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2008 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.)' of Death Record PLEASE COMPLETEFORMANOENCl..PSEFEg. 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 .~ LDR.I 11 (V1 t1 R /(z Lo Pi:. z- ..J) E e. _ ~'1. ;2ot';( First Middle Last Name of Father of Deceased Social Security Number of Deceased ,N!lct.fllfL f'i 2zl}RELL I !()!:.--/<;!- OL,t8o First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death V J c. TOIUA j) J:'j. {(N 2.5 e :s r: Pi :3 i 1'~~- ".? :) First Middle Last Month Day Year Place of Death \J ['- 0 Name of Hospital or Street Address Village, Town or City ~~ E. C E. \ S-ounty Purpose for Which Record is Required GE.e 1 1.0\)8 10 5e:ITLt E:STt:lTt: _,~, r-I r.:q~ ". What was your relationship to the deceased? Fu/vi;f<AL Dtf2 e c:. Tel<.. In what capacity are you acting? -s; A Me: If attorney, name and relationship of your client to deceased Signature of Applicant ~Vv-~ a. Jt1ddulA1j Date /:1 - 31-o'if Address of Applicant r;4 f. MH uJ s7. IAJ /I pP IN c;'e. t2 5 P 711... U.. ./If 'I 12<;'-"" coMPLETE FQRDEATHSOCCURRlNGASOFJANLJAAY1198a< ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASEpR1NTNAMI:ANP:APPB-E;~~WI-lI3RE:RECOH[)?HPl..JLO~E.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 Pl.EASECOMPl..ETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. CE\VED UEe ~ 2008 Name of Deceased ...-.- :J.uLVle ,~ First Middle Name of Father of Deceased (Lnu..-Lco ~~r6'\.-~ First Middle Last Maiden Name of Mother of Deceased //00 \'~- Middle Last ~~~ \ ). - 2(1 - 0 t3 V\l. Social Security Number of Deceased D'\? - 2~1 .. '0"';- ~ ~ Date of Birth of Deceased Age at Death \r~.MMJ~' First )0 Month \ Da ~\ Year '=t-i- Place of Death \ ~ '?:, \....kL-L> ~ ~a..dc_, Vu. Name of Hos ital or Street Address Purpose for Which Record is Required ~(~ W~Y:11~~r Village, owl'i' rCity ~D LL+'L.lu..) County "^'-- ~b ~ ~!~1 What was your relationship to the deceased? -t'^ M..IU.X LLI.I"-f..(".hJ\--- In what capacity are you acting? - If attorney, name and relationship of your client to deceased Signature of APPlican~~ [tv (}....-' Straub, C.lldldl1() ,'" llub)i~ )') - ?f..) -(;J i!) :,s l::ll~t \ldin Street Address of Applicant I) () nox I' ~ I Wapplngcr~ Falls "Y ! 2590 ..'......--...,.-....'...'...'...-...,.,..'.'....,-.-...-,',--,"","--,- .,,_. ....................,.,"'.. ,.... ',',','..... .. COMPLETE FOR DEATHS OCCURRING AS OFJANlJARV{. 1988 < ....... .<'.. .... ~ Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death 'PLEASEPRINTNAMEANDADDRESSW'HE.RERECORCfSHc:>Ol.DBESE.Nt<. Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record Pl.EASE COMPl.ETEFOFlMAND ENCCOSE FEE .. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Name of Deceased ~hv \Z-:) t== First Middle Name of Father of Deceased C~~~ First Middle 'bV\V\ \ ~ Last buu~~ Last Maiden Name of Mother of Deceased CcJ.l~^- Sw ~1-t \ \ ~ First Middle Last Place of Death ' =?:::>~~ ~:::;)U.) \ ~~~V\ K Name of Hos ital or Street Address Purpose for Which Record is Required ~ ~J.-)J'"y"-; Date of Death or Period to be Covered by Search l"?-;>:;))' oS Social Security Number of Deceased )D~ ~[)-- d-39"~ Date of Birth of Deceased 1':2- \'-\. )4 ~=r Month Da Year Age at Death +\ . I'> Wo.'J:J ~V- Village, owxJr City 'DlJ.-+dq~ ~ County ;Lu.t c-+UV-- ...-- ,..(),^, " I ~, ERK ! StralJlL (,a[cllcu l(: ,"c t [,llvcy 0 ,~ Date J )--3) - D :)~) l.~( l. 1(... . ~ l'() l',(),\ 1:\ 1 . . II' ,., i 'J,')r, Wapplflgcl~ \ (I.." " .- Signature of Applic t Address of Applicant COMPLETE FOR DEATHS06CURRINGASOFJANtJARV11968<H ?'. ~ Number of copies requested with confidential cause of death $- Number of copies requested without confidential cause of death .PLEASEPRINTNA.MJ;ANDAD.DRESSWHERERECOFlO$HOUl.DBESENT..... .. Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.)' of Death Record pL.eA$EPQl\ftf"..ETI5f=QRl\IlANPENCl...Q$E;FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash ~'eEIVED DEe 3 n 2008 Name of Deceased Geo~~ First Middle Name of Father of Deceased Date of Death or Period to be Covered by Search 8rf..)bc..c..~e\;J Last I d-../ 1(5/0 g Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Place of Death Middle 5 /-Jv cL5oV' Last Month Da Year b, Wcf ft'n Cy? ",A/'( Name of Hos ita I or Street Address Purpose for Which Record is Required Villa e, Town or Cit Count I What was your relationship to the deceased? In what capacit~re you acting? If attorney, na1e and relationship of your client to deceased Signature of AP~icant I4/v.,..l>c-ff ~~ Address of Appli ' ant Date ) ;) /3 c/o e.. fCOMPLETEFQRbEATHSOCCURRINGASOFJANUMY119SS<< .. 7 Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death pL.eA$EP$IN"tNAMEANbAt:H::)J:ifE$$WI-II5FO;l=tJ:Q()t=lOSHQUI..PElE;SI5NtH Name 0Wl ( e.. / ~ jVl ;111 Address ' n 7/ City LJ ~ ~ p r {\(:~/ r J!.J Zip State I J.S-5 0 DOH-294A (6/2000) ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ,--{ E C E:. t \J E Name of Deceased FirstCOfJr Middle Name of Father of Deceased Date of Death or Period to be Covered by Search Last'KWC i Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased z~F Last 11111 (.. pt.. Date of Birth of Deceased MonthOc( laD (p P Year lV4/I'I!t1trt: f:Gf r Yl[ Villa e, Town or Cit Age at Death First Place of Death Middle 2- tJ117C/1r3 Count Name of Hos ital or Street Address Purpose for Which Record is Required offl C 11ft-II (.,1 C? 4"AI ~Is77 (;17/ dIV What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of r:I Date /21$1/7; <f , t ~(i.tlU>#L ~ ~p Signature of Applicant Address of Applicant ~ f 'A./etlp. ...1. COMPLETEf::OR..OEATHS..OCCURRINGAS..OFJANtlARY.1 ...1988..<............................... J - Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLeA$1; J:lfON"f' NAME ANQAtn:)$]$$S'WHeR15 RePQapSHPlll...1) $ESeN1' 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 CollY of Death Record FEE: $10.00 per copy or No Record Certification. . IV~ Please do not send cash ori$l!'P? ~ r.:: D 7'0 . / 2008 'lI2Ak Edward Sungaila First Middle Name of Father of Deceased Last December 20, 2008 Social Security Number of Deceased Charles Sungaila First Middle Last Maiden Name of Mother of Deceased 051-20-7110 Date of Birth of Deceased Age at Death Eleanor Wassell Middle Last February 20, 1927 81 Elant at Wappingers Name of Hos ital 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 Xt ( ((C) l ~ u:L L / I Address of Applicant 895 Route 82 , P.O. Box A Hopewell Date 12/22/d . Junction, NY 12533 5 ~+h CJ2r4l-f{.co....-~ wifh cause of d.w.--J-f\ 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 Albany, N. Y. 12237-0023 Application to Local Registrar for Coey of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash orj~ ~ .N' e.11~ "'C[ Vi '<'OOB Cora Evelyn Cusano First Middle Name of Father of Deceased Last December 17, 2008 Social Security Number of Deceased Raymond Cusano First Middle Last Maiden Name of Mother of Deceased ()54-~-/S95 Date of Birth of Deceased Age at Death Doris Curry Middle Last April 30, 1966 42 28F Alpine Drive Name of Hos ital or Street Address Purpose for Which Record is Required Wappinger Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relation hip of your client to deceased Signature of Applicant Address of Applicant 895 Date /2(ZZ/uf . 82, P.O. Junction, NY 12533 .> I 'c 0..-\ v\ Ce y' -h .(- I( r\..- -\t' ~ V-.l I -H., (' (\ U~ <.J-~ CU; o.J ('- --J V 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 PLEASE GOMHLETEFORMANDENCl.PSEFEe FEE: $10.00 per copy or No Record Certification. Please do not send cashR~e'~'VED ...... .. ....... ..... .........--->{ Name of Deceased Joseph A. First Middle Name of Father of Deceased Joseph First Middle Maiden Name of Mother of Deceased Jenny DeCarlo First Middle Last PLEASE<PR1NIOBTYPi;' ." UEe L' 2008 . .... .... .....TA\AJl\f . Baccomo, Jr. Last Date of Death or Period to be Covered by Search Dec. 24, 2008 Bacomo, Sr. Last Social Security Number of Deceased 098-22-4278 Date of Birth of Deceased May 28, 1931 Month Day Age at Death 77 Year Place of Death 89 Old Hopewell Rd., Wappinger Name of Hospital or Street Address Purpose for Which Record is Required to settle estate Village, Town or City Dutchess County What was your relationship to the deceased? In what capacity are you acting? same If attorney, name and relationship of your client to deceased Funeral Director Signature of Applicant '>S j'/l~ I}' J..W.i"tlbA~ Date Address of Applicant 64 E. Main st., wappingeK Falls, N. Y. 12590 /0)- }</-D 'J COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1.1986 . 6 Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death ..PLEASEPflINTNAt"tEANPAOPRE$$WHEBEReCORPSHQLJL.DJ3ESENT...... Name __ Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar For Coer of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy of No Record Certification. Please do not send caS~~CI ~ ,dl PLEASE PRINT OR TYPE Name of Deceased Date of Death or Period to be covered by Search George B. Brubacher December 18, 2008 First Middle Last Name of Father of Deceased Social Security Number of Deceased Edward Brubacher 077-16-8583 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Olivia Wagner 9 3 1920 88 First Middle Last Month Day Year Place of Death 5 Hudson Drive Wappinger Dutchess Name of Hosoital or Street Address Village, Town or City Countv Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Date December 22, 2008 Address of Applicant 1028 Main Street, Fishkill, NY 12524 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 7 Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record . . ptt=A$eOQMPt.E;TJ; F()RMANDt:NCI..Q$E FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. nA' ~/lffr5'"~~rv..s What was your relationship to the deceased? //' j1- In what capacity are you acting? /#~ VI"?C"~ r7~ If attorney, name and relationship of your client to deceased Signature of Applicant ~ I ~. = Address of Applicant !;/ ffivK~ /tV ,/if. d4.Jr',- / Name of Deceased /,4/ #ir/7 f'G- )JIFliiAS First Middle Name of Father of Deceased 1fJ1l1/Y't1I'D fCfVATlUS First Middle Maiden Name of Mother of Deceased ~L~Iv"""'" First Middle Place of Death !/'-7' y ~;~6-j fl~.~ Name of Hos ital or Street Address Purpose for Which Record is Required Date of Death or Period to be Covered by Search t//* vi' Y .../ If., /2/j7/~r Last (! ,.",~ J' 4- Last Social Security Number of Deceased d ~ 7 -? y - }-:l ~ r, ~,iE Last Date of Birth of Deceased Z '7 Month Da 1/'1:./ Year Age at Death ty j./;-/,~/V6.,..".l ;:::#ct-5 ill e, Town or Cit j)U1Z ~. Count DEe 0 8 2008 Ivy TOW; CLERK Date / 0/' S-- / kA' r / U,g3 ........."............_------....,.-.....",.---.-......."...'............."...--........-.-.------...-----....-.."..',...,',',...',',",..'...-.... CQflII pL.ETe. FOa..OEATHS 6CCURRINn..As.OF JANUARY..1 .1988............ -k Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PL.I;J,\$t:PRU-'1"NA.Mt:A.Nl>ADDRE$S'WI-IJ;RE$J;O()$D$HQOL.OSESEN1' 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 PLEASe CONlPLETEFORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Nam;~f Deceased --t:tCtnie-t ~. First Middle Name~of Father of Deceased ,'Jl , clftl irst Middle Last Maiden N~;';;\ci=r of DeceasN h t'1-e ~ Middle Last Place of Death 32- QUA. ~V~ Name of Hos ital or Stre t A ress Purpose for Which Record is Required PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search 11- za-oo Last U ~~nn Social Security Number of Deceased ~2--- I ~ - I =to] Date of Birth of Deceased \0 /2- - ~~-a- Month Da Year Age at Death ~\ ~~~ ity County ~o-t LQ A~i~ 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~...z.-~.oe n6~ COMPLETE FOR DEATHSOCClJRRINGAS(')r=JANUARV11988 Number of copies requested with confidential cause of death RECE\VED NO" 2 4 2008 N CLERK ..PLEASEPRINTNANlEANDADDRESSWHERERECORDSHOULO..BESENr. .. _ Number of copies requested without confidential cause of death 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 GOMPLETEFORM AND ENCLOSE FEE < FEE: $10.00 per copy or No Record Certification. Name of Deceased ~~#?'/I First Middle Name of Father of Deceased 0pl'?? First Middle Maiden Name of Mother of Deceased /!/J'/,P~~ tJ First . PLEASE FWUNTQ:RTYPI::)> .. '.' Date of Death ~r per~od to e Covered by Search A'F,A?A/#'~Pez- // z~ d r Last Social Security Number of Deceased ,/f/r-r,4' /? Last SK"'f - 0/- 7t:) ~ S- Date of Birth of Deceased Age at Death Middle D.5v814 Last ., Month I Day ~~ Year ?~ Place of Death /~ / Et.-rl ,vr c2 ff/#//#fEA:S Name of Hospital or Street Address Purpose for Which Record is Required ;::::;;;L ~ ~.P> j))Af~/V'7EA'f ~US ~, Town orettv J> ,,,,-- Count What was your relationship to the deceased? pt:> In what capacity are you acting? rj) If attorney, name and relatio Signature of Applicant Address of Applicant Date "':I~ AI .'coMPLETE' FOR DEATHSOCCURRLNG AS Or=.JANUARY1 . 1985 <i" S- Number of copies requested with confidential cause of death __ Number of copies requested without confidential cause of death .... ...PLEAS.E...RRINr..NAMI::..ANP-A.PPBJ:ESS..WI-U:3HE.RE.CQRP...SHQl.JL-O...E3I::...S.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 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. PLEASEPRINTOR TYPE Date of Death or Period to be Covered by Search \ l- ( fa -C) <0 N~eceased --r- nefh::.- ~T1CV\ne...- '-J ~C&f~ First Middle LaJt Name of Father of Deceased ~n~ First Middle Maiden Name of Mother of Deceased ~Vlee... ~~u.rn.~ First Middle Last Place of Death ~ 2\ ~CVl~ ,\~ Name of Hos ita I or Street Address Purpose for Which Record is Required ~rd O-t G~ \.\~~ Ltlst Social Security Number of Deceased '"2-Ct.. ~ Ce - \44 or Date of Birth of Deceased Age at Death 7?::> ~ -"'2- - \~"3c> Month Da Year ~~~ County ~i~ What was your relationship to the deceased? t=7A~\ J:::i rec~ ' In what capacity are ou acting? c() ~~.p- CJ ~ Ml ~ If attorney. name e ation ip of your client to deceased Signature ot Applicant ~ ~ Address of Applicant - - - \ -:=, ) I w~ Date ~O \ \-\~ . _._.. .. ."........ ""...__ __,....... .,,____,_._ ... _. "__d'..._".... COMPLETE FOR DEATHS OCCURRING AS OF JANUARY11988 ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death RECE'VED PLEASEPRINTNAMEANDADDRESSWHERERECORDSHOU. , ~,' ,. 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 PLEASE COMPLETE FORM AND ENCl.OSEFEE FEE: $10.00 per copy or No Record Certification. Please do not sREc'Elv'ED NOV 1 7 2008 Name of Deceased V~~ ~I First Middle Name of Father 0\ Deceased LEb~~ V\leu.{l;1C ~, First Mid~ Last Maiden Name of Mother of Deceased H~v)C)n c-. Scctt- First Middle Last o lA.)e.rl Last ~\J . 1 t..{ / ~co Social Security Number of Deceased 10 \ - ~2. - :'20'1 Date of Birth of Deceased k~ \c.:.. tcr-t"2- Month Day Year Age at Death (0 CO Place of Death I~ O\d Q-OT Rd. Name of Has ital or Street Address ViII Purpose for Which Record is Required . ev.d c-? L~'k A~\r~ ~~ County What was your relationship to the deceased? hA.~\ t:::::::(V-t:'_C~ In what capacity are you acting? c:v'\ ~ ~ \-F C3-P '~m\'~ If attorney. na relatj ship of your client to deceased Signature of Applicant Address of Applicant \ - 1"1 -~ COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 1988 ..> ........ '"" f- Number of requested with confidential of death -- caples cause - 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) Leonard Klein Arthur l. Gellert Stephen E. Ehlers John A Geoghegan Lillian S. Weigert James M. Fedorchak Stephen E. Diamond - Scott l. Volkman David R. Wise' Roderick J. Macleod Bevin S. Harrington Daniel H. Stock Susan L. Flynn '" Pamela B. Richardson '" Kelly L. Traver' laura E. Vincenzi ,.. Gellert & Klein, P.e. IIIIa) Attorneys at Law 75 Washington Street. Poughkeepsie, NY 12601 (845) 454-3250 (845) 454-4652 fax Counsel S. Nina Gellert Raina E. Maissel <I Senator Stephen M. Saland Robert C. Vincent, Jr. Westchester office 3010 Westchester Avenue Suite 302 Purchase, NY 10577 (914) 249-0100 (914) 249-0111 fax Joseph H. Gellert (1907-1989) wwwgklawus 'Also Admitted in (T "'Also Admitted in NJ -Also Admitted in MA & FL <lAlso Admitted in England October 15,2008 Town of Wappinger Town Clerk's Office 20 Middlebush Road Wappingers Falls, New York 12590 Re: Estate of Andrea M. Paustian Our File No. 24913.2723 RECEIVED OCT 1 6 2008 TOWN CLERK Dear Sir or Madam: Weare currently involved in administering the Estate of Andrea M. Paustian. Mrs. Paustian died January 15, 2008 at her residence located in the Town of Wappinger. At this time, in order to proceed two (2) certified death certificates of Andrea M. Paustian are necessary. A copy is enclosed for your convenience. I enclose a check payable to the Town of Wappinger in the amount of$20.00, which represents the fee to obtain two (2) of the decedent's certified death certificates. Also enclosed is an executed Application to Local Registrar for Copy of Death Record. For your convenience in forwarding the said certificates, enclosed is a postage paid envelope. Thank you for your assistance and cooperation. Very truly yours, SED/lmg Enclosure cc: Ms. Pamela Barrack EIN, P.e. N E. DIAMOND F\USER\c1ients\B\BARRACK, ADMIN\Paustian Andrea M Estate\Request for death certificate Itr. 100108.wpd / . ,AIDENCf ,"UOI I I HtI3Z~HICI REGISTE~MBER 1 NAME FIRST CORR 'Ii: 1/17/08 JCM Cl NEW YORK STATE DEPAIHMENT OF HEALTH ,rtFICATE OF DEATH ><><\jV-KK 2{8/08 JCM ***CORR ?/20{08 j'1 LOCAL REGISTRAR COpy MIDDLE LAST 2 SEX. MAlE 0- fEMALE 1XJ2 I JA DATE Of DEATH. . I MONT" ........... OA\ I 11 15 I 200S : 100 >' 4B IF FACILITY, DATE ADMITTED : . MONTH >,. DAY !! I I 4E:COUNTY OF OEATH I I Dutche$$. ..ylWl I 3B. HOUR' ( I NCHS ANDREA 4A PLACE OF DEATH HO$PITAl (Check one) OM ER o 0 HOSPITAL OUTPATIENT o M. HOSPITAL INPATIENT o P m PAUSTlAH PRIVATE HOSPICE OTHEll RESIDENCE FAClllTi (S/I8C/Iy) s:.. 0 0 I 40 lOCALITY: (Check one and spedly) ftT.TAPPINGER I CITY VilLAGE TOWN '" 121 Coooer Road; unit 1 : 0 0 IX! -.ii'lshK1lf 4F MEDICAL RECORD NO 1 40. WAS DECEDENT TRANSFERRED FROM ANOTHER INSTITUTION? (ff yes, spectfy "'st/tutlDn name, ell)' or town counl)' and state) 1 NO YES ". I IE 0 6A Ay~~~NS ,6B EIFNTUNEROEF 1 YEAA 6C. IFUNDER 1 lIAY IA CITY AND STATE OF BIRTH. (If nof USA Country and I IB IF AGE UNDER 1 YEAR, NAME OF HOSPITAL OF "'" : h~1ER. minot": ReglDnlProvmce) I BIRTH: : moottls I O!ys r 1 I 1 I I I I I I I J 02 16 1956 51 yrs. I 1 I I I Scotland ~ 9 DECEDENT Of HISPANlC ORfGIN? C~ the bOHS;.ttilt best ~be tVheftt8r tilt dW!t1enti5 ~nisfVHJspamcJtalllJO 10. DECEDENT'S RACE: C1teck one or more races to mdlfalf whal/he decedent coosll1erea himself or fJerselllo be A 111 No, 001 SpamsWHlSpaIIlCILatino 8 0 Y~" Mexi"", Mexican American, ChlCllI1? A IXI Wlllle/C.uca',," B 0 BI,cJ< ar Alncan Ameneao C 0 Asian Indi,n D 0 Chinese C 0 Yes, Puerto Alc'n 00 Y", Cutian , 0 Fllip"o F 0 Japanes, G 0 Korean H q V,,\fIamese E 0 Yes, Other Spani,MilSpamc/lBlino (Specify) . J 0 NatIVe Haw."n K 0 Guamaman 0/ Ch,morro M 0 S,moan - 11. DECEDENT'S EDUCATION' Chetl./IJe box mal best aesaitle5 tI1e h~1Jt$/ deW;; 0{ teYfI ,I sdJoot completed" the D/1Jt 01 tfeJ~ IDs Bth Urade 1 0 9l!l'12lh grade; no diplom, 3'0 HiUh schOOl graduate or OED NO Amefle,n Ind"n or Alaska N'llVe (speCl/y! Om 0 pO Other As~n (speCify) 4 SomecoU.gecredilh.ul 00 degree 5 \AI Assaml", dfgl" 6 B,cIJ,lor, deg,;,,' I 0 Master, ..g'" 6 0 Doctorat.IP,lllesSional degree S 0 D1her(specJtyI .: 12. SOCIAL SECURITY NUMBER. 13. MARITAL STATUS;.~Oh' "tsU@VIVINGSl'QUSE: frl/erlt1me :'" . NEVER MARRIED MARRIED WIDOWED DIVORCED SEPAR~TEO ,~~~ ~~';~: survW(ng spouse ~ !'. .: . .' OG'Y..4lO-7018 01 02 <<13 04 Os . .... I.... ....., . ::;:~I~~- ,~w~~~;.w~~OO"'OO~' ,..~""~w..J:~~ I ff:.~r J~~ouritry NY\ .' II not. USI< ~. .. . ' . " (j VI~GE T'i:tJ 'WapPl~r . ; ~'J~N CI!JN~R Vlrl-~g: k~g~ TOWN; I 160. STREET AND NUMBER OF RESIDENCE: .. : 16E,l1P CODE:'.. 1 25 1~ Cooper Road; UnIt 1 '. . ." ! 1$4 ..... tWe~r i 17 ~h~~~F fiRST )11 If \.AS: .' r Mf~5M~~E ~ FIRST. , MI. LAST '.' "'"",",,",oo..,,i*;;]h;;a~~ilitt'."""";;;"';:"';"';":i "~;"4~ ' ~~ .,., ' , ; '. ~ .'. I 4H8wk:lanQ.~.NY.1~ . .......... ..... ..... .. :'~.:~ J2::::-'~~t~~~~~-;1~=~'1"'.W>~t~~,:~~; I; " , :~' ~ ;EI'= ::;;'!~"m' >. ~~ . ' ,.\ 'c. :;;~~.."""" " , '~ ;;;.~,~tl11l'~ ' ~_' .."7! ' . "'\'!"-"""~ ~~ " a,s ~ ot-L.".., '~.' .' .,~ I. ........... ...........1 II U~()Or . ", ~'" ITEMS Z5 THRU 33 COMPLETED ElY c.E~fiFYiNG PKYSICIAN '"!!R ERICORO~EI\MEDIMtEXAMI~ER", T .... .... ..... '.' 25A.CERTIFICATiON: TQ th~best of my knowledge,l1eath occurred Mthetime. date and piac~ilnd due tothecausefstated. .... --c' ~.~ _jT**.. 2/6/08 . '. Q:l'tifler'sName JX;1i<'~ ,<r CJ\V,+e ~ 'ILicetl;~.2(;~a,' ISlgtlat~(L', .............::~onth::. Year.' . .......... ..... .' - . . '-. ?~, '\, .' l~ fJte/j.,-1.t'~40< '. 7 Zoo ..".." ..... Certffier'sl1l~. ~8 ~::;~i~9 PhYS~C~e~i~ :X:~:;;:;:::::::',::,g Physitianlj.r<?'W{f,j"., ;i;, f ," 't"~r4!'.".':"('..'.e~" "",~?, . 258 If COlOneilS not a physician, enlel Cor~ner's PhysiClan's n,ame & litl.. license No . . .. SignalUre: --- .T ........'. T~... . . .. Year' . .' . ". ~ . '.< I '1 .. .... '. 25C.IIC.;..rti'''i1snafanendtngphYSiC~enle'Att''''dingPhysiCian'sname&tilie license.!;'.... ,. . :c.a Address. 11l ,'-/")() ",1.1 .' I 'Y ~, ')e ", . . :, Ltt V'tf W) ~ -'0~1~1 ... 3?7 .f\0.' 'I :::>", (n:J\A.':1rlP-~e,f So.{' rN \7 ftJl 26A. Attendmg physician Month 0" Year Mon~ 0" y,,/ 268. llec~ll$ed!aSl s.en ~ive Month Da Year '26C. P,oUOO\Jncol ... Mtlnth--:::-: n,;; . y",. .' . urn. . attended deceaseD FfIDM I I I TO I I. I byattendiPQ pl1yslClan ....... I '. I O"d DN."j /11 AT .; M'I . ..... 27 MANNER OF DEATH ~ ~ UNDffiRMINtll PENDING 128. WAS CASE REFERREq .TO . ___ !29A. AUTOPSY? '. " 298.IFYES, WERE FINDINGS USED TO DETERMINE NATURAL CAUSE ACCIDENT HOMICIDE SUICIDE CIRCUMSTANCES INVESTIGATION CORONER OR MEDICAL EXAMINER? NO YES REFUSED, CAUSE OfDEA~? .'..... ~1 02 03 04 Os .:.:~:... DONO 1~, Do rii:i 02! 'VONO' ~~S C'I~ 0... C(jH~lDENTlAL SEEiNSTRUCllON SHEET fOR COMPLETING CAUSE Of DEATH CONFiDENTIAL .. . 9 -;;:, 30 DEATH WAS CAUSED BY {ENTER ONlY ONE CAUSE PER lINf' FOR (A) (BI1'AN D(C)'} . .' . ... 'A""ROX'MA1IINT€~VAL '\-' ., . ,u. , "~". ,I,". .... BETWEEN ONSET ANOOEAT" ~ '..., PARTlJMMEDIATE CAUSE: ** . .; ~_ . 1 . ,,~ ',;, IAI-!4:-,...,+,,;::-- Probable Cardiac Arrhvthmia I ~ ~ DUETOOB.ASACON5~N(:EOF: I ~ ~~ - (B) ** Cocaine Cardiomyopathy, : ! ~I = ~ ~C~ETOORASACONSEOl!1:NCEOF . . . .... ..... '. -=.. i . '.' . '~~IW PARTII.OTHERSIGNIRC,l,NTCONDITlOfiSCONTRlllUTlNGTO.: ** AtherOSclerotic CardiovascularDise~setDIDTOBACCOUSECONTRIBUTE1011EAT~? ..' i.. i>' I' DEATH BuT NOTllElATED TO CAUSE GIVEN INPARTI(Al ~':"':" ~~ --::~'. . ..:' -':'~ . "''''' --:.~. ." T_ JlDN010YES tOPROllMLY ~KNOWN : :~. .~- 6,'.. 31A.iF iNJURY. DATE :, 1110UR I 318. INJURY lOCAllTi:(CIiy or town and Clluirty.ti~ stale) r 31C. DEsCRlIlEllOW INJURY OCCURRi;O' '.' l:iln,PLA.Cv_E~o.nNJURY:. '. I 31E.1NJURYATWORK? ~.:.lt h. MOI!TH DAY YEAR i I '. . , .... I.' .' I NO ~S. C>-.Q ':'" I'.' I I . Ii m' ~ .... . . .'. 1 '. ! .' too 01 . ~ f~<...~~ 31F,fFTRANSPlIRTATlONINJuilY,SPECIFY. n /3.2 WAS DE T. .'^ . 33A.lFfEMAL~~.;,^"...,~L.,,,:. hC,.",' . 338 DATEOFDE~IV~RY: yf.P#"'~ r, ~" ..~& !......~'eJ"5 ,On""J/ope.,,, 20PiSl0l9" 30Ptdlst"" ~&rl IN J!.lI YES O~,gnonlwil""~tyu, ,0 PI_ .!!tJm.~"~h 20N"Pf"ln"'i.bUlP'oQllaI1lwi~;"42liaySOld"ih MONTH-'ll ~'-'nVA I' I'. ~':" ti...."UiJiD.... 40mHER(s/eo/y/ 'T .," Do 01 30NOl""gnant~ui",gnant43da!s'o1year!!lQJ!d"th jOUn,.","ilp"gnanl"'lh~p"l...r' ~,J.,,,, . J1U~ IlI\ " liTHO UO^ o,~ O^,'~ . , . . . .'. % ~ ,,'- NURSING . HOME o YEAR 4C , 4G. NAME OF FACILITY (If nol facitil)', grve address) I 46 111(,1)1' O",C 5. lIATE OF 81RTH MONTH DAY YEAR . " . 7A ~ 8 SERVEO iN U.5, ARMED FORCES? (5IJe<1/Y years) NO YES [10 01 18 '. ; .' . . RO OtherPacillc Islander (specity) , ." :. SI } NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Cae>' of Death Record ....... .. .,......................... ...,....-..-............ ..................... . . . . . . - - ...". - . . . . . .. ............ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Andrea M. Paustian First Middle Name of Father of Deceased Thomas McEniff First Middle Maiden Name of Mother of Deceased Mary McKay First Place of Death 121 Cooper Road; Unit 1, Town of Wappinger, NY Name of Hos ital or Street Address Villa e, Town or Ci Purpose for Which Record is Required . (:.::..':: ,i.. ':fJ:mtYPEI)Ii"I))::::tt)),i))),}/)i/j//}i:)}(\:::: Date of Death or Period to be Covered by Search January 15, 2008 .............