| CONNECTICUT STATE DEPARTMENT OF HEALTH CERTIFICATE OF DEATH | |
| NAME OF DECEASED: | Mary Nackid |
| PLACE OF DEATH: | St. Mary's Hospital Waterbury, New Haven County |
| USUAL RESIDENCE: | 184 Meriden Rd. Waterbury, CT |
| SEX: | Female |
| RACE: | White |
| MARITAL STATUS: | Widowed |
| SPOUSE'S NAME: | Said Nackid |
| DATE OF BIRTH: | November 18, 1892 |
| BIRTHPLACE: | Lebanon |
| DATE OF DEATH: | January 23, 1963 |
| AGE: | 70 Years |
| USUAL OCCUPATION: | Housewife |
| FATHER'S NAME: | Michael Mowad |
| FATHER'S BIRTHPLACE: | Lebanon |
| MOTHER'S MAIDEN NAME: | Unknown |
| MOTHER'S BIRTHPLACE: | Lebanon |
| INFORMANT: | Anthony Nackid |
| CAUSE OF DEATH: | Pneumonia |
| INTERVAL FROM ONSET: | 4-5 Days |
| DUE TO: | Intestinal Obstruction |
| INTERVAL FROM ONSET: | 2 Weeks |
| WAS AUTOPSY PERFORMED?: | No |
| CERTIFICATION: | I hereby certify that I attended the deceased from December 21, 1962 to January 23, 1963, that I last saw the deceased alive on January 22, 1963 and that death is said to have occurred on January 23, 1963 at 6:00 A.M. |
| PHYSICIAN: | Paul Sirop, M.D. 38 Central Ave. |
| PLACE OF BURIAL: | Calvary Cemetery Waterbury, CT |
| DATE OF BURIAL: | January 25, 1963 |
| NAME OF EMBALMER: | Thomas Flanagan |
| FUNERAL HOME: | Mulville Funeral Home Waterbury, CT. |
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