . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . ... $....... J. limited Services ::::=.: --"~~)4I~ TOrAL OF FUNERAL HOME"CHARGES I ~-= ~F.JrtJ1J . -- $... . . . . .., . .. 11. ........................................... $............. $ ;;"75"412 Dl s=::"'~.................. ~: ~DrorAL-"CIIAIlGFS ................. .s-l?7t 2. CashAdvances............................... .~$' . fl:-. 7.?:.OO Date..R'.~~..-:.QO......... / f-' 70 I TOO"ALFUNBRALCHARGES . _'m ~ Th' _in< ..",mo.'''' b," "'" by (ta) mo ..d I_by""" . edge recetpt of a copy of same and agree to pay the above funeral account for such additional services aud materials as are ordered by me, 01 before. .f. -.1 if: .-' a(), . . . . . . . . . In the event that this accOUI not paid in accordance with the terms of this agreement, the undersigned he agrees to pay any and all costs and attorney's fees incurred in connection the collection of this account. n. CASH ADVANCES These are estimated charges for items to be paid to others. We will charge you no more for these items than is actually paid the third parties. (Describe and. show estimated charges.) 1. Cemetery or Crematory ......................... 2. Clergy Honoraria .......... .~. &"'i .~.~... 3. Death Certificate Transcripts.. .., . . A . . . . . . . . 4. Livery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Pallbearers ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. Public Transportation. . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Gratuities... .. .... .., ., . .,. ., .. ., . . . . .... . ., . 8. Bridge & Road Tolls. . .. . .. . . .. . .. . .. . . .. . . . . . . . 9. Telephone & Telegraph Charges .. .. .. .. . .. .. . . . . . 10. .. ......................................... ESTIMATED TOTAL OF CASH ADVANCES ~(!tt $............ . :::5t.~.: $. ../Yflj:... $ .. i1r.. . $ .. .. r(.t.. .. $ ..1ft.... $ ..;f'(t.... $....yl.t... IV. EXPLANATION OF CHARGES Explain charges for embalming and for any items that are not required by law but may be necessary because of cemetery requirements, crematory requirements or other selections made. o $............. () $. . 9rLlP" Combined charge for other Facilities and Staff (specify). . . . . .. $.~..... J (J/~F./~ ,....~~~p~ Combined charge for Facilities and Staff for visitation is. . . . . . . . Combined clwge foc Facilities and Staff for funeral service is . . . ~~ ~MN])' ~n Printed or Typed Name of Funeral Director i'''~'oO Date Y"',;L'O () Date PUBUC NanCE The New York State Department of Health is responsible for licensing and regulat- ing New York State funeral directing under the Public Health Law. You may contact the Department at: Bureau of Funeral Directing, New York State Department of Health Hedley Park, 6th Floor, 433 River Street, Troy, New York 12180 STATEMENT OF GOODS AND SERVICES SELECTED INVOICE TO = The undersigned hereby authorizes the above funeral establishment or it representatives to obtain custody of the remains of The undersigned hereby authstrizes the above funeral establishment or it representatives 0 to embalm [ll not to embalm the remains of '. L, . h .' Other Authorization by "Charges are only for those items that are used. If we are required by law to use items, we will explain the reasons in writing below." Prior to the discussion of these funeral arrangements, I was presented wit! copy of this funeral firm's "General Price List" for which I hereby aclmoWled receipt, and bavehad an opportunity to review the firm's Casket Price List a Outer Interment Receptacle Price List. TERMS: This account becomes due}l-/';;" -00 . U remains unpaid Rond , - / :J.;- (>l'J a late charge of ~ tfo per II (annual rate I tfo)may be added to the unpaid portion of the balance due. g:tff:.~:~~~g Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Relation to Deceased. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . By........ ..................................................... Print N...... of Uc:cased Fu--' I ADDITIONS OR ALTERATIONS OF SERVICES AND MERCHANl SELECIED. The following changes represent items of service and/or merchs ordered or altered subsequent to the original funeral agreement. AUTHORIZATION INITIAL c=J......................... $............... c=J.......................... $............... Total Adjustments to Funeral Charges . . . . . . . . . . . . . . . . . . . ., $ ADJUSTEDTOTAL.. ................................ $ Credit. . . . . .. . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . ., $........ EXCLUSION OF WARRANTY. The only warranties, express or implied. granted in connection with the goods sold with this funeral service are the express written warranties., if any, extended by the manufacturers thereof. No other warranties and no warnmdes or merdumtabWty or fitness fora particular purpose are extended by the funeral director. .1- 2i:r;p.. ~ BALANCE DUE.. ., ., ., . . . .... . ..... . ........ ..... $- M C\I <D "f - """ C\I 6 o O? - w W II: I- J: U c( W a. .I..- ROB1;Kf b. AUCHMOODY FUNERAL HO.M.ES, INC. .' FISH KILL POUGHKEEPSIE HOPEWELL JUNCTION The Sum of For Funeral Expenses of ... ti: E o u. o CASH ~HECK o SOCIAL SECURITY OVA BENEFIT o LIFE INSURANCE Date ~ ~ 6Z..000 - oUars Amount Received $ / OZ 70 .!!E ) By~,dtVUaQ . , . STATE OF NEW YORK ss: COUNTY OF COIIBDDD ftal:J'ICATIOlf, CAD DD DUICJD.'tIOR [.or u.. when p.titioner i. to b. .ppointed ~ni.tx.torl I, the undersigned, the petitioner named in the foregoing petition, being duly sworn, say: 1. VERIFICATION: I have read the foregoing petition subscribed by me and mow the contents thereof, and the same is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters I believe it to be true. 2. OATH OF AmlINISTRATOR as indicated above: I am over eighteen (18) years of age and a citizen of the united States; and I will well, faithfully and honestly discharge the duties ~ of Administrator of the goods, chattels and credits of said decedent according' to law. I am not ineligible to receive letters and will duly account for all moneys and other property that will come into my hands. 3 . DESIGHATION OF CI..BRK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the SUrrogate's Court of l'\V-rc.H-~S County, and his/her successor in office, as a person on whom service of any process, issuing from such SUrrogate's Court may be made in like manner and with, like effect as if it were served personally upon me, whenever I cannot be found and served within the State of New York after due diligence used. My domicile is: I ~ Cf+Mn B6<S ~, AJ g~ 7~ W {3/ .p A-/2.JC... (Street/Number)' (City, Village/Town) ,,;,y. (State) J;J..4C, 3 (Zip) bfl;1~r~~VL~ Signature of peti oner on the day of , 20_, before me personally came to me known to be the person described in and who executed the foregoing instrument. SUch person duly swore to such instrument lJefore me and duly acknowledged that he/she executed the same. Notary Public Commission Expires: (Affix Notary Stamp or Seal) Signature of Attorney: Print Name: Firm Name: Tel. No.: Address of Attorney: -5- NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coey of Death Record . ...................>PtEASEcOMAcsmsFOAMANoeNCLOsEFes>... ...............,..........__.................._...................",..............,_............_...........,............ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased 8 Errj First Middle Name of Father of Deceased ..JeSt? First Middle Maiden Name of Mother of Deceased 13 cLEt/ First Place of Death / q SC~I be LI1Nci Name of Hos ital or Street Address Purpose for Which Record is Required L..I7N.lJ,ER Last Date of Death or Period to be Covered by Search ,t:}U(i ij; :<C><JG fl.; E [Mil /of Last Social Security Number of Deceased (~G.3 '- ,/2-'7.21(;' Date of Birth of Deceased Age at Death '79 Middle 10/11:..'7'"1/1/':: z.. Last Month Da Year , Town or Ju r(./I~S:~ Count W/J /'1") Nee/?, To 5E7IJ..E Esr4T[ What was your relationship to the deceased? rUJl!elt'J1l- HoME In what capacity are you acting? S"'AP?6- If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant ~tZ.~ t,ij t!:' %h,~';&: ~ff'-?'ALJ. .?~, ??j Date ,qu C;. :5"; ,;lea? ..>................................................<y............COMPL.EfEFoaDEATHsocCURRINO..ASOFJANUMv1U..i988)<.........:..../..................... 5- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ....................................................s...............NT.... .........AM.......e.....A.............U.......O...R.......S....S.......W......H........S.. .e.........e........................S............................................................................... ... ..-_................ .... " ..... ...... .,. .... . .... .. . . .."..... ................-.... .... .............". '. ... .. .-. . . .". .. ,... . .... .. ... . ... .... . .. . ... .. ... ... .... .................. ................. ... ." .. ... .. . ., .. . .... ... ... ., ....... .. . .................. ..........................PLeA......&...PfJ.........,..Jlt.........::........ .Ntt..... ..:............ :&..:........................,;.....:.::...,1. .::COIQ,....J1QQ.t:tlJi'&JJ,;Nl................................ 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 Recor2 PLEASE COMPLETE FORM AND ENCLOSE FEE ~ ~ :II :ll VI ;! ~ o III ~ i III ~ 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 \.{\ m; \t-c K \~L:; ~ \ I "200 G::> First Middle Name of Father of Deceased Social Security Number of Deceased LA 1'\ \t.-t"\ C v....)."\ o \~CJ\...d c..... First Middle Last 11z... - l-f'-\ -qC1 Cl ~ Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death U ., ~ (l" 11'.\ '" G;. - ~- ''1 "?;.o ==J'5 First Middle Last Month Day Year Place of Death Wo--rPf ~.~-er '.'0 R,^S6 Aqt-.< ~i-U1~~ Name of Hospital or Street Address Villaqe. T~r City County Purpose for Which Record is Required A'~\\"'s crd 0-+ L\-\c: What was your ~elationship to the deceased? 1-Vt~1 Di reci-cr In what capacity are you acting? on ~lr of' ~-n~ 'j If attorney, name and relationship of your client to deceased Signature of Applicant ~ . ~~ Date 5 -"2 -0 cc. Address of Applicant Fb~ l'd\ ~~FC-llls, ~ \2&~=\6 . , COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 1988 ~umber of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE pfur-irNAME AND ADDRESS WHERE RECORD SHOULD BE SENT J Name Address City State Zip Code DOH-294A (6/98) . .. .-,n,' Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record .....PCEA.SSCOMPI..ETSFGtRMANPENCUOSSFES>.......... ,....--................................ ...... ............ .... ............ ..... ...... ...........-.......- .... ,.. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased o-~+e. First Middle Name of Father of Deceased 9~~\\-- Last Date of Death or Period to be Covered by Search ~\"'J Z.~2~(e:, Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Middle Last Month Place of Death raZ ~-pen-c::a.-' B\vd., A-p;- c 'O~ Name of Hos ital or Street Address Purpose for Which Record is Required Da Year '~~~~ Count t:=",J o-f' ,~{:'~ a...~".r~ What was you~ relationship t.o the deceased? ~~. p 1"-~ In what capacity are you acting? eN.' 'oe-y-p-\...(:' C3~ -\-~, ~ If attorney, name a~hiP of yo:, client to deceased SignatureotApplicant ,'\J:Jf. ~~, ~. Date Address of Applicant ~ \31 t W~ ~\ ~ T-z.'-\-a~ ~-r' \ L.b~6' <.<CQI\1IPL.ETEFORDEATHSOCCURRINGASOFJANUARY111984 1:-l::j Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . . ..........<..<n.......PUEASEPA1NTNAMEANIAODRSSSWHESERSOORDSHOUCO..BSSSNl'....................i<>......... ... ,......-...."............................................................................................. ........ ..................-........-.....................................,..... . 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased C 'TOy/r1 , First Middle Name of Father of Deceased PLEASE PRINT ORTYPE Date of Death or Period to be Covered by Search G-u-;i) 0 Last Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased. Age at Death First Middle Last Month Da Year Place of Death /.J-9 eV'L~Y tV) W'AfP'/16e~.J ffl1 /1Y/~O Name of Hos ita I or Street Address Villa e. Town or Ci Purpose for Which Record is Required --;? Lt L [ ':;;;v e.r;-; ~ 0/1 {' ST"A-/C O~~il5' Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to de Signature of Applicant Address of Applicant f"46tA '.' . ... .'. COMPLETE FOR DEATHS OCCURRING AS OFJANUARY11988 .... -1- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .. PLEASEPRINTNAME ANDAODRESS WHERE RECORD SHOULD BESENT \ I. I 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 ~ ~ :II :00: Ul ~ ill fll ~ l m ~ o ." ::: ~ ~ 8 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE Nam~ 0. W~f,tv\ J Tv', Date of Death or Period to be Covered by Search Do - b Lo- '<rODle First Middle Last Name of Father of Deceased Social Security Number of Deceased '--\V\ ~) t? L-01\'lLV\- \ ~'a - \~ - 9"(TS\ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death U--\VuV\V\{ t \AIY\ v1\ \ ~ OB-- 0\ -\ q ~LP -~ (:1 First Middle La Month Dav Year Place of Death ~q NM t\tLC~V\.SCtclL ~. J . WLtW\~~ b~VU?SS Name of Hospital or Street Address Villaae.<TOWn)or City County Purpose for Which Record is Required [jV\. YJ< \fUA \ .r b~ ~lV\\-1 \t-j What was your ~elationship to the deceased? A~\flt \ elV,( C>1u.r In what capacity are you acting? - If attorney. name and relationship of your client to deceased - Signature of APPlicatl.L-~lA.i.sil'l,L 0~l10 Date J. - d-.-=l- OLP ot.Aonl if" <mt 'SC; ~- ffia.\vl, ':k- .___\l~ t'11111l;.fL~ tiLli}L_!JI A l~~~ --- 1997 STRAUB FUNERAL HOME Town of Wappinger 2/26/2006 Transcripts 40.00 1 [ l\ -\- \ ~~-e-e l vL-\-cY~\~) Cash - M & T Checkin T. Logan 40.00 DOH.294A (6/98) . .. ...,nt' ~ 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 Cf \I1z-tb'kh 'j:) . First Middle Name of Father of Deceased L-re~ -""Th-tJ~~ First -. -J ~ Middle Last Maiden Name of Mother of Deceased V\U'~ ~ First Middle Last Place of Death ~S~Y\ ~VL"V\ ~r-~0-evtkv- uJ~ ,{6 ~ \ I~ Name of Hos ital or Street Address Ilia . Town or Ci -\\Wll ~~ lUj PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search () '0 - 0 s- - &-DC::lP I ~ :II ~ en i:. 1;1 o ", I ! o '" FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Social Security Number of Deceased ~ ~ 8 OS5 -:2;-\ - vo...r+ '2:> - &~.- \ Dt\-S- Month Da Year Age at Death C[a Date of Birth of Deceased \>t\c\t1ts<; Coun Purpose for Which Record is Required Of\-. 'cx.AA. \.f' 0-\ ~\ \ What was your ~elationship to the deceased? In what capacity are you acting? If attorney. name and relationship of your client to deceased \ (P-.e1D1 Signature of Applicanl- ~-\-\ ~ ~ Date 0. - d- -=l - OlP Address of Applicant ssE, r\'V!UVl ~ c::x . ) \.l )t.Lpp ~ ~\ \s \ ~ \ ~"-1 D . COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1988 ..l9.