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DEATH TRANSCRIPT

   

DATE FILED THE CITY OF NEW YORK DEPARTMENT OF HEALTH AND MENTAL HYGIENE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

      
  

 

 

           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NEW YORK CITY CERTIFICATE OF DEATH Certi?cate No. 1 56.07-024.495
DEPARTMENT OF HEALTH
ND MENTAL HYGIENE 
LEGAL NAME
{First Mama} [Middle Name] {Last Name}
2a. New York City Type of Place 4 i] [sing Homer'Lor-g Term cam Facility _2d. Name at hospital or other lecitlly Ill not laptlity. street add
1 Cl Hospital Inpatient - 5 Heepce Facility ?mad L- 
5 .r 2 Emergency DepUCrutpatient El Decedent's Residence
2 r3 Death mm 3 El Dead on Arrival Other Specify
El .
2. Date and Time 3a. {Month} (Day) {Year-mitt 3b. lime AM 4. Sea . 5. Data last attended by a Physiotan
IJ ol Death - W4: dd
3; 69 .2007 ?30 0PM 5'29 r57. 
:h
*3 El. Certlliet I cerdty that death occurred at the time. date and place indicated and that to the best oi my knowledge he urnatic injury or poisoning DID NOT play any part in causing death.
and that death did not occur in any unusual manner and was due entirely to NATURAL CAUSES. See in etructlone on revered of oer'tltloate.
I 
it t; . 
9 Ext-r 3
E2. Name ot Physician Signature 
{Type or Print)
241 .. .
as ?master? in: (105% {at Adam/,4 yuy mm mm Nu. zero 75?; am go :5 a 7
Usual Residence State To. County City or Town Street and Number Apt. No. ZIP Code Tie. Inside?Crty
Limits
1355 [Jena Street 'ma? 213'?
3. Date at Birth {Month} (Day) 9. Age at last birthday Under 1 Year Under 1 Day it] I 
"3351 Months Days Hours Minutes
a May 23,1946 1 61 3 .. 5
3 tie. Usual Depupation [Type at work done during most of working lite. 11b. l?nd of business or industry 12. Aliases or AKA:
:5 "r ir 
5 DUB
13. (City State or Foreign 14. Education [Check the box that best describes the highest degree or level ol school completed at the time of death)
3 1 El em grade or less: none 4 Eli Some college credit. but no degree 7 Ci Master?s degree rag. hut MS. MEng. new. 
2 Cl 9th 12m grade: no diploma 5 Cl Assoolate degree (15.9.. M. ASI 3 CI Doctorate top. Edit} or
?152? 5' P1181130 Rica 35 High school graduate or GED Bachelor's degree tag. AB. Protessional degree tog. MD. DDS. DWI, LLB. JD:
2?6 15. Ever in US. Armed Foroes? 15. Marital Status at Time of Death Su nrivinq Spouse's Name {It wite, name prior to ?rst marriage} {First Middle. LastMarried 3 CI Married. but separated SEIWIdowed
f: 2 El Divorced t? Never married 6 Unknown 
18. Father's Name {FireL Middle, Last} . 19. Mother?s Maiden Name (Prior to ?rst marriage} (First. Middle. Last]
I r.
Hemecio Luge Isabel Sanchez .
20a. Inlormant's Name Bob. Relationship to Decadent 201:. Address tStroet and Number Apt. No. kitty Slap Code)
?2 eseice Torres Daughter 1355 __Decatur Street 6" 
.
a 1g. Method of Disposition 2th. Place at Disposition (Name at cemetery. cremalory. other place}
Burial 2 El Cremation 3 CI Enlombmertt 4 City Cemetery 
Linden H111 Methodist Cemetery
5 '3 Other Speciiy -
21c. London at Dispositim [City a State or Foreign County} are. Dale oI dd 
Disposition
Ridgewood ,Nettrr York .- June 15 I 2007
22a. Funeral Establishment 22b. Address [Street and Number City a State ZIP Code)
R. G.Drtiz Funeral Home Inc 201 Bavmeyer Street .Brooklyn,New York

 

 

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This is to certify that the loregoing is a true copy at a record on tile in the Department oi Health and Mental Hygiene. The Department at
Health and Mental Hygiene does not certify to the truth of the statements made thereon. as no inquiry as to the facts has been provided by law.

 

Steven P. Schwartz. City Fl strar
e?tureelli' ed on the heel-t. Reproduction or alteration oi this transcript is prohibited
Health Code if the ?15 '5 slorl 0f V'Dl?ll?n 0' any provision of the Health Code or any other law.

. DOCUMENTND. .V5724B7

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Do not accept this transori t_

by ?3.21 ot the New Yorlt
DATE