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Home My WebLink About0964 ~ ~~1~ ~ ~ ~ n.n ~ocK.c~sna,w~ ~ CERTIFItATE OF DEATH STA1E OF CA~IfORN1A-DEPARTYENT OF VIiBIK HEALTM E~T~ i J~ ~ ' ~ -4~t-_ r'" ~ ~ • k~ la NAYE OF DECEASED-s~~51 eurE ~b rqo~E N~rE ~ k twST rurE L DATE OF OEATH-an oar ~[uTb »011~ ~ CI~: i ~1 ~ iAPPER Februa 1 1 66 ' 0 t~ .a...a w.o...•-_ ~ • r ~ vj 3 SEX ~ COLOR OR RACE S BIRTHPLACE ~o,,,,,.,. 6 DATE OF BIRTN 7 AGE •~y* r wot~ ~~u~ r wo[~ t~ Mwas ~ ~ 1Nele i~/hite N~r- York Ma 188 6.w~s I ~~3 ~ ~ 0 NAYE AND BIRTHPLACE Of FATMER 9 YAIOE[I f/~Y9EaAN0 BIRTNPLACE OF YOiHER 10 uiR(M Of w~ui CWR~Tnr fl SOtut SECUNiTr NtMME~ LOlll i~~ -N w J ra M~H ring - Nev Jerse U.S.A. O 6-09-816 ' 12: IAST OCCUPATIOM 17 ","",~'„',.,4. U NAYE Of IASi E11KO~ING CWI~~h~ p1 fMU1 1S KINp OF 1NDUSTRII OR BUSINE55 ~ w o°'}~ y18 McClellan A.F. Base Government ~ . ~ ::'K- i s ww~p~s.sasq s[ti ~Ki w~~eoiio a~o.c~[o ~w wa.co ba NAYE Oi PRCSEI'R SpOUSE 18~ PRESENT ~t IAST OCCUPATION OF SPOUSE a u~~~„ " ~ - i d Dicie M Ho r Clerk-McClellan A.F. Base w~.~ ~ Ft pF DEC E o~ MosntK 19t STREEI ADDRESS-~avt sr~ctt w wnu ~oacas w ax~iwr vo ~or esc r o ~oa wKes. , ~cm e~nwrn. ~ • • ' ~ @1'C ' ~Kb9t ~ ' 1 de J - .St.TE@t. ~ :a..a..n ~ c~ n ~~~lc CJTY OR'T01Nq~ t; 19e COUMTr 19c cE~r ~ SOE~i?i~ 19r ~~~iOTM1aM~A~11r N r 24 r ~ ,i~ ~ ~~+l- ~ ' 20?. IAST USUAI NCE-STREET 11DORESS •c.ws*r~ 20~ ~r ws~~oc ar• v w*swt ar~ cooo~~rc ~n 21rNAME OF 1NiORMANT ~r ot.[~ nw srous[~ <y[~ON U- arraews~~~auw `d'o. `w • e ~o..r.wn• ~o~ro~ii[ ~~n O k-l ~ a~~.~r .na~~.r~ ~ ~ qTY Oq TOI~~-~ 20o COUNTII 20c 5T11TE 24 AOORE55 OF INiORYANT ° ~ ' . / Sacramento California ~ L 22c PM OR CORONER-Sr.n~i wca[t o~ mir N U. - 2L. PH~514 ~v c~.,,....... oi.... occw.co., .w~ o..~ .wo n.c s... t . ~ ~YOY[ ' ~M~ ; ~ • it~l[O ~[~dY ~MD TW~ ~ ~~t[MOfD ~M OfC(~LO ~~Or O iCS , .-~1 - ~ IT t T ' 22 C ER•' ~~'c•'•q••"•ru.