- Number of copies requested with confidential cause of death _ '0 Number of copies requested without confidential cause of death , PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE. SENoT oJ 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 COe)' of Death Record <C.P.......L...EASS.COMPC$$EFOAMANDENdtOSSFEE......................>...........<....<..<......... .._-............................ ," .... ......................................................,..-......... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased VIOLA First Middle Name of Father of Deceased Dominick Capparella First Middle Maiden Name of Mother of Deceased Elvira Petrillo First Middle Place of Death STEFANI Last Date of Death or Period to be Covered by Search 6-5-2006 Social Security Number of Deceased 126-09-6967 Last Last Date of Birth of Deceased 08-08-1919 Month Da Year Age at Death 86 12 Brookside Drive Name of Hos ita I or Street Address Purpose for Which Record is Required Wappingers Falls Villa e, Town or Cit Dutchess Coun What was your relationship to the deceased? In what capacity are you acting? Funeral Director If attorney, name and relationship of your client to deceased Signature of APPlicant~ ~ Address of Applicant Funeral Director ... ...............,.......,._---,.-.--,.,..........-.......--..........................................................................................."........"....... .............,.__._-.-_._---.-...--.-.._---.-.--.....-.................................................................................................,....,....., ,...--...,-...---".-......---..,.-..--..--..---,',...............,........................................................................................".,..,.. ....... . . - ... .. -..... . ....... ... ..-..... ......... . ... ...... ' ,. . . . . . . .. . . . . . . -.. .. .. .. . , . . . . .... . .. . .. . . . . . . ............................. .. . . .. . ...... .... ...... . ....... .... ... . .... ... .. .. ... ........ ..... .. , ... .... .. . ." ..... . . . ... .. . ... ... .... ...... . ....... .. ,. ........ . ........COMPl..ETE..FOR..DEATHS.OGCURRING..ASOF..JANUARY...1....1988. / / ;/ ~ c\ o..~ r~ Date rp~<;/6 ---2..... Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death "FOR PICKUP AT WINDOW" ..................................................................<./>....PUEASEPRINT.NAMEANDADDRESSWHEAEAECOAO..SHOUtttSS.SEN,................................................ . .,..,.................-..,.-...---.,..-.,...-.......,...........,.................................................,......."'.....,...............................-..-....-..................... Name Robert H. Auchmoody Funeral Homes, Inc. Address City Fishkill State New York Zip Code 12524 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for eoI!)' of Death Record ...... ....................etEA$SCPMPWeTEe.AMANQENCI4Q$SFEE<......>>............................... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ACtttl'sE /11. First Middle Name of Father of Deceased ~~F~S 5 Last Date of Death or Period to be Covered by Search 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 ital or Street Address Purpose for Which Record is Required Villa e, Town or Cit Count What was your relationship to the deceased? A~N-e.V" / jJ/~ c-c-~ rz In what capacity are you acting? ~A /1'\, c.. If attorney, name and relationship of your client to deceased Signature of Applicant /~ ~ , .-2 =- Address of Applicant ...tII! Date 6- "2 tf - tJ {, ..........>..........<<<.<8^M..>~(~i:::~~R<<<D<e........~'.ffl..'>S ~rlnR>Jil...Nbi:S......8~i~N>.j)(bQ1 <1...<9......~~...<....<.<>.............................. .. .... ......'-"""" .m"''"'..''.......E'!ij;I'.. .<... M......... ...._1I;t.v.... .0.. '''.I....M....YE..~" . y""...............<. .._>............. --.!i- Number of copies requested with confidential cause of death I - Number of copies requested without confidential cause of death .....................................<.<..>......<eI4IiA$EP8INTN..EAHPAQO.S$SrWHEaerAEOaAJ)$APUtQEJSSEJilm..?...<>................................ ... Name /ll, /11: It 4//17 . 6. mil / c 17 A-,J j 5'" /J Address 3 -; ( #'0 () A'~ v ,4 (/ C. City /. '-j I. /1;' /~I '< /v-l- /2 (.. 3 State ~ t,j ~ --It Zip Code /..I &:,c J DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section APplication to Local Registrar for Co of Death Record FEE: $10.00 per copy or No Record Certificabon. Please do not send cash or stamps. .....;%A~tlliQM~&...~t:~l\l!.l$MtWA:XXX}:}:/:}.//::::::};.: First:J.., 1 Middle Name of Father of Deceased ..-- First ~ ~ Middle ...J . Maiden Name of Mother of Deceased (g...J?- & lP S~ Year Age at Death First Middle place of Death ~E" Name of Hos ital or Street Address Purpose for Which Record is Required S-I- vV '- 1 t D'^ 5$ Wo..pfL"'4,,lr5 Villa e, Town or Ci Count --r V') v.,r CLV'C e.. What was your relabonship to the deceased? 5 · r J::.e (' In what capacity are you acting? <, t-M< Fr.l"...\-... -6--.,r<~.,~ 11 attorney, name and relabonship 01 your client to deceased r :.....W:!~iiiii:ii:i_'tiIS~A&DillllliiiiijJ\i!bialliilf!itNWiM!NW / ~ Number of copies requested with con1idenbal cause 01 death . .... l Number of copies requested without confidential cause of death ... .................c.PP$A$epsltttNAMe.ANO:AQQSe$$YlHe..ERe.Q(>:RQW$H ... Name Address City State DOH-294A (6/2000) 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 Joseph James First Middle Name of Father of Deceased Marco First Middle Maiden Name of Mother of Deceased Anna First Middle Place of Death 15D Scarborough Lane 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 of the deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Romani, Sr. July 14,2006 Last Romani Last Social Security Number of Deceased 075-20-8112 DiRicco Last Date of Birth of Deceased 2 20 Month Da 1927 Year Age at Death 79 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 Address of Applicant 1028 Main St., Fishkill, NY 12524 Date Jul 15,2006 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 5-H 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 Reg istrar for Co of Death Record PLEASE COMPLETEFORM.ANDENC:LOSEFE~ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ,t.J 0;'~ )4 First Middle Name of Father of Deceased . / lI'i'cfvr E hIPpie, First Middle Maiden Name of Mother of Deceased 13c-1 rf-hJ. c/{A/e ~ First Middle Place of Death Y7 t!--/J> ~~ Name of Hospital or Street Address Purpose for Which Record is Required . PL.EASE..PRINT OR TYPE Date of Death or Period to be Covered by Search j{ epj-e r- Last JI/~ t' ;2 ~ ;2000 Social Security Number of Deceased / 0 ~ - / h- - 07.5'h Last Date of Birth of Deceased Age at Death Last Month oc.f wF Da cS/ 1::7 vie J,r- fJ County What was your relationship to the deceased? FL/ ".....,01 In what capacity are you acting? If attorney, name and relationship of your client to deceased J;? ,--,..... ,. ;j /) Signature of Applicant Address of Applicant /~/~ ~ ;; ~vle' J--.). .~j-?l"'U/P// ,. Date hh..?