Preview
FILED: BROOME COUNTY CLERK 12/30/2021 02:05 PM INDEX NO. EFCA2021001401
NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 12/30/2021
EXHIBIT “F”
FILED: BROOME COUNTY CLERK 12/30/2021 02:05 PM INDEX NO. EFCA2021001401
NYSCEF DOC. NO. 24 RECEIVED
INDEX NO NYSCEF:
. E FCA2 02 12/30/2021
10 0 01
21
DEATI-I TRANSCRIPT
D E FILED THE CITY OF NEW YORK - ÓEPARTMENT OF HEALTH AND MENTAL HYGlENE
CERTINCATE OF DEAfH Certmcate No. 156-21-005132
DEPARTMENT OF HEALTH
AND MENTAL HYGLENE . .
. hi127, 2021 03:14 PM
ROSALIA · STERN
. . . ''°fÜ all
(First,Middle,Lost Surros)
2a.HonYorkCMy2cifypeofPlato 4D NursingHemasong TelmCaro Fadily 2d.AnyHosploa care29.Nama (IfooItacally,
ofinspitalorothertacloty dreeladdress)
'
Place '"|®'t BCd*1*
26.Borough 10|30spliallripallant 5O Hospice Fachy ·. .
01 2O Emolgefr/Depl/0vlpailers
8RIDocodents Rosideaco
a 0ath Brooklyn aO Deadonaval roother spaony go , 166 S 9th St , Dracklyh, NY 11211-6100
O DaleandUmo 30. (Month) (Day) (Year·yyyy) 0b.Eme O AM 4.8ox 5.Ditte19g1altendedbya Physician
ofDosth nim d4
27 2021 . 1130 I PM. Female 01 25 2021
January
6. CorCIlor: occurred
I certllythatdGBC1 atthetime,dateandp|gceIndic:±±(N toViebestofmyknowledge plDNOTplayanypartin couskin
lniltryorpoisorilnp
traumallo dsath,
anddidl,deam didnol occur
inanyunusualmannerandwardueonealytoNATORAl. CAUSES. SoeInstrucilenaori rsvorseofcarllifnete.
KYl WIN YU n ,,,, / / n, /
N moomaciencertiaor
(typeor IJrInt)
11249' ,, . .... .... Signature Av|hendealgg
Elesiny,lealir
St Brodklyn, NY
admo,, 74 Wallabout . e, .uce a . 2043.15 ___. Deo JAN-27-2021 . .
" *
Stalo 7b.County
ta. UsuotRos1dence Tc.,0ityofTdwn . nad mher. : •
7jl.,6troot , ApLNo, glPCodo 79. City
New York Kings Broo2yn 1 6 S.9th St , Apt 30 11211 1ElYes2O No ,
8.DaleofBirth (Month) (Day) (Year.yyyy) p.Ageatlostbirthday . . Ulyfat1War .: Undar.,f
Day,..'. 10.Social
secudlyNo.
a,Usualon ationmpo ofwaskdoneduringmostofworkingcis 11b.l0ndci bushess.6ritsfustry•.
10AInsesorANAs
sew Home Rozalla
(0ity&StateorForeign
3.ofrthplace Countrý).14.Edu lon(checkthgboxthatbestdesodb.es highestdecree orlevelol satidolcornplognid
attheikneetden|h) ....
. 1O a gr&[o'orIca no * 40 Somoc rotAl,3utnedogram.7.0,Master)degrea(o,g,MA,MS,Ning,MMMsw,MiiA .
3 Romania , cowi-i rihgrade: no omg se(soodatopovoo,(..6,. .6s) .ocrDectoraq(a , PhD,
Edo)o r
39Higlischoolfre4lrge or·0ED. aO ffadheler%
degree(e.g;,04;/d,es) ; ;=f±r;es (e.g.,MD,ODS, DVM,LtBelD)
Medlal/Partnership:Stants' brdenih- "3
15.EvarinU.S. |6. stitmo . 17. Spol/se'r/Parinnis
Sviviving Name (;M:Mt;;:;i;ardage)(FirthMiddles
Ltan
' Armed Forces? I Q Morried 2Q Demostle p·
Partnershf '5C(l Ivo,rcad
4O Marited, butsupprot,nd 6Q NeverNfarded · 6BY wed
CC 7O Othor,8pedly.--. a O Unknowr. , .... ,l . -
Norno(PilorlotiralrpairiagoFirst.Middly.1.ait)
18.FAthorreateni . • '19tMolber/Pn'rentNanie(Pdortolirstnionfogo)(FirstMiddle,Last)
Hersh Moskowitz Devorah Unknown .