-....... ._.................-.................' .................... .,.................................... "' Last Social Security Number of Deceased 067-40-7018 Last Middle Last Date of Birth of Deceased 02/16/1956 Month Da Age at Death 51 Year Coun Estate Administration What was your relationship to the deceased? In what capacity are you acting? Temporary Administratrix If attorney, name and relations' of your client to deceased J> OCtO:? Signature of Applicant Date Address of Applicant 22 Market Street, Poug keepsie, New York 12601 ~ Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death Name Stephen E. Diamond, Esq. c/o Gellert & Klein, P.C. Address 75 Washington Street City Puughkeepsie State New York Zip Code 12601 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 Certification. Please do not send cash or stamps. First O.~lI' ':>E Middle l'"\ Name of Father of Deceased Last O~\ Date of Death or Period to be Covered by Search O-~~-o1 Social Security Number of Deceased O~ -3 - DO; ~ ~ f Cjo FirstKA { h Middle U Maiden Name of Molher of Deceased C.ARd-~PrN M First Middle VAN- Last ?Elf 1~S~1\1~ Y Last Date of Birth of Deceased L/ b Month Da {tIS Year Age at Death Place of Death ' , E LIl NI CJ-F )AJ flPP l;\l C-e-j26 Name of Hos ital or Street Address Purpose for Which Record is Required -rl\t 6 tJ-\<- ftNc..~ WF1ppiN~be~'FA-11 Villa e, Town or Cit 3 Du..+c-h b E3 Count RECE\VED What was your relationship to the deceased? S 0 K- In what capacity are you acting? .6 E" F If attorney, name and relationship of your client to deceased Signature of Applicant ~ ~ (joj-- Address of Applicant (~I b 7 N A N f, -+ ' TOWN CI ERK Ir'\ - Z- j- 0 "g :ye U '-' t5EP1COg...J) N.. . )2-522 ............."........--.............'.........................---,.---,...,,..., .._,---_.. 'COMPt..E"tEFOR.OeAtl-ts..OCCURRINGASOFJANUA-RY..l.' 198Et.... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PI..l:-A$EPRlfll"tl\lAMEANPiAP.PftE.$$WHSaeRECQR[) SI-fOUI..O BEseN"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 Coe.v of Death Record .pl.I;Ase..PPMPl..ETSrQllMANP.ENCLQSS...r=SE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased L-f U/I.J~y 1- S c.liff c:) fE or..:' I( First Middle Last Name of Father of Deceased Ht'E4JR '(' St..'illecj/EolE.~ First Middle Last Maiden Name of Mother of Deceased F '-'oe~I(/CC' A. ;/t:'O 'cltZtU1C# First Middle Last Place of Death !ZUJlllF 11 T tJIlPl-'IN<-14Eli!b' /=;;Jt.-L.S Name of Hos ital or Street Address Purpose for Which Record is Required ,:: 1.1;<1 Ii teA L- 'VI R.G CTt)1(. Date of Death or Period to be Covered by Search II /10 jot?; Social Security Number of Deceased o C; I - 30- S '1'1J~ Date of Birth of Deceased 08 0 S' Month Da Age at Death /938 Year 76 it)ItIO('7f11J<%R~ /7J'-L S Villa e, Town or Cit J)?I rt!lrlE S::; Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant ;w I? du)~ Date /1 /io/as / f ..........._-----.-.-.-....-...."......-........--...,.. ...-........._--_.._----.---............... COMPL.ErSFORDEATI-lSOCCURRlNGASOFJANUARY1 ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death NOV 1 1 2008 TOWN CLERK Pl.l;ASI;P$I,."..NANJSANPAPPflE:SS'WtiSllSllSCPRPSHQUI...I>$ESENT< Name Address City State Zip Code DOH-294A (6/2000) FecExl US Airbill Express FadEx Tracking Number 8665 3502 8647 From Please print and press hard. 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Z co " "' .... ~ Z .... :z: ell n co "'ll -< '" "' ... co " "' $ ~ z '" .... co ~ .. . To most locations. Packages over 150 Ibs. n ~,~~,~?~Xa;~ight ,--I Saturday Delivery NOT available. f -To most locations. o Fed Ex Tube o Other f * Declared value limitSSOO n HOUl Saturday ,.J at FedEx Locanan Available ONLY for FedExPriorityOvernightand FedEx20aytoselectlocations D ~~C~~9~UN1845 .,~x___kg o Cargo Aircraft Only c ( -c ,. " .. :- c " 7 Payment B~_ Enter FedEx Accl No..' Credn Card No. below. --------, o ~~~~~\o S",oo 0 Recipient 0 Third Party 0 Credit Card 0 Cash/Check 1 will be billed Total Packages Total Weight ~~No ~. Credit Card No. Date ( $ .00 Total Declared Valuet tOur liability is limitedtoSl00unlassyou declara a higher value. Se e back for details. By USiflg this Airbillyou agree to the service conditions on the back of this Airbill and in thll current FedEx Service Guide, including terms that limit our liability 8 Residential Delivery Signature Options Ify.' "";,,, ",,,,",,. ,ho,kO,,,,,."odi,,,,t ( No Signature o ~a~a~~~~Ybeleft without obtaining a signatufefordelivery Direct Signature Someone at recIpient's address may sign lor delivery,1iJespplies ~f~~i~~7; a~~~~~~re o recip;e.nt's ad.dress, someone ~fg~ ~~~g~~~~~. ,~r::p/~Y c Rev. Date 10/0&0Parttl58279-<D1994-.2G06 FedEx.PRINTED IN U,SA,.SRS \519\ FRANK J. GILBRIDE II CHARLES S. TUSA BENNETT H. LAST' THOMAS P SPELLANE JOHN P TESEI, P.C." ERIC H. SELTZER FREDERIC P. RICKLES+ KENNETH M. GAMMILL, JR. JONATHAN M. WELLS LINCOLN W. BRIGGS++ GILBRIDE, TUSA, LAsT & SPELLANE LLC ATTORNEYS AT LAW 31 BROOKSIDE DRIVE P.O. BOX 658 GREENWICH, CONNECTICUT 06836 COUNSEL ROBERT N. LITTMAN' SHEILA ANNMARIE MOELLER'" 708 THIRD AVENUE 26TH FLOOR NEW YORK, NEW YORK 10017 (212) 692-9666 FACSIMILE (212) 661-6328 'ADMtTrED IN NEW YORK ONLY "ADMITTED IN CONNECTICUT ONLY "'ADMITTED IN NEW YORK AND WISCONSIN ONLY ....ADMITTED IN NEW YORK, NEW JERSEY AND FLORIDA ONLY +AlSO ADMITTED IN NEW JERSEY AND VIRGINIA ++AlSO ADMITTED IN FLORIDA H+ALSO ADMITTED IN MASSACHUSETTS THEODORE L. SANDLER+++ SAL MELI.... CHRISTOPHER D. BRISTOL" DOROTHY MATTHEWS FREEBURG ASHLEY VAN VALKENBURGH ELIZABETH W. RIGSBEE NICHOLAS E. FEDERICI (203) 622-9360 FACSIMILE (203) 622-9392 November 7, 2008 VIA FEDERAL EXPRESS Town Clerk Town of Wappinger 20 Middlebush Road Wappinger Falls, NY 12590 Re: Arnold Winston Dear Sir/Madam: We represent the Estate of Arnold Winston. I would appreciate your forwarding two original death certificates to my attention at the above address. I have enclosed a federal express envelope for your convenience. I have also enclosed the Application that you requested and our trustee check in the amount of $20.00. Sincerely, ~~ 0, ~/du Lincoln W. Briggs Enclosures NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record .MiAND!!ENCL. ~. 0: l.LJ -.J FEE: $10.00 per copy or No Record Certification. Please do not send cash or stam~ ~ - ~ - .....:,....-........,........'..... .................. . :;:::::::::::;::::::;::;:::::::::: .......,.......................... Name of Deceased ;!ltN () 1"- First Middle Name of Father of Deceased ;-I A lR If First Middle Maiden Name of Mother of Deceased r/=1rf '7? IJ J-e.. W..Il i I'l sf.f i IV First Middle Last Place of Death r? j ..(' flit~ ^ /Q 'I ~ - J tf'l 6/cI lip/€- ((/~ II 'i:&~ r:L I Name of Hos ital or Street Address Villa e, Town or Ci Purpose for Which Record is Required WIll s foN' Last Last Social Security Number of Deceased oft) - /~- 7/~3 Milt sre. iN' Date of Birth of Deceased ..1 IF Month Da If ~ J.. Year Age at Death RiP tJ~II/;YJ.e~) /JUT Coun esS What was your relationship to the deceased? In what capacity are you acting? If attorney, name and r~latlonsh: of your ell":,1 10 deceased Signature of Applicant _A.-~ ~ Address of Applicant ~ / ~ ~O ts I d".z", .[) ;!'; ~ Rob,,, ~1t;"1 0 .eced01rt':S 4~/rAr Date ///7 /~p , Gr..eRhu./IOh , c:;r t)(}'d'30 ~ Number of copies requested with confid~ntial cause of death _ Number of copies requested without confidential cause of death Name City State ..e. ..s/ cr Zip Code DOH-294A (6/2000) Oct 05 08 . f;;:-~"'~"; ..;~ "At. ';'.' ..;.'-RES IJENC, ,~ . :", 'J,.;-.!',..:_, -~ ;:; ~ >; 1i ffi .~ ~ € = ~ ~ ~ w < L.I- ::i!: 02:0610 '~-~'-,'~- ~~S1t~~" " I>lME; 'lAST Fortin 203-341-9476 ~._._. - .._L~ ....f1 '~ST"'~ DEPARnilENT OF HEALTH CERTIFICATE OF DEATH '~CHS \f.U: I'r~,;c::...~' .:.; ~:- :~a-: ..1 -0I9n9Jft')f) MID),", !AS, .......... (j,}n. fIUAS"IG PRIVAT~ ~or~: .AESIOEllC; o [J ffilAlf 02 a. ml I 'It"', 'iilo08 I 4E. !r r.,5,CILlI'f', OAT: AQ~!,ITTED; I r.~o;'.I1", 10J 'HOS"IC[ FACllITv o HOSPITAL Irl000iE;lT OTHER ~'SIi<,i~:1 g 4C ~G 7A , 6:. If U~~.ER 1 O~Y ,/'" CITY AND STAJEGF iiIRTH: IN foot USA GIlun"pn1 76. I' AGE.UNOEP.l WJ1. NAI!E Of HOSPITAL Of' I fl~~~tP.. Il1lnUlt", I Rep.fJ,v'Pr~vif1ct} ."' .. .. :;: BIRTH: . . I I I '1_ I J I 'I ~~I , I Y '. i. !)ECEDEt:T OF HISP,v. ~ ORIGtN': C!JI:t L'It btttr !All (ltjr des.:,'iDf. '*Ii~! .'/,: ~,1! .~ ~""'~.1iCI'ao'rtw. 1~, D=CED~rn" Rloe;: .. ta (I.'tl c.~mc!, fK!J Ie L'kW!j"",,~"~ l~.' c,,~"3t1rC t,~list'i r;; nt!S!J1" IN' . NO ~1 A~loJ'IlO!s.>anISMilSP:''''l.2l''~ . au l'",Mel.can.M"''''.l:neri''"C"""". '^~v,'n.~"''''''i.', a::Ja",orN'it""l.nerl::an c~~~ 'liar, ~,DCh"".. ..:'.'( J?~:a cOn',Pu'~.Rl"'. .,:D::J."Y":':'I.", ,OFd'Pil1O'.FO~,,,' GORMan". I{q~'.ln>""~:.: ...~ 1fl"-i~ E 0 y...Dl'''Sl>""II!HlscaniclLi1i\;.!S"",~! J CN~r"II....'i.."~'."O G'.m.~,Orciwn.", "MD s.m.." 'l.OECEOErjT'SfDU:4T.'O~;""',u.""''''''''''dmJI...r''NgIr'':'<Da<''''''''~_''''''''''''''rl.'''''..." D : .' . ":" . ..' .,. ....:: .' 1 0 ~!lhCraiJe 20 YIt.-12Intl1de:r:3di.:JIcrn;: . .J 0 lfi~~s:;tloOrpra:lllltllor~E[j tJ Am!!.nc~ IrclllJfl~I~lslar~I'ft(spec':(vr .0 S.TtccU*,,"'rl,OOIno dllF" ~ 0 AssD:JiI!e' O'll'" ; I!s!- 8>choO"""l,;.:' p::J Oller Asia'.i"'::i~, 10 lIis"", d"", & 0 0"""1;0'1""';""" <leO/t, sOOther (sP'tio/! 12. SCi:~.l SECUAITY 'lUMBER: 13. MARI1Al STATUS: '4. SURVIVING SPOUSE: fro,,', 'Ii"" it: r;f\Jf.A t.:AAnIED .. MAR.~I~ 'Nlt:J~':EC SEPARAr,:[l l11l"ffd (Jl Jtfll!aifU' 1,'SU,.'Mfi:; $j;OI.';~t!. 080-,;(-7/'-13 01 02'~ ::J~ w,j,.er."''''~i!er...,",. 78 . . . '.' It'o Dt~,~ Pao'I: lSIa"'cr 'I~#Y! ,. OpHcd 51 25 [,IS' 30 31 3iB OR as acao CANCER I. . APPfIOXIMAlE INTERVAL "!I;tWflNGtlISf7 AND O!ATH .:..... I , , .,~ It:... .'f;),o -t'k ~.. . ", "31B.II.JUA1'lQCAlJ1Y; IC~f o'lOW1l.ndCOtlnt/ and .rate; , . . :':1 ". m. ."" 32;WAS OE::ElJEI([ '. . . ..'HOSP"ALIZ;oIH~NO' '. 'lAST 2 MOIHI'S . . "". ". . '... O. DID .rOllACCO ~SE :alITaIBUTE. TO DEATH? o 0 HO 1 0 YES 2 0 PROBABLY J 0 mll(fWWlf r 310. PL~CE(if IIJJURY: I 31E-INJURY AT WORK? , ,NO YES : ..1:10 01' 338. DA';< Q, DELlI'ERY: .... 20r<<.:lt....~.tll;prl9l1ilQwttlt.l~0iYi1ll1lti".Il. .',1D~.1tl D"'" VE~#C; ',.'. 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DeptJFloorlSuita,tRoom Address To request a package be held It I specific FedEx location, print FedEx addrssshere "" W1fi"J-tv :t-tl Us ZIP /e< J?~ NY State 0388042986 4a Express Package Service o ~:~;,~o~~~'in~~~ht snipfT!ents will be delivered on Monday unless MTUROAY Delivery is selected. O FadEx 2Day " FedEx Express Saver ~=:=n:~:r~~~~Monday LJ ~~J~'o:i~:~V~OT available unless SATURDAY Oe1iv8l'Y is selected. L-----..:: FedEx Envelope fate not available. Minimum charge: One~pound rate. 4b Express Freight Service o ~:~~p"a1:'!.e~l'.r shipments WIll be delivllf&d on Monday unless SATURDAY Delivery is selected. -CalltorConfirmation: Pscksges Up 10 15/J Ibs. D f~~~!J[:Js~~:~i~~~~ delivery to S8~act IOliSOO1S,- SaturU8y[J!:!ive.ryNOT8'JlIilat:;e. -TofnOltiiJClfli...::e. o t~~~b~~:~ ~~elP~~rsd!Y shipments will be de/iverBd 0,1 Monday unless SATURDAY Oe~V8ry iJ; ssle!:tecl. Pscksgss ovsr 1511 i~s. ~ ~~~~~~~r:~i9ht l..-.J Saturday Oelivary r~':'T e\.'lIl12:~:::!. -To mnrkK:8tiGOIL 5, !)l:k8ging Er.Fad~ Envelope' D FedEx Pak' 0 FadEx ~~~~ed~~~~ ~~Sturd,. Pak. Box D o Other FedEx Tube -DaclaredV&llA~mit$500. 6 Special Handling O SATIJRDAY Delivery NOT Available for FedEx Standard Ovemight. FedEx First Ovemight, FedExExpress Sav&r,orFedEx3DeyFreight. Does this shi~ conbIin dangerous goods? I One box must be checked, I o No 0 X;:erenached. D r~:per'sDeCJ8rlltion Shipper'sOeclerabon, natrequired Dangernus goods (including dry ice) cannat be shipped in FadExpackaging I~---- Include FedEx address in Section 3. ---------'1 o ~tOF~~t~~:~ NOT Available for FedExFitStOvemight HOLD Saturday o at FedEx Location Available ONLY for ~tf8~~~~~~~no~s o ~ryryc~~9~UNl845 __X~J:i D Cargo Aircraft Oniy 7 Payment B/"!!'i---- Enter FodEx Accl No. or Credd Cant No. balow. -l o Sender . D Recipient D Third Party 0 Credit Card D Cash/CheLk AcctNO,tnSecbon 1 will be billed. FedExAcctNo. CradirCardNo Exp. Data Total Packages Total Weight Total Declared Valuet $ .00 t~~~~a:~~::~~~!~~~~~e~fsY~~~r~~ad1n a~~gchue;~~F:d~s~~~etoGu1:~~:~s~I~~i~:i~:~s~~~:~ho~u~~i~eb~l~,the 8 Residential Delivery Signature Options ItYO",,,,,';',"';,OOM..oh,,kD;,,",,'odi,,'" No Signature o ~~~~~~~~y be left wilhoutobteinin9a signature tor dehvery. Direct Signature Dsomeoneatre,c'P,ent's ~~~~:~.1fe~y :;t7i~o; rf~~~n~1st a~~~a~~~~re o recipia.nt'saddress,somevne :~~ f~~{;dhe~Z~~~;:pS;IJ~:.Y 15191 -- - -- ---- -- - ---- - - - - - --- _._- -'- --~ .._--- Rev. Date IO/lJ6oPart/158279<l1!}94-2006 FedExoPRINTED iN U.SAoSRS Fii ,; ,h ~... := '" &, ,{ Z- ;eo .J: " C, '" -< '" :To '" '" ::a '" ~ :!l ,< '" '" -i '.'-:i ~:..; '" "" ,. ,-> '" j'.. ~ " .0 :::> <= '"' :>: " I'N I'N C "' C New York State Department of Health Vital Records Section PlEASe COM Application to Local Registrar for Copy of Death Record Submit to Town Clerk . FORM AN FE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. FlrstWilliam Middle Name of Father of Deceased Blake Last PlEASE PRINT OR TYP Date of Death or Period to be Covered by Search 2 April 1931 RECE\VED Chitty Social Security Number of Decease~lCl '4 2008 Last Name of Deceased FlrstWilliam Middle John Malden Name of Mother of Deceased Henrietta Haughey First Middle Last Age at Death Place of Death 40 Date of Birth of Deceased TO Month A ril Da Year 1891 Name of Hos ltal or Street Address Purpose of Which Record Is Required? Estate of Alice Marion Clarkson Poughkeepsie Villa e Town or CI Dutchess Coun Michael J. Collesano, Esq. What was your relationship to the deceased? 19 W9ii"t 44"th ~"tr~Q"t. 16"th VIoor New York, New York 10036 In what capacity are you acting? If attorney, name and relationship of yourdlent to deceased He was the decedent' s cousin Signature of Applicant (~tl(cu~~k~'-f-'iLV-_ Date 10 October 2008 Address of Applicant 490 West End Avenue New York, New York 10024 eRRING AS Of JANUARY 1 1988 Number of copies requested with confidential cause of death 1 Number of copies requested without confidential cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Laurie Thompson 490 West End Avenue New York, New York 10024 Address City New York State New York Zip Code 10024 Toll free .: (800) 378-3403 access code 77 DOH-294A (6/2000) - Page 1 of 1 , ,- Law Offices of MICHAEL J. COLLESANO, LL.M., P.C. MICHAEL J. COLLESANO, LL.M. Attorney 19 West 44th Street, 15th Floor New York, New York 10036 T (212) 227-6879 (866) 432-1882 F (888) 716-2544 C (646) 221-2284 www.nyslegal.com Of Counsel MARC A. BERNSTEIN STANLEY J. COLLESANO 29 September 2008 Att: Town Clerk Wappinger Town Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590-4004 RECEIVED OCT 1 4 2008 TOWN CLERK l~~: [:,tatc of Alicc Marion Clarkson Dear Sir: Please be notified that I am an attorney on an estate in which it has become necessary to obtain certain birth, death and marriage records. We are in the process oflocating heirs to prove their relationship to the decedent. We will need to obtain a certified copy of the death certificate for: William Blake Died: 2 April 1931, Wappingers Falls, New York Father: William John Chitty Mother: Henrietta Haughey He was the decedent's cousin. Therefore, I hereby authorize Laurie Thompson of 490 West End Avenue, New York, New Yark 10024, to request said certificates from your office on my behalf. Your assistance is greatly appreciated. Very truly yours, (vQU MichaclJ:coUesano MJC:hl 69 Delaware Avenue, Suite 501, Buffalo, New York 14202 . E-mail: Michael@nyslegal.com , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ,J,~ CC n ....H"\~ First Middle Name of Father of Deceased I? \ - l( 11 n <-Q '1 Last Date of Death or Period to be Covered by Search JJ. L, 0 'I I - .) L (' \~ \J J k 0 -'J,' 'j ,S.,,'- p~, .It I +- First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased t\ n 1/1 'L 'P-(I +-Q.. \' -"::, .- t9/{p First Middle Last Month 1..( Da J 5 Year Place of Death / Fie n+ (\f l< r S , n'it \-to I'n~ - \!l-o.'S1 +r\-+ VO -l.,j Q Pf)~ 'n~3 -fy S (--Cl II s Name of Has ita I or Street Address Villa e, Town or Cit tv y Purpose for Which Record is Required :v J.. i" S C) n Cc ( Social Security Number of Deceased o y':; - n cy - (/ ~ ~ Age at Death 13 1) cd C' It-(:,.cs:' Count E'VED What was your relationship to the deceased? !\J ,.Q, c -E::.. In what capacity are you acting? :P ,(' t-\ . If attorney, name and relationship of your client to deceased OCT 9 7 2008 TOWN CLERK Signature of Applicant \ \C~ \ \l< f.<~ ~ _ Date Cf-T- 7" ,J 0 cl " Address of Applicant .,) CV LV I Cl \I\.k \ 'fcL - CX-f ~. h~\ \ S, N - y. "-:<'>>>.':<<<<<'>>:-:>>.::-:<-:-::-:-::::::':::::::-:::-:::-::.::-:::.:-::-:.:-:.:.:.:-:-:.:-:-::::-:<-::.::::::::::::::::::-::::::::"::::::":"::::::::'-:-:::'.:::::::::::-:: ................COMPLETE..Foa..OEATHSOCCURRING,AS..OF..aANOAR'l...11'~8$ ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death al..!:A$$e$JN$NANJI$ANPAPP$.I;$$W...SFlI$ASOPFlP$HQQIlP'$S$EN.... Name Address City State Zip Code DOH-294A (6/2000) .. t !~~ ilii: ~ 1 ';:1=1 ~ ~ t:':l z...c: ..~ 53 i ~ .jooolf ~ ~ ~ ..~m &~'~h'Z .'.'~ ' 0 en \.8 m P~[ J';>" ~ :... ::.: ~ fC~....~. <. 017 < ......s. .... l' . :;~ '" t""'\ --- ~ ,/''''''' l~-~~-'~~ 1~:19 FROM-Dietz & Dietz, LLP 1-845-454-4966 T-039 P002/002 F-040 NEW "'ORK STATE DEPARTMENT OF HEALTH . Vital Records Section Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ~e of Deceased G"eD'(~\.0- \-\, \y'e.rolo.:.\\b~ First Middle Last Name ?ffa~r of Deceased ~ ' N \ l:'\ () -\-1 0(' e s Ve.:s l" -\-"Z-' S First Middle Last M~ Name of Mother of Deceased \ e '<\ L-.as ~ c.~ \ ':> First Middle last Place of Death ~ ' llo VUrnrtV'~t') Vrlue Name of Has' or ~treet Address Purpose for VttIich Record is Required b s -b.A-c A:l m 1 n l 5 W o.'-h6'11 What was your relationship to the deceased? No /JQ In what capacity are you acting? ..4+lLY nel] --k>V [' 0+ . n attorney, rwnuld r~""JfI:liont ~ G.-.f...:iJ..- Signature of Applicant -----/ ~ 1 Address of Applicant d Conn 6n Date of Death or Period to be Covered by Search cR ~ [0 -- d.CX)'6 Social Security Number of D8ceued ()\lD~ \l{~.q?oY Date of Birth of Deceased I a 3 I~ -\20 Month Year Age at Death ~P~l . . Town y r; ~~J\~~lQ-5S Coon ~ Number 01 copies requested with conf~aI C8US9 of death ~ Number of copies requested without confidential cause at deaIh Na~. I \~ l(Y\o.:" \;. T) I e+"-, E::, ~ Address ~~ 0W<,-q City ~ "" \<.~-'C \'~\ p. Stale --D.\) ZipCode 'LUG 1_ DOH-294A (612000) Paralegal Carmela E. Newman THOMAS E. DIETZ Attorney At Law Two Cannon Street - Suite 207 Poughkeepsie, New York 12601-3224 Legal Assistants Colleen C. Misner Michele A. Macintyre (845) 452-4000 Fax: (845) 454-4966 Date: October 8, 2008 Chris Masterson, Town Clerk TOWN OF WAPPINGER 20 Middlebush Road Wappingers Falls, NY 12590 RECEIVED OCT 0 92008 TOWN CLERK REQUEST FOR SEARCH OF DEATH RECORDS FULL NAME OF DECEASED: _Georgia H. Trembellos DATE OF DEATH: February 10, 2008 PLACE OF DEATH: 16 Vorndran Drive, Town of Wappinqer RELATIONSHIP TO DECEASED PERSON: ATTORNEY FOR ESTATE Number of copies required__3 (Fee for each copy: $10.00) Purpose for which transcript lS required: Insurance: Social Security Benefits Banking Transaction Stock Transfer Veteran's benefits Sale of care or property SetLle an estate ____x ~ ' Signature of APplicant:~~ ~(~- Address of Applicant: Thomas E. Dietz, ESQ., 2 Cannon Street, Pouqhkeepsie, NY 12601-3224 Our File # 6830 Paralegal . Carmela E. Newman FROM-Dietz & Dietz, LLP 1-845-454-4966 TUUMAS .E. UlKIZ Attorney At Law Two Cannon Street - Suite 207 Poughkeepsie, New York 12601-3224 T-039 P001/002 F-040 10-09-'08 13:19 Leul Assistants Colleen C. Misner Michele A.. Madntyre (845) 452-4000 Fax: (845) 454-4966 FAX COVER MEMO SHEET TO: TOWN OF WAPPINGER ATTN: Town Clerk FAX NO.: 298-1478 RE: Estate of Georaia Trembellos FROM: Colleen Misner MY FILE # DATE: October 9. 2008 NUMBER OF PAGES: .2 (including this page) COMMENTS: Enclosed is the Application Mr. Dietz as attorney for the estate. letter you received with his check. for Copy of Death Record signed by Please attaoh this form to the PLEASE CALL IF NOT PROPERLY TRANSMITTED TO YOU OR IF YOU HAVE ANY QUESTIONS REGARDING THIS TRANSKISSION. CONFIDENTIAL COMMUNlCATION- This transmission is intended only for the individual to which it is addreSsed and may contain information that is privileged. confidential and exempt from disclosure. ~f the recipient of this communication is not the intended reCipient {or its employee or agent responsible for delivering the eommunication. you are notified that any Qissemination, or copying of this communication is strictly prohibited. If you have reoeived this communioation in error. please eall the sender immediately and destroy the original communication. Thank you. IRS CIRCUL~ 230 Disclosur@: TO ~nsure complianoe with requiraments imposed hy the IRS, please be aware that any U.S. federal tax advice contained in this communication (inCluding any attachments Or enclosures) is not intended Or w.itten to be used and cannot be used for purposes Of (i) avoiding penalties that may be imposed under the Internal Revenue Cod@ or (ii) promoting. marketing or recommending to any other person any transaction or matter addressed herein. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record .........,I..E5A$S,COMPl..lS1"I;...gOflM.ANPiENPl..O$s,...r;Et:..... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of Death or Period to be Covered by Search t 1'.. > /~FLerCN Last Dc..'T 1J/,~ooS' First Middle Name of Father of Deceased A1>,l)/I1 First Middle Maiden Name of Mother of Deceased t1NNA ( UNl<'.rJG'<.J", ) First Middle Place of Death EL,l/NT A r W/i/'/'//VGEf2-S r/lL.t.S , wAPI0-vGc,25 r/-JLLS, NY Social Security Number of Deceased 2E L 113 Ijfi(1'1 Last 39.Lj-o/- <1151-1<:,- Last Date of Birth of Deceased OCT_ ~~~ Month Da I', / 'I Year Age at Death 93 J) U Tc I{c-> S Name of Hos ita I or Street Address Purpose for Which Record is Required -; 0 5E TTLi Gs. TA Tf::..- Count What was your relationship to the deceased? ;::::Ulv~RAL ,D/I2[C TelL In what capacity are you acting? SAM C If attorney, name and relationship of your client to deceased Signature of Applicant ~. ~ - II/1...P',./. /~ Address of Applicant t.. 'I f: -"h--J ~ M (;J 41')' 'J~ '^ J~ _ /J. y. Date /0 - 17 -oS' /.:J6)<fO ..............eOMP1..E1"EFQR..OEATHsoeCURRINGAS..OFJANl.IARY..1 ....UtSS.. -L Number of copies requested with confidential cause of death OCT 1 7 2008 TOWN CLERK _ Number of copies requested without confidential cause of death . ..... pt.E5A$fEPaIN"tNAMI;ANPJ.\i)pas,$SWH$aE:R$CQRI)SHQUl...paeeet-rf 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: $10.00 per copy of No Record Certification. Please do not send cash or stamps. Name of Deceased Werner First Middle Name of Father of Deceased Friedrich First Middle Maiden Name of Mother of Deceased Rosa First Middle Place of Death 103 Smithtown Road Name of Has ital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Henzler September 29, 2008 Last Henzler Last Social Security Number of Deceased 072-24-3474 Lipp Last Date of Birth of Deceased 3 18 1923 Month Da Year Age at Death 85 UJ /~ [>{'; N Go, ~i~hltill-- Villa e, Town or Cit Dutchess Count What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased (j L' Signature of Applicant \ J 1il.JU 'y Address of Applicant (J,028 Main Str t Fishkill Date October 1, 2008 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 ~ Number of copies requested with confidential cause of death RECEIVED Number of copies requested without confidential cause of death OCT 0 1 2008 LERK PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Regi~r for COe>' of Death Record . .....................PLlEA$ECQMPJ4emS F'GAM*NQENCt.Q$efE$U> <. ....... FEE: $10.00 per copy or No'Record Certification. Please do not send cash or stamps. Name of Deceased \<"01' t tV'\ A First Middle Name of Father of Deceased 1(ober ..