~6 )-, ,., 4/ r / / .5 -.? ? . . ,... . ",,"', ..' ..' "." ....CQMPLETE.FOFl..OEATHS.OCCUR:RING.AS. OF.JANUARY..11.98S... ~ Number of copies requested with confidential cause ~f death _ Number of copies requested without confidential cause of death .PLEASEPRINTNAME..ANOAOORESS..WHERE.RECORO.SHOllI..DBE...SENTq....... .-- Name Address City State Zip Code DOH-294A (6/2000) ~ ROBERT B. DIETZ THOMAS E. DIETZ DIETZ & DIETZ, LLP Attorneys At Law Two Cannon Street - Suite 207 Poughkeepsie, New York 12601-3224 Paralel!:al Carmela E. Newman (845) 452-4000 Fax: (845) 454-4966 Lel!:al Assistants Colleen C. Misner Michele A. MacIntyre June 20, 2006 TOWD Clerk Town of Wappinger 20 Middlebush Drive Wappingers Falls, New York 12590 Re: John C. Cwiklik Our File #: 6181 Dear Sir/Madam: I am enclosing our firm's check in the amount of $10.00 for the death certificate of John C. Cwiklik, whom we have been advised died on September 1, 2001 in his home at 10 Bell-Air Drive, Wappingers Falls, New York. The purpose for the death certificate is for the sale of real property. Thanking you in advance for your cooperation and courtesies, I remain, Respectfully yours, DIETZ & DIETZ, LLP a / "-- P QJ / i/~ -J /~ By: Robert B. Dietz RBD/mikki Ene. J tJO (, )r ~ ;. ifl& , y''' . :J1. ~; /' .k ()/ r 4,/~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record i.....>.....PI..EA.SS..CQMPl.JS"tEFOAM.AND..ENOLOSS.FEE<................ .................................................-......"..."..................................-."..........-....-...... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased P,/-1T~/c-/1t First Middle Name of Father of Deceased 6- () 6 eN I:::' First Middle Maiden Name of Mother of Deceased Q. fk-J\ c- I~ First Middle Place of Death 67 6-6~D J<.O Name of Hos ital or Street Address Purpose for Which Record is Required /:= 6 I/t- 1 E:.. MOOR:/2 Last Date of Death or Period to be Covered by Search ~119/ob Social Security Number of Deceased /-f 14 WI Last Date of Birth of Deceased I3A-R R I==- rr Last Month g- Da 6- ~ ~r Age at Death 70 W /t (> P/^,6- F= R. r:::::/tJ- J-..,.S Villa e, Town or Ci Dvrc ft/265 Count What was your relationship to the deceased? H () s!3A-AI 0 In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant Date 6/B-/ /06 , / ..................<>i........>.......................cOMPl..ETE.FQRDSATSOC'CUSRINGASOE.JANUARYj...1988)................................................ i Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . .............................................................PI..l;A.SEP$IN't'N.EAHPdPREs.$'WHeSiAeG<>AP.$HPUl.;.I)IIE$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 Coey of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased PLEASE PRINT ORTYPE Date of Death or Period to be Covered by Search First ~ Middle Name of Father of Deceased Last Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last . ()- zLf - s 3o-Z: Date of Birth of Deceased Age at Death First \" \ Middle Place of Death \ 2- '5 os\10( ~ \-\\l\ ~~ Name of Hos ita I or Street Address Purpose for Which Record is Required t> I Yeaa L/ ~U~C~SS Count \OWn What was your relationship to the deceased? In what capacity are you acting? If attorney. name and relation hip of your client to dec -\ Signature of Applicant Address of Applicant Date w)zo)o6 I I I ....... COMPLETEFORDEATHSOCCURRlNG AS OF JANUARY 1; 1988 .'. >. ...... ...... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRlNT NAME AND AODRESS WHERE RECORD SHOULD BE SENT . .' ~ .... Name \ Address ,. , City State Zip Code DOH-294A (6/2000) ;- NEW 'teRK STATE DEPARTMENT OF HEALTH \fital Records Section Application to Local Registrar for COe>' of Death Record .. ..... .:PI..IiEA$I$COMeCI$'t$ItQRM4NPIiEHCI..O$I$FliEe. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased FirsS,aw 'Middle ~ } I JG..ast ( Name of Father of Deceased Date of Birth of Deceased Age at Death First Middle Place of Death Name of Hos ital or Street Address ~ Purpose for Which Record is Required ~ Last Month cr..,r Da 6 Year ,9 - What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant Date ..Y/VAJ../................ ............/U.........COMPLETs.FoabEATHsOCOORRINGASOFJANUARy.I..1iu.........../:...>............................ V Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ..................Y..:.............<...<...........PI..$A$liEe$INtt'N.1iE4NO..SI$$$W'H$SI$$$PQR.SHPtJI..Q$IiE$$N't..UC..................... Name Address City State Zip Code DOH-294A (6/2000) ~ F(------- ._-~- . . .. - c ' Ie.! ~, r, f Dea!h Certificates - New York State Department of Health Page 1 ., Death Certificates Where do I obtain a death certificate copy for someone who died in New York City? The New York State Department of Health does not file and cannot issue copies of New York City death certificates. For deaths in one of the five (5) boroughs of New York City (Manhattan, Kings, Queens, the Bronx, and Staten Island), please visit the New York City Department of Health and Mental Hygiene web site. Please note that the borough of Kings is also referred to as Brooklyn and the borough of Staten Island is also referred to as Richmond. Where do I obtain a death certificate copy for someone who died in New York State outside of New York City? What is a lawful right or claim? · For genealogy or family history copies, please visit our Genealogy web page. · For certified death certificate copies, please continue. l. V Who is eligible to obtain a death certificate copy? vt ~~C , l -Co -If J) ~ fO 0 .iJ cYl ,,-,<~~~ 0~~ ~ ~l' ,,\\ t 1(\ , \ \l \ f' \.v. · The spouse, parent or child of the deceased · Other persons who have a: o documented lawful right or claim o documented medical need ~~ o New York State Court Order If the applicant is not the spouse, parent or child of the decedent, a lawful right or claim must be documented. An example of a lawful right or claim would be a death record needed by the applicant to claim a benefit. Documentation would consist of an official letter from the agency verifying that to process the claim they require from the applicant a copy of the requested death record. Identification Requirements - application must be submitted with copies of either A orB: 1. One (1) of the following forms of valid photo-ID: o Driver license o Non-Driver Photo-ID Card o Passport o Employment ID 2. Two (2) of the following showing the applicant's name and address: o Utility or telephone bills o Letter from a government agency dated within the last six (6) months Important Notes: · Failure to include necessary identification will result in rejection of your application. http://www.health.state.ny.us/vitalJecords/death.htm 11/30/2005 r NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for CollY of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE OlA' do Last Social Security Number of Deceased osL-\ - L-\<D - 62-6<0 ~ ~ :II :,0: III i: ; o m i ... i:: m ~ o ." :: ~ ~ 8 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~ cY\V'\ F First Middle Name of Father of Deceased ~ohn First Middle Maiden Name of Mother of Deceased N~ First Middle Place of Death ~ \ I~i Ct(r~ 1"~d Name of Hos ital o....swkt Address Purpose for Which Record is Required ~ qll\\-do Last PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search ~ l,{V)e \C, Z-OOCo }ad~vO Last Date of Birth of Deceased Afn\ 2=1 i l~et Month Da Year Age at Death 52-. ~~ Coun 0-( L,'-k A ~\~ =:::. What was your ~elationship to the deceased? ~er~ \ r~~ In what capacity are you acting? c:::l-Y' ~~ ,..p c::::s-.f> -+d.vnl' \~ If attorney. name and relationship of your client to deceased Signature of APPlic:N. ~ ~ ---.:::" Address of Applicant ~ ~ f"3 \ COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 11988 7 OU 0 / ) .;\ Q/ v\' 'j'f - Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRfNTNAMEANDADORESS WHERE RECORD SHOULD BE. SENT ... Name Address City State Zip Code DOH-294A (6/98) . ....., nl' Q PLEASE /\ CC'~,,/ ~. ..