19. Rosa Conti
1State of Connecticut Department of Health Bureau of Vital Statistics Certified, Death Certificate of Rosa Fornino.
The certified document is dated June 08, 2004.".
"1. Full name of deceased...Rosa Fornino
2. Primar cause of death*...cancer of right eyebrow
3. Duration...unreadable
4. Secondary or contributory....acute unreadable of heart
5. Duration...3 days
Remarks......(none)
I certify that I attended the decesed in her last illness, and that the cause of death was as above stated.
Signature...John unreadable, MD
Dated...Apr 25, 1925
Address...280 Ann St.
Undertaker's Certificate
PERSONAL AND STATISTICAL
1. Full name of deceased Rosa Fornino
2. Place of death--Town...Hartford, CT No. 73 Congress St. Ward....(blank)
3. Number of families in house...2
4. Residence at time of death(town)...Hartford...(State or Country)...Connecticut
5. Occupation...None
6. Condition (state whether single, maried, divorced or widowed)...Widow
7. If wife or widow, give name of husband...Antonio Fornino
8. Date of death--year...1925...month...April....day...24
9. Date of birth--year...1839...month...(blank)....day...(blank)
10. Age in years...86...months...days...(blank)....days...(blank)
11. Sex....Female
12. Color...White
13. Birthplace--Town...Sassano...State or Country...Italy
14. Father's name in full...Francesco Conti
15. Farther's birthplace--Town...Sassano...State or Country...Italy
16. Mother's maiden name...Giustine....
17. Mother's birthplace--Town...Sassano...State or Country...Italy
18. Place of burial...Bloomfield, Conn....Cemetery...Mt St. Benedict
19. Name of informant...Mrs. Antonio Novello...Address...73 Congress St.
20. Was body embalmed Yes If so, name of embalmer...Felix Sagarino...License No. 792
Signature of Undertaker..(signed)...Address...190 Front St.
If death was due to a Communicable Disease, the undertaker's certificate and affidavit on back of this certificate must be signed and executed by a Licensed Embalmer
*See other side
1Connie Haydt, Marriage Certificate of Joseph & Mary Metziere.