I received this from the Norwich Town Hall. It is stamped, "Connecticut State Department of Health, Bureau of Vital Statistics - Hartford, Connecticut, U.S.A.
1. PLACE OF DEATH:
(a) State of Connecticut (b) County: New London (c) Town: Preston (d) Length of stay in town: ______________
(e) Name of Hospital or Institution: Norwich State Hosp.
2. USUAL RESIDENCE OF DECEASED:
(a) State: CONN (b) County: Windham (c) Town: Brooklyn
(d) City or Borough ____________ (e) Street Number _________
3. NAME OF DECEASED: Alice E. Slater
4. SOCIAL SECURITY NUMBER: _______________________
5. SEX: Female
6. RACE: White
7. SINGLE, WIDOWED, MARRIED, DIVORCED
8. IF MARRIED, WIDOWED OR DIVORCED, GIVE NAME OF WIFE OR HUSBAND: William A. Slater
9. DATE OF DEATH: August 1, 1951
10. DATE OF BIRTH: 1-4-88
/ AGE: 63 years, 6 months, 18 days
11. BIRTHPLACE: Killingly, CONN
12. USUAL OCCUPATION: Housekeeper
13. WAS DECEASED A VETERAN? No
14. FATHER'S NAME: Wm. A. Keach
15. FATHER'S BIRTHPLACE: Scituate, R.I.
16. MOTHER'S MAIDEN NAME: Fannie B. Smith
17. MOTHER'S BIRTHPLACE: Killingly, CONN
18. INFORMANTS NAME: Hospital Records Preston CONN
19. BURIAL, CREMATION OR REMOVAL Date: Aug. 2, 1951
Cemetery or crematory: Westfield Cemetery
Place: Danielson, CONN
20. NAME OF EMBALMER IF BODY WAS EMBALMED: W.E. Tillinghast - License number: 908
21:SIGNATURE:
22. CAUSE OF DEATH:
(a) DISEASE OR CONDITION DIRECTLY LEADING TO DEATH:
(looks like) generalized Arteriosilerosis
senile arterios clerotic kidneys
22. OTHER SIGNIFICANT CONDITIONS: (looks like) cholelethiasis
27. SIGNATURE OF PHYSICAN: Hannah Pierson
Address: Norw. State Hosp. Date: 8-2-1951