-' -~ - tY(.;.:~__---; fl)' 4.)~ ~b? . 6/<;1"~ lication to Local Registrar For Copy of Death Record NEW YORK STATE DEPARTMENT OF H Vital Records Section ..OSE FEE FEE: $10.00 per copy of lo not send cash or stamps. PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search Viola Stefani June 5, 2006 First Middle Last Name of Father of Deceased Social Security Number of Deceased Dominick Cap parella 126-09-6967 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Elvira Petrillo 8 8 1919 86 First Middle Last Month Day Year Place of Death 12 Brookside Drive Wappingers Falls Dutchess Name of Hospital or Street Address VillaQe, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? Funeral Director In what capacity are you acting? /J If attorney, name and relationship of your client to deceased j,\~ ~ c5(. Tlcvv~ Signature of Applicant Date June 7, 2006 Address of Applicant Auchmoody Funeral Home, 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 - Cit State Zip Code Y _____ -- DOH-294A (6/2000) -- tV.-1A 20 . vr ~ -"'11'1{ 'PtNGE:~~/DDLE:8 ~PPIND" J:.-1LLS USN ~OA wc~ ACCclVcD . NEW "'OR~ FAOM . 12590 ...~ ,~~ r FE:t:.. - ...ocal Registrar If Death Record I or stamps. ~me of DeceasrQ __ "- \-1\\-\0\ "e:.:'~ D ~ First Middle ~e of Father of Deceased ~ ,QfU\e.Q First Middle aiden Name of Mother of Deceased ~~O- Last ~-\O() Last 00cw First Middle Last G,aLQ o~~~" d-\D ~ Name of Hos ital or Street Address Purpose for Which Record is Required Date of Death or I _ q 114/0 be Covered by Search Social Security Number of Deceased Date of Birth of Deceased ~o~ ~J i.~ ~I~~\'S Age at Death lo fJ'{. ~ Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Date 6C6\ lCjo Signature of Applicant ~ ~~ Address of Applicant L\ ~ ~\....t ~ m~ {)"'). v \ ...... - ..............-.-.........-.................-.................................................................................................... .............................................. ::::::::::>>>.::r:eOM~RLETEJFDBUDEATH~S:::OGIUR:RINQhis:::QpJJANUARit:1:: ~:\i988Utt::\r:n:::>>::::::>::>............ _ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ...............................PUeA$EP$JrfrN.E.ANQAQQSE$$....$$.l$.A$POAb$HOUl..p..aE$$i\lyn..............>.................. Name Address City State Zip Code NEW YORK STATE DER~1V6E}.L TH Vital Records Section t:~ MAY \ 5 2006 PLEASE COMPLETE FORM AND ENCLOSE FEE TOWN C!.E~K FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Application to Local Registrar for COE!)' of Death Record PLEASE PRINT ORTYPE ". Name of Deceased Date of Death or Period to be Covered by Search .J 0 H rJ S. F JaR ITO M/PI 1.3, ~O()(, First Middle Last Name of Father of Deceased Social Security Number of Deceased V I CTo(~ F lOt? 'TO /~g- 1'1- t51J')... First Middle Last . Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death JuSEPa"Jf efT f<.OLt..JI /l11l Y 2, 19~i '7f1 First Middle Last Month Dav Year Place of Death 12. l/IIlf,rRIAL 6LIIP. Wi4Pf'IIliG-e~S PI1LLS N.Y. <j)UTCHt>~ Name of Hospital or Street Address Villaqe. Tmvn or-Gitv County Purpose for Which Record is Required To 5E1rL( EST~Tt: What was your relationship to the deceased? F Uf<) E1UU- .]) f/? E <: T tSlL In what capacity are you acting? SAM" If attorney. name and relationship of your client to deceased Signature of AP~licant ::J~ a. tf11L~ Date .~r- /..:r-o ~ Address of Apphcant C,4./::.. MAul.! Sj.W4PPllvG€t2<; FALLS . IlI.Y 1~~-7'O COMPLETE FOR DEATHS> OCCURRING AS OF JANUARY 1; 19S6 .'. ... ". / a. Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASEPRINT'NAME ANOAODRESS WHERE RECORO.SHOULDBESENT' ." .... Name " Address " I 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 PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINTOR TYPE . Name of Deceased Date of Death or Period to be Covered by Search MA~'1 1... srEJ}RNS M,q,/ 1/, ~()o(., First Middle Last Name of Father of Deceased Social Security Number of Deceased (!.H~IS Torf-lEJ< .JOH ~ .soN' () fJ'f- :Ie. -fi~a:s First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death LENA Cf1LLUC.C. I JflfI/ IS; /133 '72 First Middle Last Month Day Year Place of Death )?o3 f /..J Jf14 (AI ~~ WI1f'r'lNr:€t25 FI'/LLS, j;) ()Tclle-~5 ~> I . Name of Hospital or Street Address Village. T-QWfl OIi"G+ty County Purpose for Which Record is Required To SE T7/~ r-c:..TA71..- What was your relationship to the deceased? Fu,veaffL .PII2E'-7 t>(L In what capacity are you acting? SI9,."C If attorney. name and relationship of your client to deceased Signature of Applicant Y(~~ (2. ~A47 ~ Date ..!:>--/~-o(., Address of Applicant &'4 e /PJa~ a-. W~f"-1-'A.dJaL/... hJ- 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 Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar F or 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 Anthony Spada May 16,2006 First Middle Last Name of Father of Deceased Social Security Number of Deceased Pasquale Spada 104-03-4234 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Antionette Morano 2 14 1915 91 First Middle Last Month Day Year Place of Death 355 AllsAngels Hill Road Wappingers Falls Dutchess Name of Hosoital 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? Daul!hter In what capacity are you acting? If attorney, name and relaA of your client to deceased Signature of Applicanf ~ ---------- Date Mav 16,2006 Address of Applicant '1 Yonkers Avenue, Yonkers, NY 10704 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 4 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 Annette Soada Address 681 Yonkers Avenue City Yonkers State NY Zip Code 10704 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ,~)/-III2-L-f?1I First .... ( Middle Name of Father of Deceased rHo IlAl1f First Middle Maiden Name of Mother of Deceased S ~~ l;t Middle tU:a~5tJN Place of Death HOUTCi-A-/ ~L ft PT~ ,tfA)"u J4' M 14 rz:; PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search Last Jw t[)~ . C(~ uJ I L--5() IJ Social Security Number of Deceased Last Date of Birth of Deceased Age at Death '-/7 Year Ljg- 17 L).,'cHE5 \ Name of Hos ital or Street Address Purpose for Which Record is Required ---- K- ~o 5 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 ~/ ~f Signature of Applicant Address of Applicant ~~(r{J~ 07 6, IWIt: 5 r" /i-fJ. -- Date tj -:J tc> -0 ~. 13 6J1CCJ IU JJ / . I J..!;,CJ g 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 flLRE/J--i 111/ 4/J1/tIV Address / () 7 Gfl5T M A 1;tJ ,6 -r AK '-/ City '-8 ~,U. State JJ / Y. Name Zip Code ) OZ 5CJ ii7 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for Coe.Y of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE ~ ~ :a :0: tn ~ ~ '=' m ~ i m ~ o 'Ol 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 ---r.:::- . F. '~C={A e~r ~Ce- ~\, 23;ZCcJO Firs Middle Last Name of Father of Deceased Social Security Number of Deceased ~~ ~~; 052' - Z'1"cr=t32- First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death 1(>~V1~ ~~\i, N.AJ. 