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T ~ ~ s e~_ nwTS so~ oR M~u.TM CERTIFICATE OF DEATH :~'~53~'j
~~a~s a ¦UR[AU OF YITAL fTATltTid FL08IDA srwts ~t.~ Na ~
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ord •Aen BIRT NO. R~iIiTRAR•• NO.
p r o p e ~ 1~ 1. KAC[ K~[ATM COO[ NO. 2. YlYAt ~fIKMC[ (~I~..~ Mw~/ Iw~/. )l:ww:atw~: R~.i/ww W~ ~iiMiw.)
e:ecuttd ~ a STATE b.00UMTtl
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i n p~r- A. CIT1/. T01/N.OR LOCATqII r. a n~?cc os oum~ t. CITr. 70YM.OR LOCATIOM r. K SIOENCE
¦anent INSIOE CRY UMIT51 Tar OIl .S rin S INS10E CITY UMITSf
r i i , Ta Ot1 S rin ~S ~ O p p ~ ~s
f. NAME OF ~~/.~e t~ w.Nr.t. rr.~ war w~ra.) ~ sr~er soo~ss
IqSMTAL Olt *
11ST1T1T10N DOA Ta S 169 Ho ive W
3. MAM[ N Fn,~ ~rrr~ Lot 1. DATE u..n nn r~..
Of
I` c~`
«s?~~ EDiG1ARD H. FISHER 0E1TM November 13 967
S. SE% 6_ COLOII OR IIACE 7. MAIIRED NEYER MARRIED OA1E MRTM 9. A6E (Iw ~tp~ i uNOER / rE/M uMOEa N HK.
' ~ 24, 1903 r
64 ~ R~`" y~-
r ~ i c. Male Cau. ,,,,,~p ~ Feb.
p 1~ 101 ~ IOa. usu~ oCCWATqN (Ci~e tin/ yr~rt Ist 1~. KpIDOF MtSINE550111MDU5T~Y 11. N1tTNrLACE ($~fe w/sr~f/R eN~~(r~) 12. CIi1gN OF l1~NT OOUiIrRY7
• 1 t A p~ fwiy .we N~va.th~ nk. eoe~ iJ rdirtQ
e~nenL Pharmacist Dru Catonsville Ma land U.S.A.
blaet let ~j, FATXEII'S NAME 1/• MOTIIER'S MAIOEN IY1ME
or
t~p~~rit~~ Thomas Fisher Ma Gardner
16. SOCULL SECUR~ir Uo. D. 1N ~ S1S1MTYw[ .4Mrsa
14-18-2662 Mrs. Emona M, Fisher 169 Holl Dr. W. Ta n S rin s Florida
P~~. r•1 twwi ~r w~n~ [~e. ~.tr «u osrar ye.liar p. c.l. (e)...t ~~).1 INTEIIV0.l ~ETNEEN
d i r~ e t o r ~A11T OEnT1 ww5 GUSED ~l/e ONSET AND DfATN
IMMEpAiE CAIISE Corcna Throntibosis Acute
•ust tll•
tA• e~~-
t i f i e a t• Cp1if~Na. i/ ~a/. DUE TO (8)
•ith tA• ~ •
1 o e • 1
r e~ 1 s t r a r r~- py'E TO (t)
.ithlo 9i t/~M nsle luf.
~ ~ART II. OTI[ll SKI/i1CAllf G10110171016 CONiNMIf~IC 70 DEAfN R11 IIOf IIEUlfO 70 71E IE~YMI 06fASE C~OI~IiqN 61YEJ1 W IART 1(~) . wA5 AUTO/SY
hou~s af-• f, /ERFORME01
te~ d~~tA S ~ 1fE5? Iq~
or eetor• t ~y. pE5C11~E Mpy~ NIJUpT OtCU4REO_ (ElUn s~rr ~/iwj~t?/ 1~ Ptl~ /M PYl ll ~/@ts /f.I
¦at1n~ aa~ ~ Rp~IOENT SUICIOE NOMKIOE
dl~poat- ? ? ?
tion of TIME Of Hwr M~wt?. Dq. Yso
Dod~. nuuRr
p p. s.
W
~ 20/. IKJUIIY OaUI1RED 20r. ?IACE OF INJURII (s. i~ d~wt N~t. mI. CIT1/. 70YN. OR ICCATION OOUNTY STATE
wNK.c ~T ~ Nor rn~ac ~ J'a~. N~•~~. «uer. MK ety.. ete.)
r1011K AT 1NORK
21. g t d~wa~d Irom ~ . to ~ ~nd l~at sa~ hx'~ai(ii(Ir~ ~ 7/ t 4/
DNfh oceurnd ~t ' a~ on fM d~N ~t~t~d ~bw~; ~nd fo tM 6ut d u~~ kno~Ndh. lrom th~ uuw ~t~t~d.
A 11 1 t~fs ~~~T11~ (pryrn ~r f4k) ?m. AODItE55 ?Il. DATE SIGMEO
•r• to D•
~,.P~.c. ~ J. 0. Norton, M. D. , Medical Examiner Dunedin, Florida 11/13/67
atev~att. 23~. ~JIIYL.CREMAi1011. 2~ DATE Zk. NAMEOfCEMETENYORCREMAT011r 23/. LOCATIONIC~(/.lNVf.Mhlplf/) ($dt1
IIEra?K (31MA1 1 .
val ov. 14 1967 I,orraine Park Cemete Baltimore Ha land
a. ~ e i s t~. ruNC s s~o~Ci
`th F~~1 Home a. wrE ~cca w wrx ~s. ~aariu~Y s~w? -
~••.~~ss E. E. Padgett~ Tarpon Springs, Fla. November 14, 196 &nid F. 4andish, giatrar ~
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