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. • ~ ~ • ! 1 ~ . ' , ~ : - - • ~ ~ . , _ ~ _ - - . _ ~ 133312 _ . • NORTH CAROLINA sTA?E 00ARD OIr HEALTH ~ Buauv o~ v~rwi. STwT~K+c~ ~ _ S . CERTIFICATE~ OF DEATH 2~ 't • ~2~3 ~ ` _ ~ ~ oE/l • RMNtralN~ O4L NI. CNtlMab N ~ • : ~ L MOYE (U L ItEi OEN E1 OF EOs _ : « t~s.sY pl 1~ 1~It~, le t MuU ~ . ~ ila r~b : ~ N~, 7'~ t~r~~;p~oc w~ ..rw itueuL) O t•) cnr w M.. z . ~ ~ ys~l ~t Msdt~tM~ ' - .r .w r i.,riw . : w.at.u.. ' tn sw.e RF.a '1'L/ ~ • trra..oa..rayy t.) ts ~w..r n.w..s. 1~ .~.r.a u.~at i•: i~.....~.. ~ a.~.~ ~q It bny~ Mn. ~w Mq t~ Ui.A.t ~ ~ ~ ` ~ ~ w. ric~ • ? '?~a G ~ - ~ i(~) i~slalEnwihr ~ MEDICAL CERTIFISATION ~ ~ ~3 .w•u M'- ~7 ~ R~yK/f Ms~ I• ~(a) SINM~ rtM~r~4. Qab ~f qaf~ ~r? 1 at Y Y NS~IMh~. 2~NtfM tfe~~ ~ I ~;~L~ tyY`tb~/i ~u ~"f~ ~ 7 ~ J ' we d ~n~ad ~e ~tt~ ~ . ~ , tuat ~ we ~ , ~ t ~ ~ ~ ~.Jtd...in. u.n.. r..ra. . - ~ l~~Mla ~f Ma OrtatM~ , i j • • M ~M M Mdt~M - ~t~. das asd 7~st) - ~ ; ~~~u{i/~ YMn 11w 0 If bw tlu~ ~ WI • ~ ~ ! s` . ~ ~ Oa t~ t!~'~'~ ~ . i a~++w lCyv. ar~, x l&aa or fordss soustq) . , i ' ? Y~M MnMtIM ON 1~ - • ~ : ~ - - ~+++~f N M~w . NysRlu ~ ~ ~ , ow~«.~. ~ :r = s~~ • • t~oa. re•s••w•un~. i.w.~.c a~.m~ o.a~w u» " ~.w a .ides ~ ~ . ; ~ . . G t.~in•t1::. ~ ...W .benld ~ ' ^ • Y N ` ~ • • ~ " ~~M~/cYy. ~ ! i . ~ t~ Il rat ~w M sd~rul ~at~a. fq M tM t~pwt~~: ! . ~ at~n• sid~ ~r M~lNM t~H~r) 1 ~ ~ ) pab H Neat~ , . ~ N) 1Nwn rN ' i ~ ; : J~ w...r .°jb o.u. .s...~ (q ON bJal «sM ~i~rt MM~ a~~..w°~'.+°i~.... ~.s`:~i.ww . , E : . ~ t ~,;r~ Na« t . ; - . . (4~s 4n ~t N~•) . . w? r,.,ra ~ w~u. a .«tit" _ { , - ~,~r0,,,, - . - ~ t•) ~i.....t • ' . . i • ~ ~~~N . ~af ~ ~ 2~, tlNa _ - _ 1f,p, , . . ~\`=L~ = ' / ~ . . ~ ~ ~ t i' ' 3 . M - - I osrtity tbet this is a tarves ,ptwtocopy ot the origi~l rsoord liled in . . 4oltsiet ~ ths O=tioe o! iFital Ststistios~ N. C. Ste?te Bo,ar~l o! Health. ~ ~ . 03 ~ ~y~ • ; P~?gss D~ste ies~ds~ . 1 3tate ltegisLrar. , - - . . . . .