'Z ( q2:(:) 7S , First Middle ast Month Day Year Place of Death \A1..ff'crr~ Fq \ \6- ~~ 28 PWQfCO rla.c::ra Name of Hospital or Street Address ~ Town or City County Purpose for Which Record is Required ~~ o-f' L,-k. A\a,~ What was your ~elationship to the deceased? _~ \ ~Y-ec--fz::u In what capacity are you acting? on ~,+,' ~ ~vY1I\j If attorney. name and relationship of your client to deceased Signature of Applicant '0 ) ~n 'a Date L\- Z5-o<o Address of Applicant ~ ~ l3L W~~ll~ N'f IZ,g; 6 , ~ ~ 8 COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 11988 ~ 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) . ....,nll ~ TOWN CLERK '" TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NEW YORK 12590 RECE~FROM f ~A'~ Jl/!.-Ir 09280 DATE if/!7 Jt> I, $\ loB DOLLARS AMOUNT OF ACCOUNT THIS PAYM;js \j5J7 BALANCE DUE lit CHECK o M.O. TOWN OF WAPPINGER TOWN CLERK CHRIS MASTERSON SUPERVISOR JOSEPH RUGGIERO April 10, 2006 TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI ROBERT L. VA LDAT I Catherine M. DeCarlo 143 Sunrise Drive Lancaster, Kentucky 40444 Re: Copy of Death Certificates Dear Catherine: Enclosed is a copy of the death certificate for your father, John Robert DeCarlo who died July 3, 2000. We have not been able to find any record of your mother's death. If she was declared deceased at one of the hospitals, you would have to write to their vital statistics department. Vassar Hospital St. Francis Hospital City of Poughkeepsie Dept. of Vital Statistics PO Box 300 Poughkeepsie, NY 12602 Town of Poughkeepsie Town Clerk 1 Over ocker Road Poughkeepsie, NY 12603 I am returning your check in the amount of $20. Please send a new check in the amount of $10.00 to cover the cost of your father's death certificate only. Sincerely, J~L~~ ;(~ Sandra Kosakowski Deputy Town Clerk / Catfierine 'lJeCarfo 143 Sunrise 'Drive LIJ1lCI1SteT, 1(!Y 40444 S94024509 9/15/1957 14 CJAM.1 ~ 1:, ~~~~~~ =:.:- ~ &/~;r ak;.;.u Ch4-'; JO.[IJ ..... '- d,UJ ~ rtUJll_ c-----, Dollars {TI I' =:~~, ~ For rk1 ~ W. I: 0... 2 . 0 a 2 7 ... I: . 0 2 ~ . 2 a II- 2 5 2 7 ~M&f1tn 2527 M' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased bet r bti\. r~"-- VV$l) {' \' e. First Middle Name of Father of Deceased [1 w.e r First Middle Maiden Name of Mother of Deceased V e...'f '^- I(Y\ O(,\.7.y\ First Middle ~ Place of Death we.\ s h Last PLEASE PRINT ORTYPE Date of Death or Period to be Covered by Search d-- \ d-d- \ 'D \.tJ "be\c\l' "eo Last Social Security Number of Deceased Date of Birth of Deceased Age at Death bell \ (\'" Last Month l \ Da ~ ~~ Year Il~ D~~e~S Count VUl\-rr ;'\~ ~l \.S Name of Hos ital or Street Address Purpose for Which Record is Required {\v'j . Villa e, Town or Cit tct Vt ul~{C . LV 6.dUt-kN What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased CQMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1:' 1988" -'- Number of copies requested with confidential cause of death ~ '}-'1 \$\0 Uq ~" Signature of Applicant Address of Applicant _ Number of copies requested without confidential cause of death I PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City" State Zip Code DOH-294A (6/2000) Catherine M. DeCarlo 143 Sunrise Drive Lancaster, Kentucky 40444 (859) 509-4230 April 5, 2006 Town of Wappinger Falls Town Clerk's Office 20 Middle Bush Road Wappinger Falls, New York 12590 RE: Copy of Death Certificates Dear Sandra: I am requesting that you send me a copy of the death certificate for my father and my mother for my records. I have enclosed a check for $20.00 to cover the cost for each certificate. Father: * John Robert DeCarlo DOB 3/21/1931 000: 7/3/2000 Mother: NO Catherine M. Nolan DOB: 1/19/1934000: 11/1/2005 If you should need any further documentation and/or information, please feel free to contact me. Thank you. ~ )j.il~ Catherine M. DeCarlo ~\ii Apri110, 2006 Catherine M. DeCarlo 143 Sunrise Drive Lancaster, Kentucky 40444 Re: Copy of Death Certificates Dear Catherine: Enclosed is a copy of the death certificate for your father, John Robert DeCarlo who died July 3, 2000. We have not been able to find any record of your mother's death. If she was declared deceased at one of the hospitals, you would have to write to their vital statistics department. Vassar Hospital St. Francis Hospital City of Poughkeepsie Dept. of Vital Statistics PO Box 300 Poughkeepsie, NY 12602 Town of Poughkeepsie Town Clerk 1 Overocker Road Poughkeepsie, NY 12603 I am returning your check in the amount of $20. Please send a new check in the amount of $10.00 to cover the cost of your father's death certificate only. Sincerely, Sandra Kosakowski Deputy Town Clerk "'j, '".'. Catfierine 'lJeCarw 143 Sll1lTise 'Drive Latu:i1Sf;er, 'l(!J40444 S94024509 9/15/1957 elf, ii! om. $ ~O!!P 827/421 1023128 Town Square Bank 150 South Main St_t Il .. :;~dd b#-~... fl2t~jgl;lArtJo -~ .:0... 2.0827....:.02:1.2811- 25.... Dollars ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for Coey of Death Recorg PLEASE COMPLETE FORM AND ENCLOSE FEE Ha-dd e.V\ Last Social Security Number of Deceased \\L{- '"Z-2- 5lo\~ z ~ a ::II :00: VI i: iil o III ~ ... i:: III ~ o ,., : ~ ~ 8 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased C~"th-c:-n V"\e. First Middle Name of Father of Deceased L,^~~ First Middle Maiden Name of Mother of Deceased "R~h-e ( H 0"" _c~ First Middle Last-.J Place of Death ~ '.lo..~~ PI~~ Name of Hospital or Street Address Purpose for Which Record is Required r::en n \,ACe ~ Last PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search \..--\ o.....rC-h L q, '200 G:. Date of Birth of Deceased ~~cSr <0 ,C{ \'::7 Month Dav I Year Age at Death ~b \-..J~i ""(f\ Villaqe. ~r City 'Dl.A.~~ County E:~ o-f' L\'{:~ A~\VoI":;;;;. What was your ~elationship to the deceased? ~~\ In what capacity are you acting? Or'\. ~\-t=. If attorney. name and relationship of your client to deceased Pf'ecicc cf') .~~\~ Signature of Applicant Address of Applicant ~. ~~~ c--~ 'po ~~ \~\, Date t-\ <!to.. -<""C-V) 30\ 2c:x:..cp \N~ndS\~\.\~1 ~-J \c5"';b COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 .1988 ber 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) .. .., rH' Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For CoeY 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 Lillian Brnzgul Heider March 31,2006 First Middle Last Name of Father of Deceased Social Security Number of Deceased George Renner 088-28-5619 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Netti Brill 9 21 1907 98 First Middle Last Month Day Year Place of Death Hudson Have Care Center Wappingers Falls Dutchess Name of Hosoital or Street Address Villaae, Town or Citv 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? Dauehter In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Date Auril 3, 2006 Address of Applicant 22 Hausner Drive, Hopewell Jet., 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 Dolores L. Ruchin Address 22 Hausner Drive City Hopewell Jet. State NY Zip Code 12533 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for Coe.v of Death Recor2 PLEASE COMPLETE FORM AND ENCLOSE FEE Social Security Number of Deceased ~ ~ :II ;ll: (/l ; nl ~ I m ~ o .., : ~ ~ 8 FEE: 510.