2011
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section. Genealogy Unit
P.O. Box 2602
Albany, New York 12220-2602
General Information and Application
For Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE _ $22.00 includes search and uncertilied copy or notification of no record.
2. Original records of births' and marriages for the entire state begi1 wiIh 1881, deaths begi1 wI:h 1880, EXCEPT for records filed in
Albany, Buffalo and Yonkers prior to 1914. AppflC8lions for these cIies should be made directly to the local office.
3. The New York State Department .of Health does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Adninistrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical
research.
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
Date of Marriage
Place of Marriage
and/or Ucense
Date of Marriage
Place of Marriage
and/or Ucense
Name at Birth
Date of Birth
Place of Birth
Father's Name
Mother's Maiden Name
Name of Bride
Name of Groom
~~~ ~~~ €lM~r~
~l I - f \ II y(\q
Date of Death Age at Death 7 S-.., Date of Death ~ Age at Death '7:5
Place of Death \('l~~~!\ \ Place of Death ",J{\-f'f\}'t~n.\ ~ Il~
Names of Parents Names of Parents ,-,riA X ))(~\. 1',/\
Name of Spouse Name of Spouse ~\' 1\J16D1 S-r ~ ~~
For what purpose is inlonnation required? Cl, cf'-L; Ln~
What is your relationship to person whose record is requested? - ;; - - ~ ,- ~ ~ d Ai AJ
In what capacity are you acting? ~ ~
SIGNATUREOFAPPUCANT ci'-tJ~-~ ~J. ~DATE ,/"" III
ADDRESS
Send record to: (please print)
If requesting birth and marriage records, please sign the following
statement
To the best of my knowledge, the on(5) named in the application
are deceaSed. .-
City
DOH-1562 (06/2003)
S~e
Zip Code
(over)
Name
Address
..
General Information and Application
For Genealogical Services
tEY/YORK STATE DEPARTMENT OF HEALTH
VitII Records Sedion. GeneIIogy UIit
P.O. Box 2.602
AJIMrf. New YOItl: 12220-2602
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL puRPOSES.
1. FEE _ $22.00 idIdI&....... ___:Ld capJ ar r.~ uf lID......
2. ()rigiI8 nards at births.... ...... far.. .......... .1881, deIIhs begin will 1880, EXCEPT bl8COfds fled it
,..",. BuIIIo 8IId Y..... prior to 1914. ~ tar.... ciIiIB IhauId be ... cIrecIIJ to llelocllolD.
3. The New York State o.-b.MIIll.of Hedh does not have N.- York Cly MCDnk except tor births oc:curring in Queens and
Richmond counties far.. y&IIS18811nugh 1..,.
4. Please read the MiniM" Rule SunInBy on the...... side of....... which specil8T J8ID ..1IbIe tor getlellogic8J
research.
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth. death OR marriage.
Date of Maniage
Place of UIIriage
aJWJIor LicenSe
i /,'1. "J: M be -r
Name at DeaIh ~ I i I qY'Y\ ' I ,(1 l r ..J (\
Date of Death ~: D-./1957 Aga at Death ~~
Place of Death Hu Vll\~ \J V\c r N~
, I...........
"'---of \" J;. .!. I~J
nw..... PanlnIa WI' .
'VJ /' \ ~--~ I
Name of Spouse i 1'\ " ~((.?C ! bQu)
/.. \'
For what purpose is infonnation requiied? \.:?-"p(\e'ri IG~ I (J~'
What is your relationShip to person whose record is requested? lVi' p c. Q;
In what capacity are you acting?
SIGNATUREOFAPPUCANT (J~/ (), )~n d8...... DATE Av'~ :,.',';'-, /~)\ \
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ADDRESS . () II vO ,:-QfllJE'(\, kvO \ IV'f 12'5"<g ~ e. \ ~ l) - ,) ~'t - j r'i '1 )
,
" requesting birth and maniage records. please sign the foRowing
14IateIIeIt:
. To the belt of my .... the person(s) named in the application
118 deu tied.
Name at Bidh
DaleofBidh
Place of Bilth
F8IheI's Name
UotheI's Maiden Name
Name of Bride
Name of GIOOIA
NIIne at Birth
Dale of 8idh
PIece of Birth
[R1~~~~'W~lO)
Falheis Name
MoIheI"s Uaiden
NIIne aI Bride
MIme of GIootn
TOWN CLERK
Dale of Meniage
PIece allIIIIiage
....or LicenBe
Name at DeaIh
Dale of Death
PIece of Death
..... of PII8IIIs
MIme of SpouIe
Age at Death
Send I8COId to: (pI8II8 priM)
r\ , t "1., ,
Name l ~Q{b; f\'. ka/'t: /1""\
AddresS YfQ - T~vd i ~~(('&O{\
City - ~~~o 1 \ Slate N '(
Zip Code i"2 S K'S SIGNATURE Of APPOOANT
DOH-1562 (06/2003)
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IJRIV}4:R LICENSE
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1'MllI NY 1~
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" 1923, Mr. Mahar wa.th,. lion uf :
t Wllllam J. aAd Irene 'fubbY :\18" ,
. hart He w.. educated In stornl" ..
t vllte ..hoola and WI' Ilrlduatt'd Ii
1 from the PawUnl Illlh Ichool<<
~ in t IMO and from Northwt'ltt'rn (
t unlverlity. BOlton. in I lJ4U. lit' I
. had been alsoctat..d ",tUh the'
t IBM plant .ince August. 1949. I
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Local Registrar
for Co of Death Record
::::~::::;::;:~::::::::::::::::
..............,...
