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State File Number: 053634
Recorded District: 3202
Register Number: 683
New York State
Department of Health
Bureau of Vital Records
Certificate of Death
DECEASED:
1. Name: Walter N. Webert
2. Sex: Male
3A. Date of Death: 7-11-71
3B. Hour of Death: 5:20 A.M.
4. Race: white
5. Age: 69
6A. Veteran of U.S. Armed Forces: No
6B. If yes, specify war, or dates of service:
7A. County: Oneida
7B. Town:
7C. City or Village: Utica
7D. Length of stay in Town, City or Village: 29 years
7E. Hospital or other institution (If neither, give street & no.): Faxton Hospital
8. State of Birth: N.Y.
9. Decedent Born: 11-23-01
10. Citizen of what country: U.S.A.
11. Marital Status: Divorced
12: Surviving spouse (if wife, maiden name):
13A. Usual occupation (even if retired): Carpenter
13B. Kind of business or industry: Generalized
13C. Social Security No.
RESIDENCE:
14A. State: N.Y.
14B. County: Oneida
14C. Town:
14D. City or Village: Utica
14E. Within the corporate limits?: Yes
14F. Street and Number: 616 Varick Street
PARENTS:
15A. Father's Name: Anthony Webert
15B. Mother's Maiden Name: Eva Biggers
16A. Informant's Name: Mrs. Charles Hand
16B. Mailing Address: (include zip code): 642 Varick Street, Utica, N.Y. 13502
MEDICAL CERTIFICATION
Part I
Death Was Caused By
17. Immediate Cause
(A) Obstructive Pulmonary Emphysema
Approximate Interval between onset & death: 5 years
Part II
Other significant conditions: Conditions contributing to death but not related to cause given in Part I (A): Cor. Pulmonale
18A. Autopsy?: No
[parts 18B. through 19G. not completed]
TO BE COMPLETED BY CERTIFYING PHYSICIAN ONLY
20. Part 1
A. To the best of my knowledge, death occurred at the time, date and place and due to the causes stated
Signature: Charles R. Markason, M.D. 7-12-71
B. The physician attended the deceased
from: 10-25-66 to: 7-12-71
C. Last seen alive: 7-10-71
21. Name and address of certifier (Physician, coroner, medical examiner, coroner's physician, medical director): Charles R. Markason, M.D. 1424 Genesee St., Utica, N.Y.
BURIAL:
22A. Burial 7-14-71
22B. Place of burial, cremation or removal: St. Joseph Cemetery
22C. Location (City or Town, State): Yorkville, N.Y.
23A. Name and address of funeral home: Ryczek Funeral Home, 604 Cottage Pl., Utica, N.Y. 13602
23B. Registration No.: 02147
24A. Name of Funeral Director: Edmund J. Ryczek
24B. Signature of funeral director: Edmund J. Ryczek
24C. Registration No. 04891
25A. Signature of Registrar: M. B. Monsay
25B. Date filed: 7-12-71
26A. Burial or removal permit issued by: M. B. Monsay
26B. 7-12-71 |