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE PRINT OR TYPE \..(\e\ n~ Date of Death or Period to be Covered by Search ~V""CVl "'2Q I -z.oo CD Last t--{~~ Last o-zq - o~- --T.s 15 Date of Birth of Deceased ~9 \'-\ \9 Ie.; Month 0 Da' Year Age at Death 8~ D.-... -\Chec~~ Coun e>r L \.r~ o-:\~\~ What was your ~elationship to the deceased? In what capacity are you acting? OV""'l If attorney. name and relationship of your client to deceased ftA.~1 P'Yec~ ~IC"-l-F' &-h:LVV\\\ ~ Signature of Applicant 7~\J" C"1r-l..;'~ 9: ~ --. ~---...Qate \--\.-rc.\n::.o\ -zc:>dO Address of Applicant 1::0 ~ \"0\" ~\rxct~ ~~~ N-( \2~ G COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 11988 51'\ 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) . .. ...,nll Q LYONS & SUPPLE Counselors At Law 5 Cliff Street P.O. Box 227 Beacon, New York 12508-0227 (845) 831-1234 Fax (845) 831-2268 John L. Supple Gregory D. Supple >I< Paul B. Supple Wappingers Falls Office 92 E. Main St., P.O. Box 46 Wappingers Falls, N.Y. 12590-0046 (845) 297-0600 (845) 297-8877 'NY & CAL BAR James J. Lyons, Retired () Wappingers Please reply to: (x) Beacon March 24, 2006 Wappinger Town Clerk 20 Middlebush Road Wappingers Falls, NY 12590 Dear Sandy: Please find this correspondence a request for a certificate of death for a William Townsend, year of birth 1895, date of death 411945, and place of death is New Hamburgh NY. Please note a check in the amount of$10.00 is also enclosed to represent your fee for same. If you have any further questions, please do not hesitate to contact our office. Very truly yours, Paul B. Supple PBS/ale enclosure ~1\O~ - ,.---- NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for CoeV of Death Recor2 PLEASE COMPLETE FORM AND ENCLOSE FEE ~ a 21 ~ In il1 ; o 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 S::...n~ Date of Death or Period to be Covered by Search t--\~l H o...rc:.Y--. \5 12oc>Co First Middle Last Name of Father of Deceased Social Security Number of Deceased ~,,",<,-R...c. ,'0 -:;:::'~V"\ ~ 09-4 - \9 -:t S~'--I First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death C.Cl.........~t-k- N e..-\-e..cz:> \ 2. - e - l '1-z. ~ '?J"2 First Middle Last Month Dav Year Place of Death ~~o~JL~ yo Fte.\::k;.~ .~, -..tc::J . .~~~ Name of Hospital or Street Address Villaqe. ow ority County Purpose for Which Record is Required .~ d~ ~~ What was your ~elationship to the deceased? ~~\ \=:>i<1eC-~ In what capacity are you acting? c;::!)r-. ~H' a-P .~'~ If attorney. name and relationship of your client to deceased Signature of APPlica~ ~ ~ Date 5- 1 (p-o (p Address of Applicant t=b.~ '~I N~~ t=-c.A\\.S: 'N'-( .\2~~6 , ~ ~ 8 COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 11988 .)t oU ~;~\~1 umber 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) . .. ..,nt' Q NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Co of Death Record PLEASE COMPLETEFORMANDENOLOSEFEE> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ..PLEASEPR1NT:ORTYPE............. .. Date of Death or Period to be Covered by Search 5IR'n1Ge-~ Name of Deceased j){)AlAI-O Go First Middle Name of Father of Deceased Last ,.;r A- /'01'. ? /? 9' ~ ,/ Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Place of Death Middle Last Month Da Year Name of Hospital or Street Address Purpose for Which Record is Required Villa e. Town or Cit Count Signature of Applicant Address of Applicant 4dtc;~() 'j/J I}...; ') P fli rJ e. S '( What was your relationship to the deceased? AU 6 IT r'i-IC In what capacity are you acting? If attorney, name and relationship of your client to deceased Date ,_ ,,_. .d""'" .......' .. ......' ' ,- .. ,,' ,,' ,," . ......... ......... ....:..COriJ!:PLETEFOR.DEAl'HSOCCURRINGASOFJANl.JARV1 1988 _ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ..PL:EASE...eRn~"'NAMEAN[)..AD[)RE$SWHERE.RECORP/SHOULDBE.SENT..... . :.... Name Address City State Zip Code DOH-294A (6/2000) " \ 124 Dartmouth St. Rockville Centre, NY 11570 February 13, 2006 Registrar: Town of Wappinger 20 Middlebush Rd. Town of Wappinger, NY 12590 Dear Sir or Madam: Please send me fifteen (15) additional certified death certificates for Martin J. Ostuni (with raised or colored seal) listing the cause or manner of death-. Mr. Ostuni died May 6, 2005 and was a resident of the Town of Wappinger. I have enclosed $150.00 for your fee and an original of my Certificate of Appointment as executor of the Estate of Martin J. Ostuni. Thank. you for your attention to this matter. If you have any questions please do not hesitate to call me at 516-678-3114. Very truly yours, ~i~~ ofMmtffi J. OSwID . ~~.1 1,. ,I ,., i p\ j .,~. ~.u v Y{ 2:>4" cy I p/~~ L01:ik -4,1 \ (jif e{( ~~ ]: $tutl) wt-. ~hk> {)((l(~ ;> .. SURROGATE'S COURT OF THE STATE OF NEW YORK DUTCHESS COUNTY CERTIFICATE OF APPOINTMENT OF FIDUCIARY File No. 94884/2006 IT IS HEREBY CERTIFIED that Letters in the Estate of the decedent named below have been granted by this Court as follows: NAME OF DECEDENT: Martin J. ostuni DOMICILE OF DECEDENT: Town Of Wappinger DATE OF DEATH: May 5, 2005 FIDUCIARY(S) TO WHOM LETTERS ARE ISSUED: Kenneth Cotty Kenneth a/k/a Cotty TYPE OF LETTERS ISSUED: LETTERS TESTAMENTARY DATE LETTERS ISSUED: January 17, 2006 LIMITATIONS ON LETTERS: NONE and such letters are unrevoked and in full force as of this date. Dated: February 3, 2006 IN TESTIMONY WHEREOF, the seal of the Surrogate's Court of DutcheSS County has been affixed. L.S. WITNESS: Hon. James D. Pagones, Surrogate of the CoeAfE(:: 6l1i~~~if~J~~ls COURT y~or~ ~ KAREN A. JOHNSON flEDI IlY CHIEF ClE~K Chief Clerk of the Surrogate's Court THIS CERTIFICATE IS NOT VALID WITHOUT THE RAISED SEAL OF THE COURT (Note: SCPA 710 PROVIDES IN PART: "4. No fiduciary shall remove property of the estate without the state without the prior approval of the Court and upon filing a bond if required by the Court.") 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: $10.00 per copy or No Record Certification. Please do not send cash or stamp PLEASE PRINT OR TYPE Name of Deceased . Date of Death or Period to be Covered by Search !it.-8t::-ertl .8. G~115S I ~- /- . , ./ .1 First Middle Last '^-. Name of Father of Dece'ased Social Security Number of Deceased AI (X 1":+0,- , C~ rC;6~, lit./- 03 2;S/9 First Middle Last M,aiden N9me o! Mother of D;r;;sed. Date of Birth of Deceased Age at Death ~ li7' ------ 8 )Z,J.he-tY) Ca~l I J I ) U\ First Middle Last Month Dav Year Place H Death W CA.-PPi nf-t'.-rs ~q. Il.s tv\.} DlA.~ chUf u.d ~ n Ii a.,oc/) Name of Hospital or Street Address Villaqe. Town or City County Purpose for Which Record is Required 10 CO-.s h ,{'\ b lot ("l cl-.s What was your relationship to the deceased? G~ndrno+hLr In what capacity are you acting? ~Ir.,;.e. L..L.t ~ a....; II y- If attorney. name and relationship of your client to deceased Signature of Applicant ~~ (2. J&/~~^ Date c9--W lOb , Address of Applicant 7 J{( v ~+ tJ )(.)3 ])0YLb 'U 1 (- ;J- alp % /6 COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 1988 .:2- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City State Zip Code DOH-294A (6/2000) .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record f?I..EASE:COMPl..J$'1"EROAMANPENOJ..,OSEFEEY FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased t \1Qr\~Cj -:r()~Y\ First Middle Name of Father of Deceased ~ dY\4. '€S First Middle Maiden Name of Mother of Deceased fY\ax-~ First Middle Place of Death 0 \ ~<(D \-\O?ewe.