\- First Middle Maiden Name of Mother of Deceased .s ~fN'"c:-"'\ I-b. ~ " ~ First Middle Last Place of Death L (p \ 120 b II,A l>"",,", L. VI Name of Hos ital or Street Address Purpose for Which Record is Required ~ljV'\"" last Date of Death or Period to be Covered by Search Sc -+-. l~, z..oO~ Social Security Number of Deceased WP'lr"""-5> Last as"!. - ~'1- 2-8'5 ~ Date of Birth of Deceased Age at Death 10 Month oS Da (If! C, '1 Year l-f3 J> '^ f-c. Lc ~ > Coun r.B.J cU Signature of Applicant Address of Applicant t-1 Cf../z,."" t.- PI-! /A/ r_ _ . , What was your relationship to the deceased? In what capacity are you acting? Fit ~/- ( --z:;:7, vc... c... ~ ,..,- r-, ~ ,,I' If attorney, name and relationship of your client to deceased ' ~/\- f? Date .... )t:>.I<& 'Fe; gOK ,4, ~4..JLI1 7e-1",.N:J /2 ~J ""lJf"'f':;. .)C'.. J08 ,.,--..-,....,........................ .--.........-...... .....C....O...M...P..W..... ......".. , . . :::::-::-'-:'"::<<<..:::',."-=.: .::-::: ;::: ....> ...........................-........................--......... NOAR-V't1!.> ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PU;A$EPa'.Nl'NAMGANPAQQ8J$$$WaS91laECOAQIHQQ.t,Q$E$SN"f'> Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Koreen Date of Death 09/14/2008 H Place of Death ffi >CXWxTown or~~J( Wa in er fa. Manner of Death GJ Natural Cause D Accident (.) LIJ Medical Certifier Q Age 43 years Middle Last A Flynn If Veteran of U.S. Armed Forces, War or Dates Hospital, Institution or Street Address 161 Robinson Lane Wa in ers Falls D Homicide D SuicideD Undetermined 0 Pending . Circumstances InvestIgation Sex Female Death Certificate Filed >QJ9XT own or~~)( DBurial Date 09/15/2008 o Entombment Address ..0Cremation Poughkeepsie, New York Date Name Ponciano Re es Address 841 Route 52, Fishkill, NY 12524 District Number 1368 Cemetery or Crematory Pou hkee sie Rural Cemete Title MD Wa In er Register Number 26 .~ D Removal - and/or Address ; Hold <:> .e; 0 Transportation Q by Common Destination Carrier Place Removed and/or Held Date Point of Shipment ........ 0 Disinterment Date Cemetery Address ... 0 Reinterment Permit Issued to Name of Funeral Home Mc Houl Funeral Home, Inc. Address 895 Route 82, Ho ewell Junction, N Y 12533 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Date Cemetery Address Registration Number 01178 Permission is hereby granted to dispose of the huma~~ains .des?ri~ed abov! as indicated. Date Issued 09/15/2008 Registrar of Vital Statistics~ LlJ ~ (signature) District Number 1368 Place F I certify that the remains of the decedent identified above were disposed of in accordance with th' Z LIJ :E w en IX. <:> o z w Date of Disposition Place of Disposition (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises (please print) Signature Title (over) DOH-1555 (02/2004) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.}' of Death Record ....PLEASE COMPL.ETE FORM AND ENCLO$E FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased .\-::> ~r-t W , First Middle Name of Father of Deceased "2~.rt- First Middle Maiden Name of Mother of Deceased R~~\ ~\\ First Middle Last Place of Death , A I r=e.-1- 'p. ~ Name of Has ital o~ Street Address I.-a"" =C.D Last PLEASEPRINTOR TYPE Date of Death or Period to be Covered by Search ~f';-, ) I 'ZOa'C, Social Security Number of Deceased 28 \ - 42 -- L-\e<-t~ \=>~ Last Date of Birth of Deceased ~b. 22; '4 a.t'=t Month Da Year Age at Death ~\ Purpose for Which Record is Required ~\ ~-\ L,'C A ~C\r'=::. J " rn " What was your relationship to the deceased? ~ ~~\ d., ~ ~r-\-cc- .1 In what capacity are you acting? on Ioeb. \-f' a.f' t=:..VV">~ "'-\ ~ If attorney, name and relationship of your client to deceased --.-J Signature of APPlicant~ . Address of Applicant -r--C:. ~'"\,J c,' c,:;) ~ nJ o COMPLETE FOR DEATHS OCCURRING ASOFJANUARY1"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 SHOULO 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 .........pl..eASE..PPMPl...lE'I]Sf=QRMANJ:).eNQt.e>SEFec...... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stam~~CL-L:k V cU Name of Deceased Date of Birth of Deceased Age at Death First \Y'I " > Middle A Name of Father of Deceased First(\\ X'\u \ Middle Maiden Name of Mother of Deceased First Middle Last Place of Death G-)a.\?~'I\~\Q\~ ~C\.\\5 Name of Hos ital or Street A'ddress Purpose for Which Record is Required '~<",<:.\)I"C~Q\ - ?:>ef\ \~'c.t~"'-'-l Month I Da Year dq ScC\.\;\o\Ou~ Ld:V\e- Villa e, Town or Cit Count What was your relationship to the deceased? f\ ,eLQ. In what capacity are you acting? Se.) F If attorney, name and relationship of your client to deceased Signature of APPIiC~'u' f2... Address of Applican u ~JA ~ - Date 1/ c9A) C<(; ..............<....<COlllJPL.ETEFORibEATHs..oCCURRING..ASOFJANUARY.1.....19SS............... ~ Number of copies requested with confidential cause of death o Number of copies requested without confidential cause of death Pl..EASEPfur'ftNAMfEAIIIPAOPRES$W",eAlE FU$PP$f:) Sl-fQUL.QaeSENl' Name Address City State Zip Code DOH-294A (6/2000) ~'-"'--""-"-"" ~. .12 BYEs lE:1NQNE ....,..~. . :R; 4B .... ~,._ IS$UEIl 12-20-0s fXPfAl'S: 12-29-13 _1n : M~ , ~-~. \... ]"' ':'~:: . J1 . John Hancock Life Insurance Company John Hnncock AnnuitieE; Service Canlsr 164 Corporate Onve, Ponsrnolllh, NH 03801-6815 MaihnR Address: PO Box 9507, Ponsmollltl, NH 03802-9507 (800) 824-0335 v'N/W,)hannullles.Gom August 26. 20m; Daniela Capparelli 402 Waslllngton Ave Beacon, NY 12508 Dear Ms. Capparelli RE: CONTRACT/CERTIFICATE # GP24217050 NAME OF PRODUCT OPA CHOICE (2003 EDlTION) LlNE OF BUSINESS IRA ANNUITANT MANUEL A MOREY The death claim for the above-referenced contract is still pending. Please be advised that all original paperwork, including an original death certificate for Manuel A Morey, must be submitted by Daniela .Capparelli, niece and the sole designated beneficiary of the above-referenced annuitant and contract, as copies arc unacccptable, This account will remain invested in the current fund allocations, but furtller activity will be restricted until tlle deatll claim has been settled. Please return a copy o[ this leller along witil tile outstanding docwnenta'fiqn. A retum envelope is enclosed [or your convemence, We will promptly settle tlle elaim upon receipt of all completed infoITllation, lfyou have any questions or concerns about tlris letter, please call us at 877-543-2363. Our Claims Service Representatives are available on weekdays from 8:00 a.rn. to 6:00 p.rn. EST. Sincerely, John Hancock Annuity Services Life Im:.urance, annUlbe~, Including group annuitie5 are products issued by the follONlog affiliates John Hancock Life Insurance Company (U.S.A"", John Hancock lile Insurance Company and Johr, Hancock Variable Liie Insurance Compan}", Boston MA . not licensed In New York L T.P..11 07 TOWN OF WAPPINGER TOWN CLERK CHRIS MASTERSON SUPERVISOR CHRISTOPHER J. COLSEY TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL WILLIAM H. BEALE VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI August 29,2008 John Hancock Life Insurance Company John Hancock Annuities Center P.O. Box 9507 Portsmouth, NH 03802 Contract/Certificate# GP24217050 To Whom It May Concern:: Please find the enclosed Death Certificate for Manuel A. Morey. Please feel free to contact this office at 845-297-5771 should you have any further questions. :fr6PJLtd {rto So Sincerely, '. John Hancock Life Insurance Company ,? ",,,,L ~~ the future is yours . John Hancock Annuities Service Cenler 164 Corporate Drive, POr1smoulh, NH 03801.6815 Mailing Address: PO Box 9507, PonsmouHI, NH 03802-9507 (800) 824.0335 IfN>IW ,jhannultles.Gom AllgllSI 26, 200t Daniela Capparelli 402 Washington Ave Beacon, NY 1250g Dear Ms, Capparelli: RE CONTRACT/CERTIFICATE # GP24217050 NAME OF PRODUCT GPA CHOICE (2003 EDITION) LlNE OF BUSINESS IRA ANNUlI' ANT: MANUEL A MOREY The death claim for the above-referenced contract is still pending. Please be advised that all original paperwork, including an original death certificate for Manuel A Morey, must be submitted by Daniela ,Capparelli, niece and the sole designated beneficiary of the above-referenced annuitant and contract, as copies arc unacceptable. This account will remain invested in the current fund allocations, but further activity will be restricted until tlle deatll claim has been serried. Please retUTIl a copy of this leller along Witil tile outstanding documentaCiqn. A retum envelope is enclosed [or your convemence. We will promptly settle fue claim upon receipt of all completed information. If you have any questions or concerns about tins letter, please call us at 877 -543 -2363. Our Claims Service Representatives are available on weekdays from 8:00 a.rn. to 6:00 p.rn EST Sincerely, John Hancock Annuity Services LIfe Jn5uranc;e, annUlbes, IncludIng group annuitie5 are product!:> I~ued by the folloNlng affiliates John Hancock Life Insurance Company {U.S.A.)-, John Hanccck 1Ile Insurance Company and Johr Hancock Vanable liTe Insurance Co;npan)", Boston MA . not licensed In l'>Iew York L T~P..-11 07 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coey of Death Record Pl.r:ASe.PPMpL.r:"TI:f;:PRl\IlANPfENeCQSr:<r::I:1:>r.. . FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of De~1?seQ lM I l.L-1/(W\ First Middle Name of Father of Deceased ~ :JOHN First Middle Maiden Name of Mother of Deceased. 1 Rt)S.E f1€Al-...f First Middle LaJt Place 3j~th r?t VE fL Pof(b ~~ Name of Hos ital or Street Address Purpose for Which Record is Required ~"J.,{ last Date of Death or Period to be Covered by Search ~ 2CR 2Q:\\( ~'-I L-e last Social Security Number of Deceased o~ - L--ID,- 3JIJ Date of Birth of Deceased 'J-Cp Iqt{s Da Year Age at Death /I Month vJJ\PPI~ (,-E(L r Cit (;2- 1A;'TC\-\Es S Count L€:-Gf\l, What was your relationship to the deceased? FL>' In what capacity are you acting? Fl). If attorney, name and relationship of your client to deceased ~16 Jl;U'>M~ ~~ou~ Date Po~ r4>. { fl.X-( Ni~ Signature of Applicant Address of Applicant .COl\ll PLETE.. FOR..OEArrHS..OCCUR RfNG..AS.. OF..JANUARV i... ..19$$ ... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .,t:lJ~i VcD AUG 2 '; 2008 PI.!:ASEP131N"tNAMI:A.NPAPPRES$WHr:AefU$PPRtlSl-lQUl. Name Address City State Zip Code DOH-294A (6/2000) ~~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Recol"ds Section Application to Local Registrar for Co of Death Record PLEASE GOMPLETEFOHMANDENCLOSE.FEE.. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name ot Deceased IX:>rothy M. First Middle Name at Father of Deceased Sterling First Middle Maiden Name of Mother ot Deceased Dansereau ., Last PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search Aug. 21, 2008 Masten Last Social Security Number of Deceased DqIJ- 3g'- cl3~8 Date of Birth of Deceased Age at Death Julia Bridqe First Middle Last Place of Death 59 Remsen Ave. S. Name of Hospital or Street Address Purpose for Which Record is Required to settle estate MonthSept. 27~a} 947 Year 60 Wappingers Falls Village. Town or City Dutchess County What was your relationship to the deceased? Funprrll Direct.or In what capacity are you acting? same if attorney, name and relationship of yoer client to deceased Signature oi Applicant Date Address of Applicant 64 E. Main SL, Wrlppi nryers Falls, N. Y. 12590 PLEASE>PBINTNAME...ANDADDRESSWHEREHECORD>SHOULDBESE . CO MPLETEFOR DFATHS OCCURRING AS OFJANUARY1l98&... ~ Number of copies requested with confidential cause of death _ Number at copies requested without confidential cause of death Name Address State Zip Code City nnH-?q4A IFi/?ClOO\ ,. .,. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coe.v of Death Record FEE: $10.00 per copy or No Record Certif19a~pn~ .Please do not send cash or stamps. ,-U::' V \;- ~ \J L- LT 1:'\08 AUv l. _u Name of Deceased i. / __ \, (t 1\ () D }... M MJU U..- \' \~ c.,VJ l \l Ul...u...r1'- First Middle Last Name of Father of Deceased M~s~~ iWI~ 'i\ \"5Z-- 40 - S3~l Maiden Name of Mother of Deceased CA..~ First Middle Place of Death ~LMl\ Name of Hos ital or Street Address Purpose for Which Record is Required Date of Birth of Deceased Age at Death ~1e) Last Month Da Year 5<6 DU\~~S Count P1-7 ~\ l" Villa e, Town or Cit ~l What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship, f y r.c1ie / IF.krUr<. Signature of Applicant Address of Applicant ... . ----....."".-.---....".,.........................-..-..-...........--.......................--.............--............-.---....... .......COMPI..E"J'"EFOaDEATHS..OCCORRtNO."SOF.JANl.IARY..1.....1~M ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PCEA$EPalf'{fNAl\IlEA~PAl:lI:)J~.e$$W"'";$eFll;p()A()$I-l()tlL.[)$e$I;~". Name --1U' rl\.M-l \! V'\J7r-t-, Address q \..\ b N-kL U ~ ~ ~ City ~b.:C{)J State~'f Zip Code lZ--5o<Zs DOH-294A (6/2000) I .//d.// .I>"~ rn..-M4 \ ,,~,._,.-..o-, .. ' .t. i Nilll4il!l NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for eoI!.\' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Ht:Gt:iVED First l-bw&.rJ Middle .5 Name of Father of Deceased LastJ.(<!efer 1S lei ~ Social Security Number of Deceased Tr,l '-I r::R1{ First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Place of Death Middle Last Month 6 Da Year.l~ tJc..~p''.rl'1e.,/ /V'-( 1~5"~O ~S' :3 7 5fcoK.. t+~" I . p<....:rc. h ~ $' S Name of Hos ital or Street Address Purpose for Which Record is Required Villa e, Town or Cit Count What was your relationship to the deceased? In what capacity are you acting? l.c..~ );f"/iOroc.VV1< VI r If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant XA/V'p~ i-:>..~ 1016 /f/'r" 5/''::> _ Date >< /.2-/10 <0 "," ............"..........,.......-...........-.,........-...............-.............-................-----.."...--..-......,.,'.'...',.,.............,..'.'. COMPl...EJ"EFO.ROEATASocduRRlNd.AS.OFJANUAR'V1 1988 ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PI..S\$EP$lf',I-rNAMEANPAI)Q$l;$$'WHeaI$IlEOpllPSHPt..Il..[)$$$EN1. Name /!/PL-" Yo.'-;/< <;(c-...r~ Iokc...tz Address J ~ yr?, de/It. hu<.t, p\ 0/ City CJc... rflvtj<? r State A/, Zip Code I )..,S- <; 6 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital RecOl"ds Section Application to Local Registrar for Co of Death Record PLEA E COMPLETEFORM.AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased f-tDwA~D 5. First Middle Name of Father of Deceased ~ ER BERT First Middle Maiden Name of Mothel of Deceased ~C/'-(t2u';)E. S'CH0BE(l First Middle Last Place of Death 3 '1 SPot) 1< H It- L ;:2 j). PLEASEPRINToRTYPE Date of Death 01" Period to be Covered by Search ft Uc,,, I fl, ;;?Oi) rI I<EE tER.. Last rlv EL€ R.. Last Social Security Number of Deceased o qO'- J'd - ~~3 ~ ~) . Date of Birth of Deceased ,J U.'I) 6 5'1 Month Day wA {?f?/ tlfG:EI( /9~3 Year Age at Death ~ S- Naf190 I3f Ilc3pilctl or Street Address ~, Town oP-6+ty- Purpose for Which Record is Required 'Tc> S~TTt.t::.- Et>Tr17C j)un::"HE5>S County What was your relationship to the deceased'! F,) III F 12 tcI/'f)r K ~ <: 7 () ,,'- In what capacity are you acting? g A Me- If attorney, name and relationship of your client to deceased . 'j , i ~ t2. AUd/~tLj c: 4 c' /}n~~ J!f. (.,()/}ff .Y~. n J' Signature of Applicant Address of Applicant Date <if-I <:J -09 GO MPLETE FORDEATHS OCCURRING AS OF JANUARY 1 1988 ~ Number of copies requested with confidential cause of death Ht:.Gc~ VED _ Number of copies requested without confidential cause of death ',"(' . (1 2008 AJI] ~..J. I. . T'^':' CLERK PLEASEPRINTNAME...AND.ADDRESSWHEREHECORDSHOULDBESENT........ .<> Name Address " City State Zip Code nnH_?q4A (f)/?OOo\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Recor"ds Section Application to Local Registrar for Co of Death Record .PLEASE COMPLETEFOHMANDENCLOSEFEE ht:Ct:~ VcD FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. " v ~ 2008 TOI/If' ( OJ::RK Name of Deceased Jeannette First Middle Name of Father of Deceased PLEASEPRINTORTYPE . '.' Date of Death or Period to be Cover"ed by Search Brannen Last August 16, 2008 Jessie First Middle Maiden [\Jame of Motller" of Deceased Annie First Place of Death Elant at Wappingers FallS Name of Hospital or Street Address ~ Purpose for Which Record is Required Pettit Last Social Security Number of Deceased 083-09-9251 Middle Peters Last June 16, 1915 Month Day Year Age at Death 93 Date of Birth of Deceased Wappingers Falls Village, T~r €it)1- Dutchess County To settle estate What was your relationship to the d2ceased? Funeral Director In what capacity are you acting? same If attorney, name and relationship of your client to deceased ~~;r::~:;~:~~:i:~;t 6~A;;;n ~~~~:~~7 Falls, N.Y. Date Allg 1 R, ?OOR COMPLETEFORDEATHSOCCUBRINGAS'OF.JANUARYA -f-. Number of copies requested with confidential cause of death '";1 Aile f (', "000 "-;',i./t;. I'! t",", I: _ Number of copies requested without confidential cause of death Tn'.' '"" 0.' J::RI< ... ...... PLEASEPRINTNAME .ANDADDHESSWHEREHECOHDSHOOL::OBESENT........ ." --'. '. Name Address City State Zip Code I' \...- nnH_?q4A IFl/:;>OOo\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record . PI..EASE PQfJlPI..I5Tt; FOfll\llANP.eNCI...O$e....Fet;......... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~i 1C'Q.V) Date of Death or Period to be Cover First Middle Name of Father of Deceased 011\ i\Q First Middle Maiden Name of Mother of Deceased ell e € t'\. ri-~<l1c. c:.c M. p \ First Middle Last Place of Death I F;;rtP'1.<Jre, Urive Name of Has ital or Street Address Purpose for Which Record is Required rd-- Y Last 1^/IOiol TO\N~ J CLERK Social Security Number of Deceased f/,C}I,.<L(lC!""Pi Last I d.. l.{ , Z '2.. - 35'73' 2. Date of Birth of Deceased lc, '-I /Cf:J..'( Month Da Year Age at Death 7~ \;J~'PPi "5er- hils Villa e, Town or Cit Du! cke.s;j Count Proof of IfY\c'Th~rs De.d-T'>-1 "'Q' -ri'\">"',d."<"~ (Vo\iC.t'e: What was your relationship to the deceased? Di U5i'\ 'te... In what capacity are you acting? c:. X e.(l 'Vtof Cl fh!,-\\.z<:, t" s. e .:,i-<i. i.<<:. If attorney, name and relationship of your client to deceased Signature of Applicant ~/V et.M./INl. h:..^f Address of Applicant S 5' SVA U f f"(d, Date g/ld'2...ooti Storl"'" v; I(~ I\}Y' IZS-'lr~ ..-.......-. .-----.....,......"'................................-..............."_................,,..... ..COl\llPI..EtE..FORDEATHsocOORRING,AS.OFJANUARY..1 198$.....................>.... ... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PI..EA$EPFUNt'NAfJlEANPAPP$:e.$$)ltI-lt;Rl5fleCOflPSHPOI..PBEseN.... Name R c) x <1 Vl '1 e ~y \ Address J 5' S" ,\ V f R.. dr!c/ City f)fd r 1'\ \I' lie. State N'/ Zip Code { :z (~-&- Z DOH-294A (6/2000) t ( ~~360 ... .~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for eoI1\' of Death Record eI..EA$E:P()fJIel..lS'tJ$f=()Rl\lIANDE~I..P$E:FEE. . .. FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased WtuUl.L- Vn~c.uJT First Middle Name of Father of Deceased NWUf.L, First Middle Maiden Name of Mother of Deceased ~W- Middle b~L(' Place of Death ~I Name of Hos ital or Street Address Purpose for Which Record is Required Y LU!.. ek Last Date of Death or Period to be Covered by Search \!(~ V~~ Last ['02- - ~ (!) .- 55~ Date of Birth of Deceased I to ~ Month Da Year Age at Death ~~LL Villa e, ToWn or Cit 55 brrCttt~ Count ~ tJSU92AWc.tS ~ets R AU6 6 7 2008 TOWN ClFRK ...>........<.....COl\llPLETEFORDEATI-lS.OCCURRlNG..AS.OF..JANOARV..1..19SS......................................... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death eUEA$EPRJN..-NAMEANQJ.U)[)EtE:$SWHJ$RISAJ$C()J:tOS",O:)UL.f)$ESJ$N"I"< Name MulM1J V Vl~\'t'~ Address ~b uNtJ <S<l" ~ ~ City ~~ W0 State 1\1 t Zip Code r2S05 DOH-294A (6/2000) . .J.iU?~ ~..t .-A.{-_'....-tl1_1~. CLASS 0 -f"~ "Ii \ I i i _~lJ -- ---~ 'r 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. Patricia J. Kelly First Middle Name of Father of Deceased Last August 4, 2008 Social Security Number of Deceased Michael Kelly First Middle Last Maiden Name of Mother of Deceased 110-40-3777 Date of Birth of Deceased Age at Death Helen McGinn First Place 0 Death 15 Peel Lane Middle Last March 25, 1949 59 Wappinger Dutchess Name of Hos ital or Street Address Purpose for Which Record is Required 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 TOlM~J CLERK Signature of Applicant Date Address of Applicant 895 Route 82, P.O. Box A Hopewell Junction, NY 12533 10 Certified Copies of Death Certificate with Cause of Death PLEASE PRINT SEN'!' 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 Recol"ds Section Application to Local Registrar for Co of Death Record PLEASE GOMPLETEFORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. " Name of Deceased KATHLEeN First Middle Name of Father of Deceased l-/owAI!..J First Middle Maiden Name of Mother of Deceased ...>U L. I A First Middle PLEASEPRfNTORTYPE Date of Death or" Period to be Covered by Search --.JULY ..':11, :Z~" ~ Ho~rt. ,.; Last 'TolJ5E'f Last Social Security Number of Deceased o ?I 1-3 '1- 'Ktt. 5' (!) 'NE 1'- Last Date of Birth of Deceased ..5- .j f9Jfl-/ Month Day Year Age at Death Name of l~o~pittJ.1 or Street Address Purpose for Which Record is Required /0 Seno! eSTt47C IV"'/-' ~/ /II' ~ E I(" V~ Town or &fy .-1J u rmeS S Place of Death 3t Et?lIltV JJI? County What was your" relationship to the deceased? p:::'u/llf:I2f.fL VI t<€C;6 L In what capacity are you acting? .54"", c." If attorney, name and r'elationship of your client to deceased Signature of Applicant Address of Applicant ~A-"'~ d 1(111/.:,4- - Date -Jl/Ue-. (; ;1..(J(;3' t.. /..f E. M~(lV .57.t"'r,o//Ik;ERS F.4LLS. ~ y. I:?S9D CO MPLETEFORDEATHS OCCURRING AS OFJANUARY11988 ~_ Number of copies requested with confidential cause of death _ Number' of copies requested without confidential cause of death - .__ ___ PLEASEPRINTNAME AND.ADDHESSWHEHEHECORDSHOLJ - iftfI~ - .t!M,- - Name Address City TO\Nf\/ CLERK State Zip Code nnH. ?Q4.A (fl/?OOO\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coe.v of Death Record . .....pl.eA$EQQMP...15TEFQFlM..ANP..eHPI..(;)$15..FEE....... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased t:/c.C/;4~ First Middle Name of Father of Deceased /7/'AX First Middle Maiden Name of Mother of Deceased /~J /,;tjt. /c-' /-/C /3/Ju-J~J First Middle Last Place of Death ~e of~ ~~/Str~et Address Purpose for Which Record is Required MtJ /1'/?1,,4 i/ Last Date of Death or Period to be Covered by Search ~-o/ .;w-c y Social Security Number of Deceased 'S~- tC/V Last ,/?iy_ /0-73 7&- Date of Birth of Deceased .~ l :)-. Month Da 2'1 L 'Y Year Age at Death (f'l V4:K j~5-S Count ./ /j)) "'- What was your relationship to the deceased? /v t.t'/vg /Z /7 i .. / /C: c~/ <..).IV In what capacity are you acting? If attorney, name and relationJhip of your clie . deceased Signature of Applicant ~ '~.~ ., Address of Applicant " , 7 J. If RE'GE'fVED JUl. .3 ~ 2008 T()IN~l Cf FR . - -.. k " '--CcS-rlC: /.P',/4i~e~"C. S ;VA- Date 7/3//eJ / ' 24/u J ......."."........,......."""...."'...".-...."".............--.--.....'.-.....-..-.........--...-....-.-...-..----..-...............,..........-----...,.,."............."......._----,............ . ........... ....... '.COI\IIPL.ETEFORDEA'J"HSOCCURFtINGASOFJANlJARV1W1988<... !5"" Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ...PI..!;A$15...PIlI.Nm.NANleANO..AQPR15$$.'W'HEA15..FlEOORQ$HPUl.U.El15$EN'J". Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Reg istrar for Coer of Death Record .....PL.EA$E.COMP1..I5"fI5..PQRMANP..EN(;1..0$I5Fes....... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased First 1!'110lr\ Middle A Name of Father of Deceased Age at Death Middle1l c:. Last Month AVI\\U'V\ G1Ih~~~ ~Id') ~q- 0 S~f\orvOvl~l.. L..,n-e.. v..:>"-;O{:>''''ju> Name of Hos ital or Street Address Villa e, Town or Cit Purpose for Which Record is Required n e ~ d FOY ~fA-/ fP/A-rpu 51::..5.- First 'fMI I Place of Death Da Year F-....\ \ 5 L>\).~....... '0 (fY'l-- /2S-'1L> Count What was your relationship to the deceased? In what capacity are you acting? &.. qtLj' '1lAft/cdC'; / , If attorney, name and relationship of your client to deceased ('J4+he. y v/13 Signature of Applicant m aruuJ d. m~ Address of Applicant 1!Jldj' J If-/) WClffit7ierS I-AilS Date 7/;8108 v..J~w "flY/.-- /2 s-'1 () ...........COMPI..ETEFOabEATHsocCURRINGAS..O#..JANUARV..1..1988. ~ Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death RECE\VE.O Pl..!:ASEPRI"''J'"NAl4EANPAOPfJl5$$WI-II5RI5Fll5p.. . Name Address City State Zip Code DOH-294A (6/2000) ,. .. '): '"r~n..