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FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps.
Name ?f.D4h~d~ C
YFfr~ Middle
Name 1f~t?i1 of Deceased I J r1
~sr' tAr Middle TdClVl Itk
Maiden~ ~1 other of DeC~'hd11
lir:tfll Middle Last
Place of Death Lj, bk\ ri
Name of Hos ita! or Street ~r~~s
Purpose for Which Record is Required
Dale 01 110eriod i be ~6q Search
What was your relationship to the deceased?
In what capacity are you acting?
If attorney, name and relationship of Y
Signature of Applicant
Address of Applicant
Name
Address
City
State
DOH-294A (6/2000)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Local Registrar
for Coey of Death Record
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FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps.
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NFUTle of Deceased . Date of Death or Period to be Covered by Search
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First Middle Last
Name of Father of Deceased Social Security Number of Deceased
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First Middle Last
Maiden Name of Mother of Deceased Date of Birth of Deceased
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First Middle IN La.st Month Os Year
Place of Death 1) ,- d d ~ \ \. a (L..
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Name of Hos ital or Street Address Viii e, Town or Ci U
Purpose for Which Record is Required
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Age at Death
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What was your relationship to the deceased? d. ~ <.Q V\ de. V'\ t
1:-: what capacity are you acting? ~I y ci e: cJ2-.V\ d eV\t
If attorney, name and relationship of your client to deceased ~/ A
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Signature of Applicant .:.. /\AL . ~ d~'
Address of Applicant i.\ \ \ t:::..1. M 5 we::) t '" e..\ ~
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~ Number of copies requested wiih confid~ntial cause of death .
_ Number of copies requested without confidential cause of death
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City '^' e s\ ~,'e\c\ State l't , ::J . Zip Code 01090
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
Albany, New York 12220-2602
General Information and Application
For Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes search and uncerfified copy or notification of no record.
2. Original records of births'and marriages for the entire state begin with 1881, deaths begin with 1880, EXCEPT for records filed in
Albany, Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical
research.
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, de . e.
Name at Birth mlf7TRttP 11/ IJ R JI)
Date of Birth lj /c,! /,/'
Place of Birth IA./It: P P / 11/( Pl.! j.--nLtS lilt
Father's Name u-ptftV D& Lt5JIE {?fl/;l 0 (
6"M(!!,G"'?
Mother'sMaidenName ~~y o.AR/:)fI~~jl+
MAR 25 2011
OWN OF WAPPINGER
Name of Bride
Name of Groom
Names of Parents
Name of Spouse
For what purpose is information required? fR$j ( '1 /JJcJt.6t1fPD ~ trT~ ' lIv' ill
What is your relationship to person whose record is requested? ~ Ol'iI otC J~ 4-fl11+-1{ Y L"::}b-Le,?, (;14 J
In what capacity are you acting? 1J~/ ~~ ~A'lt~~ J 5foJ(j,(/J..L\ Iit( .
SIGNATURE OF APPUCANT ~ te~n?' DATE "J'~ -1 S; 10.(/
ADDRESS
Send reCOrd' lj>I.... ~n11
Name ,(J / fl eLo /~ fll..~
Address q J1 !pI{ U f r
City f ~dr State~ Zip Code / () q (~
DOH-1562 (06/2003) (~L.(1))7J.\-13~~ cell
If requesting birth and marriage records, please sign the following
statement.
To the best of my knowledge, the person(s) named in the application
are deceased.
(over)
"'-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
Albany, New York 12220-2602
General Information and Application
For Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
,. FEE. $22.00 includes search and uncertified copy or notificalion of no record.
2. Origina! records of births and marriages for the entire state begin with 1881, deaths begin wiIh 1880, EXCEPT for records filed in
Albany, Buffalo and Yonkers prior to 1914. Applications for these cities should be made directly to the IocaJ office.
3. The New York State Department .of Health does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for geneafogical
research.
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
Name at Birth 'W' LLI A IY\ PAftKEC? ~
Date of Birth rG 6 S J I ~O J...
Place of Birth W A P P.
Father's Name C H f\ R L~.s W ~ 5Lt; Y \-I t\. \G;f.(
Age at Death
Father's Name
Mother's Maiden Name A~ '" A tv\. ? A R KE. R.