son,feeimni·sNamo .. o Decederif 20c dress(SiraniaridNumber Apt.Mct '
tob.RolallonshÏp City&State ZIPCode)
Devorah Fried I . . :Daughter . 90 Ross St Apt 6l(, Brooklyn, NY 11249
'
els. MotivdofDispostilon tib. PlaceW01spealton ofcemetery.
(Name crornalary.other
place] . .-
1WSudol ito otomallon 3O Entomhmost, 4Q Chy0^omoto . .
&Stateor
210.LocafJea^!^..:pnm(City Forelpn
County) 216.Oate
of Inni dd yyyy
Monsey, NewYork 01 27 2021
Estabilthment
224.Funeral b.Address$IresQndNumber City&State ZIPCode)
Yerelm Orthodox Chapel 63 Broadway Brooklyn, NY 11249
Hinlory.™
NoConrocIlon .
VR15(Rev,
oMto)
BVT20210150590 january 27, 2021
Isatruecopyo1arecord
ThisIstoctitify thatttleforegollig onIllsin theDapsItment ofHealth
andMentalHyglens. rhsDepartmeal ofHealth
andManlal Hy0isne doesnotcertilytothetruthol
thsstatements itiadethereon,asrioinquiryasto thetactshasbetaprovidedbylaw. . GretcheriVanWye, PhD,City R Istrar
T
Donotaccept utiless
tillstranscript it bears features
thesecurity lisledontheback,floproduc,tion
15prohibited
of thistranscript
or aharallon by§3.19(b) of theNewYorkCItyHealthCode11Ihe
purposebi1heevasion orviolation oftheHealtliCode
of anyprovision or anyotherlaw.
14000005332
Preview
FILED: BROOME COUNTY CLERK 12/30/2021 02:05 PM INDEX NO. EFCA2021001401 NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 12/30/2021 EXHIBIT “F” FILED: BROOME COUNTY CLERK 12/30/2021 02:05 PM INDEX NO. EFCA2021001401 NYSCEF DOC. NO. 24 RECEIVED INDEX NO NYSCEF: . E FCA2 02 12/30/2021 10 0 01 21 DEATI-I TRANSCRIPT D E FILED THE CITY OF NEW YORK - ÓEPARTMENT OF HEALTH AND MENTAL HYGlENE CERTINCATE OF DEAfH Certmcate No. 156-21-005132 DEPARTMENT OF HEALTH AND MENTAL HYGLENE . . . hi127, 2021 03:14 PM ROSALIA · STERN . . . ''°fÜ all (First,Middle,Lost Surros) 2a.HonYorkCMy2cifypeofPlato 4D NursingHemasong TelmCaro Fadily 2d.AnyHosploa care29.Nama (IfooItacally, ofinspitalorothertacloty dreeladdress) ' Place '"|®'t BCd*1* 26.Borough 10|30spliallripallant 5O Hospice Fachy ·. . 01 2O Emolgefr/Depl/0vlpailers 8RIDocodents Rosideaco a 0ath Brooklyn aO Deadonaval roother spaony go , 166 S 9th St , Dracklyh, NY 11211-6100 O DaleandUmo 30. (Month) (Day) (Year·yyyy) 0b.Eme O AM 4.8ox 5.Ditte19g1altendedbya Physician ofDosth nim d4 27 2021 . 1130 I PM. Female 01 25 2021 January 6. CorCIlor: occurred I certllythatdGBC1 atthetime,dateandp|gceIndic:±±(N toViebestofmyknowledge plDNOTplayanypartin couskin lniltryorpoisorilnp traumallo dsath, anddidl,deam didnol occur inanyunusualmannerandwardueonealytoNATORAl. CAUSES. SoeInstrucilenaori rsvorseofcarllifnete. KYl WIN YU n ,,,, / / n, / N moomaciencertiaor (typeor IJrInt) 11249' ,, . .... .... Signature Av|hendealgg Elesiny,lealir St Brodklyn, NY admo,, 74 Wallabout . e, .uce a . 