~. ',. ~\ \..... ". ,...'1.....,'.'.'.. '" '~ ~t .r ,-....:_- . DRlVERUCENSf ' tD~_.,i44:8D6 008;-..0'1'" ~;M.~ aoSC~UGH LANE .wAPAI~S:1f!1.S WV'25l!lO se:K:t1',EYEl'1BL.' '+!'f:''S4NCLASS:.f) 'E' ~ ISst.1EO: ~'~S:DM1"11 4l1.~.1J'~ ~ ;,~! ~st0ester . . gO\1.com Marguerite Holmes Deputy Public Administrator July 21, 2008 RECE\VEO JUL 2 3 2008 TOWN CLERK Department of Public Administrator George J. Lambert Public Administrator Mr. Christopher Masterson Town of Wappingers 20 Middlebush Road Wappingers Falls, New York 12590 RE: Michael F. Stach 45 Myers Corners Road Wappingers Falls, NY 12590 SS#: 084-26-5666 000: December 20, 2005 Dear Mr. Masterson This office is administering the estate of Andrew Drab, uncle of the above-mentioned decedent. As discussed on the telephone this morning, I am returning the two free death certificates which you had supplied initially and requesting that you replace them with two certified cODies, to include the cause of death: Name of Decedent: Michael F. Stach Date of Death: December 20, 2005 Place of Death: 45 Meyers Corners Road Wappingers Falls, NY 12590 These certificates are required in order to petition the Surrogate's Court, administer the estate and for the liquidation of Mr. Drab's AIG policy. Enclosed is check # 124577 in the amount of $20.00 to cover your costs. A self- addressed stamped envelope is supplied for your convenience. Thank you. GJL/kc Enclosure Richard .J. Daronco Courthouse - 17th Floor 111 Dr. Martin Luther King, .Jr. Boulf,vard White Plains, New York 10GOl Telephone: (911)995-:i700 Fax: (914)995-2288 .J J ,21. 2:) 3 11: (: 1 ~,M No,0911 p, 2 _AMERICAN GENERAL THE UNITED STATES UFE INSURANCE COMPANY IN THE CITY OF NEW YORK P.O. Box 871 Amarillo, DC 79105-087] 1-800-362-9878 CLAIM DOCUMENTS CHECKLIST June 3~ 2008 Contract #: 2BA0384288 Deceased: Andrew Drab Beneficiary: Michael Stach C/O George Lamber Please forward the following items to our office within the next 60 days. We require a certified death certificate which contains each of the following items: (1) cause(s) of death~ (2) the deceased's correct and full name~ (3) the deceasedrs correct social security number, and (4) a raised seal or colored stamp. If a completed death certificate has been provided to the company~ please disregard this request. Please complete and return the enclosed Form 409, Annuity Claimant Statement, with information pertaining solely to the estate beneficiary, not that of the executor or a family member. Sections one through seven of the fonn must be completed, and the notarized signature of the executor and co-executor (if applicable) of the estate or a personal representative must be affixed to each space provided. Additionally, please provide us with the legal documents which name the executor(s) or personal representative(s) of the deceased's estate. Such documents include Letters Testamentary, Letters of Administration, or a small estate affidavit. Many states' probate laws provide an affidavit procedure that may be used to obtain death benefit proceeds without the need to probate the deceased's will if the estate is considered a small estate. If you and your legal advisor detennine that an affidavit is appropriate in your situation, please submit an affidavit (and/or other specified documents) which complies with the deceased's state laws, in lieu of Letters Testamentary. j'")~II~] '""i...-..i.l:_ r ( l j I j , ~ I j I I I I .jJ ,21. 200~: '1:01AM ~I ^, 9 · 1 ili iJ L i .... 'J . p, . We~hg' . ester -"",..,,,,-~,,,,.-!<,. o~com :;:?}{~~~1~~~C..' . FACSIMILE COVER SHEET D~partment of Ptloli~ Admini$tratcr George J. Lamhert Pllblic Adminhtrator DATE: July 21, 2008 Marguerite Holmes Deputy Pubjjc Administrator THIS l\!lESSGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY'l'O 'WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSER UNDER APPLICABLE LAW. If the reader of'this mlllssage is Dot the intended recipient, YOU An BE:REBY NOTIFIED that any ~mi:utIoDJ distribtltio~ or copying of thitl c~muzlication is stric;:t!y proll1b!ted. ' lfyotl have received this commUDieation .in error, please notif'y 12$ immediately by te1ephoDe and. return thie JX1ellsage to lUi ...t the below addross via. the United States Postal Service. Thank you. TO: Chris Masterson FAX NO.: 845-298-1478 FROM: Kathryn Croce FAX NO.: 914-995-2288 RE: Estate of Andrew Drabb Certified Death Certificate for Michael F. Stach NO. of PAGES: 2 - Total I am attaching a copy of the letter from AlC requesting the above referenced death certificate be certified and include the cause of death. Thanks so much for your help with this matter. "I.ICHARD J. DARONCO COURTHOUSE _17TH FLOOR I "1 Dr. Martin Lut/'l(!r KIng, Jr. BOl.lllward White Plains. New York 10601 ~.W2~~rhp~~Ar~n~_rnm Telephone; (914)995-3700 Fa},;: (914)995-2238 NEVJ YOFiI< ~TATE OEPARTfv1ENT OF HEALTH Vital Record, Section . - Application to Local Registrar for CoPy of Death Record L PLEASE COIIIIPLETEFOHMAND ENCLOSEFEE FEE: $10,00 per copy or No Recol'd Cel'tification. Please do not send cash 01' stamps. PLEASEPRlNTOR TYPE Date of Death 01 Period to be Covered by Search \Jame of )e.;eased _:iJ~cTH'7' Fir,;t I\lame of f=aher of Deceased A/II.Dt<EtU Ful! DYII//i First Middle Last Maiden I\ame oj Mother of Deceased wALt~.JA, flUG teA 6 , Flr!:t Middle Last Place oj Death ~o Et.. M ST. V. rJ1iddle \! J SENII,J Last .J IJ Lt' 1'1, loo ~ Social Security Number of Deceased 13.;.l-13'" ,5'573 Date of Birth of Deceased /11'12'[ Is-, I 9~1 Month Day Year Age at Death ?II WI9P~r dGees F/fLL S' V i II age. T1JWl'1"Ur..f*y 1> U7 citeS ~ Name of :10S pital 01 StrE~et Address Purpose lor VVhich Record IS Requimd rT c) S ETTLf c 5 TATf County CEIVED JUL 1 What wa,; y)UI relationship to the deceased" !:='UN8'I2IrL TJlllFcTtJ fl in what cap ~city are you acting? _ S' /1 Me If attorney. name and relationship of YO'Jr client to deceased TOWN CLERK SignfJurE:: 0' Applicant _~~_t2.....-_~~~ ~ Date '7- I ~ -" II Address of Applicant t if C. 0?~ -4t.. tUW'>"T 'f'u .:1..J/1Jr /'J'1f COMPLETE'POBDEATHSOCCURHINGAS OF JANUARV.t 1988 ~ Nu'T ber of cepies requested with confidential cause of death __ Nurr bel' of copies requested without confidential cause of death I ! Name _, ! I.Addr.2ss ICilY . PLEASEPRINTNAI~E AND.ADDRESSWHEREHECOHDSHOULDBESENT . Zip Code State nnH_ ?q,tA IFi/?OOO\ 9 ~ oA ~ /~ ( jUJ-~ 'i~/' N~~ / M~~ ~~~~ ~~ ~ . ~ ~ " NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for ColD' of Death Record ....Pl...$J.\$E.C()I\Ilf)l..E:l"E...FORI\Il..ANDIi5N.Cl..P$S...Flie FEE: $10.00 per copy or No RecoJd Certification. Please do not send cash or stamps. Name of Deceased (: PrR l- First Middle Name of Father of Deceased Social Security Number of Deceased jA-O'\ P-S f!:> f''fS d ,v I 2.""'" ?- 1-.- "7 b 06 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased )> / 'ft? .Q... (2.. e.5~ CG'" e'41114{::J{ /2-- /1 1/ :3 0 First Middle Last Month Da Year Place of Dea~d'">>l1L ~ S ;:e~ jy?<TIL~ p~ . iV,;t:rf;. ;:/f.?bS # /_ Name of Hos ital or Street Address Villa e, Town or Cit Purpose for Which Record is Required J B 1215"'/1/ Last Date of Death or Period to be Covered by Search 11/30/0'7 Age at Death ?t Count RECEIVED .x~ IA Il-,('~ What was your relationship to the deceased? -4 {,It.-L ~ d In what capacity are you acting? <:).-"!-- L P- If attorney, name and relationship of your client to deceased TOWN CLERK Signature of Applicant (J~ f 63~ Date Address of Applicant W ~ElV j1, ~c. pfl>. /4' 4f f. ~tJ-p..S N 'j 1/2.1 /~ fS . el..~$Ef)alN'tNAI\Il$At4t)AOpaS$$Wl-lEaEFlEPQl=lp$H()Ol...I)$S$EN'I' Name Address City State Zip Code DOH-294A (6/2000) .. l'i.,Ii'\. ' '1 .~~ , C1inm"S"'Il€"I.,otc 'ieh"". COM],\1ERCL~L 10:912 752 503 D R I 'V E R ;L 1 CE p.., S [ 006: -m.a2.33 BRYSON.~.L 5.~"DB. WAPI'INGIS~NY 125JO :iE EiDE:I1,..:::es.~~:; r-,;r ($~ aaf07f80 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record f?l...iEA$ECPMPce"J"J:.I::QANANPENQI..P$EttEE> FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. First flal"o lei. Middle Oq/"-4~- ff)6 Maiden Name of Mother of Deceased ~ FirstJeSSi'f!..., Middle Da 28' Year Place of Death ) l' /' {/ NY / /okrlry 12Jod lAJUff{ IlJe,rr rc. S, Name of Hos ita I or Street Address Villa e, ToWn or Cit Purpose for Which Record is Required IJpdat! ;:"t1u,-}(!t'tA I )CeOUAts What was your relationship to the deceased? f{ (j 575*"-0 In what capacity are you acting? pUr fjlft1J~ If attorney, name and relationship of your client Signature of Applicant ~ Address of Applicant 3 5 1::; , Age at Death 4~ Uu fel1 e :;5" Count CQI\IIPLETE..FQR DEATH S..OCCUR RfNG ASOFJANUARY...1.....198i>... ................. 2 Number of copies requested with confidential cause of death RECEIVED - Number of copies requested without confidential cause of death JUL 2 1 2008 I vw!'-~ CLERK PLeJ.\$iEPAIN"J"NANliEANPAPPflJ:.$S'W'l-IJ:.Ae FlJ:.CORP Sl-fPIJl...D ElESEN't Name ,{ ~ tJVb s: . )fPFr(o Address 35 Ut. )?;e4 S4-j/1-t Ur, City ?o t.L- ~ State NY Zip Code /;( 51~ - S9w DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased .J..rv'.'{\ ~ 0501'-"0 Hc...~U<LT First Mi.ddle Last Name of Father of Deceased Date of Birth of Deceased ,0 Age at Death First Middle Maiden Name of Mother of Deceased Last First Place of Death Middle ?~ i-/7?- ~ <-\1> Last Month Da Year t,...l..-t?;1n(<.)~~'; A/i Name of Hos ital or Street Address Purpose for Which Record is Required Count b.j I <.J...65 - 1 What was your relationship to the deceased? In what capacity are you acting? L.c.-w };;1/\'FrJ.rc.e Vl"e .:/1, T If attorney, name and relationship of your client to deceased . bA<lIl7L.-- P.)"I"\ llV\ Signature of Applicant ..J...v\v. yo-..--/.,? /~ fi/Y~ P Date 7//#' t> Address of Applicant 1(. /1\. cJ die.. b U\,l, {l 0/ CJctP I 'v1,,~t-" Lr; ..A/ Y ..............}........... COMPLETE FQs..OSATHSOCCURRING AS OF .JANUARVj.,98S.................................... - Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death ..................PCeA$EP$IN'1"..NAMEANP..AQQRE$$'Wfle.se..ae.OO$P$HPQCI.)1 $E $e.NXH <.......... <.............. Name Address City State Zip Code DOH..294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Reg istrar for Coe.v of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased /'] ~/hJtI?J T5w--eoc First \rw,iddle Last Name of Father of Deceased jt1f1 r14 t) /-0 (! Cf A./J7/17/77 JU ~ First Middle Last Maiden Name of M~O of Deceased HL/(S',4-- /LL6 First i I Last Place ..o!?eath /J . ~-~ -rfr~~A-- /,::?'L{/,o, Name of Hos ita I or Street Address Purpose for Which Record is Required ~/17W /C-v Dale o~~;; P7; tog: Covered by Search Social Security Number of Deceased ()7t/- ;;r--r- ~7 rJ Date of Birth of Deceased ;/-/'1- ~ Month Da Year v~~oe~1t;4 . Age at Death 71 UV7C~" Count Signature of Applicant Address of Applicant Date What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship Number of copies requested with confidential cause of death .-- .-. -_..."".............."."..,-...--...._- ..........,.......""",.......... RINGASOFJANUARv11988> ECEIVED .. 1 ~ 2008 _ Number of copies requested without confidential cause of death pl..eASl;paIN'l"NANJEANOAt)(::u~:e$$Y{f'lJ;aeaJ;QQal)$HPQl..[)f3e$eN... 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 CollY 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. Joan Theresa Speirs First Middle Name of Father of Deceased Last June 21, 2008 Social Security Number of Deceased Richard Gannon First Middle Last Maiden Name of Mother of Deceased 065-22-5460 Date of Birth of Deceased Age at Death Josephine First Place of Death Granger Middle Last February 9, 2008 4 Rowell Lane Wappinger Dutchess Name of Hos ital or Street Address Purpose for Which Record is Required Count What was your relationship to the deceased? Funeral Director I n what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant ~Lt' (c0:;, L 4 Address of Applicant 895 Route 82 , P.O. Box A Hopewell Junction, NY 12533 Date (~ \ ~L:-~ I uy 4 Death Certificates with cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE. SENT 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of Death or Period to be Covered by Search First I Mi.ddle A- Name of Father of Deceased Last frp.~ Social Security Number of Deceased First / v{. Middle S\ Maiden Name of Mother of Deceased Last fYJore Date of Birth of Deceased Age at Death First Place of Death Middle Last CJCArp~'^~~r-j .IV'i Month Name of Has ital or Street Address Purpose for Which Record is Required Villa e, Town or Cit ~ EirI FO....t:...ot.(Y"\~V\ T Count b .~ What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant It': \ yc---/ ?~... iUN :i 0 2008 TOWN CLERK Date b/30/o~ .6AMj.Sil:#fi:i:yF......~.R..........D:E........~~.H.......S ~BUR.......R.......I..Nh^S OFfKN.......U.......~6"'1.?1~d6> .-.-.......:'.~v ...r::.....::.:::..:.: -:"~ ;- :',".. ":'::.-:". .:-.y.yyy..... :-.. .... ~..,".. ............,..-:~"". .. ."":::l:::-:::.". ':':'. .~~.:-:-. . l Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .. ..... ...... ....pl...liEA$l;aSINTNAMEANUAQQRI;$$'W...$fi{1$9EOQ90S!iPQCI)1$I;$.n-A...>. Name 111'1_<) ~ ZI\V,yc..''"lI''''- / ~/7# ~/09b Address j <t> ~'JJ t~.b (..( s ~ tJ-. .01 . City tJ~~f'f\.c~:t r-('c;..//S I ,vy State # Y Zip Code / )... S-$- 0 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record . ..... ... ...................................}......>......>.<.>>>...<..P(.~A$E;:cp.euETe:FQflMA.I)~NCUQ$E;:ffEe:))...:.:.......................... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~d. First Middle Name of F ther of Deceased Last Date of D~g 7i;OdjO i 9o;G by Search Last Social Security Number of Deceased /a~ - I~ - fiS11 First Middle Maiden Name of Mother of Deceased ~ First Middle Place of Death Lf.~ ~: Name of Hos ital or Street Address Purpose for Which Record is Required HJ-.~ ~ Date of Birth of Deceased MO~;z,/.:l~/ /9.lY:r Age at Death ~? ~-,~~ta-~ I itLJ: VillaQ~, 4~~~ lfu;:--. Coun Wh. at was your relationship to the deceas~ ~ ' In what capacity are you acting? ~ If attorney, name and relationship of your client to deceased Signature of Applicant I< ~ ~. ~ Address of Applicant Date o :r/() ~ / :lbt5S f / .::.i:COMPLEtiiFQliii.EAT.::6CbDRRiNG.:ASmQ:dANUARY.119. .......... ........ ..........". ................. -..... - -. -.... ................-...... -... ........................ .. ...n.". .0. - Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death .- -. ........ -.. q----.. .....n... __............ ....---.........-.....---... .-.-,..-,.....-... ....... ....-- .--' .-.-........ ...--... ...-............ . - . . - , - . - - - - . - . . - - . . . . . . . . . . .. .. .... ... . ....... UptJ;A$Ee8lNT..eANUAQQBe$$\Vtlf;ReRee.oaQ$1ifQUotPBe]:~e"rI:? ....--..........'...................-.... ........-'-.....-..-......... ....-. ...,.......-........... ........-..... ...................,.......--.... . .. --..... -................ -. ..... '.' ~ .'.'.........-...-.........................'...............-.:....,...... ......---.......-..'....-.....--.,... ..............,..... ...... .... ....- Name Address City State Zip Code DOH-294A (6/2000) . 1\~ T T~""'" . ; "'\Q''''''' ,i \ 'k'j?"',.!'t'.',:~"'< ,1ii:-.:_ .. _ ""f1,." _\~- --~,:-;;" ",: ~ - __ ,_ '"~ """,,,,~,,,,-,_, , '\o.,.::k, ~-"", "'-. ,,' '-L..., " ., 't:" ~'"-;:",",:." "~l~e',,""i.'; ._llRfi:"ERLlCENS" ID:298299755 P0f3'ifl3'103,zs CONDDE$~G 42:D(lR01\llY,fiS -W1iPPmG4irS R.$ fiV12590 SSC:"EYE$: 'BR,H;T: ~ GLASS: '0 E: ",-lllr,B ," ISSlJED: ,~SCPIRE8:63-03-111 ~(,:fl.th, ~ 25885570 ;, '~0 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Nam-f of Deceased .1ro~ First Mi.ddle Name of Father of Deceased First Middle Last Maiden Name of Mother of Deceased Dat0~rth ~~ceased So Month Da Year Age at Death .90 D~~s Count First Middle Last P~S D\~\k~WY- ~ L~9-~ NarJe of Hos ital or Street Address Purpose for Which Record is Required ~~\L~ v~~~~~~\\s What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relation Ip of your ,.... .; e ~ 1-, o.a }(42.- \, Signature of APPli2f Address of Applicant 1\ REG8VEO JUL 0 3 2008 ..-,../ < COM PWETEFQRbEATHSocCURRING AS QFJANUARvd11981 ~ Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death PUeA,$I;PRJN'tNAMEANIAQPSS$$V(I'IEFU$aEOORO$HOQCP1$S$EN1'< Nam e 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash ofifEeEIVED L03200B Name of Deceased (" '0\90/~ '" ~'" erGo'" First Middle Last Name of Father of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Death or Period to be Covered by Search O<::')D'f.:" o~ Social Security Number of Deceased O~'~-~~~~6$ First Middle Last Place of Death ~,~ ~\,~- $ ( Name of Has ital or Street Address Purpose for Which Record is Required ~ 0\\Le. oft-. Date of Birth of Deceased 1 J D~ ~ '1"1 Month Da Year Age at Death ~ ~~~S' Count ~IT:~t~~ c~~ \ S What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of Date 0'1 lo~ )o~ , I ---- Signature of Applicant...J.rr. . Address of Applicant . .CQI\IIPl..E're..FQRDEATHs..OCClJRRING..AS.OFJANUAFlY..1Ji9Ss -L Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death pL.EJ.\SePFuNtNAMeA.Nt>1d)paeSSJ/VHi5F1lSFU;CPRi)S!-fOV(.osSSi5t,rr 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of ~eceased \ ROll 0-\ (} vJ 1\ \c1M 'First Middle Name of Father of Deceased W~I1tOJn First Middle Maiden Name of Mother of Deceased Mddr( tI First Middle Place of Death Name of Hos ital or Street Address Purpose for Which Record is Required ()1\ f!.- lY\ e~b(~h; \< \ tA ~YDi-~ Last Vt~p(1)f~ Last Hull Last Date of Death or Period to be Co~tJtd &y3S., \\~IDk' Social Security Number of Deceased ) 3,~ - 3~ -II) / I Date of Birth of Deceased I D ;q'/iJ Month Da Year Age at Death b7 \tJ~prf(/ 1'fn 11 ;1/ Villa e, Town or Cit Count What was your relationship to the deceased? ~ 0 lAj Yt In what capacity are you acting? ,M~5 {, f If attorney, name and relationship of your client to deceased Signalure 01 Applicant -1lJ1\~ ~ 1NCli) ~ Address of Applicant CJ -3 OO~' \W{ \\K.. ..s.~(\ (l J r( Date~ \) ~ f)W(J\.S C~<;~ ~~ AL 3S~ V?J ..............CQMPl..ETE.FOR.OEATl'iSOCClJRRING..ASQF.JANUARY..1....1~$S.... ~ Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death I,')l..EASEPQINTNANlf5ANPAPPAESSWt-IE.fl15FllSCOFlPSHOQWDEJESISNT Name Address City State Zip Code DOH-294A (6/2000) . I'JEW vOF;K ~TATE DEPARTfV1EN-:- OF HEALTH 'vital RecGld, Section . _. Application to Local Registrar for CoPy of Death Record FLEASE COMPLETEFORMANDENCLOSEFEE FEE: $10.00 per copy or No Recol'd Certification. Please do not send cash or stamps. - ........... ........ . ... .dd ............ PLEASEPRINTOB.TYPE .... (\jame of Je~ea~,8d Date of Death or Period to be Covered by Search ~f.l.Mes J, L 'ION 5 ..JVNt. .;lo ~OD ~ FirE;t Middle Last I Name of Fa'her of Deceased Social Security Number of Deceased joSE"PI-\ v, t.. 'ION S 08.2- I:J. ' '1tJs'1 First fJ1iddle Last Maiden 1\]aI1l13 of Mother of Deceased Date of Birth of Deceased Age at Death '= L,1.Af)eTH zA'-'/\/ 01 .:J( Iq { 9 gfl First rv1iddle Last Month Day Year Place of Death / S' UJ. ,QCIIJ)~l'ft 5,. W4pI'IIlJ 6- r:.RS F4u5 j)vra..Jr;J.s NamE~,-Iospital or 8t/(38t Address Village, T"tl'ml or f;ffy County Purpose lor Which Record is Requimd ,0 5ETTLf' G S "T .tl T t- What wa:'; y}ur relationship to the deceased? POIIIG-IU.,.l J)r t?ec:.76tt.. I n what cap lcity are YOLl acting? S A IfIj c" If attorney, l1ame and relationship of your client to deceased SignaturE: 0' Applicant ~~ tl J01J-l'~1u11 . Date , - :1 '3 -Dg AddrE,ss of6.pplicant ? Lf B~'l.';' k. oJ"rr~~~""~ .JJ~.A n.d" I ~ S"9c . COMPLETE FOR DEATHS OCCURRING AS OF JANUAHY1 t988 ~__ Nurr: ber of copies requested with confidential cause of death _,_ NurT ber of copies requested without confidential cause of death RECEIVED PLEASEPRlllTNArv1E AND ADDRESS WH UL i I Name , Addr.2ss E JUN 1. :i 2008 TOWN CLERK Zip Code State nnH_?qci.A Ih/?GOO\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coer of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased -I' ~ i"'o-... C; I First Mi.ddle Name of Father of Deceased ~~~ \ Last Date of Death or Period to be Covered by Search o S d~ (O~ Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last First Place of Death Middle Last Date of Birth of Deceased O~ '),. ~ Month Da So Year Age at Death 51 Name of Hos ital or Street Address Purpose for ~hiCh Record is~eq~ired ~ ::>\ \L~ ~Q._{) co' , ~ Villa e, Town or Cit RECEIVED Count What was your relationship to the deceased? In what capacity are you acting? IN v'"-,Yh 6h-Q~ C~~e .s "MvtS} bA/\6 If attorney, name and relationship of your client to deceased Signature of Applicant ~~_~~?t 04'L.._fl Date ()~~~<i, Address of Applicant }'I:... ~ ~ ..... ..CQMl?illETEFoabsATHsOCCURftINGASQFJANUARV1U198s. - Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death .. .......................Pl..!SA$$..aRlmtNAM$.ANO.AQQR$$S..-WHEReREQ()RO..$HOUIWP'.$$SENX........<.......................... Name Address City State Zip Code DOH-294A (6/2000) -- - ~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~ '(\\I). f i"~ ) First Mi.ddle Name of Father of Deceased First Middle Maiden Name of Mother of Deceased Last First Place of Death Middle Last Date of Birth of ~ceased ;Y9 o b 0'-1 V 0 Month Da Year Age at Death Villa ~~ ED JUN 1 8 2008 Count Cotv\ ES-.\ N t\ <;. ~ b.4'V d~ , Date o 6f\M.'...'.r#i..~i#i#n.RnD..E.IlT,.H'.'....S?nr.,.., <';"'i~R.'.'..,R'iN6j\S<?,n,>F.'.',/i, iN.'.U,.'...', ~b, #'1819, d~, >" .. Y:V ..r:,,""'::,:::~..VY. .. .. ":,::... ...V:sf.~y... . I: . ~.M. ...v ..~". .. Y..O::l::.'::... ..~ .. - Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death ",.,.,.,"',.,""....pI...I;A$e.PRINTNAMe4NO.AQQle$$.'\MHEaenRE~RQ$HPQl..p$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 COe.>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased MAl)U6L A. First Middle Name of Father of Deceased tfv\ f\-t\.)u&L A. First Middle Maiden Name of Mother of Deceased MOR~~I Last Date of Death or Period to be Covered by Search 05 \ () --=r- ~ 0 &- KORey Last Social Security Number of Deceased IDb~Lid-q51d. Date of Birth of Deceased Age at Death First Middle Last Place of Death c9Q]) Sc.cu60\Olt~~ UJ Name of Hos ital or Street Address Purpose for Which Record is Required Month Da Year tA.JQ~pl~etS~LL~ tJY Villa e, Town or Cit I :25'10 UU.J'C-~9S'S Count What was your relationship to the deceased? ~ Q 't~ In what capacity are you acting? If attorney, name and relationship of your client to deceased o \ ~ ," ,. '" Signature of Applicant rM (~ A,?-r; ~ Address of Applicant Q.qD ~("~a....o&-'\J...\.<:~ l~_ ~o..fP' ~Q\t'S TOWN CLERK Date O~ \ \ d-.\O 0- r- o..LL i \01..{ \ ,g. S q 0 .-."..""""....--.----.-..........".....--..----.-.... COMPLEre..FOS..OEATI-iS..OCCORRINGASOF..JANUARY..1 1988 .,... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death RECEIVED Name Address /"' JC;, I l. ~:nR pL.l:A.$EPftINtNAMf5ANP.AJjpaS$$WHtEAERISCOFUJ-$ffOUl..PBESENT TOWN CLERK City State Zip Code DOH-294A (6/2000) J' '" -""-T t , \.- \ . \, "~"~ CommiBllIOl1er <If Motor Vehld,,, 10:488 544806 "" DRI\~R lICENSE OOB:ifl9.i()1,,- MOReV,MAtlIlEL.:A DDSCARftCRDUGH LANE W:.tPP!tNGSRSIl.1..sNV 12510 SEX:1I'EYE$:'BL.fIi: '&084 CLASS: I> E:.. ~ ISSlllEO.'2!;ooS"~S:'89-01""" .!JII~~"1f/4 >>868!IB1 We~tcllester gO\1.com 1)(')lill'tn1l:nt of I'uhlic Administriltol' George ,I. Lilmhl'l't Public Administrator June 9, 2008 Registrar Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 RECEIVED j ,;;f; I 0 2008 TOWN CLERK 1\larguel'itl' Holmes Dqlut\' l'u hi ic Adm in istrator Dear Sir or Madam: RE: Michael Stach Wappingers Falls, NY 55#: ~84-26-5666 000: 12/20/2005 This office is administering the estate of Andrew Drab, uncle of the above-mentioned decedent. We are writing to ask if you would kindly furnish this department with two certified copies of the death certificate for the following: Name of Decedent: Michael Stach Date of Death: December 20, 2005 Place of Death: 45 Meyers Corners Rd, Wappingers Falls, NY These certificates are required in order to petition the Surrogate's Court and administer the estate. Enclosed is a self-addressed stamped envelope for your convenience. Thank you. GJL/jad Enclosure ]{iehanl.J. Damneo Courthouse - 17th Floor 111 Dr, Martin Luther King, Jr, Boulevard Whitt. Plain,.;, New York 10601 Telephone: (9]4)9~Jfi-3700 Fax: (D14)995-2288 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N. Y. 12237-0023 Application to Local Registrar for COPY of Death Record PLEAS~ 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 Mario John Ercoli First Middle Name of Father of Deceased Last June 8, 2008 Social Security Number of Deceased Mario B. Ercoli First Middle Last Maiden Name of Mother of Deceased 063-38-8647 Date of Birth of Deceased Age at Death Betty Ross First Place 0 Death Middle Last April 27, 1948 60 4 Daniel Sabia Drive Wappinger 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 at Applicant M<-' (~ Address of Applicant 895 Route 82 P.O. Box A Ho ewell ~'Jf5) ~<cC . o /10 lu?" . 