ALAN JAY REVITS; Date of Death: 7/7/2003; M; Date of Birth: 9/16/1951; AGE: 52; SSN: 144-42-0547; PLACE OF DEATH: Hospital, Inpatient: Riverview Medical Center, Red Bank Borough, Monmouth County; RESIDENCE: NJ, Monmouth County, Shrewsbury, 109 Samara Drive, INSIDE CITY LIMITS? YES; ZIP CODE: 07702; BIRTHPLACE: Montreal, Canada; DECEDENT EVER A MEMBER IN U.S. ARMED FORCES? NO; Surviving Spouse (Maiden Name) Olivia Brook; USUAL OCCUPATION: Assistant Manager, Harmony Bowl, Middletown, NJ, Entertainment Industry; RACE: White; OF HISPANIC ORIGIN? No.; DECEDENT'S EDUCATION: 14 Yrs.; NAME OF FATHER: Murray Revits; Maiden Name of Mother: Lee Camp; NAME OF INFORMANT: Olivia Revits, Wife; NAME OF CREMATORY: Rosedale-Rosehill Cem. Assoc., Linden, NJ; John E. Day Funeral Home, 85 Riverside Avenue, Red Bank, NJ; Signature of Funeral Director: Michl Cutil, License # 4305; Signature of Registrar: Sharon A. Ruddy; DATE RECEIVED: 7/9/03; Immediate Cause (Final disease or condition resulting in death). Sequentially list conditions, if any, leading to immediate cause. Enter UNDERLYING CAUSE (Disease that initiated events resulting in death) LAST: a. SEPSIS 2nd E. Coli, 1 week, b. ACUTE RENAL FAILURE, c. GI BLEED 2nd GASTRIC VARICES, d. CIRRHOSIS LAEMENECIS; Other Significant Conditions: Ascites, Encephalopathy. Signed: John Paul Swidryk, M.D., 7/8/2003
