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HomeMy WebLinkAbout0738 1~3691 . ~ ~ . ~ - - ~ MARYUWD STATE DEPARTMENT Of HEAL~I! DIYISION Of YITAt RECORDS„ 301 W. MtESTON STREET, lALflMORE. MARr1AN0 21201 ~ ~ CERTIFICATE Of DEATH - : ~ l. DE(FASE4#IAME ~inl I~iM lel l~a OAIE OF DFA1N !k NOUt i i x o~; Orp «M~) L• TA O.~r Yw M' c~ U SUt l RKE S~ DAIE OF ? A6E (w •3 ~~~+~u~e s~ee ~ w ~ ~ ~C ~ ~ /3 ~ ~ ' ~ /~~tL- /T ~ o ~ M= a~nruc~ ts~r. n~ anm~ a wrw caMnrrr j~ ~Rwnn~np cou~n a outw . ° S : ` ~ .1~ ~ rwoow~u p aro~ao p /h o ~ r' • o.. ` r,~ a. ~a un a~ a n~ ~i. wu~a xo~rtKa ramuno~p ~w M~ it.. usiww acur~noM ( er .at ~~e uiau~ ~ua • c., ~ ~tnN oiMa~) IwiM ~e~t d.~«kiM ih....~ H,.1ir.1) a~ousmr ' ii7 ¢ ~ T ~Qt/16 T N B.C ~ rt?r ~ a Ib USt1Al RELOfN(E rMlrn McMSd iw4. i insMlrAo~ R~sidMU b~low 13c C11Y OR T01NM u+ ~t m ur~s} 13~. AMD 11111DER ~ ~ y ~ ) STATE~ 1~. (OlM(IY 1b~ /3 I~ST ~T' 1{ i~T1KRS irsl la1 li MOilH'S M~IDfM MAI~ R~sl W ta. f v c~~r__ O •ri ti0 c~ ~ i~o wAT OE(EASEG EYER N US. ARMED FdR(ES~ If? 50(IQ SECIRIIt N0. Il. rfORM~MI Aiiiw s; ~ x 3 r.s.w,«~know) F r+••• ~ _ - ~li.C.D~I•d!p C s ? , L: ? It fAYSE OF OEA1M (E~er odp w a~ pr i» br M/ (c ' ~ r~ ~ ~ tARi 1. DEArH wAS~ ~ ~ ~ `s ~ p OYE iQ Ot AS A 016FjOl~IQ Oi _ . u) ~ a + _ "'iiai~:~rAicA„w (b) i ~l.t ? ~ 1, eu-N iw~rlMt~ io~i~ (~j. ~ ~ w:.. nu. ~ ouE ro, aR ~s ~ co~auouE a ~ J ~ / (ti '--1 ~ ~ ~ ` ~ , ~ i.- ! ~ ` . ;~`n t f t~ s~~ caa?~s coKrew?rnc ro o n~ ~ur No? e~~?~ ro n~ ~ o~ acaai~ c~va~ w? t- - • ~ ~ ' ~ j c o ~ er~ lLt.•i i ~Gtf~r • ~ . ~r,' oFOVUn ~~caionaMFatrmNaior~t~noNw~se~ ioo. wtam 1os nt~ Fiwou~.s taaaf~c w tut~rrw W i, ~ : ~ i , ; ~ ~ ~ Of OfAiN? - ~ ~ C10~~. . . - .s 1 a . , tlk iWE OF ~ tlc NOIN Mll~ OUI~RED (EnM aMir~ d i~jiry w M 1 a M t. Ww It) C: :c 1'' otc ~ difseQ~~uw . HOUt AlY~l Yar6 Dq Y~or ~ 1 4 ~ I /i ~ • V ~ ~ 7:I ~a R. ZM. ~E a~Y CMlIQ 1~~ lIC 2~~. ~~AT1~1 SYM~ w~.~. ~ M ~~Nw ~OtM1fy w'~"~~~ 2te-f , p n;~ i,o~dy or ~a.a n» a«wua~n . is . fo ,~91~. ~no~ ~i~ ~we) bst . : i~s o H~ ao 1,i v 3!~3pi~? t•;dRw aliw on T' ~ 19 , and ot in (m1f) ~~I ~nio~ d~ath acua~d on tM dub and Iw~x ond rom sM ~ V` E-. ~auc.~rar~d'obov., i~l (rw) (d~e) die not N.w Ih. body otter deoth. ~ ~ . y~ • rt ih 01?1E SIG~1ED ? ~ ~ ~ t~EE MIK 01lE(i0t ~ MIYi ? r' , - - = 21M~fN15RIAN'S 2b.ADOtESS . : r7 C~ - N~~~1P~) ~ / ~ ~ . ' Gi Z~ ~i Ib BtRl~l.(t[MAlION, JX. DAiE a~. w~r~ a cur~rfn a cecw??ar 27l IOCAII~ ((AY M 1~~ ~(~N~ (Sld~~ ~ :t : : = I~f!".'~"~~ 0•• 1 68 I~T LIt:COLN OS1~STlr'R7 LADls'NSiiUHO YdTiQb asORk:~:i } ~ S : ; v~ ~ .~.~"~~10~AKLt:R ~ S SOl'iS L(C. ~AO~j s30 WI:iO.AYh. ~to hr ~catuut n? nasnuus swiu?u~ . ~ Fi~. ~ ~ ...tt. i1~:SH. D.C. 2b016 a?n ~ , ~ . j ~ ~'w W ~ m~ ~ ~ R ~Z ACO ~ ~m ~ H o~A ~ ~ao o ~ ~~z ~ n ~AO c o mC~ ~ e~ , c--~i ~ ~ ~ ~o ` C N ~ m:~7 ~ O 7l ' 7D .a r ~ ; ~ -.r P p 1 ~ ~ ~ a~i15 ~ ~ ~ ~ . _ . . _ r~_x~