0 Date Junction lU~ \ \\ \O'tJ~ C~~"" 20 Death Certificates with cause of death PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT 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 .. .r,t 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 Certification. TOWN CLERK Name of Deceased ~b First Mjddle Name of Father of Deceased -:4~'Ob Pr . First Middle Maiden Name of Mother of Deceased '0\ AQ. '" G. 3\I.J Ke...- FirsP Middle Last Place of Death. n \ ~q'i fi-\\ ~~ ~ \\ \<-IA Name of Hos ital or Street Address Purpose for Which Record is Required {4, \-\ en ~c 0 Last DatE 01 Death or Period to be Covered by Search ~\Y--~ Last Social Security Number of Deceased Date of Birth of Deceased d. I ~ I 7'';;0 Month Da Year Age at Death 7\ ":b \A ~Lo ~ ~ Wofr\~ ~ ~..;\\ Villa e, Town or Cit County What was your relationship to the deceased? ~\.~ In what capacity are you acting? If attorney, name and relationship of your client to deceased r Signature of App!!cant -L \J \ \~ Address of Applicant Date ~ / {)-Jo? { . .."'......--.-.........."'....."'.,-.----..-......--,-----"",...",._--"""... COMP[eTe..FOA.OeATHSOCCURRINGAS.OFJANUARY..1 ...198$....................... . ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PL.EA$I;PRIN';I?NA"-'eA.NPJU)Q$.E$SWHI$R15 Rt;PPFlQSHPQl..D $1; SENT Name _l \ Sr-.... (V\ ( &\..~:-lL- Address ~ ~ f~QfQ ~e. City \.0CAee\"~ 'Yj\ ~\\, State AJj. Zip Code Id5"9D DOH-294A (6/2000) ~ IDuIiN: 1U. ~utt.edidb: cfIlIUmnrinl ~1l5fitnl, ~ut. ClIolh ~prin9' ~.efu Worn ; c: Iris ~rfifiU/fi(L/~_ LIS1\. DIANE HENKEN " /t{t{l()~~~tr)/ MR. AND MRS. JACOB ADRIAN HENKEI-T /~n/d;YcY(bO/u/i~/4t__ 1: 28 ____/f.)::c~/b()/t~.jjt;{)JlZ /& llt.h /~~ ._----- ~I tll "{- FRIDAY_ YI APRTI.________ ,/'9 58 :t r 31u ~ifnr~~ ~hrtrrllf ~',Jrtt(1- ;m;Y(I/il/~;rJ l'llf~)lyl d/1i/IIIAYrIl/ Ii! ;:;,J/gIN/{I/:; liJ/lrli I(I(I;/~I(I;;{/I/ f/!/r,{) 1 {( lit/II; (/l/r:'I;II~/{(/?r, 1: /) r/ ~ /P! JIl"/('(/lIt'l' "\1/UY'f1t ~~ ^ b W</l.; r~! i'" d~.f~:~., . .<:'~I'~"o/",~? /~;/~;'.Jt"''''~''1f'' ""~l""''':''''''''l,''i'''''''''''i '.'i.....' ,........; '/"1' ,., '.L... "1"; "/:'1""/1" '/'" ,....,.. IV '~ ~ J...'-..'__.lll.IW~,Ji>.J.!' . ',:.' l.:-J~ .1. ~ ~,i.,,,_~~ ~\~ ~,'~.:, . J..:J.:_'~ ;uo,"';"~ ',,'1/ ...:>1 _"i~ ~'! 6;\., .J!1Ik.'. " '\ IJ1_U~_t LUI.I~.I_UH lJ IllllU~H U_IJ_IJ.II,~!! f Y H I'Tln II,' f1," lil'lHtoHIH Il!UllJJ.PttU ',IH','HHf,lH OU;II1N COPVR1GH, 1938 1.'"rU.I..IN C. HOI..l"ISTER CO CHICAGO 10 ILL ) -mCfJ ~.Co<l Zl.'m<N~8 ffi .i><:It~;c:)ro o on -0 "tiC" . . rn -. -0-1;1) -<~_::tI'" ..,zm.... -~T'7 U1. : l' ~~) ~~ Y: .10 - ~ .. ~ i~ CI} '. ?.~~.~. . i! ! >(Jl. ~E ; z;s~.~~":~? j -- c ..., o~.. ,..-7' .. ,. tv'" j<J CN!L.i \l;',,_~ ;; 0)" I '-. , 0) ~ ~"t"- . U1 ~ ';'v..~.. CD; '-.-- "" f 1". .... s ~ ...;Jp 0) ii 1"""<""__ CN~ito ~E V' li/ ~ " SO ".. ..~ ....~ ~.--. ~..'/'~ l000ooi1''. ~ ...~- -, $ L 'W ~ .?1~1 . J "'"<0 - m< ~::;;7;" Z......; fJ)r~ m..~...,,,,,t 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 t--\d>r<:::V"\~ ~ First Middle Name of Father of Deceased g~t\e.. Last Date of Death or Period to be Covered by Search Felo le,Zoo'e, -Jc~t'h<::"~ Brc'?-d \ ~t First Middle ~ Maiden Name of Mother of Deceased ~~ Uc- \-....{o--YloV'\ First Middle Last Place of Death E \OCVl'"t 0..-1 No..W~~\\S Name of Hos ital or Street Address Purpose for Which Record is Required Social Security Number of Deceased GC98 -1'-1 - 9080 Date of Birth of Deceased - ~ <LV'\ \, \~ 2. Z Month Day Age at Death 8h Year ~I~~~~\'€, Village, Town or City 'h~ County ~hJ 0.(1 L;~ A~'0> What was your relationship to the dec;;~e ~~\ In what capacIty are you actl~'V ~ Iad--.~l+' If attorney, name and relation o~~l![. ~~nt t~Q.~ceased I ~ ,~y Signature of Applicant I"\J. N~ .' Address of Applicant "'Vb ~ \ :::" L=>l rc:::c... -\cc 0-0 ~'Y)\ I ~ ___ Date 2.\\ . oCCJ 1.1 ~......... ~<<O?\"':\1f~ m\ \s , ~.-; \ c...S16 ... ........--..., "".......----- -........"... COMPLETE FOR DEATHSOCCURR1NGASOFJANUARYl 1988 ::') _~_ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE...PRINTNAME...ANO..AOORESS..WHERE..RECQRO'SHOUl..O.SE...SENT 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 eoI2.\' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. RECE\VED FEB 2 0 2008 Carmelo Melendez First Middle Name of Father of Deceased Last February 16, 2008 Social Security Number of Deceased Lao Melendez First Middle Last Maiden Name of Mother of Deceased 581-24-1670 Date of Birth of Deceased Age at Death Monserrate Pinero Middle Last September 18, 1926 81 38 Wenliss Terrace Wappingers Falls Villa e,Town or Cit 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 (40C'&L.' [a/YX.c~1 L)!: I Date 21ft'} (UY' . Address of Applicant 895 Route 82, P.O. Box A Hopewell Junction, NY 12533 6 Certified Copies of Death with Cause of Death 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 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 Rosaura M Sosa April 12, 2008 First Middle Last Name of Father of Deceased Social Security Number of Deceased A velino Martinez 131-10-6275 First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death Margarita Ramirez 6 10 1914 93 First Middle Last Month Dav Year Place of Death Elant At Wappingers Wappingers Falls Dutchess Name of Hosoital or Street Address VillaQe, Town or City County Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased What was your relationship to the deceased? Funeral Director In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant / r;,~ ~. J)ckvL",- Date Aoril14,2008 Address of Applicant :' 1()28 Main St t, Fishkill, NY 12524 './ COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 3 Number of copies requested with confidential cause of death Number of copies requested without confidential cause of death RECEIVED APR 1 5 2008 PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD B Name Address City DOH-294A (6/2000) .. I'JEW YOF\K ;TATE DEPARTMENT OF HEALTH Vital Records Section - Application to Local Registrar for Co of Death Record PLEASE COMPLETEFORMANDENGLOSEFEE FEE: $10.00 per copyor No Record Cel'tification. Please do not send cash or stamps. \Jame of Je,~ea!:,ed A LICe Fir~;t Middle Name of Fahel' of Deceased .jo SEPt-! PLEASEPRINTOR TYPE Date of Death or Period to be Covered by Search tJ/f ~j) Last A f'R/L. ,) ,?, 200 $> Social Security Number of Deceased First fv'liddle L 4,::: t=:1 N Last 0(,'7- ;;(~- ?-5'3'1 NoR/oN Last Date of Birth of Deceased M/ft :;0, Month Day Age at Death Maiden Name oi Mother of Deceased /.3:' LIZ !f@cir1 First Middle --' Place of Death 3" .]:>OUJv2'! ,q v~ Namf' oi :-IC~lJltal or S~reet Address Purpose lor Which Record IS Requll'ed I 9? '1 Vear 7<:j t.AJ ,q I" I'IIIJ 6- €t2 t; F4t L C; Village, rfJvJl, or City -1)u Tc:.HES s- County 'IV -5ETTLe ESrATt! What wa::; Y Jur relationship to the deceased'? j'= u IvEI? 1ft. ])/ /;>EC. TD 12- In Wll3.t cap~clty are you acting? S /-1 {VI e- If attorney, 113m::> and relationship of your client to deceased Signe.tun:; 0': Applicant _~.+!-~ 0 _--<Q{)./ut..Li4 . Address of Applicant (4 Co. MAIN -ST. w/l-~//u('.,Et<~ FAJ...l-5 RECEIVED APR 2 8 2008 TQWhJ atEff/("o 't /J.Y. ~, COMPLETE FOR DEATHS OCCURRING AS OF JANUARY1 1,988' -#-__ Nurrber of copies requested with confidential cause of death ___ Nurrbel' of copies requested without confidential cause of death i I I Name - I ~ddross L-n PLEASEPRINTNAMEANDADDHESS WHERE.HECOHDSHOtJLD BE SENT State Zip Code nnH-?q.:j.A ,hl?OOO) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - /._~ i! [ ,- I / Tr~ns. p;rmit Name First Middle Last I Sex Alice Ward Female Date of Death I Age If Veteran of U.S, Armed Forces, 04/28/2008 79 years War or Dates I- Place of Death Hospital, Institution or Z City, Town or Village Wappinqers Falls Street Address 36 Downey Avenue, Wappingers Falls UJ Q Manner of Death ~ Natural Cause 0 Accident o Homicide 0 Suicide o Undetermined o Pending UJ Circumstances Investigation (.) Medical Certifier Name Title UJ Q Kari Reiber MD Address 387 Main Street, Poughkeepsie, NY 12601 Death Certificate Filed District Number I Register Number )()I~-OO~}{Jr Village Wappingers Falls - Village 1324 11 . 0 Burial Date Cemetery or Crematory o Entombment 05/02/2008 St. Mary's Cemetery Address OCremation Wappingers Falls, NY Date Place Removed ~ D Removal and/or Held _ and/or Address ~ Hold 0 Date Point of ~ D Transportation Shipment 2i by Common Destination Carrier D Disinterment Date Cemetery Address . D Reinterment Date Cemetery Address )< Permit Issued to I Registration Number Name of Funeral Home Delehanty Funeral Home 00432 ........ Address ........ 64 E. Main Street, Wappingers Falls, NY 12590 ) Name of Funeral Firm Making Disposition or to Whom ........ ... Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remain,s described above as indicated. ;/k (C' , Date Issued 04/28/2008 Registrar of Vital Statistic? "./UfLt." 1~~LD (signature) District Number 1324 Place Wappingers Falls - Villaqe ' dJ 0 YJL< CivLCcb/'J/( /tt:u; it) r < ..... I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z UJ Date of Disposition Place of Disposition :E (address) UJ f/) a: (section) (lot number) (grave number) 0 Q Name of Sexton or Person in Charge of Premises Z (please print) UJ Signature Title (over) DOH-1555 (02/2004) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name 0.1 Deceased 1-, /tt../# 111 First Midale Name~Father of Deceas~ ~14Nj( LI rJ J irst Middle Maid.fJ1 Name of Mother of Dece~d t:. L l'2ft&fftll\4 . 41J1TSQi{J IN~ First Middle Last Place of Death ~ [JlLeif/~I6~ Dl, Name of Hos ita I or Street Address Purpose for Which Record is Reri.red ~E ti!4L j 1frV ~ Last Date of Death or Period to b'f(gWNeeEE~rch <1- .9. S-- 0 ~ )uJf Last Social Security Number of Deceased 001 - ~ j -Lid. ~ Age at Death 79 Jlrre~ / ' Date of Birth of Dec,eased () 9 :3 /1 Jil Month Da Year Count What was your relationship to the deceased? . ==vt' In what capacity are you acting? tu /vI[: fL:U. lG EC;:JEj f( ./ If attorney, name and relationship of y client to deceased ^ Signature of Applicant Address of Applicant ....---.--.....".....--..---.-..,........"'.... ........"..-,.,--_...... ....".---...."."...".,.---.-.............. COMPL.E't'EFORDEATHSOCCURRINC,lASQFJANOAR'V1 Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PI..!;ASEPFUNtNAMeANPAQpaS$SWHeFt15aeCPRP$l-fPUL.P$ESENt Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ...... Date of Death ... '.-:': April 25, 2008 .. IA Place of Death Ii: City, Town, or Village Wappinger I~ Manner of Death ~ Natural Cause 0 Accident ~.:.'." Medical Certifier Name .~ Elaine Lind2ren Address 374 Violet Ave., Pou2hkeer>sie, NY 12601 .., :::::: Death Certificate Filed District Number .:.:': City, Town or Villaqe Town ofWappingers o Burial Date April 28, 2008 o Entombment Address ~ Cremation Pou2hkeepsie, NY 12601 ',~' Date ;: 0 Removal ::: and/or - ~ Hold ~ ~ ~.: I Age 79 Middle Last M. Lane If Veteran of U.S, Armed Forces, War or Dates Hospital, Institution or Street Address o Homicide 0 Suicide \ Sex Female ::-::: Name First Lillian 7 Orchard Dr. o Undetermined 0 Pending Circumstances Investiqation Title MD I Register Number Cemetery or Crematory Pou!!hkeepsie Rural Cemetery Place Removed and/or Held Address Date Point of Shipment o Transportation by Common Carrier Destination o Disinterment Date Cemetery Address o Reinterment Date Cemetery Address ::\ Permit Issued to ..... Name of Funeral Home Sweet's Funeral Home, Inc. :::::: Address ,:: 4365 Albanv Post Road.Hvde Park. NY 12538 II::? Name of Funeral Firm Making Disposition or to Whom , " Remains are Shiooed. If Other than Above , " Address t~, ?:: Permission is hereby granted to dispose of the human remains described above as indicated. ... ,.. Date Issued 04/28/2008 Registrar of Vital Statistics I Registration Number 01705 (signature) ::: District Number .. Place Town of Wappin2ers ~: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition Place of Disposition (address) (section) (lot number) (grave number) .;.. Name of Sexton or Person in Charge of Premises ~ ~. Signature (please print) Title (over) DOH -1555 (02/2004) Name Elaine Lind ren M. D. Address 70 O'Neil St., Kingston, New York, 12401 District Number 1368 Cemetery or Crematory Pou hkee sie Rural Cemetery . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Name First Lillian Date of Death 04/25/2008 I- Place of Death ffi.~~Town o~~ Wa in er C Manner of Death ~ Natural Cause D Accident LIJ fB Medical Certifier o Age 79 years Death Certificate Filed ~Towno~~ o Burial Date O 04/28/2008 Entombment Address [LlCremation Pou Date Wa in er ~ D Removal - and/or Address ~ Hold o B; D Transportation 2i by Common Destination Carrier Date .. D Disinterment Date Date D Reinterment Permit Issued to Name of Funeral Home Sweet's Funeral Home, Inc. Address 4365 Alban Post Road H de Park, NY 12538 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address f'- oY\ :,\~ \ lJ I Burial - Transit Permit Middle Last M. Lane If Veteran of U.S. Armed Forces, War or Dates Hospital, I nstitution or Street Address 7 Orchard Drive D Homicide D Suicide D Undetermined Circumstances Sex Female D Pending Investigation Title AUendin Ph sician Register Number 10 Place Removed and/or Held Point of Shipment Cemetery Address Cemetery Address Registration Number 01705 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/28/2008 Registrar of Vital StatisticsC\1t.:u.u~~ L)) (sIgnature) District Number 1 ~f\R Place I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-- Z W :!: w f/J cr o o z w Date of Disposition Place of Disposition Name of Sexton or Person in Charge of Premises Signature DOH-1555 (02/2004) (address) (section) (lot number) (grave number) (please print) Title (over) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coey of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased fn 4 1\.,) L( t?L ~ First Middle Name of Father of Deceased '(\1f10Llb L- A, First Middle Maiden Name of Mother of Deceased /1, I c ;21>1 Last Date of Death or Period to be Covered by Search ~ (V\AL( o'it I 900~ Social Security Number of Deceased ~l c.H~ G"l( Last lOCo -h\~ -qS\~ Date of Birth of Deceased 1050 07 Month 1+ Da Year Age at Death .t::... r:L,... C'\/I -.) r L{' , First Middle Place of Death 0 t\ '\ t:- o Ci ~L.) . S C fA- I?. e, u. <) h Name 01 Hos ita I or Street Address Purpose for Which Record is Required Last 1 (\WC I 0f\r-Pf/..:)'1QuS,\-ALLs ~l Vill~ e, Town or Cit ' j"-l \' T'J [l tc y\." ~"5 Count What was your relationship to the deceased? F A""\ \-\ EfC In what capacity are you acting? If attorney, name and relationship of your client to deceased RECE\VED MAY 2 1 2008 TOWN CLERK Signature of Applicant -+-l71 ~ 'h1 ~ Address of Applicant 'S, A\fY\ e.. AS (:~ t?-L)CfC-' " t. .)..- Date rl'\ ~ ~ '(1 \ d-CO (s- .,-. ---..-------...- ........... COMPI...ETE..FORDEAl"I-lS..OCCORRINGA$OF.JANOAAV...11988 .J Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASS...P$IN-r..NAMEANPA[)[)R.ES$ViHe.fle..Re.PQAD.SHPUL.D..li3e...$EN'T'" Name Address City State Zip Code DOH-294A (6/2000) "')\.~".... .7......). /''''-.' .n...li(...... '" "'I..r..:.,..~ ....... . ..............f<....'....,.. ;, .".t "U., j in " ,""", ."'" 'e':. ..... .... ~... ..... ......~l ..;~1.:: . '~_rilt_Velides DRNERLICENSf ID:488 544806 OOB:09-0i'-.28 MORSV,MA;NUEl.,A aI)SCARI~ LAtE WAPPING$RSFLSNY 12590 SEX: tltEYE$; 1:11. ffi: .SolJlI CLASS f) :E: .' . All, i ISSUED: '03'~:EXPlRES:09-01'11 '. "" --J.J# 111 *'1 -288&9!1S1 ..st.. ~)19-1~9ifl .1-~NTtFICATION CARD NUMBER 051732136 E)(PIRES 09-01-2008 MOREY, MANUEl A SR 128 SHARI DR GUYTON, GA 31312-5007 SEX liUlTWIlA T! EXAM DATI EYiS M 09-01-1928 0A-86-2OlM BW HEIGHT WEIGIlT CSC FEE 5-03 172 8 62 010.00 Ir ~j f$ "''-' .-3.. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coe.v of Death Record PLEASE'COMPLETEFORMANDENCLOSEF FEE: $10.00 per copy or No Record Certification. Please do not send fAIf Qf 9t~. ,OWN Name of Deceased 'ty~~v~ C1, v"YlVU0l I ~( First Middle Last Name of Father of Deceased \\'\.e~ (~. \~tvu~/\ ,)Y: First Middle Last Maide.!l Namebf Mother of Deceas~dJ 0 . CZ:~ . U~ l~f\,t~ First 'Middle Last Place of Death '21-i?1 0 S~-/\::>l){b~ ~ ~'--t--t Name of Hos ital or Street Address Purpose for Which Record is Required ~^vv '\0-<. U{) u Date of Death or Period to be Covered by Search ;,.-..., , -"" .~ - t- cUt6 Social Security Number of Deceased \ O~ --y 2 - '1 ~ (L Date of Birth of Deceased Ci - \ \- . )0 Month Day Year Age at Death lu~~f\~ \ ~r Village, o~j;)or City ~7 ._..\~ L^JG~LuL1 County What was your relationship to the deceased? In what capacity are you acting? If attorney, nam? and relationship of your client to deceased ~ } i Signature of ApplicanT: '\1 Address of Applicant '/"tc~V- ,--. ..--' (jJ~ - StrCluii, (:atalano & Ilrl1vey "c; East ~Iain Street P () Box 13 1 Wappin Jers Palls ~ Date COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1. 1985 i -----J--.-- Number of copies requested with confidential cause of death- S~~ Sl VG~ ~ 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Nall)e 9f Deceased \;tYlc--~n- &r. N-e'-0 \a.VlC First Middle Last Name of Father of Deceased ( Social Sec . y Number of Deceased ~ -K. V\V1t.-C~rt N.-cuJ\al/\C O'W-- S'1 - 8B'12- First Middle Last Mai~me of Mother of Deceased ~~ C-v-iSP\\t\D First Middle La~t Place of Death 23 ~~,k~~r~e \<\AV\ Name of Has ital or Street Address Purpose for Which Record is Required . '~Y1c\ What was your relationship to the deceased? In what capacity are you acting? a.>V'\ If attorney, name a~ShiP of your client to deceased Signature of Applicant D ~ Address of Applicant -t==b I 2:> i Date of Death or Period to be Covered by Search Wa. 72. 200 CO Date of Birth of Deceased 6b 12- \CfG:2. \ Month Da Year Age at Death L-fi ~-k~~:~ Count c-r Lt~ A-'~!~ ~tc.A(.'"j n I("-ea-kr k ~Ia l'-p c:>-p '~YYl ~ ~ LA ') ...--.-.....-_.- ........._--_......................."",..-....-".,-----..-.--.-.-..----------_.............-.........-. COMPLETS..FOA DeAfHsocCtJRRING..As.OF JANOARv...1......19S8 ............................ , 2-Number of copies requested with confidential cause of death RECEIVED MAY 2 7 2008 TOWN CLERK PLEASE...P$lN,....NA.NlEA.NPADIlFtISSSW'HEae REPO FlP.. SHPQI..Il $E'.S EN,....... _ Number of copies requested without confidential cause of death Name Address City State Zip Code DOH-294A (6/2000) STRAUB, CATALANO & HALVEY FUNERAL HOME . Town of Wappinger 4898 5/27/2008 Copies - V. Newland 120.00 Cash - M & T Checkin Copies - V. Newland 120.00 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record . .......................Pt.1i5#$J;OQ.P4fi1'Ef'OAMANP1i5SQpQ$E;eJ5e<................... FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased W \ \ \ "O-vY\ ~. First Middle Name of Father of Deceased W \ I I \' [L(Y'\ First Middle Maiden Name of Mother of Deceased ~ C,ed q e..... '13u..vv First Middle Last GrC"'{ Last Date of Death or Period to be Covered by Search 5/2~3 Jug' C-y(', '-{ Last Social Security Number of Deceased ~~3-2o-C{~yq Date of Birth of Deceased L/ /i/ZS:' Month Da Year Age at Death ~ Place of Death , :$ q SLlC I ch 'PLOt 62- Name of Hos ital or Street Address Purpose for Which Record is Required Wapf:?( n~v v Villa e, Town or Cit DvA,..dcVu S~ Count RECEIVED What was your relationship to the deceased? MAY 11 2008 In what capacity are you acting? .f"GC ~vrJ. 'DI Vl" <=-:-\"1.,.......-- TOWN CLERK If attorney, name and relationship of your client to deceased Signature of Applicant + ~. ( cU..j Address of Applicant 0 F3u)( Jl} !-to f jJ Cz J-Pl ( Date --:Jef S:/2 7 / (;cf' Alj (L)3) ... ,.,..,.-.,,'.........".'................"'................................,..................,............................,...............,...,.. .......-.............,.,............,.........-........",..............,.,---_."......... . .<eoMLE'teiFORDEATHSC:......iRRI. ....... ......../OFJANUARY1198S<>>>.. . ~'1N mber of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death . ......../<.......PP$ASepaoftf.JAMJ5AIQAQP8ES$..WliE8laReOPAI)$HPQtP$e.$ENj'.............................. Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Dece~ed +V-VI YI fl. OS{)f( 0 First Middle Name of Father of Deceased Je5~ First Middle Last Maide~~\o: Mother ofd~ceased OSJ VI 0 First Middle Last Place of Death LJ) q 0 rt~Gni\~ Last Date of Death or Period to be Covered by Search \~ a. G\. ~ Social Security Number of Deceased v\Q)~ DRte of Bfrth of Deceased t+ft'd I:; ) C,7J-. Month Da Year lAJo..)~ ~ / Age at Death 3b Name of Hos ital or Street Address Purpose for Which Recor~ is Required C \4> uv) Villa e, Town or Cit Count What was your relationship to the deceased? In what capacity are you acting? t'v ~\\ If attorney, name and relationship of your client to deceased Signature of Applicant ~'Liu rr- Address of Applicant 8. 5 ~ 0 c;:~ V\J ( i$\ ( o$V~ (p)(J' -0 V'" Date Sl~~O r \j\l J oc 5 COMPLErEFORDEATHsOCCURRfNGASCU=]JANOARY1.19S8 ~ Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death RECEIVED MAY 2 9 2008 TOWN CLERK 1?1..l:.A$EPRINtNAMIi5A.NPAQP$l;$$WHEAr;Fl$c;OAPSHPQl.[)$E$ENT Name Address City Zip Code It) DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. What was your relationship to the deceased? ~H€ftf / 'lJ,r~(. In what capacity are you acting? f'r"t'~ ( '/Ju,.;Jf.V" If attorney, name and relationship of your client to deceased Signature of Applicant M- tJ ~---- Address of Applicant I J 7-'fo ~iZ;:j Vt ~ Name of Deceased ~IzO"1.~J 'f: First Middle Name of Father of Deceased tf4 fry First Middle Maiden Name of Mother of Deceased {Yt &j (\q~< ..f- First'" Middle Place of Death 't J l1~w TJ~ If Last IJ~ If Last /(~ /--",ifltllt Last II~Jr:~J#)(.1; Name of Hos ital or Street Address Purpose for Which Record is Required ~ ~ It! f Date of Death or Period to be Covered by Search ~ r- ~ 7'" J.cCJ Social Security Number of Deceased 6G.,({- 4 Date of Birth of Deceased UJ. J..{- Month Da 1J. l 7 J\.J Year Age at Death r-r /:)1.;; Ie "JJ Vt:;lf'i'IJ~r ~ /0 jJt( Villa e, Town or Cit TOWN CLERK Date J-J 1- 0-1- ;e,J~J ~ 4. ,,4y ;IY 2 "'"\ .COMPt,E"'E.FORDEATI-lSOCCURRfNG..AS.OF..4ANIJARY...1.1~88............... ~ Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death F>l.I:A$E...PfU N,....NAME..ANP...APPRE$$..WHeRI;.. RepORP..SHPOL. D$ESeN........... Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - TWpermit Name First Thomas Date of Death OS/29/2008 H Place of Death ~ * Towno~ Wa in er ffi Manner of Death 0 Natural Cause 0 Accident (.) IJ.I Q Age 58 years Middle Last T. Bell If Veteran of U.S. Armed Forces, War or Dates Hospital, Institution or Street Address 95 New Hackensack Road, Lot 24, Wappinger o Homicide 0 Suicide 0 Undetermined {] Pending CIrcumstances Investigation Title Medical Examiner Sex Male Medical Certifier Name Dennis J. Chute Address 387 Main Street; Poughkeepsie, NY 12601 District Number 1368 Cemetery or Crematory Pinelawn Memorial Park Register Number 15 Death Certificate Filed ~ T own o~jtOOEl Wa in er < JL] Burial Date ./ 0 Entombment Addr~~~02/2008 < DCremation Pinelawn, NY Date Place Removed and/or Held .~ 0 Removal .... and/or Address !:: Hold (J) o .~ 0 Transportation Q by Common . Carrier < 0 Disinterment U 0 Reinterment Permit Issued to Name of Funeral Home O'riell Funeral Home, Inc. Address 137-40 Brookville Boulevard, Rosedale, NY 11422 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Date Point of Shipment Destination Date Cemetery Address Date Cemetery Address Registration Number 01326 Permission is hereby granted to dispose of the human remai~s d~c~!bed ab.ove as indicated. Date Issued 05/31/2008 Registrar of Vital StatisticLhtLL-Lj '-II (IZ-L-e.l) (signature) District Number 1 :1RR Place " r .OC\/ .... I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z IJJ :e IJ.I (J) Ir o Q Z IJJ Date of Disposition Place of Disposition (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises (please pnnt) Signature Title (over) DOH-1555 (02/2004) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.