2043.15 ___. Deo JAN-27-2021 . . " * Stalo 7b.County ta. UsuotRos1dence Tc.,0ityofTdwn . nad mher. : • 7jl.,6troot , ApLNo, glPCodo 79. City New York Kings Broo2yn 1 6 S.9th St , Apt 30 11211 1ElYes2O No , 8.DaleofBirth (Month) (Day) (Year.yyyy) p.Ageatlostbirthday . . Ulyfat1War .: Undar.,f Day,..'. 10.Social secudlyNo. a,Usualon ationmpo ofwaskdoneduringmostofworkingcis 11b.l0ndci bushess.6ritsfustry•. 10AInsesorANAs sew Home Rozalla (0ity&StateorForeign 3.ofrthplace Countrý).14.Edu lon(checkthgboxthatbestdesodb.es highestdecree orlevelol satidolcornplognid attheikneetden|h) .... . 1O a gr&[o'orIca no * 40 Somoc rotAl,3utnedogram.7.0,Master)degrea(o,g,MA,MS,Ning,MMMsw,MiiA . 3 Romania , cowi-i rihgrade: no omg se(soodatopovoo,(..6,. .6s) .ocrDectoraq(a , PhD, Edo)o r 39Higlischoolfre4lrge or·0ED. aO ffadheler% degree(e.g;,04;/d,es) ; ;=f±r;es (e.g.,MD,ODS, DVM,LtBelD) Medlal/Partnership:Stants' brdenih- "3 15.EvarinU.S. |6. stitmo . 17. Spol/se'r/Parinnis Sviviving Name (;M:Mt;;:;i;ardage)(FirthMiddles Ltan ' Armed Forces? I Q Morried 2Q Demostle p· Partnershf '5C(l Ivo,rcad 4O Marited, butsupprot,nd 6Q NeverNfarded · 6BY wed CC 7O Othor,8pedly.--. a O Unknowr. , .... ,l . - Norno(PilorlotiralrpairiagoFirst.Middly.1.ait) 18.FAthorreateni . • '19tMolber/Pn'rentNanie(Pdortolirstnionfogo)(FirstMiddle,Last) Hersh Moskowitz Devorah Unknown . son,feeimni·sNamo .. o Decederif 20c dress(SiraniaridNumber Apt.Mct ' tob.RolallonshÏp City&State ZIPCode) Devorah Fried I . . :Daughter . 90 Ross St Apt 6l(, Brooklyn, NY 11249 ' els. MotivdofDispostilon tib. PlaceW01spealton ofcemetery. (Name crornalary.other place] . .- 1WSudol ito otomallon 3O Entomhmost, 4Q Chy0^omoto . . &Stateor 210.LocafJea^!^..:pnm(City Forelpn County) 216.Oate of Inni dd yyyy Monsey, NewYork 01 27 2021 Estabilthment 224.Funeral b.Address$IresQndNumber City&State ZIPCode) Yerelm Orthodox Chapel 63 Broadway Brooklyn, NY 11249 Hinlory.™ NoConrocIlon . VR15(Rev, oMto) BVT20210150590 january 27, 2021 Isatruecopyo1arecord ThisIstoctitify thatttleforegollig onIllsin theDapsItment ofHealth andMentalHyglens. rhsDepartmeal ofHealth andManlal Hy0isne doesnotcertilytothetruthol thsstatements itiadethereon,asrioinquiryasto thetactshasbetaprovidedbylaw. . GretcheriVanWye, PhD,City R Istrar T Donotaccept utiless tillstranscript it bears features thesecurity lisledontheback,floproduc,tion 15prohibited of thistranscript or aharallon by§3.19(b) of theNewYorkCItyHealthCode11Ihe purposebi1heevasion orviolation oftheHealtliCode of anyprovision or anyotherlaw. 14000005332