~»«cwi.~o...w ..o..n o..~ .+o ••«0 22o ADDRE55 2 A SIGNED ~ ,yp~~ ~~o.. •..c c •ws s..~ao ~[ao+.ro ~ ..•~a ..~.o ~ G r.l,_~~~ ~ a...rK+ar....~o.oece•uo•s+aou+io~•~•r 2 2~~Gg lt~l ~?V@~Sacramento ~y 66 ~3. ,'^.~°.;.~„M"`,~ "'O""'~• 2~,DATE 25 NAME OF CEYETERI/ OR CRENATORII 2 E IMER- t~ME ~o uwr~o~ IICENSEMlY~EII :JI N . . om nt 2-16-1 66 East La~+n Mausoleum -J . ~ 47~4 ~ - _ . ~ 27 NAME Of FUNERAL WRECiOR ~~~"S°""""1O 28 °.',~.`i.i«~i w'~a.sN.~..A~ 29 L GISTQ~ TIM~ FEB i s isss ~ ~~y= iv" `~~C 4. J E, A11dT6M8 ~ Greiliah p a~ ~ i0 CAUSE OF OEATN [~iu aw~ wc cwst n~ ~s[ rw aw•c. ~ cd cl. ~ ourw w~s c~usco s. PPROx1MJ?TE ~ W ~l ~EDUTE CAUSE .a~ _ _ - INTERVAL •-1 A `T I~-~- ~ ca.onwus v ~ ~ ~ ? BETwEEN ~ ~ •M• Y~MICM pVETO~~~ ~V ~{/1.~J - ~ V~X~ANO W1V[ Aq[ ~O~M[ ~ ~~or~c~usc ~ATM .J v-~ VMO[~t~~MO f1~~~6M ~ • ~/~f'~~~__-~. _~(.O_ _ 4-1 _ C~V![ a~fT ~JE i~ ~C ~ \C4 ~ PMT/ A~~i./j~ ER S~.n1iKANt COND~TIONS CON Ti1iG i0 DE M!i NOf AEI~iED TO T,~NE TEYrYr4l OK CONpT10N WVEN W~ARi 1~~~ ' ~ ~ ~ ~ ~I ~t~ytss „Q ~ ~C~z~`!'7M~dlI~l~Q[2LLttil~ivt/, ~ ~ il OPERATIOl~CNEC• 32 DATE OF OPERATIOIi 33 AUTOP5II-tMfC~ OME ( .e.nro~w?- onur.v~.~ra~w?-- r.an~hwww~ r.e~s.n~ar~?- •J O.IYr4~ I i NG+firY~+~ 1 •~~M~I.fhr~NCH ~~if~Oq~ ~ c~OS~~faK1VM~w ~ rNt~ ~~i~~~~ ' ~ M wG~b~~l.~•~• i . pr~ti.~-aYO~ltr~~~• _ IV~IMNrR~W~~1•~•~• ~ . A' AtO~MC (~sMfMN~r• ~(4MfYp~T~ hMOV~[ t~uV\O~d~t• f~~~~~f~N~OM~I~ Y ~ ~ J l~. SPECIFr ACf.10ENT. SUICIpE OR MWUCWE 31~ DESCR~BE MOw v11uRr OCCURaEO ................e............«....,.. c. ~ .-i ' CC - Q - - ~.z~ f~ ~ 35?_ TiME ww ~ou*M w. ~w , ~ OF W~lAlr ° - ~ v U a..) ~ " C ~ 35~ YUUq1f OCCURRED 35c PU1CE OF ~NJURr ;;~°,e„ ;!y';;"' ~ 35o CR7 TOWN OR IOCATION cain~ sr~n : ~ :7 . ~ o . , IT ~T ~11 •~~.w.y~~ ~ FILE~ AN~ RE TY F~-a" 5T• LV~~ Rp VER?F1E0 . ~ : 36 +gT ,fAN 2y PM 38 152 o~Ta~s T , C~RK C~RCUIT COUR ~~K~64 ~ 963 , v s _ . - - s. ~ ~r~- - r: =.fi:~.