>' of Death Record FEE: $10.00 per copy or No Record G.ertification. Please do not send cash or stamps. Name of Deceased C ~'\tll-l-€.. r "'T First Middle Name of Father of Deceased {-t-e., 4vll.-~J Date of Death or Period to be Covered by Search Last (jC..O/~ 06 Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Last Age at Death l'v.-n-/ r> tlvf.;TC-tL 69- "Du't"C{(:e- s. J First Middle Place of Death 11l ~ ~'1 ~I'-< Name of Hos ita I or Street Address Purpose for Which Record is. Required , Month D. Villa e, Town or Cit Count N <;( TNv'E-S.Tl Gl'tTl (v..J What was your relationship to the deceased? ~ Nf- In what capacity are you acting? l..A-V 8v.foflt.l::YVH:;...... '{ _ O..,c,cl t /~ t. (3/..1. I ivu ~/J If attorney, name and reC\ShiPiof;ur client to ::00 C,"""~"S './uJv ~ Signature of Applicant ~ lr= ~ Date ~. ",_ 4" Address of Applicant ( ~ tv1, i\dtt ~\,\ ~L-.. l4A.. ( If'J Af'f' _ f.J'( .........COMPLETe.FORDEATHs.ocCURRtNG.ASQF..JANUARV.... . - Number of copies requested with confidential cause of death JUN 0 If 2008 TOWN CLERK _ Number of copies requested without confidential cause of death f:)4eASe...f>FUNT..NAMIi5ANtlAt>[)FlE$S.VVl-lJ;Re..aJ;PQI'tt>..S!-fC>tJL.Q.$E..SJ;NT' ..... 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 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 <;; /}:t It; f' Name of Deceased V 11'1((",-1- & First Middle Name of Father of Deceased i\Jev-Jla-'^ Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Middle Last d ~ \tV, I J IUd'~'1 f2.l.t,..., Date of Birth of Deceased ~ ';;)( Month Da Age at Death First Place of Death (p( Year 1./7 Name of Hos ital or Street Address Purpose for Which Record is Required C"ttLk R~I(C ~\.Jr.Q What was your relationship to the deceased? ':f1f(- fOLI (t J)JV In what capacity are you acting? () ff1 ( I lit'\., PoL-l L t '15 ()S, ~ l: '> J If attorney, name and relations~ur client to deceased Signature of Applicant \,vv. ~\.....f~ ~1I\ d Co r'Y\l?Jtv'''Oate S:/'dd /~ ,f Address of Applicant _I ~ V"\ \ J j Ie ~~ jh.. rzl , IjJ C:. IYp , ~J'v M1 Villa e, Town or Cit WMfllVGCyL Count 'Dc! 1( 1+ COMPt.E't'EFOR.OSATFlsoccIJRRlNG.AS..OFJANlIARV..1 .1988. ~ Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death RECEIVED MAY 2 8 2008 . .' ........P4EA$EP$fNtNAMEANO..APPa1E$$..WI-IEAE.AEc:QRD;.S 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 Charles Joseph First Middle Name of Father of Deceased Charles W. First Middle Maiden Name of Mother of Deceased Rose First Middle Place of Death 171 Dorothy 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 Hendricks June 1,2008 Last Hendricks Last Social Security Number of Deceased 211-38-7091 Gerber Last Date of Birth of Deceased 1 7 1946 Month Da Year Age at Death 62 Wappinger 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 Date June 3, 2008 Address of Applicant 1028 Main Street, Fishkill, NY 12524 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 DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for CollY 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 .9eceased r.l( /l-A/'~ L-- S- First Middle Name of Father of Deceased A.?la/ First Middle Maiden Name of Mother of Deceased /f/V''/v,4 $,IIf,Kr-Ed.... First Middle Last Place of Death E?I'1~ Name of Has ital or Street Address Purpose for Which Record is Required ~/& 6/l1'/<"'..c / /1/7 Last PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search ~R-y /'/ -z:. (Jar 6~,k'~'" A"';:1 Last Social Security Number of Deceased d0"1 -0'7- Rz~S- Date of Birth of Deceased g" Month t Da /~ Year Age at Death -;9:::? c44#//Y~~.s ~~C-S Villa e. ' V07. Coun What was your relationship to the deceased? In what capacitY are you acting? rZ/ If attorney. name and relatio . of your client to deceased kEk>S rP Signature of Applicant Address of Applicant C C)",v /V Date r~~ ,.......~~~ COMPlETE FOR DeATHS OCCURRING AS OF JANUARY 11988 -4- Number of copies requested with confidential cause of death - Number of copies requested without confidential cause' of death PLEASE PRlNT NAME AND: ADDRESS WHERE RECORQSHOUlD BE SENT' . . . - . Name Address City' State Zip Code I"\I"\U ""A ^ 10/"",,1'\\ I . .. CARL S. WOLFSON STEPHEN L. GRELLER OF COUNSEL WOLFSON, GRELLER & EGITTO, P.C. ATTORNEYS AND COUNSELORS AT LAW 11 MARKET STREET POUGHKEEPSIE, NEW YORK 12601-3260 TEL. (845)454.2200 FAX (845)454-4366 PLEASE REPLY TO POUGHKEEPSIE OFFICE New York City Office 146 WEST 57TH STREET SUITE 53C NEW YORK, NY 10019 TEL. (212) 245-0491 JOSEPH A. EGlTTO KEVIN R. GRECO CHRISTOPHER P. RAGUCCI* *MEMBER NY AND CT BAR TffiS FIRM DOES NOT ACCEPT SERVICE BY FACSIMILE TRANSMISSION April 28, 2008 Vital Statistics Town of Wappinger 22 Middlebush Road Wappingers Falls, New York 12590 RECEIVED MAY 1 4 2008 Re: Estate of Mildred Sucich Date of Death: 3/26/08 TOWN CLERK Gentlemen: We are the attorneys for the Estate of Mildred Sucichwho died at her home in the Town of Wappinger on March 26th, 2008. We enclose a copy of her death certificate for your reference. Please supply us with 3 certified copies of her death certificate. We enclose our check in the sum of $30.00 to cover the cost of the certificate and a return envelope for your convenience. CSW/cp Ene. Thank you for your attention to this matter. Very truly y~s, {/r- CARL I WOLFSON ; I . U RECE'VED MAY 1 4 2008 TOWN CLERK JUH-]'jQ I IlUUUUO) o 0 Ch,",se H 0 V"lnamese MOSamoan R 0 a~" PaCIfIC Island" (specify) ~ROM :WOLFSON GRELLER EGITTO FAX NO. :8454544366 ." Ma~ 14 2008 2l~1PH HP LA5ERJET FA~ Ma~. 14 2008 01:36PM P1/1 p. 1 NI!WYOAKSTATE OEPARTMENTOF HI:ALTH ~I RcM>>ord" ~tion Application to Local Registrar for Coav of Death Record FEE: $10.00 per copy or No A9COrd Centftea1lon. PleaH do not I.nd oah or stllllTlp&. .. Nama of DecMMd #-1' L:D ~tO First Middle Name of Father of Deceased t<AO~ FiNt Middle Malden Name of Mother of Oeceaeed ~~f\ ~~M/...k First Middle Last Plaee d o.ath .).3 7 6l.O \~ E.L<.- l2-\:); Name of or Street Addreae PlJ~. for Which ".cord I. Required U c.e.. U ( D-'-.n kJ C f\-So S c.'~ oS uC..\c..H LaIlt o.t. of Death or Period to be eov....d by SelUQh ~ /2.(. io r t;() Ib\ c.1f L8st SocIal SQCUrity Number of 0eceIlnd o 8<0 - 0 I - ., /I (.. Date 01 Birth of Deeeaeed 0'- 23 1t:\15 Month Year Age at Death q3 1> UlZ-fJt_SS Coun V\lhat WM your relationship to the decH88d? ~tt,'-f ( ~ rcvO In what cap8City are you .mlng? h;Tn:~2N 'i:."1 . w atlllmoy. ..... ond _Onoh~~rli'o.od _ . ::--' Signature of AppiC$1t (: ,t......)Jr,. _ Addna of AppIieant - Number of oopkals f1KIU98ted with oonfldentlal oa.... af death _ Numb... of copt.. ~ueatCld without confidential cause of death ~l.~~(:~~)f{;. ~r..l;\""'""wrJ t{"jP{ ";' ,'" ~":~." I ,n,t'l )"3"C..L~;': I ,-,~'\~'\'\': f:~~^;;"~"'~;~J)"~ <l"'; ~!"~t,i.\.."~-:'-)".:f::i;.m:~~.sj:!f"~~ !'i'lf;rpJa{?l~'_.-~1~~1"I1t.1l~....oJI) ""~M>, ,...,.t...~'L'..J..::..J.~' .", ),:x-...., x ( . 1..).. ... ....~~\ ^' ...............-., ~OC.li .. .\t...)~... . c~.f,,_...u.", ,,~-......o;..,; ~....~,TlO,....,L...~~~m1t"&~\ti)t* Name eM:: L . s . W r/l.-JF.5 CJ tV. ( Add,.........JJ _ ~IL~:, ~ r- . city ( tkJ i.. Ii:\!.. ~r .f. So I L 2-. S D . State~.._ Zip Code (L_~() I DOH~294A (112000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe.>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased r;( A Nces.. First Middle Name of Father of Deceased A/h~.~ ~ . First Middle Maiden Name of Mother of Deceased Ail N fJ (3 Ax-teJ::. First Middle Last Place of Death E t c.J N r III u (2 M~"j (f C()IV/( /.;ivf7 Last Date of Death or Period to be Covered by Search 5 / I/O 9 ColJklt,Jy Last Social Security Number of Deceased o '6.3 - d j - g;J fa 5,-'" Month 0 X Da 0 k' \ ~ ll( Year Age at Death Date of Birth of Deceased OJ IA~ Name of Hos ital or Street Address Purpose for Which Record is Required ,-/. I r .--:\ .l}rv11 !L ;0::-c D What was your relationship to the deceased? h A' AI ~~ft i 1-101.-1 e- In what capacity are you acting? f4n'I'l,-/ /1/6ftJ I If attorney, name and relationship of your client to deceased Count DukfheS' Signature of Applicant Address of Applicant 1 " y a (" it~f2Y If/. 'ttLC.6 /S5 '7E?L?~ .$E tSe~ IJ / Date f\! v/ f /,;;J5() % , ~. CQI\IlFrl"ETEFOR [)EA...I-lS..OCCI.JRRING AS..Of= JANlJARV i.....i9aa. \! % Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death PL.EASI;P$IN-rNAME=ANPAf)PFtIS$SWHfSRISREPORi:)SHPtJl..[,)Elt:SI;NJ' Name Address City State Zip Code DOH-294A (6/2000) MAY-Uti-200B 09:32 ATT RICK COWLE B45 225 3027 P.002 IT Application to Local Registrar for Coe.y of Death Record '" NEW YORK STATE DEPARTMENT OF HEALTH Vrted Records Section I~!~":"<.t~',~~~ 1'~~'" ::::~~.j(~..,~';: ';:';j,~;,~i1::~,]~~ :.~ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Oecvased ~ First ~i J Date of Death or Period to b:'__~overed by Search ~ d", 7 c20oJ> Nam~r of 0ece7 /!;ev. z; Social Security Number of Deceased m First Middle r ~ .-" hd2 7"/ Maiden Name of Mather 01 DeceaseA -!. Oate of Birth of Oeceased Age at Death IVl A E(e- I.) Dr1:SJCJ1>r( / ,51..3 LS U~ / r ~t j Middle Last Month Dc v~ 7":::> ptaceof~A _I."~S ~ fi}Jh ~ Name of ~tlAddress Coun Purpoce for Which Record is. Required r Middle WhBt was your relationship to the deceesed? In what capacity are you ~ng? If attorney, name and relati~nship of your 0 . Signature of Applicant Address of Applicant 5 Number 01 copies requested with confidential cause of death L.....;.. Number of copies requested without confidential cause of death .,."~.. "-'~' . <. - ....... <>.,....-...,........~..;.:I;;:"..~~~ ' ~ .. >, ~.r", ...~. ; '.'. ;h.' . ~ . ~~;':-'C'-r::.~~if!.r~~ ~ RECEIVED MAY - 6 2008 Name AddraiS City ~~~~t-::t. ~~ ~ , ,State /tV OOH-294A (6/2000) cOd L20CS2C!:O.L SLtol-962(Sb-S) ~"'O NM01:l.oQi:I ~: 60 sooz- 1: - Al;jW MAY-06-200B 09:32 ATT RICK CO\l1LE B45 225 3027 P.OOi The Law Office of Rick S. CowIe 90 GleneidaAvenue, Carmel, New York 10512 Telephone (845) .225-3026 Facsimile (845) 225-3027 E-mail J:.Cowlelaw(a)comc:ast..Det FACSIMIJ...B TRANSMITI'AL SJi:..HET sI,=,lar Please deliver the following number o/pages ~ (including cover sheet) to: . ( 1l~~ ty1~ ~dUHf/4oJ~ 1'':7..0 d-flJ>- /r-?~ ~~~/JT DATE: NAME: COMPANY: FAX:IF: RE: MESSAGE: ~M~zk)~ ~ClJ/LJ{ ~~~~ ~ IU~~ d~ ;;;,.:;-;& ~. :~~:- .: > r'-" ~ -----.-- nns FACSIMILE IS INTENDED omy FOR THE USE OF TIlE IN))IVIOUAL OR ENlTIY TO WHICH IT IS ADDRESSED AND MAY CONTAIN lNJlORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND :FX.EMPT FROM DISCLOStJRE UNDER AP1'LXCA:BUl LAW. IF'IHE READD. OF nus FAC5lMILE IS NOT THE IN'I"SNDED RECIPIENT OF mE EMPLOYEE OR AGENT RESPONSIBLE FOR DE~G THE MESSAGE TO THE IN'rENDED RECIPIENT, YOU ARE HEREBY NO'W'tl::X> THAT ANY nlS..~ATION, DISTRmUTION Olt COPYING OF TInS CO"MMUNICA.nON IS TRICTLY PROHDunw. IF YOU HA VB RECEIVED THIS COMMUNICATION IN EllOR, l'LEASE NOTIFY US IMM.EDIATELY BYTELEPHON.E OR E-MAIL. AND APPROPRIATELY DISCA:R.D THIS FACSIMILE OR RE'I'URNTO SJiNl'>E.1L nM.NK YOU. . LO (J) 00 (\J o o THE LAW OFFICE OF RICK S. COWLE GLENEIDA AVENUE (ROUTE 52) CARMEL, NEW YORK 10512 ADMITTED IN NY, CT 8< WASHINGTON D.C. E-MAIL: rcowlelaw@comcast.net WEB: rcowlelaw.com 00 o -- 00 ~ '<t o o o C II) rELEPHONE (845) 225-3026 FACSIMILE (845) 225-3027 April 30, 2008 Qj - ro o E :J o E <( ~ Bevilacqua lilacqua, ex-wife of the deceased Matthew Bevilacqua., who died the Decedent's 6 year old son and requires Death Certificates to ler benefits on behalf of her son. Q) j w 0 oJ () ~ C/) (.) 1Il ~ uS u ~ 0:: (.) '+- N ii: 0 "C ..- ro It) u. Q) 0 0 0 u 0::: !E w 0 .r:. >- (.) 1Il Z iL ~ 'c u. ro .... Q) 0 0 E -J 0 E ~ e Q) () .... E .r:. <0 ro Q) u. I- ..- () ~ w r; five certified copies of the Death Certificates for Matthew 1 the amount of$50.00 for same. Id cooperation in this matter. If you have any questions, please do . , NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record Certification, Please do not send cash or stamps. Name of Deceased IY1A 1T" A......> First Mi,ddle Name of Father of Deceased bz.,J, L"ryo.Jn Last Date of Death or Period to be Covered by Search 3/17 /CJ<t Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last First Middle Last Place of Death z.o r Whcf4J<<l ~ Name of Hos ital or Street Address Purpose for Which Record is Required ~MIt1t:jL. :Gtv&5"7 Date of Birth of Deceased ( "2.3 Month Da {,s Year Age at Death 7'~ ;J'((J'~'Z(2. ~,(s Villa e, Town or Cit ~~J,~ Count What was your relationship to the deceased? I n what capacity are you acting? If attorney, name and relationship of your client to deceased ~t,u- (jt-ZL ~ t, "z.,. Signature of Applicant Address of Applicant ~h~)v ! I ..... ...}..........Y..U..COMPl..ETE.FQSDSATHSOCOORRINGAS..OFJANuARY.1U.iso................ -L Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death ...............?PUe<<$S..PS.NmNAMEANP.AQQSS$S..WHESf$.aEPO:ao..$HPQCn.$S..$EN"t......U.................... .. Name Address City State Zip Code DOH-294A (6/2000) TROOP "K" -SP WAPPINGER Bel UNIT 18 Middlebush Rd. Wappingers Falls, NY 12590 Proudly Serving Since 1917 DATE: 04/21/08 Number of Pages: (Including Cover) 1 TO: Waooineer Town Clerk FROM: Inv. Scott Hurlev Fax Number: Direct Number: Emergency Number: Email Address: (845) 298-1961 (845) 298-0952 (845) 298-0398 SHurley@troopers.state.ny.us NOTE: Re: SP Wappinger BCI Case 08-233 I am requesting the death certificate for Matthew Bevilacqua (DOB 01/23/65, DOD 03/17/08). Thank you. Thank You, Inv Scott Hurley **** NOTICE **** The information contained in this facsimile message is privilege and confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly forbidden. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the above address via the United States Postal Service. i\JEVV YOFiK :3T ATE DEF'ARTMEI'-JT OF HEALTH Vital Recol'dE Section . -----<::llII Application to Local Registrar for Co of Death Record l PLEASE COMPLETEFOHM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Ce:'tificat!on. Please do not send cash 01' stamps. PLEASEPRINTOB.TYPE Date of Death or Period to be Covered by Search '~a;ne of Jg~eaE.ed 1-1 EN~i Fir"t p Middle MUGL\ /l Pr</ t. ;;} d. ,;}oo 't Last Social Security Number of Deceased Jot)- /~ - 11'1-.5> i'-Jame of Faller of Deceased YON ATCI First Middle i-1 U C(; \ Last NANCY First Place of Death C} ~J , u l..l:... I fv1iddle Last '7 IV _ R€MSeN It Vii:. . Date of Bir'th of Deceased (j J-f ;)~ /"1;;l!{ Month Day Year W flPPI"/6tTR. 5 F;:J LL S Age at Death ?J Maiden f\anll~ of Mother of Deceased _')UT'::"#E ~ ~ Name of -Jospitai 01 St,eet AddrE~sS Purpose for Which Record is Requil'8d Village. TOvvn or City County '70 5gTTL~ €STATE. 't ~v\; "\O~ Whatwa:; y)UI relationship to the deceased') FUt\f~R~'-])' tZec.TolL In what cap:lcity are you acting? oS AMt:.- If attorney, 113m2 and relationship of your client to deceased '. ~ .' I Signe.tur," 0' Applicant ,-J(~ a, ~&A'!if Date I Ad d ,oss Of~P plioan! ~ H ". >>> A oJ .s t: W /! p;' ,~ .1" Ii' 5 FI'J LL 5 No Y q,-;j::J-c8 COMPLETE-FOR DEATHS DCCURRlNGAS OF JANUAHYJ .1988. .-1-- Nurr: ber of copies requested with confidential cause of death i ! i Name I ~------ I.Addr.2ss I City . 0 PLEASEPRINTNAlvlEANDADDRESSWHEHEHECOHDS OOL ,,\0 ___ NJIT ber of copies requested withollt confidential cause of death State APR 11- Zip Code N ClE.~t< nn~...L?q4.A <f)/?OOO\ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased C\CM-~ First Middle Name of Father of Deceased ~r\\'1 ) '''ue--n~ First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased Age at Death c.ctt'\\~i, 'f'€-- ------p~d~~~ 1) ( I ~ \9' 0'6 001 First Middle Last Month Da Year .. I ~ \ Place of Death. \/'0. n ~r) - \:.. '\1/ ________ _ -L. I [pCj,O~ =?,\ f\Le.,~ q - '-'"'\\ \ ~u- S I\J\ D ~ \~~~ Name of Hos ital or Street Address Purpose for Which Record is Required I -_.~\}.)~ Last Date of Death or Period to be Covered by Search Lf\m\o~ Social Security Number of Deceased \\\I\\~r 05S - eX '6 - 'l~9 Villa e, Town or Cit Count What was your relationship to the deceased. In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applican ........_,.,.,. .__..._-.-...,.,.._,-"". ...-----...""...--........".....---.."...--...-.--........-......._---......._--,-... ..... .COMPl.Er12..FOA..OEATffSOCCURRlNG..J.\S.OF..JANOAAV...1 198$ 3 Number of copies requested with confidential cause of death RECEIVED - Number of copies requested without confidential cause of death APR 2 5 2DOr PtieASe...PAIN,...NAMEANPAPf)ftl;$S..WHI;I3S.8I$CPflP..$HPUl..p..aE..SI$N,..... Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last I Sex Clara Miller Female Date of Death I Age If Veteran of U.S. Armed Forces, April 23, 2008 99 War or Dates ~ Place of Death Hospital, Institution or Z City, Town or Village Wappingers Falls Street Address 6202 Princess Circle w C Manner of Death [R] Natural Cause 0 Accident o Homicide o Suicide o Undetermined o Pending W (,) Circumstances Investigation W Medical Certifier Name Title C Dennis Chute MD Address 387 Main St., Poughkeepsie, NY 12601 Death Certificate Filed District Number I Register Number City, Town or Village 00 Burial Date Cemetery or Crematory o Entombment April 28, 2008 Forest Lawn Cemetery Address o Cremation 1411 Delaware Ave., Buffalo, NY 14209 Date Place Removed Z D Removal and/or Held 0 E and/or Address (J) Hold 0 Date Point of a. ~ D Transportation Shipment C by Common Destination Carrier o Disinterment Date Cemetery Address D Reinterment Date Cemetery Address Permit Issued to Timothy P. Doyle Funeral Home Inc. I Registratioo~ber Name of Funeral Home ~~rftJ'oker Ave., Poughkeepsie, NY 12603 Name of Funeral Firm Making Disposition or to Whom !::: Remains are Shipped, If Other than Above :::E Address 0:: w a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued Registrar of Vital Statistics (signature) District Number Place ~ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Place of Disposition W :::E (address) W (J) 0:: (section) (lot number) (grave number) 0 C Name of Sexton or Person in Charge of Premises Z (please print) W Signature Title (over) nnH_1 """ fn?/?nni1 \ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Decease~ if) ;J fr/( ;r IJ ~~e DFe. Date of Death or Period to be Covered by Search Last v L-~ ;{ /j /o(J,y Name of Father of Deceased Social Security Number of Deceased I vZ3 --.:20- I C;~ .J- First Middle Last Maiden Name of Mother of Deceased /1/1 L /../5 Z. First Middle Last Pla~,of Death fJ 3 oz.. :;L>~ ~r ;fYfr~ .~ / t/ .D Name of Hos ital or Street Address Purpose for Which Record is Required Date of Birth of Deceased Age at Death Y(j 7)U7C/(~~:S' all! I/cr d f-P A?, .~ Villa e, Town or Cit Count -----;//f) / {/ What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased Signature of Applicanj Address of Applicant t/Z~u-- 4//1~~ I APR 1 1 2008 TOWN CLERK Date 1/311/&8- .........-----------.-..........."........'..........-...............""'.......-.--..".-...........................---.-.....".-.................-..-...."'....--..-,--,-"""",.. COMPl..e-re FOR OSATFtSOOCURRINSASOFJANOARY1. 198$ c:::2 Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PL.l:A$Ei:.lAINmNAMJ:ANPAQQflE$$'WflSRefJSCOfJQSHPUI..[)$I;SSN$ Name Address City State Zip Code DOH-294A (6/2000) ~~~~~~~~~~~~~~~~~~~~~~ ~1 New York State Department of Heallh O"h'" N=e Kent m 1il Certificate of Marriage Registration D,,,,,,",o -- 395~ ~1 ~ LoC" n'g"'" No. J 40 ~ ~ Th; is tl! certify tllllt tile /'erS1H/S identified he/ow were HIIHTied orl tlU' dute ami ut the pluce specified as sl'l!lI'll hy m r~ t h, dilly nwsteled IlCells' am/ ce!"tifi",t e of IlIlHTiage 011 fill' 111 ill is office A . ~ ~ ~...' Groom Name Erik A. Sollenberger ~ ~ First Middle Premarnage Surname ~ WJ ~ Check box if same as premafflage surname ~ ~ New Surname (if applicable) ~ ~"J. Clubhouse Drive, Lake Carmel, New York ~ ~l Residing at ~ ~J Date of Birth Feb. 11, 1956 Place of Birth York , Pennsylvania ~ ~ Month Day Year City, Town or Village/State or Country ~ ~ Bride Name Sheila Fabian Broder m ~ First Middle Premamage Surname Malden Name (If diflerent from premarriage surname) ~ Sollenberger 0 Check box if same as premarnage surname. ~ ~ New Surname (if applicable) ~ ~ Clubhouse Drive, Lake Carmel, New York ~ ~ Residing at ~ ~ Oct. 17, 1952 Bronx, New York m~ ~ Date of Birth Place of Birth ~ Month Day Year City, Town or Village/State or Country ~ Date of Marriage Jan. 13, 1988 Place of Marnage____:__Pa tterson Jew York , NEW YORK ~ ~ Month Day Year City, Town or Village ~ I (SEAL) TOWOmC!IYCI"k~~~ ~OC~h~~;' i';,,, I ~ ~ ~ Any Alteration Invalidates This Certificate ~ ~ Iss~ed Pursuant to Section 14-a, Domestic Relations Law ~ ~i DOH no (C,eel ICo"'"'' yenl , ~ ~~~~~~~~~~~~~~~~m~~~f~~~~~~ -,. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coe.v 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 First N f ( (' Name of Father of It I ~lir~P-lY\ Middle J EL~J(C M~ide~ Name" of Mother of Dece}7'e,d,' ! ,', ".." f )jeLl! e () Ie /ckcl/'cLr- First Middle Last Place of Death -1 C)~- Nl~~~f~of-i1al o~~tr~2fdtes~ ;~ Purpose for Which Record is Required ) . t,.\' , iA I,. '1- lV'l ('.' ( , ,r....fLI c f V ,,_.i l , ! What was your relatidnship to the deceased? In what capacity are you acting? If attorney, name and relationship of your client to deceased ( esk-e Last Date of Death or Period to be Covered by Search J (J-J 110 01 ' Social Security Number of Deceased 1 0 ([ Co ~/ I (.;J ~ Date of Birth of Deceased Age at Death ( . Month.J 0, __) Day L L_- Year r)t.; ilu/clu. . County t -' iL'iJ./f/2c~'--'/ ~ l-cJtJ Villa e, Town or Cit MAR 2 200~ TO''''l'l (~l !- Hit( Signature of Applicant Address of Applicant (}.(\ J ~ [)fl{ 11- )({vy(' Date S C {Ill (\n Y ('l frr(\ CJl1 tlUtiSc!'} , 1./'-1 I (i li)/' . ..."-_....".-.-,'--,..,',.,,,.--....,.....,..',....,.'-,.................-,.......,.,..."..-_.._..,',',.......,.-.-,-.......-.'.............,',..--_..,..,.,""...-.--............---- ',..- C()MPLETE FOR OE.M-HsdCCURRING AS C.)f:.jANU.Mfv 1. 1985 J Number of copies request~d with confidential cause of death _ Number of copies requested without confidential cause of death ............PLl;ASi:...P8IN'tNAl'IIIi:At.APAf)PRE$$.WHERE$ECQRP..$l-iPUt.P..SS...$i:NJ" Address ) Ii City (~/c ICv\ ~ ( ,.~ ) (,{)/'.{ ( )/ . ( ,r l.'> r Tlv- State A..Jl Zip Code I ,~,,' J ' I C,I,{) Name '---; h r; (\ fJ.. DOH-294A (6/2000) C 612525 STATE OF NEW YORK DEPARTMENT OF HEALTH CERTIFICATION OF BIRTH DISTRICT NUMBER REGISTRATION NUMBER THIS IS TO CERTIFY that the person named on this certificate was born on the. date and at the place. shown and this record of birth was filed with the Registrar of Vital Statistics of this Registration District. 5906 591 NAME SRONA ANN LESKE SEX DATE OF BIRTH FEMALE JULY 5, 1963 PLACE OF BIRTH (COUNTY) R VILLAGE WESTCHESTER PORT CHESTER FILING DATE JULY 8, 1963 PORT CHESTER DISTRICT JULY 22, 1999 DATE DOH-2248 (12/98) . DDH'l~ol (lUrlUU;1 RESIDENCE NEW YORK STATE DEPARTMENT OFHEALTH CERTIFICATE OF DEA17H LOCAL REGISTRAR COPY MIDDLE LAST NCHS HOSPITAL 00/\ EH o 0 HOSPITAL OUTPATIENT o t OS T L iNPATIENT o NURSING HOME o PRIVATE RESIDENCE '&1.. Jl) 4G v W. DECEDENT'S RACE' GMt}; one OfmQffJ fdCes rQ,mdlcal/J what 1M oeceoenl conSJdefed mmsefl or herSeI/ 10 bf' A.::-rgj WtllltVCaucasian B 0 _'Blatk:D; Afrjca-n-A~erjcan C' 0 Asmn Indian D.-CD, Chtnes~ E 0 filiplno f 0 Jall'nese G 0 Kalean Ii 0 V"tnarnese J' '-0 Native Hawaiian K 0 Guamamall of Ghamorro M 0 Samoan NO Amencan Indian or Alaska Nahve (speclly) f 78 , f , f If AGEUNOEA1 YEAR, NAME Of HOSPITAL Of BIHTlI: . , ,," ~c NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~/:.fa . First Middle Name of F.a aJ her of Deceased ~dqYt-\ First Middle Maiden ~ame of Mother ,of peceased /1./ v,Y'C{ V, ~ First Middle Place of Death ,/. _ 3 31 c.-e~)vr 'f-h I( 0200. / Name of Hos ital or Street Address Purpose for Which Record is Required 1= !k'/n..R-v- Last Date of Death, or Period to be Covered by Search '(/9 /&o-v 7 . S:;t. f --l ~~ Last Social Security Number of Deceased 0& fr- A f.{ - ;2&;1/ Date of Birth of Deceased Age at Death Last 8 Month Da /y /130 Year '7 c:, LOc~~/' FZils Village, Town or Cit . 'l D aN(.{<J- Count ~tii: ~(j, eZl' . -f s;fO:t{ ECEIVED MAR 2 a 2008 What was your relationship to the deceased? Fiu.,,~'\.CtI ttfa.LP_ In what capacity are you acting? ~(.