Mother's Maiden Name
Name of Bride
Name of Groom
Date of Marriage
Place of Marriage
and/or Ucense
Name at Death
Date of Death
FEB 1 7A9~OJtlDeath
TOWN OF WAPPINGER
TOWN CLERK
Place of Death
Names of Parents
Name of Spouse
Name of Spouse
For what purpose is information required? G t:. ~ Eo 0 ~ 0 G "-f '
What is your relationship to person whose record is requested? Go ~ p.. ~ P 5A"U G \-\ 'TE. R
In what capacity are you acting?
SIGNATURE OF APPUCANT
ADDRESS '7.:> O.
Send record to: (please print)
Name LI ~ OA, r B\..> ~'< A
Address Po Bo'X 3C-3
City G Lt:.,J \4 A I'Y\ State ~ Y Zip Code f?- S '- 7 SI RE
DOH-1562 (06/2003) ~ GL L. '1 \ ~ - '- 0 ~ ~ \ \ 0 <..:.
DATE C:Z/l7/;to (I
, .
~ :'1. I 2.$ 2-
If requesting birth and marriage records, please sign the following
statement:
To the be t of my knowledge, the person(s) named in the application
are dece d.
(over)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
Albany, New Y ort 12220-2602
General Information and Application
For Genealogical Services
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes I8II'Ch and uncerlled copy or notiIcIIion of no I'ICOI'CI.
2. 0rlgNJ records of biths"and maniageI for the enIi8 sbd8 begin '-'1881, deaths begin wIh 1880, EXCEPT for records led in
AlJany, Buffalo and Yonkers prior to 1914. AppIicIIions for Ihese ciIie6 should be made directly to the JocaI oftice.
3. The New York State Department of HeaIIh does not have New York City records except for births occurring in Queens and
Richmond counties for the years 1881 through 1897.
4. Please read the Administrative Rule Summary on the reverse aile of this sheet which speciIies years avaIabIe for genealogical
research.
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
Name at Birth r ' \nA 1LC {)
Date of Birth ~ 1'- i \ Li04-
Place of Birth lAl~/~t( r~~
Father's Name b I ipC) "l)p ~(' n
Mother's Maiden Name IDo.ilOYl ied 4- Orhilito
Father's Name
Mother's Maiden Name
Y"t't5'eS-L
If requesting birth and marriage records, please sign the following
statement:
To the but of my knowledge, the person(s) named in the application
are
City
State ) \\
(over)
DOH-1562 (
~ {J ~lOtb .
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Reconis Section, Genealogy Urit
P.O. Box 26al
Albany, New York 12220-26al
VITAL RECORDS COPIES CANNOT BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 incbIes 88lRh and UIICIffied copy or naIiIcaIion of 110 1'ICDI'd.
2. 0tigitaI records of biths" and marriages tor lie enIire stili begin wiIh 1881, dedts begin wIh 1880, EXCEPT far records led in
Many, 8uffaIo Ind Yonkers prior to 1914. AppIcaIions tor... ciIiI8 should be .... directly to the Ioc:aI office.
3. The New York State Deparbnenfof HeaIlh does not have New York City records except for births occurring in Queens and
Richmond counties for the years 18811hrough 1897.
4. Please read the Administrative Rule Summary on the reverse side of Ihis sheet which specifies years avdable for genealogical
research.
General Information and Application
For Genealogical Services
To insure a complete search, provide as much information as possible.
Please complete for type of record requested, birth, death OR marriage.
Name at Birth E tJlttA\~ Jf'Js,~ ~rr/rc,1'\
Date of Birth .2..~"" / ~ 11
P1aceofBirth/Japf'/~J-.s h//o6
Father's Name];&"ei..J~ Vdrn1.t?/1
Mother's Maiden Name Kd1~~~ (tnU"f E//f2n)
For what purpose is information required? r-./)~~//"1f'l
What is your relationship to person whose record is requested? d~/kr -//} -law
In what capacity are you acting?
SIGNATURE OF APPUCANT .~d-A../ ~~
ADDRESS
Send record to: (please print)
Name ;:;1!.~rA .~/tJ~t..Eb
Name of Bride
Name of Groom
Date of Marriage
Place of Marriage
and/or Ucenae
Name at Death
Date of Death
Age at Death
Place of Death
Names of Parents
Name of Spouse
Father's Name
Age at Death
Name of Spouse
DAT~x..I /20:20//
City
DOH-1562 (06/2003)
./~;{n.di~~
~'7W~~~ ~~ftAU
d2~ ~L.L~~ /f't:"'ad:- tdp.pp~_~,Jy /..2.5'70
Address .tJ~t> 1> ~f
State .x-
Zip Code
If requesting birth and marriage records, please sign the following
statement:
To the belt of my knowledge, the person(s) named in the application
are deceased.
k~
SIGNATURE OF APPUCANT
(over)