New York State Department of Health
Report of Death

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1: Place of Death:
D.o.A. Potsdam Hospital, Potsdam
2: Usual Residence of Deceased:
South Colton, N.Y.
3: Name of Deceased:
Alexander Ernest Stone
4: Date of Death:
May 20, 1963
5: Sex
Male
6: Color or Race:
White
7: Single, Married, Widowed, or Divorced:
Married
8:If Married, Widowed, or Divorced,
Name of Husband (or) Wife:

Catherine Hebert
9: Date of Birth:
May, 3, 1904
10: Age:
59 years and 17 days
11: Birthplace:
St. Anicet, Quebec
12Citizen of what Country:
United States
13a: Usual Occupation:
Lumberjack
13b: Industry or Business:
 
14: Father's Name:
Wallace Derouchie
15: Mother's Maiden Name:
Celina Brunet
16: If ever in U.S. Armed Forces:
No.
18: Informant:
Mrs. Leland Lashomb
24: Buried at:
St. Agnes Cemetery, St. Agnes, P.Q. - May 24, 1963

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