(f}'uel li.tLU) If attorney, name and relationship of your client to deceased f(;-t-U''1.{L{ #-tLQL TOW'" ("I FRJ,< Signature of Applicant Address of Applicant \)J,~f1.-.4. ~ %t. -<-it::;? v /0 ~ 2r ~~~( Sf. Date Fr'slJ Ct'll I'~y " (~S-;i Y ~/.>g~3 , :-:::-:<<::::<<<::<>:::-:-:::-:-:-:::-:-:-:"<:>:::::::>-:::.;.....;.::...::-: ::::::.:::.:-:-:.::_:..--:::::.::.::::.:.:::: ::.":":::::::,: ::,::: ... ..., - -- - - .... '.. COMPLE'I"SFoa..OEATI-lS..OCCORRfNG AS.. OF JANUARY 1.. 1988.<............... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death ......PCSA$E.P$tN,...NANleANP..APPfU:ss..Wl-ieJifEJifeCPJifP..Sl-lPQI..P..SE...SEN,....... . 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 FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased L-/?A- M First Mi.ddle Name of Father of Deceased (tt~ Last o;?-.-- 2- y ~O ?>' M~R ') Social Security Number of Deceased ,r' r: 0' \"0\/\'" First Middle Maiden Name of Mother of Deceased Last First Middle Place of Death ).... Z {20"-'':>0 E:. ~[?- Name of Has ital or Street Address Purpose for Which Record is Required ~TPir~ ~L( :IJvv~c;,T76-A-7)ut-J Last Date of Birth of Deceased oZ /~ Month Da '7~ Year Age at Death IAJ ~'p..? IN ~'L Village, Town or Cit V?/ bu~ff.S Count What was your relationship to the deceased? f\)Ou { ~~ Pc/U!; ~fs.i)b47~'- In what capacity are you acting? If attorney, name and relationship of your client to deceased .~ :fL u ~"<- ~ Date (A ~/7~<z5 Signature of Applicant Address of Applicant ..,,,..............,.,....., .""""",..."""."....... ,.."." ""....""",........ COMPI..ETEFOS..DeAtHs..OCCURRING..As.OF..aANUARY...1 ....1~$$ -1- Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PL.EJ.\$EPFUN,..NAMi;ANPAPPRE$S\Mt-II;Rl;RECOFtQSHOUl..paeSeNT Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coer of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased /J1IlI-7'-11 E J1/ First Middle Name or Father of Dece~d '/1#A-lv" ~. First Middle Maiden Name of Mother of Deceased ~ /Y99-rf; Last /!" J Date of Death or Period to be Covered by Search gc!//?/JCtPtI,4 . Last /// ~A! C/:/ / '/ v V'/;J r Social Security Number of Deceased o6'f' bt7 6'~f~ Pl//LIJC ~tllJ Last Date of Birth of Deceased Age at Death .4J/JAJ/tE First Middle Month Da Year Place of Death , 1"1/'//;I2:~#E #/V/T f)t7f Name of Has ital or Street Address Purpose for Which R~cord is Required /?7 -1-e. ~*! /-/7/f//6 /Pc/ Villa e, /~ What was your relationship to the deceased? In what capacity are you acting? ~ V If attorney, name and relationship of your client to deceased MAR : '1\'08 t. l.!t Tn\^,~d f'! !'::DV Signature of Applicant Address of Applicant "7 ............COMPLETE.FOR..DEATHS..OCCURRING..ASQF..JANUARM1...1988 - Number of copies requested with confidential cause of death :;;? ;:::;; Number of copies requested without confidential cause of death Pl..l;A$EPFUN,..NAMEANQADPfiS$$WI-O;$EAECPFti)$HPlll..[)$E$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 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. Nartf Deceased o.nue.J \},Y\t::e..,.n- irst Middle ",ern, Last Date of Death or Period to be Covered by Search ~b. 9. zoots Name of Father of Deceased .. I Q.~e.. \ 'i First Middle Maiden Name of Mother of Deceased ~rMeI~ l N3tkt'tMIn) First Middle Last Place of Death fiij Nam~i~r~n:~~ \b Purpose for Which Record is Required \ . ~q o-f L,~ SOCial Security Number of Deceased \j , e....~ Last 132." t..\o - <509 \ Date of Birth of Deceased -::rot\. \0. I~ Month Day Year Age at Death 6e ~il:Yt~e.e- County ~iyl!5:a What was your relationship to the deceased? ~rz::,...\ :r:::rYl!.c:..~ In what capacity are you acting? 0,,", b..no.I -+ o-+' ~ I~ If attorney, name and relationship of your client to deceased Signature of APPliC~ . Address of Applicant COMPLETE FOR DEATHS OCCURRlNGASOFJANUARY11988 l-t1 - s.c fCJl,\ SeN\c... _ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death PLEASE PRlNT NAM HERE RECORD SHOULD BE SENT Name Address 01 ""08 \- L ':- \ !.. , City TOWN ClE~~te Zip Code DOH-294A (6/2000) i,JEvV VOF,K ::TATE OE>=)ART~/1Ei\jT CJi= H'::,.6L7H \ital Record~ Section - -- Application to Local Registrar for _Coe..Y Qf Death Record - .......:::.- r- --.-- ~___________ '~LEA~~~4oiVIPLE~~~.F~R.M-AND-EiJCLQSE'FEE,' ===-__ l___FEE: $10,00 per COP!' or No Record Certific:=-eleOS" do not send cash a" "amp' 1 J ~r\jame -: Je ~eas[~d -~ /-jCUrv PLEASE PRl NT OR. TYPE Date of Death 01 Period to be Covered by Search FirE;t ~}'iddle ff1L/122?' l_ast !\jamE' of Fa'her of Deceased Fi:ptvUS FirE;t fv1iddle ---- Maiden Name of Mot/ler of Deceased HELfA frllLLI PS Last Age at Death First lV1iddle S7/JLTF:P,- Last '87 Place of Dedth ;; ilL; cL 0 H0f"cW.:V,_ /!.]) (.,<)PI'f'f/l,C'GlL , !>L'T(..f.fi::S:5 ,~~aTTie of :-1ospital or Stmet AddrE-;ss Purpose 101 Which Record IS RequlrE-;d \41+age, Town e+-8ity County -0 /u ';iTTCt: E SiAl E M J, 0 1. ~'~'~n A,; ,(, iVu8 Vvhat wa:; YJUI r(:;lationshq= to thl? deceasE-;d') ~___EU/vE-t::.tjL />/L' U TDC T()\Mi\l 01 f'=Qk, In wh3t C3p1City are you actn;J? _____ S "'?_~7-'=:______ If attcrney, flam'? and relationship Df your cli2rt to deceased ___________ I I Signatum 0' Applicant _~~~~-2+----- Da~e 3 - I,~' -.j 8 l Aodress of L\'PPllcant__~tLl:.~-+--~~~~;~!:14 .::),j ;~A, Y7 ~y.-/:,;/S yo f----- COMPLETE FOR DEATHSOccURHINGAS OF JANLJAR"I -_ ,1-988 r ;; -- ~urr ber of cupies requested with ::;onfidential caUSE: 01 deaTh - 1_ Nurr bel of copies requested without cOI'ifid0/ltlal caLlSE~ of death 1______---- ----------.-----.---- -------------PLEA.-sEfiRTNl--NArVlEMj-o-ADDR-ES":S-WHERE. RECORDf HOULD BESENT Naml2 ____________ ____________ ___ ____________ --- I City ~- ======~=:=~~--~:=-~~~-~ -_- ,. _ ~~~ Code -I nn H_ ?q,l.A I hi;:>liOO \ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Albany, N.Y. 12237-0023 Application to Local Registrar for Coey of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Rita Rose Di Palma First Middle Name of Father of Deceased Last March 15, 2008 Social Security Numbe~ d 088-28-6174 ~M~ ,~t 1~~~ Date of Birth of Deceased ,O\N \ ~Efc eath Nunzio Di Palma First Middle Maiden Name of Mother of Deceased Last Frances Di Palma Middle Last September 24, 1917 90 154 Robinson Lane Wappinger 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 relationshi Date () 3/1 ~ /!, NY 12533 Signature of Applicant Address of Applicant 895 7 CERTIFIED TRANSCRIPTS WITH CONFIDENTIAL CAUSE OF DEATH REQUESTED. 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 . .. --- -.---....-.. . y- '-", Application to'~Town Clerk for Co of Marria e Record -.' ::;.;;.E~;S.9R.tf.:;:8:g~,Ii.~cg;g..XSJi.s;s'.k;;::9.bsi;:;:;;;::;:;':~;;:,:;;:;;;;;;;::,:;;:;,;::;;:,:;:::,:,;,,;':'c.:.;;;..:::;;:;.;:;;::.:';::;;c~":c;. Fee $10.00 per copy ord issued Ihe narres of '''lclj(;L~ C bride a1d Search and Certified Copy D FeeS10.00 per copy A Certified Transcript includes all of the-items of nformalion occurring on Ihe original record of Ihe ma'rriage. A Certified Transcript may be needed where prod of parenlage and certain olher detailed informalion may be required such as: passports, veteran's benefits, COJrt proceedings, or selllement of an estate. '-.Ci.i':~::f:::j'!::::f:!:~::i!:::;!:;~::!:ii!:i\:::!:~i:i!:~~;::!:!!;::l:ffj!~f!f!~!~:::':i;~;!f:~~1iil:~f'cpf~"J.5~~E:::.c.'9:M:f)[ETE;'1?15ffM"':'~~QIFiEjC"(ijEBg:~~f!rrfi[i!;!!;ltt;~fmtr1!f:::!iiit!::c FEES: Make money order or check payable. to Tovn..of Poughkeepsie.... Please do not send cash or stcmps. There is no fee for a record to be used for eligibilily delermination for social welfare or veleran's benefits. PLEASE PRINT OR TYPE Name . (First) of Groom II r Groom's Age or Dale of Birth Residence (County) ~room 17 vie J,c )J Dale of Marriage or Period Covered by Search Place Where License Was . . r'. i .' :;/' " .Jr0"" ( '. ! -- {' l-.( I: Issued ;.-- ' ~~_ Jij . t 0,.. "it ..} (Middle) L- (State) w ,% I /1 / 4!" l 1/'6."1 '-.., .'~./". . "/" / ':...,.: (First) VerdI{ (Middle) Name of Bride Bride's Age or Dale ot Birth Residence of Bride It Bride Previously Married, Stale Name Used at Thai Time Place Where Marriage Was , .' ' J . / -. /1, . (' Performed : v v.,' :(/11 [{t. (~ rh Ire;> ft1. 'I ~p !J-ttr (County) rJ rfelt e;) (State) ;1. r- f-~'-'l( ,. . i:!;__;:ii~:;!.Ji;ii!'i!:i!i;:;!!.I:i::i:l~::~ii!;:i;:::@!~!i!ii~iir.i!!!!~!i!i!!~!!l!i!:!:i:::!:i.!;;!!i!!:!i;:::i:i;r;:::!!:i:l::!i!!!!!li:~:i:;:ii.i!::!!!:i:!:;;~:ii:;:i!i!I!!ii!;!:~i;i:!!i:ii;j:i-!~:ii~:~:;!::i:::!.i"ii!;;!i!!~!i)I!!!!I!!!i;iiiiiii~i!~!;i;!!l;~;it!Ii!~!!i!!:!i;!:il!f!~)i~!;~~t~l;!~j;!ii~t For what purpose is information reqUred? A{jJLfiC eJn/?,?- . I In wh<.lt capaclly arc you acllng'! REC8\tEO 1 , "r'I,l'I~ 'l~Q-. (....',.)", l'. ,}'_ _ " ,,~ III> rl/L.1 What is your relationship 10 person whose record is requesled? If self, state .self.- ~ L - "( /- It allorncy: Name and relallonstllp 0' your e1lclll Iu pCI :'UII:; whose marriage record is required. ':::m!::;:!i;:::::!;::!;~I;;::::iiii~!:f!:r,!!!f:!;~:!!i!::!:?\~~~i~~j~~~;!t~!~~~~;i~!~*Mt!i;;;f~]ll~ri:t~t~~~~:~*~~:::~:i~:1!;I~!~::;;'~~:;;;:*:;%~;~!11~i!j~m;~i;~!1fjl~r: ....c..... 0;110 A dress of Applicant f ~ (pLI /J ft rift; A ~ / l-{ u#. .Jtt.' ~ ('}-C:;7/ DOH-301 (3/93) .'.Co'.:.:.::- :;~i~~m~~iJii.j~liij!;~:fj~!~l~~fM~:;!:';!!~~1;!!~*;it~~:. '71/7(cY' Please print name and address where record is to be sent. (PlEASE SEE REVERSE SIDE) VS-34M .. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of/Deceased PIC nt1lld First Middle Name of Father of Deceased !Ie/I! Last Date of Death or Period to be Covered by Search J/J//DfJ Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Middle Last Place of Death I ff< A ;.; kl;AdI~ {p )) V~ Name of Hos ital or Street Address Purpose for Which Record is Required ?fJ f{{)) E Month Da Year tv 19jJjJ/;l3 f:tt s f/:; (Is Vflla e, Town or Cit NY 7)uiC'h~~ County EIVED MAR - What was your relationship to the deceased? In what capacity are you acting? IV LIS .PIJRtJJc If attorney, name and relationship of your client to deceased Signature of Applicant \+ ~Q5{1~ 7)/ 8Jk ~ Date .j /6/0 f( Address of Applicant -:ff) fY)An('hos~ 1:0 /~CJ6ilk66psiEJ Nt ........ ---_....",."",........--.-,......................-.."..-.--........",.....--..-.---.-. .OOMPl...eTe...FOA..lJe41"F1S..0CCURRING..SOFJANOAAY..1 1988 ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death f;?LEASE P$lri"tN4Me AtoJP)U)PR:E$$Wf-IE.RE: FtE.PQFtIl$HPlJl.P $I;$e.",... Name ~ ~~) -C)-I V\ s~on 0 {\ \Jf)(gO )E:.- Address~-M City State Zip Code DOH-294A (6/2000) '" II NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar 'for COe.>' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased 'john mIlls - First Middle Name of Father of Deceased 'Jub First Middle Maiden Name of Mother of Deceased /Mt First Middle Place of Death ~ N~ ~ 37 ~ Name of Hos ital or Street Address Purpose for Which Record is Required Date of Death or Period to be Covered by Search {mtrJr' Last (Y1 PH-tlCr }Il Last ! 2. - 20 - 07 Social Security Number of Deceased Date of Birth of Deceased Age at Death [{iftl ~st Month { L Da ~ ( LV t?rf1- fM,L..1 /V ( Villa e, Town or Cit l~ Year 3\ ~~ Count RECEIVED MAP 1 ' 'in ![' _ ..-r J What was your relationship to the deceased? L~ In what capacity are you acting? (vr- j ~ If attorney, name and relationship of your client to deceased Signature of Applicant ~ Address of Applicant 2 )-7 f", J'. .411-<- / {,J;yp l.ra~ 7 TOWI\~ , ;1 FRK 5~'L-08. Date / ?/r7(J .... ---.",',""'.--.-......----...........-----......'.'...".....------..,.".---...."'.--.---.....-...-----..."."..---..--.... ............COl\llPLEl'E..FOf{..OEATHSOCdURRING.As.OF...jANlJAR*...1" 1988 ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death pueAS!i5PSI,.,,..NAMEANPAOPRE$$VVFl$RI5f\ter;tlRPSHPl,.Jl...D$!i5SEN"J" Name Address City State Zip Code DOH-294A (6/2000) l 'i ?j ... .'.ii33041Ill. ..~..." 1"- .,' .,'... .... .............<', 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: $10.00 per copy or No Record Certification. Please do not send cash or stamps. ~ 3: ;Q ~ ?$ a Name of Deceased ~~ K-V~ First Middle Name of Father of Deceased JO~-E-p'" First Middle Maiden Name of Mother of Deceased ~'\e- Last 1> elM ~ Y Last First Place of Death Middle Last Date of Birth of Deceased /0 IS- /cH7 Month Da Year Age at Death 3 ~ f(re...~ CJrcJ €. tJa.pp M ?e.rs R-l /~ Villa e, Town or Cit G ~ b tJ 1-cAts S Name of Hos ital or Street Address Purpose for Which Record is Required ~ ~ 0{ fO~S' What was your relationship to the deceased? cd 4.JJy H *-( In what capacity are you acting? If attorney, name and relationship of your client to deceased Count Signature of Applicant Address of Applicant ~~ ~r{ ~~ ~Qd. ~t It; J Date ,? 1'-1 J 0 ~ YO v~ I1J.:~.er s/e jJ '1 I ~ () I . . . .-......-.----....."...."",..---......--."""-------..."..----....---..".-....".-.------..."".--........-...... .COMPL..ETE FOR OEAl'HSOCCURRINGASOF..JANUJXRY1 .U~$8... _ Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death PLEASEPRtNTNAM$ANPA.J)DRl;$$'Wt-ISRe FU$czOflP$l-fPUl...[) $E$EN-r Name Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Appl ication 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 Lisa Mae First Middle Name of Father of Deceased Ruben First Middle Maiden Name of Mother of Deceased Edna First Middle Place of Death 2 Ronsue Drive Name of Hos ital or Street Address Purpose for Which Record is Required The family requests this record for purposes pertaining to insurance and property settlement of the deceased PLEASE PRINT OR TYPE Date of Death or Period to be covered by Search Lee February 28, 2008 Last Andujar Last Social Security Number of Deceased 098-54-0638 Alston Last Date of Birth of Deceased 2 18 1959 Month Da Year Age at Death 49 Wappingers Falls 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 Applican~~ Address of Applicant Date March 2, 2008 COMPLETE FOR DEATHS OCCURING AS OF JANUARY 1 1988 25 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 Burial - Transit Permit Name Sex i Female First Middle Last Lisa Mae Lee Date of Death ---- -1 Age --- I' ~ If; Veteran of U.S. Armed Forces, February 28, 20Q?_ ___:~_ _ War or Dates ... N / A .- Place of Death Town of Wappinger Hospital, Institution or 2 Rons e Driv Z City', To"",n or Village ____ [Street Address u e _ OW Manner of Death 181 Natural Cause 0 Accident 0 Homicide 0 Suicide 0 Undetermined 0 Circumstances W ------- --..---- -- --. o Medical Certifier Name If) Title W E,lb-.. '\ _Oil'll t 7) r. lJ<\e~ S MD o ..--- ._________.._n_____. .... U.- Address 841 Route 52, Fishkill, NY 12524- - ------ -------,------ -- District Number Pending Inv_estigatiol1 -- Death Certificate Filed City, Town or Village [8] Burial Date 3/3/2008 o Entombment Address o Cremation EishkilI,l\I~._ Date Register Number Town of Wappinger Cemetery or Crematory Fishkill Rural Cemetery zD o .- en o a. en o Removal and/or Hold I Place Remo..ved. ~nd/or Held - -- -..--.- Address ____.n_ i_~.--- .__. __ --- Date o Transportation_______ by Common ,Destination Carrier , Point of I Shipment o Disinterment o Reinterment Date --rcemetery Address I Date Cemetery Address Permit Issued to Name of Funeral Home _ RobertH. Auchtno~.cIr.Xllneral Homes,Inc. Address J028tv1ain Street, Fishkill, NY 12524 Name of Funeral Firm Making Disposition or to Whom .- Remains ar~ Shippe_d, If Othe.r than Ab_QII.EL.... :E Address a:: W a. Registration Number 01529 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued Registrar of Vital Statistics (signature) District Number Place Town of Wappinger I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Place of Disposition .- Z Date of Disposition W :E W en a:: o c z W (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises Signature (please print) Title DOH-1555 (02/2004) ( over) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cashf\eeE\\lEO What was your relationship to the deceased? In what capacity are you acting? n e X .f- If attorney, name and relationship of your client to deceased Signalure of APPlican~~ .@ ~ Address of Applicant if Hc.-wk. LlAY/e: POVjh teep5te Name of Deceased AYlJre~ yVI Po-uS f- /CU1. First Middle Last Name of Father of Deceased --r11 0 fJ1 '^ <; First Middle Maiden Name of Mother of Deceased M~ry ~ct~1 First Middle Last Place of Death .' . , 'f fI- Iz I {ooPer-Ked UYlI J Name of Hos it~1 or Street Address Villa e, Town Purpose for Which Record is Required [/ J c^,- te cd c C:c u S € (j r d ec~+A clc~UQh er- o ~ 19 11 Date of Death or Period to be Covered by Search l-15-200~ Me ti1 ,"FF Last Social Security Number of Deceased 2- Month Date of Birth of Deceased /~ Da or:; 7- L/O,-76/<iS )950 Year Age at Death ;;/ DU+C~fSS Count Date 2 - z 9 -()'g-- !\JY /Z{,G/ ....--..--....,....---.------.........-----.-,---..------...---------...-.,.-".----.--...-...-......"..."",..... .. eOMPL.E1'E..FOR..OEAtHS..OCCORRINS..>>'SOF..aANOAav.1 1988 ,', L) Number of copies requested with confidential cause of death /) ~ Number of copies requested without confidential cause of death ......PCEA$IiE..PRIN,....NAME..ANOAQ[)RESS..VVl-l.ERERECORDSHOOL.OBESENt ... ... ...... . .... ... ..... --.. . ...",,-..--_. .-" -- .-...-.-...-...".-,....-........"........__......---.-.--,...".""....,.,_.... Name LJ)') I pic t u p , , Address City State Zip Code DOH-294A (6/2000) "1E f061ll p.l'lO ElICI.05E fEE p\...ep.SE COtAP\"'t;;. \ ....d casn of S\aff\\lS, 0\ e do nO se.. 01 \'10 "ecoId ce(\\licatiOn, , eas fE.~:' $"\0,00 \lef co\l'1 Na~e o~ oeceased L ~\y'(J{:rOl ~iddle ~"",eol fatnel 01 oece~ ~ \'{\ ,,-^Idd\e flfs\ 0 ceased N\aiden N3ff\.. e 01 N\O\nef~o\ e &1 S 5 0 I \.,.as\ L q)s? idd\e,' ~ I place 01 0~1b . ( dc,({ /fYC!Iv v;:j ') r(YV:,rOI ~~leet r>.ddless \'Ia(lle 01 \,\OS , , <d is "e~uiled \]\Jnlcn r,eco. pUf\lOse 10f S " .5 - ....---- r,1"N\E.NI" Of r\E.p.\,.I"r\ ~ 51 ~ ,E. OE.pp. J>lt:\N~Oc~fdS seC\IOn \,/I\a\ t'\ e ~99\\C3\\On \0 ~O~:~~-~eCO{O 10t CO 0 ~tI ~, 1(.{ \ \{ \,.as\ . d \ pe CO\lefed p~ ~~~~cn O",e 01 oeatn 01 pello 0 rt.~ 1 ~ ,,\Ill', ' ;) . d I - 08 p 01 oec~~ soda\ secUfi\'1 Nuff\ ef oate 01 Bitln 01 oeceased 5<: ?? 07 '< eaf N\on~n 03 J) ~7 () 'X \/i\\a e \ I" o\f'Jn of CI p.ge a\ oea\n S-d- ....J:M.../c. A. r' :- count WI~<e . . . \0 tne deceased'? "oUf fe\a\IOnsnl\l \]\Jna\ \f'J as , . " In 'iJnat capaciti ale ~ou act,n9 ~in 01 ~oul client to deCeased and lelatlOns r I · II a\\Olne~, na(lle 0 ~ ,tJ"e:.<. ../ I , J\. nn\iCan\ ?' Signa\Ufe 01 r"t't' '----- , J\. nn\ICan\ p.ddfess 01 r"t't' oa\e~' ,~~ Ql\ ol1.Pl1'IIS oCCUB'PIo~ ",5 Of J~U~ \ \'6 c.OtI!\ll.~f ' I cause 01 deal\> 'in con1identl3 'es le~uested 'iJI 0\ deal\> "- "u(llbel 01 coP' Ilden"at cause ~ I" d \f'Ji\nout con . C\ues\e NUff\pef 01 co\lles fe ----------- state - NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coer of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE . FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. RECEIV"- ~ of Decersed K\cl1<<re1 klernttt'\ First Middle Name of Father of Deceased ~~t'\ F: First Middle Maiden Name of Mother of Deceased f-<::,jE. ~e First Middle Last Place of Death 3\ h=~nkl,ndtlC.leA\Ie Name of Has ita I or Street Address Purpose for Which Record is Required Date of Death or Period to be Covered by Search t==eb. Zl. Zoo8 TOWN CLERK Social Security Number of Deceased oe=r - ~ ~ "t~~ Date of Birth of Deceased ~. tR, lCfsS Month Day Year Age at Death ~ ~9-=" County Q c:J' L~ ~i~ COMPLETE FOR DEATHS OCCURRING ASQFJANUARY1 1988 '+' - ~k' '$iiWv'c.ae. LW- 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 eoI!)' of Death Record PLEASE COMPLETE FORM AND ENCLOSE FEE. . FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased ~c-~~4nl$fi",e. A \ba~ Ie First Middle Name of Father of Deceased Arittu.r- First Middle Maiden Name of Mother of Deceased Li Hian -g,c::U"i First Middle Last Place of Death W N~~~!S i:tor Stre:;re'~~~~ Purpose for Which Record is Required E-'rcJ crf'Li-k Last Date of Death or Period to be Covered by Search hb. Z2, 2<=06 "-l~ Car111 Last Social Security Number of Deceased 133- ZZ - I (g35 Date of Birth of Deceased ~fo. \~ '431 , Month Day Year Age at Death -=f-=J ~ County A~\~ RECEIVED FE B I :: {DOH TOWN C1.t=:Rk What was your relationship to the deceased? -----Ft\"~ \ nr-4!.C~ In what capacity are you acting? on~\-f ~ ~,~ If attorney, name and relationship of your client to deceased Signature of APPlica~ · Address of Applicant ~ 6 t COMPLETEFOR DEATHS0CCURRlNGASQFJANUARYl 1988 -=t- 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.v 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 ft (I J (' e.tA. /Y 1 First Middle Name of Father of Deceased 1h 0 Mas First Middle Maiden Name of Mother of Deceased M c.qr y 1^'l First Middle Last Place of Death 12 J Cooper 7<oc~ UV\;+ff/ Name of Has ifal or Street Address Purpose for Which Record is Required '-PCtU~+' ;oJ1 Last Date of Death or Period to be Covered by Search 'JC-01 u e<.-r \ I~ 2008 I rI/1c (n iff Last Social Security Number of Deceased Date of Birth of Deceased Age at Death 2 Month /0 Da (Cf56 Year 6J Dvfches<; Count U dCLteJ u e5 eeJe What was your relationship to the deceased? ~ '^-U~ /1:e r In what capacity are you acting? ney-f .' .~ J If attorney, name and relationship of your client to deceased llr C;::;" . Signature of Applicant ~ ~ Address of Applicant Lf H a... fA.) k L t:Lf1 e J ? [) U~ ~ 1: ee p Sf P RECE.\\JEO FER 2 \) l TCYv'\lN GII=RK Date 2 - J q ~ og- NY /2to/ I .........""".. ...""'..............-.-..-------......---.."......,.............................."".........-----.-....--,......-......,.""""",........ cOI\IIPI..ETE FOR DEATI-lS OCCURRING AS OFJANlJA.FtV 1.1988 ~ Number of copies requested with cO~fidential cause of death L Number of copies requested without confidential cause of death ~l..lEASEPFnN,.NAMf:E..ANu..AQ[)aES$.Wt-lEaE;..REcORD..SHQUL[).BE..SENT Name W r LL~ ,'C k Up Address City State Zip Code DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for Coer of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased A"I r t.... "" First Middle Name of Father of Deceased ~ II tJ S Ii "1 Last Date of Death or Period to be Covered by Search I I $ I, c Social Security Number of Deceased First Middle Last Maiden Name of Mother of Deceased Date of Birth of Deceased 71..",...-.1 IHCGIt IR' t " ,,-, First Middle Last Month Day Year Place of Death rt, (,0 . pc r Ill, CIA i .,. ( , Wlfpp ,. AIls , ~ ; Age at Death Name of Hos ital or Street Address Purpose for Which R~cord is Required Villa e, Town or Cit .r, /:>. J.c. < County N'YS~ RECEIVED - What was your relationship to the deceased? In what capacity are you acting? NYSl If attorney, name and relationship of your client to deceased ~ r: I~ Signature of Applicant '" ~ Address of Applicant S ~ w If" &JtJ& #'A FEB 2 0 ;:i008 TOWN <<;11-8K Date t.h';''' ...---.....---."""...---."".---......--."'.."""..--."".----."'..---.-.",..---.-... ......COl\llPLSl'E FOR lJEATHS..OCCURRfNG. As. OF..JANUAQY...l.. 1.988....... - Number of copies requested with confidential cause of death - Number of copies requested without confidential cause of death PUI;A$ep$JN$NAI\IIErAN.pAt>"$e$$WHeaJ:Fti5CPRP$HPOI...P$I':$t:NT Name Address City State Zip Code DOH-294A (6/2000) . NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe>' of Death Record FEE: $10.00 per copy or No Record CertiE.et\~t);lO not send cash or stamps. fEB U 1 'lGuc Name of Deceased ate of Death or Period to be Covered by Search /1/1 to/f7~(;'.R First f) / rr1 Middle Last Name of Father of Deceased ~ -./0 h/t.J' /JR5E'r0 E.R U First Middle Last Maiden Name of Mother of Deceased. / 2//2r;6r.lh !J1?/dC.RU First Middle Last Place of Death ~f( Osbo/{IiJE !I,ll ;<d Name of Hos ita I or Street Address Purpose for Which Record is Required -L / D / 'WE"/1HtJ /l.tJ/)/V --{ot< o-fc,tf" '/0 -rR/iC /lEI< /\JI+/YJ€ 0+1 S<J '-..:.. /r; /(J - 9- eJoo Social Security Number of Deceased OJ) ~( -0-:) - 8/.;)/ Date of Birth of Deceased Age at Death Month 3 Da )9 /9 Year g / '7) bfC!h r:~i:S WAf.p/^1~RS /RIIs Villa e, Town or Cit Count Signature of Applicant Address of Applicant .8 What was your relationship to the deceased? d R Uf} h -I e R In what capacity are you acting? If attorney, name and relationship of your client to deceased Q AJe '..L ~ gate -ft:;- ! / J ..".------...., "._-.-..-....._----..-...... "",.". ..