\l ~ Name of Hos ital Or Street Address Purpose for Which Record is Required Date of Death or Period to be Covered by Search p.J It L- '""2...0 Last fe'Dt I t 'clOD" f6:1a~ '20 Last Social Security Number of Deceased r--o r~ Last Date of Birth of Deceased ID 03 Month Da Age at Death <6S- ~o Year TJv~~.f~~g~ -,:;118 Uut e-l.t eSS Count t-e..- What was yo r relationship to the deceased? W <' .e.... In what capacity are you acting? lJ)l~ J eXf'l'i(\o\ I If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant Date ... .................--..........,',.....-...........................................................--,................................,.............-.......................................-........................".....,..............,............. ....'.'.:'."..'."':".'C....O.'M..."P.....'L...'eT...........e....'F.....O.....'a.......D...'e..'.M.....'T......H.'.S.......'OC......'....'CU..'.....'...a.....R......'t..N.'Q'.'.'.JA..'...S.'...Q.....E.......'J.'.A.".'N...'..U..."A8.'...'.....Y....."j.' ".'1'.S..'8$"....' .""",.,.,.,.,."::,.".,.,,,.,.. ":'."'., .. > .'.' ...,,: ,,:..'.. :.,. " ..... .,.. .. .Y'.....,. .'. . ' :.. ...... '/' Y ." ... ,:Y. .,..., . .'.. :.,Yd.. '. ... .../Y...... --==L Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death . ....,.,.,',.,....UPI1I!ASE PAINt NAMEANbAODhESSWHSAE ASOOAtfsHOO l..o.aSSSHTi......................'.',.,.,..,.,.,. ... ........--....---....................................--................................................................................................-.......-.............................. I-IeJe (')711 \GtL. '20 Name Address City State Zip Code DOH-294A (6/2000) .. .. <l:t .'1'1'" fTl , ,tfi"T.');,..... '~' ,. 'rt'II'\ \<:(",':: V:Z"4" .~.~$-" . I.~',..,.c'::~~ / , ". r: 1 "..,,,,,"~, ~. ~";J"< . ~;:~,i I', S~:L~'" ,. ,'~';;.;J" .~ ,.,.~.~.::-..'=:'....' L~O' "'0 .c:,.;-;~: '~'_; _ ' .."', ", ,:' ,'- _ . - _ - .;.::":.:J k.':,i;--.: - /" - ..:..;_~_/:;,A, ,>-,., ,'..:'.-." ~,' ':' ~ ~ ' ~" ?~/~:~~~~: ,', ',,;,;;,Jiil:*,. " .. Dr <c 'i . ,,, C'It.J ,.,.",,...0' ' , 6i , "",lII'~ LD'Z~ i' . ,W',l ....~ t ~ l' .. fB.:"J' .:" . ;;:> . , . ~i'~_c , .t~..:d: ":',: .-' / 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 Marion First Middle Name of Father of Deceased Jack First Middle Maiden Name of Mother of Deceased Ellen First Middle Place of Death 58 Robert Lane 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 Ellison May 2, 2006 Last Social Security Number of Deceased Casio 099-14-1684 Last Moeller Last Date of Birth of Deceased 11 6 Month Da 1922 Year Age at Death 83 Wappingers Falls Villa e, Town or Cit Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? Signature of Applicant Address of Applicant Date Ma 3, 2006 ;I! COMPLETE FOR DEATHS OCCURING 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 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. PLEASE. PRINT OR TYPE Date of Death or Period to be Covered by Search Name of Deceased First ) I, I . Middle Name of Father of Deceased Social Security Number of Deceased First Il{t,- .r.- Middle Place of Death Date of Birth of Deceased Age at Death First Middle Maiden Name of Mother of Deceased Month ()!>/ Day It), Name of Hospital or Street Address A ~ Purpose for Which Record is Required Village, Town or City tu~, county7Jl(~C/;t" What was your relationship to the deceased? (( {},AA s..fA t' JZ.., In what capacity are you acting? IV.2"t-..j. G+ f/.... If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant ./, .' // .../ /,' . ( ? . ~/ . ,?- It LL.i.~ ,~'. \.....-'. ~.~ ~J;).,. (~ flw~ 311) :So: ~~L~v;>k..,IH.)/t .J (~ . Date ,) -.J 1-- () ,., 3/e3f,. COMPLETE FOR.OEATHS OCCURRING AS. OF. JANUARY J 1988 _ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ...... ...... ....> . ....... ........... H. PLEASE PRINT NAME ANPAODRESSWHERERECORO SHOUL.D BE SENT .. Name Address City State Zip Code DOH-294A (6/2000) ~J}. . ~'*~ BIRTH NO. ~~'.r'lO' State 0/ Colorado REGISTRAR'S NO.8290 DIST. 5 ~ CERTIF"ICATE OF" LIVE BIRTH OR ER 2. USUAL RESIDENCE OF MOTHER (Wh". dO<l mothn liYCt) .. STATE 6. COUNTY Cn1nradn Denver t. CITY, TOWN, OR LOCATION A NT 1. PLACE Of BIRTH .. COUNTY Denver o. CITY. TOWN, OR LOCATION Denver ,~>'Iif, npnv,." e. NAME OF (If "DI ;.. bDlpit.l. ri.. meet _J,ell) HOSPITAL OR INSTITUTION R d. IS PLACE OF BIRTH INSIDE CITY LIMITST YES ~ NO 0 2429 Downing Street t. IS RESIDENCE INSIDE CITY LIMITST f. IS RESIDENCE ON A FARMT YES IX NO 0 YES 0 NO 0 Loul J. STREET ADDRESS .~ ,'I~ Cl -" :z: u 3. NAME (Typ. or priat) fi," MiJJI, Jean Mayes 50. IF TWIN OR TRIPLET. WAS CHILD BORN 1ST 0 20 0 3D 0 Month . D.y y,ttt 6. DATE OF BIRTH 6 17 65 TWIN 0 TRIPLET 0 8. COLOR OR RACE Ne ro 11b. KINO Of BUSINESS OR INDUSTRY Diplomat Motor Hotel 13. COLOR OR RACE Turner Ne r 16. PREVIOUS DELIVERIES TO MOTHER (Do NOT incl.d. thi, birth) 4. He.. md"1 b. How md"1 OTHER c. How miln7 ftllll Jell/II OTHER cbild,tn childr,n wert bOTG "liyt (/tlWUI horn tlud III trrC now lit';"'? bll' lITe now dttlJ? ANY time .Jur cpo <<pticm}l ~ ;!: oC ... 10. BIRTHPLACE (S".. or lornln eotlntrf) Not I'" ~~ Lowr . 14. AGE (At ,im. 0/ ,hi, birth) Jac ueline 15. BIRTHPLACE (SI4I. Dr /orti,,, 'otIa"y) Geor ia YEARS o o o , 1 h."by <<"i/1 Ih., ,bit child 'Wdl hom "/i", on tbe d.'t IIIIUJ ,,1>0"". 3:~~ A M. 19. DATE RECD. BY L tAL REG. .1\ 11 1 9 1965 - OTHER (Spui/y) ,..----- (R.,i",,,, ) ~...ar STATE OF COLORADO, CITY AND COUNTY OF DENVER, SS. the {M I hereby certify that this document is certificate now on file and in my custody. day of July, A.D. 1985. a true and correct copy of Issued in said State, this Not valid witho~t t~e raised seal of the Dept. of Health & Hospitals, City & County of Denver, Colorado. County of . PENALTY BY LAW if any person alters, uses, attempts to use, or furnishes to another for deceptive use, any vital records certificate. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application (0 LO~d' t) d~'~ (I (.<1 for Co of Death Recore PLEASE COMPLETE FORMANOENCLOSE:FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased /1J, LL-) P First Middle Name of Father of Deceased :::JA:M6S First Middle Maiden Name of Mother of Deceased M IrrIJ 6: 6J A- 6.aflroAl First Middle Last Place of Death /VI / . .::2 ? ..::<3 H6::sr i -rAiN :;;,r. Name of Has ital or Street Address Purpose for Which Record is Required !1A'I6"S PLEASEPRINTORTYPE. Date of Death or Period to be Covered by Searcll ~BJZvAJ2Y <6/ .;:;ooLP Date of Birth of Deceased os-- )0 - /9t.j7 Month Da Year Age at Death I --1 I ! I i Last MAYeS 5I!. Social Security Number of Deceased s::; J - S1S - ,-/0?9 Last .5>-<6 NAPPINGE/L5 ~u..:s Villa e. Town.or Cit ~~ss COLlllly FA Signature of Applicant Address of Applicant .___.____.__ - - i What was your relationship to the deceased? In what capacity are you acting? If attorney. name and relationship f i ur client to deceased ;//-i :.-... COMPLETEFORDEATHs:::dccdRRiNG/AS:iO#)jANOARY::W>H988. ,. .... S- Number of copies reques ted with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE - PRI NT:' NAME:AN O::AOORES$::WHER E\RECOBO,:iSHO.ULO> BE SENT. Name Address City State Zip Code _m___" DOH.294A (6/2000)