-----........-----.-......""','.--.,..---------........-.. COMPI..ErS..FOR DEATlis..oCCURRING AS.OF.JANOARY..l" 1988 - Number of copies requested with confidential cause of death ~ Number of copies requested without confidential cause of death PL.EJ\$E:prUN"tNAMi5ANPAPPAE$$WHISRI5RISP(i)RD$HOUL.nSESENT ~ttt Address -3 f) (!).5 Ne 1t.!1 City W~8crs H:J//:s Name ~ State N V Zip Code 1r:J:T 9 () DOH-294A (6/2000) (!tDmmD1tWtalt~ of :tIassarquBtttB UNITED STATES OF AMERICA Certificate of Birth FROM THE RECORDS OF BIRTHS IN THE TOWN-OF AMESBURY, MASSACHUSETTS, U. S. A. 1. Date of Birth.................. ............~~.ly27,.1.9.~5.. .. Dorothy Jean Macomber ........................................................ 2. Full Name of Child....... -.................................................... 3. Sex, and if Twin Female .. ....... .............................................. 4. Place of Birth.... . Amesbury, MA . ........... ............. ............................................... 5. Residence of Parents.. Merrimac, MA 6. Name of Father ...... VernQn .~~ M~comber ... ...,........................................ 7. Occupation of Father. ... Machinist ... .............................................. 8. Birthplace of Father...... .... Hudson, MA .. ......... .................................................... 9. Maiden Name of Mother Alma M. Arseneau ................................................... 10. Birthplace of Mother..... . T.r.ac ad.ie,. ~.~., Canad~...... .................................. ................ August 4, 1945 11. Date of Record................ .............................................. .............. .................................................................. I,............... ..... ... ... . Josephine A. Jacques " .depose and say that I hold the office of Town Clerk of the Town of Amesbury, County of Essex, and Commonwealth of Massachusetts; that the records of Births, Marriages and Deaths required by law to be kept in said Town are in my custody, and that the above is a true copy from the records of Births in said Town as certified by me. Volume. . . ~ ~.2.$ . . . . . . . 95 Page...... .1'23'...... No.................. . 29th WITNESS my hand and the seal of said Town, on the.............................................. August 90 day of................ ................... ...........19 ~ ..~~ ..... .(............ ...~: :,0. ......~ ,/ '-- L~'7. OIDn ~i. ... (/' . ('" -D'l Ii, T ""0 ~ "T' X ,-"""" '" ~..,~~'! '~:hl ~R~~ JD:21S 141 867 ,. i,/ OQB;Q7..zT.4IP ." . ~~,i. 3BOSBORIlJeHltll.."FI!I " .~f1tS'NY" 1!' ., l'I2590 i:.!;ii\ .................. Y ,tB;F .EYE$S:\8l..,~*.'~LMf:D ,'ENG: ~T~.;i:' ,'.'i'iT.. ... ~usp: lt7-~~G7c27''' "I~~~~t NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Reg istrar for Coey of Death Record , .... PLEASE.COMPI..ETE FORM AND ENotOSE FEE FEE $10,00 per copy or No Record Certification Please do not send cash or stamps I I Name of Deceased I G:eo yO \ 0- \1( e en beJJ. o~ i First ~ Middle last I Name of Fatherof Deceased . ' i/J i \::::ofloYfS 'Pe s'tnf2--tS ! FlrSI Middle Last I Mald,en Name of Mother of Decease,d. I ~Lexl Lc1 s b1 Vl-\ First Middle I Place of Death i 10 VovncCvan DnliG Name 01 Has Ital or Street Address Purpose for Which Record is ReqUIred PL.EASEPRINT OR TYPS · .. Date of Doath or Period to be Covered by Search "2-ltoJug Social Security Number of Deceased 0'10 - J"-I - q ~Ol( Last Date of Birth of Deceased 3JIZ--/W Month Day Year Age al 08c\ll' ~I W Cvppl ntft+j H"U{ J Villa e, Town or Cit lJGc-/duv Co urli' RECEIVED WI1Clt was your relationship to the deceased? __ In what capacity are you acting? .!ij."./f'Urzl1 -D/ veclvY'" II attorney, name and relationship of your client to deceased TO'NN ClEBK." , SIgnal",e ~f ApplICanl -fibL" . ((}/J// A ~ Address of Applicant 7C) 13u X A ) pP c0-eL( Date Z!IZ/u Y J( i t1lj I? S 5"~ "___ I COMPLETEFOROEATHSOCCURRING AS OFJA~UAAY 1. 1~aa I I-J,Q Number of copies ~equested with confidential caus~ of death I "'-7, Number of copies requested without confidential cause of death PLEASE.PRINT NAME.AND ADDRESS WHERER~CORO>SHOUL06E SENT Name Address Clly I I I State Zip Code DOH.294A (6/2000) LYONS & SUPPLE COUNSELORS AT LAW 92 EAST MAIN STREET P.O. BOX 46 WAPPINGERS FAUS, NY 12590-0046 (845) 297-0600 FAX (845) 297-8877 JOHN L. SUPPLE GR.EGOR.Y D. SUPPLE* PAUL B. SUPPLE * NY & CA BAR. BEACON OFFICE 5 CLIFF ST, P.O. BOX 227 BEACON, NY 12508-0227 (845) 831-2257 JAMES L LYONS, R.ETIR.ED hnWlrv 1 ~ ?OOQ , C_~.I. -P-.."'".i .~_....., _ v v..... Town Clerk Town of Wappinger 20 Middlebush Road Wappingers Falls, New York 12590 RECEIVED JAN 2 2. 2008 TOWN CLERK RE: Estate of JOSEPH L. Y ANARELLA Dear Town Clerk: Please be advised that we are attorneys for the Estate of Joseph 1. Yanarella. We are required to obtain original Death Certificate for the decedent's brother, James A. Yanarella, as we are claiming insurance proceeds on behalf of his family. Enclosed is photocopy of this Death Certificate. We hereby request two (2) originals be issued and forwarded to our office. Please state the cause of death. Enclosed is your fee for the verihed transcripts. If you have any questions, please do not hesitate to contact our office. Very truly yours, LYONS & SUPPL~ q1. /). _ ~'.. .' GDS/k~s l ><.. E . ....., ncs. \ ... . ,.,....., \) " -,-- " A Verified Transcript from the Register of Deaths Date of Death. Oc:t. 3,,19.98.... "Registered No. .. Z8, Place of Death 4.. Gq;l4.. ~.,. .lmm. .~t... v..PP..waf:'.f................. d....... ........ Name of Deceased . JAIlES..A...I"lU1Un-1~... ..... Age, ,..60. . Years, ................... ..Months, Days Sex_Ie. ..... Color or Race"..... .llhite '. ..' Single, Married, Widowed or Divorced.... . ..Harried Full Name of iit....,,~ or Wife....,Patric:1a..Sc:Qtt ..................., ... ...,...... . Date of Birtll ...Iune..4,. 1938....., Birthplace.. .Beacon.,Nev.York..... Citizen of what CounLry . ..........'. ........ .... HOWaLong} Here "" ..' ... ........ Resident ,In D" S. if foreign .,... OccupationSenio:r;.Bugioeed.na....... S. S. No. .L34,":'.Z8.~e.6}. speciaIist Father's Name . James. J.Yanare1.la....... ' Mother's Maiden Name .. B.el.enJ.iJ1g. ... ... If Veteran, N 8me of War ...., . .. . .. ..... ......, ..."......................................... C~:~j } ::~:::ate Causeu S~~=~guu"~ to unoa4 ou Time Dr. in Atte~dance 1 till Death r ., . .Oct.. . ,3... .1998... .Medical. bainer, "., ..()~~...~,. J~~~.................. ""'" .........'. ..... Medical Attendant or other Attestant .Joseph.D....loss....Jr..K.D......K.E. Place of Burial St. .Ioach:1m!....Ceaetery.,..Beacon....NY. . . Undertaker Hal vey .h:Q~"J::.l. ..ltQ\lM!;. ....... "... ................ I Hereby Solemnly Attest, That this is a true Transcript from the Public , Register of Dea.t.hs as kept in the .. ... Town. of. Wappinger. . . ... Di8~~ia&:. .'1364... .. ..... .. . .... . . . . County of DUtcheaa.... .".... .. .'. ,State of New York Dated at @O Jtidd1ebueh .1W.,....w.p.p.1Q.g~J:"',,J,,1,.s. , N. Y. the(Signe::~dr~.S::: 0 1998 , Official Title legistrarof .Vital..Statiat1c. " LYONS & SUPPLE COUNSELORS AT LAW 92 EAST MAIN STREET P.O. BOX 46 WAPPINGERS FALLS, NY 12590-0046 :L :;2SS~:::::::r.::::~{=::::i:3 V\q::::S'T'C' H, F'C::TE po {".! Y 1.Gl:; tq .l~\ fo,\ Ft:'.t 11' Town Clerk Town of Wappinger 20 Middlebush Road Wappingers Falls, NY 12590 . '1 .: i : :: :: :::; :: ", ,': :; ii: Liilh:lihf:hLhdiii!:f::ffliHhl:it: ii dHhliiHtiH TOWN OF WAPPINGER TOWN CLERK CHRIS MASTERSON SUPERVISOR CHRISTOPHER J. COlSEY TOWN CLERK'S OFFICE 20 MIDDlEBUSH ROAD WAPPINGERS FAllS, NY 12590 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL WilLIAM H. BEALE VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOlONI January 22, 2008 Lyons & Supple Counselors At Law 92 East Main Street P.O. Box 46 Wappingers Falls, NY 12590 Attn: Mr. Gregory D. Supple Re: James A. Yanarella Dear Mr. Supple: As per your request, I have attached 2 certified copies of the New York State Certificate of Death for James A. Yanarella. I have also attached a receipt in the amount of $20.00 for your check #13366. Please feel free to contact this office at 845-297-5771 should you have any further questions. Sincerely, 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 01 No Record Certilica~E:~\'IIGQnd cash or stamps. l"~ \ Name of Deceased Andrea M. First Middle Name of Father of Deceased Thomas First Middle Maiden Name of Mother of Deceased Mary First Middle Place of Death 121 Cooper Road; Unit 1 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 0 Date ath or Period to be covered by Search January 15, 2008 Paustian Last McEniff Last Social Security Number of Deceased 067-40-7018 McKay Last Date of Birth of Deceased 2 16 1956 Month Da Year Age at Death 51 Fishkill 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 \ A Signature of Applicant "lG-.. Address of Applicant (1028 Main Str V <1__ Date Janua 17,2008 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) JAN-8-2008 11:14A FROM:TOWN CLERK 'I (845)298-1478 TO: 12123732735 P.2 1pPlication to Local Registrar for Co of Death Record NEW YORK STATE DEPARTMENT OF H~LTH Vital Records Section FEE: $10.0 Please do not send cash or stamps. Name of Deceased V I Yf'<<1l{j I First Mi die Name of Fathe~ ~f Deceased ({)snV~-f I ~st i Middle Maide~~m\ t Mother of Deceased . . " ~ir'fJ/V\ ~ Middle B()la~ I Place 0; ~~~ BoJr q Name of Has ital or Street Address Purpose for Which Record is Require,d (J resm Last, R'..-vpE" ". . ,-- . -- ,---. . ' '::::'':''1;;: ": .\ ....'.,." ,. 1 Death or Period to be Covered by Search 5 \ 0 67 r ( t\i Social Security Number of Deceased -- ~~ G?; Signature 01 Applicant Address of Applicant I {~far .; ~; .. . I . . -=- Nuonber of copies lequested with C"'1fldeOfl" au.e of drtl1 2... Number of copies requested without !:onfjden ial cause of death . '.... .. .;$,;NT.'\;'; . Name City Zip Code l 0 a3~ DOH-294A (6/2000) i ~! ~ NEW YORK STATE DEPARTMENT OF HEALTH BUREAU OF VITAL RECORDS ALBANY CERTIFICATE OF BIRTH REGISTRATION This is to certify that a birth certificate has been filed for TINA MICHELLE PRESTIA Born on February 24, 1970 ,~ Carmpl, (City, Village, Town) x*~ Daughter of Vincent Prestia (name of father) Ruth Ramsey ~ (maiden name of moth~~, ~ / . {/ ~tA::- LOCAL REGISTRAR ,N. Y. ~~L~ Date FiledMarch 2, 1970 Town of Carmel, Mahopac, N. Y. ADDRESS ~ and THIS CERTIFICATE IS EVIDENCE OF AGE, PARENTAGE AND PLACE OF BIRTH AND SHOULD BE CAREFULLY PRESERVED >\sk the phys.ician or clinic to fill in the spaces below when the child is immunized. Date Physician or clinic immunized against smallpox immunized against diphtheria Immunized against tetanus : mmunized against whooping cough Immunized against poliomyelitis Jmmunized against measles ,.,.', ~'::'~~':?j \ TINA PRESTIA January 10, 2008 Chris Masterson Town of Wappinger Town Clerk's Office 20 Middlebush Road Wappingers Falls, NY 12590 Dear Mr. Masterson: I am writing to request two copies of Vincenzo Prestia's death certificate. I am his daughter and need them for my records as well as for my family as we must register his death with the country of Italy, his place of birth. He passed away on May 10, 2007. Enclosed is a check for both copies as well as a copy of my drivers license, my birth certificate to verify that he is indeed my father and the application that your office faxed to me. Thank you very much for your assistance. Respectfully yours, ~W-J Jt~ Tina Prestia ~fL[T0 ~ Jartil8 i'~ Coralio Nota Public, State of New Yorl< Registration #01 C05082777 Qualified In Queens County My Commission Exp;"s July 28,':>/ 0!4- 23-13 BROADWAY, #2R' ASTORIA, NY, 11106 PHONE: 718-721-0016, E-MAIL: tina_prestia@hotmail.com NEW YORK STATE DEPARTMENT OF HEALTH, Vital Records Section Application to Local Reg istrar for Coey of Death Record . PL.EASECOMPL.ETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Nam::3o,~c:~~~A. . . FirstV'""iv..... Middle Name of father of Deceased L' tl o ~ ~ c/;.l1lw1 , c.t' First Middle Last Maiden N," of Mother of Dece~rJ _ , Ft:? D.:JO-- Middle ~rr i tls/ Place of D.~e th L- /0..1 t7<-3 /,../.5"> T'D(l (,. . Name of Hos ital or Street Address Purpose for Which Record is Required pCEAsEPRINTORTYPE ... ~ I ,.,n Date of Death or Period to be Covered by Search ~ctUr. , et' -.J avt. / 0 tlaJf; Last /f)1c~ Count What was your relationship to the deceased? In what capacity are you acting? If attorney, name and relationship of your c~ent to Signature of Applicant Address of Applicant _ Number of copies requested without confidential cause of death PLEAse PRINTNAMEANDAoDRESS WHERE RECORDSHouU)6eSENl' ... Name Address City State Zip Code DOH-294A (6/2000) .. . Attorneys Anthony L. Pagones FrancoIs R. Cross PAGONES & CROSS, PC. ATTORNEYS AT LA\N 355 MAIN STREET, PO. BOX 550, BEACON, NEW YORK 12508 PHONE (845) 838-3400 FAX (845) 838-3412 Paralegal Jill Gada Town Clerk Town of Wappingers Falls 20 Middlebush Road Wappingers Falls, New York 12590 RE: Estate of Dennis J. Hannan Date of Death: July 28, 2001 Dear Sir/Madam: Please be advised that our office represents the Estate of Dennis J. Hannan, who died a resident of the Town of Wappingers Falls on July 28, 2001. In order to transfer property in County Clare, Ireland a certified death certificate is required. Please provide the undersigned with two (2) certified copies (yIith raised seals) of the death certificate for Dennis J. Hannan. I enclose herewith our check in the amount of $20.00. Also enclosed is a self-addressed stamped envelope for your convenience. Please contact me if you have any questions. Very truly yoursy ...~ ;':" ( FRANCOIS R. CROSS RECEIVED JAN 1 0 2008 TOWN CLERK FRC:cam Enclosures )l.tb.Lfl:;:}J- J 01 <f 3 d*fj055 'y ~ -e. eI) en "",. u ~~ . ~. ~ ~I ~ e; ~ ~ i!$ " ~~ 58 j:ll:/) I:/) ~B E8~ 1-1 ,,~ ~ClO= 1-1 \C "d ~~ I Ej .... ) ~~ !E~( ~~ i 1>-1 III ~ ".,., . o=::..c U~.., "" ~ ~:z: .. =I-I~ ~.~ ... <~ ~ :- I:/) ~ Q) 1-1 0 :Z:' ~~ ~! :z: Q) "1-1 tIC ~E-I~ ~~ c:lo ~~i t~~ ~~"d ~~~ I-Ij:lj:l .. c c i E <; t'C co z U.l m 0 'u .~ w () .g, U.l 0 '" u. .c 0 lii w " ::;; <; "" u. Z ~::;; ""u. u... or w'" ::;;"" i=~ RECORDED DISTRICT NEW YORK STATE DEPARTMENT OF HEALTH CERTIFICATE OF DEATH, L -.J ,- ~ IAII: t"1U: NUMDI:t1 T 1368 REGISTER NUMBER 21 1. NAME: FIRST Dennis MIDDLE LAST 2. SEX: MALE E91 I 3B. HOUR: J. Hannan 10:10 Am 4A. PLACE OF DEATH: HOSPITAL HOSPITAl (Checi< only one) DOA ER OUTPATlE..- 0,02 0 4C NAME OF FACILITY: (If not facility gIVe address NURSING HOME HOSP/T AL lNPATIEtI,'T O. o PRIVATE RESIDENCE Kl Y R 4D LOCALITY: (Cneel< one and s.oecify) : CITY OF VlLLAGE OF TOWN OF I 0 0 ~ Wa in er 201 Wheeler Hill Road 4F MEDICAL RECORD NO 4G WAS DECEDEN7 TRANscERR"D "ROM ANOTHER INSTITUTION? (If yes. specify institution name. city or t~. county ana state) : NO YES [ rn 0 5 DATE OF BIRTH' F UNDER 1 DAY [ 7B. I I I I IF AGE UNDER' YEAR. NAME OF HOSPITAL OF BIRTH I 7A CITY AND STATE OF BIRTH: (Country I jf not U.S.A I [ [ I Glens Falls, N.Y. 6. AGE: 1= UNDEF , YEA_ en "'" ~ MARRIED OR SEPA,r:lA TEe YEAR n,JU~ mInutes -,.:'In!'"::; [ [ I 10. HISPANIC ORIGIN? (If yes. soecity) NC YES 9. RAC::.: (aao;. wnrre. ere. 1 ,. DECEDENT'S EDUCATION (Specify only nlghesl grade completed) 'h1hi te o Elementary/Secondary {O-'21 College (1-4 or 5;.) 5+ , 4. SURVIVING SPOUSE: (If wffe. provide maiaen name) {g 13. MAR IT A" STATUS I I 15A. USUAL OCCUPATION: (Do nol enter re"red 12. S081AL SECURITY NUMBER NEVEF: MARRIED WIDOWED DIVORCED 054-16-0994 03 D. ! 158. KIND 0= B~SINESS OR INDUSTRY: Nancy Means hTri ht 15G. NAME AND LOCALITY OF COMPANY OR FIRM: :Nappin ers Central School Dist. I viappln ers Falls, N. Y . , 16F. IF CITY OR VILLAGE. IS I RESIDENCE WITHIN CITY OR I VILLAGE LIMITS? :J YES [] NO I IF NO. SPECIFY TOWN' o m: Administrator School 16A. RESIDENCE. STATE: ! 16::. LOCALITY: (CneCk one and speeffy) : :iTY O~ VILLAGE O~ TOWN OF [0 0 1O Wappinger I 16E. ZIP COD,,' : 12590 16B. COUNT" [ : Dutchess 16D. STREET AND NUMBER OF RESIDENCE New York 201 Wheeler Hill Rd., Wappingers Falls, N.Y. 17. NAME OF FATH"R' 18. MAIDEN NAME OF MOTHER: MI LAST FIRST LAST FIRST M Dennis ""' D. Hannan Anna Care 19A. NAM" OF INFORMANT: : 196 MAILING ADDRESS: (Include Zip code.' :201 hneeler Hill Rd., Wappingers Falls, N.Y.12590 I 206. 6~~~ ~s~~~~~b~REMATION. REMOVAL OR I 20C. LOCATION: (City or town ano stare: hk ' I lPoua ee Sle Rural Cremator 'Fou sie N.Y. ; 21 B. REGISTHA TION NUMBER: : 00452 Nancy M. Wright 2OA. BURIAL. CREMATION. REMOVAL OR OTHER,DISPOSITION: (Specify! Crematlon VEAi= Delehanty Funeral Home 64 E. ~~in St., Wappingers Falls, N.Y. I 228. REGISTRATION NUMBER: : 01251 25A. TO THE BEST OF MY KNOWLEDGE. DEATH OCCURRED AT TH" TIM". DATE AND PLA8E AND DUE TO THE CAUSES STAT,,:: SIGNA~ . .^, /? .. - \ ~f ~ ~. r' ~ L...~ (\A.V, 25B. TH" PHYSICIAN ATT"NDED THE DECEAS 25A. ~~ IWL ~~~gJ>ts~:i.~~I~~ T6~M~~ g~;.rH E~~0~~T~g~~ THE ~ CORONER TIME. DATE AND PLACE AND DUE TO THE CAUSES STATED. 0 ~$~~~~S MED[CAL o EXAMINER 250. DATE SIGNED: I [ I MONTH YEAR 01 ~~t~~~~E ~ 25B. PRONOUNCED DEAD I 25C. HOUR: I I DAY YEAR S r5 ~ en YEAR ~ 25F. ME/COR. PHYS LICENSE NUMBER HOMICIDE 02 03 CONFIDENTIAL 9 Livin ston Street #3S Poughkeepsie NY 126 UND8ERM[N"D P"NDING 26. WAS CASE REFFERRED TO 29A AUTOPSY" 29E IF YES. W~R~ FINDINGS USED SUICID" C[RCUMSTANC"S INV"ST[GATION CO~ MEDICALEXAMIN~R? ~YES REPJSED: TO DETERMIN~ CAUSE OF DEATH? o . 0 5 0 6 ~ 0 NO 0, y"s ~ 0 0 1 0 2 I 0 0 N2 0, YES SEE INSTRUCTION SHEET FOR COMPLETING CAUSE OF DEATH CONFIDENTIAL (ENTER ONLY ON~ CAUS~ PER LINE FOR (Ai. (BI. AND (C).) APPRDXIMATE INTERVAL BETWEE/\ ONSET AND DEATH PART I. [MMoo[ATE CAUSE: Prostate Cancer~ith Metastatic Spread to liver C) . PART [I. OTHER SIGNIFICANT CONDIT[ONS CONTRIBUT[NG TO DEATH BUT NOT RELATED TO CAUSE GIVEN IN PART 1 (Ar I 31 B LOCALITY: (CTty or town and county and state) I ml . I 31 E. INJURY AT WORK? I NO YES I 00 0, I HOUR: I 31C. DESCRIBE HOW INJURY OCCURRED: I I 32. WAS DECEDENT HOSPITALIZED IN LAST 2 MONTHS? NO YES 000, 33A. IF FEMALE, WAS DECEDENT 33B. DATE OF PREGNANT IN LAST NO YES I DELIVERY: 6 MONTHS? 00 0,: YEAR VS-60 TOWN OF WAPPINGER TOWN CLERK CHRIS MASTERSON SUPERVISOR CHRISTOPHER J. COLSEY TOWN CLERK'S OFFICE 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 (845) 297-5771 FAX: (845) 298-1478 TOWN COUNCIL WILLIAM H. BEALE VINCENT BETTINA MAUREEN McCARTHY JOSEPH P. PAOLONI January 10, 2008 Pagone & Cross, P.C. Attorneys at Law 355 Main Street P.O. Box 550 Beacon, New York 12508 Attn: Francois R. Cross Re: Dennis J. Hannan Dear Mr. Cross: As per your request, I have attached 2 certified copies of the New York State Certificate of Death for Dennis J. Hannan. I have also attached a receipt in the amount of $20.00 for your check #7055. Please feel free to contact this office at 845-297-5771 should you have any further questions. Sincerely, o n C. Ma terson wn of V\T appinger NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar . for Copy of Death Record - PLEASE COMPLETE FORM AND ENCLOSE FEE Nam~~ed uJ First Middle Name of Father of Deceased LD'j \ \ I ~yy\ First Middle Maiden Name of Mother of Deceased mr~;clV~ Middle ~~~ Place of Death. 102.- ~~-c..o.- ~ Name of Hospital or Street Addre~ Purpose for Which Record is Required V\~ \~b~+~ ~v~'--\ Sf. Last PLEASE PRINT OR TYPE Date of Death or Period to be Covered by Search \ - B 2-DOC:O z ~ ~ :Il :0: en ~ ;;l o m ~ ... ~ m ~ o .., : ~ ~ FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. \( \ a ~Yb .y t-- Last Social Security Number of Deceased \~L '30~ 5 o 11) \ Date of Birth of Deceased It) \0 ,qLjO Month Dav Year Age at Death lo-=t Wi~rf I ~ Villaqe.~ City ~N~S' County JI ^ \' What was your ~elationship to the deceasedt' "UlYl.!.J Nf~ J In what capacity are you acting? ..- If attorney. name and relationship of your client to deceased \1' . ~ Signature of APPlic~n't--- ~ \;ctJX\j k..- ~ ~~ Date I - "1' 0<3 Address of Applicant 5-':::, 2:. ~ S\:, \ \D()...IfP/j~ ~ll) , ~l1 /2 ':'J'""'l. (:) RECE\VED lAW - 9 2008 lOWN CLERK COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1. 1988 -12- Number of copies requested with confidential cause of death --22. 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 " Application to Local Registrar for COe>' of Death Record NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section PLEASE COMPLETE FORM AND ENCLOSE FEE FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Last Da;~ II ;T9i Period to be Covered by Search ~me of Deceased -vJ ILO.1,1 m /fl'\[J First Middle N~~~l'"' of Dwi~i 11M H LJ ~ ~ i -5 First Middle Last Maiden Name of Moth~ Deceased ~. IV M~ ~i ( Date of Birth of Deceased q fY) 1\( V\ . ~\ r.~ IlJ ~ J-q \9\ First \ Middle Last Month . Da Year Place of Death ' ::::J C \, r 1\ f P Y"f'~ "\ t\v G \\ 15 Social Security Number of Deceased II~ O~ b3;r; Name of Hos ital or Street Address Purpose for Which R~cord is Required rVV\'f,d'J(1 ~ L Villa e, Town or Cit County RECe'VEO "'f'l:1' ]t. ., What was your relationship to the deceased? \}Vl J t:..- In what capacity are you acting? I. \.I ( (" e.- If attorney, name and relationship of your client to deceased S' fA I' f Ignature 0 pp Icant Address of Applicant TOWN CLERK fJlp. I .CDUPLETe..f=QRllEATHsoeOURRING..AS..Of.JANlJARY...1 1988........ _ Number of copies requested with confidential cause of death 2 Number of copies requested without confidential cause of death City State ---1\lL4- Zip Code DOH-294A (6/2000) " .. G, . ','" ,"" ,~,~:,;,:"~~~ 10:735 030 882 , "1""-'liI,-"r'''\l?><~T-:-''''''~''- t!..Jt.. "Ijl if ..L:~- '1':." ,"" t I I I \ '-..:..-~- ;,-i ~..::.' NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COe)' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased Date of Death or Period to be CoverlOO~"bIER o First H~o(\.... Mi.ddle Name of Father 0 Deceased Last k..~;; Social Security Number of Deceased First Middle Maiden Name of Mother of Deceased Last Date of Birth of Deceased Age at Death First Place of Death Middle Last Month ~ 3 j66~ A" <\ Name of Hos ita I or Street Address Purpose for Which Record is Required ~"T J-)Fdt--'c.w'115e1i fi/if Village, Town or Cit J>(....;-Tc.~es S Count ~ Fv"\ FOrc€.Jy)~t'11 What was your relationship to the deceased? In what capacity are you acting? Lo.w ;;:"" fO."'"te. fYl-e. "1 T If attorney, name and relationship of your client to deceased Signature of Applicant Address of Applicant 2."VI >~}> 5~ /Vtf~'? ' ~Pj\t,f~t r )(S fh.-JJk6J"~ Date J ;)... /:2.. f?" /0'7 I2J ~/11\~l}IZ/{_:.v~ ...... ...........................<..............//...H.COMPLETEFORDEATHS.QCCURRINGASOFJANUARVilli19siH..m.)).m....../.......................................... ~ Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .\eUeA$epaINPNAMeANOAQP~e$$'W"e.~efte.OQftQ$HPQUP$E$e.N-r .. Name I.V\. VI )}~ I <L / 5~ ,yfl , iJJIe..h Address sf> U~W l'vl ~e r / t5 rn (.I -;"" fl.. cJ City tJ~p ;\1 5 (J Te., ~/ls State A/V Zip Code /J..___c)90 - , DOH-294A (6/2000) NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Application to Local Registrar for COE!.\' of Death Record FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps. Name of Deceased G ~e V ~(\ First Middle Name of Father of Deceased -\--\ ~)~\ 1\ First Middle Last Maiden Name of Mother of Deceased_ \\\CX. \ C' ';-l ~C)f'~ First ( Middle Last Place of Death 4 Lk" LD.-~€-- On', C\ c-J \)\ . Name of Hos ital or Street Address Purpose for Which Record is Required -h \A" ~ Last Date of Death or Period to be Covered by Search I Z- - \ \ - '01 ~D."h Social Security Number of Deceased a9~-Y~- 205~ Date of Birth of Deceased ';> o \C1 ~\ Month Da Year L 0Cv{JtLvc\ y''v:d----hN~~ . P. ..._Yilla e, Town or Cit - Age at Death /5 ~rtt:\'.Qj~:S +~X'-XA ~..9- --r~/v{~\.~ Count What was your relationship to the dec~? ' ^ In what capacity are you acting? d'4~),v.....-"~,-Q./tA \f-\ If attorney, name and relationship of your client to deceased ~- Signature of Applicant Address of Applicant .-.......-...."....-............".........."".," ....... .......... ...,. ......................",.."...-......"."......-.... COMPl...ETE FOR DEATHS OCCUR RlNG ASC)f: JANUARYl - Number of copies requested with confidential cause of death _ Number of copies requested without confidential cause of death .~ I PI..E.ASEP$If'ltNAMEANJ:>J.\QDFtESSWHEaI$RECPFJtl$HQVl...D$e;SEN$ Name Address City State Zip Code OH-294A (6/2000) ----