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HomeMy WebLinkAbout0955 . _ otv~s~ot! oF v~tAl laEtatos, ~ot w, nt~sTOM mEEr, uun+NORt. ,~,~i~uuw ~ ~s~~ - ; Z 312•~ . ' (ERTtfICATE OF DEATH ~.3:L4O ~ i :t;~~o ~ i.,~ ~ k m?~ a oe?a a bou~ > " a'"`~ % , ~ YMA , • r_ ~ r. v 3' 1 ~ e ,.'l ~ i t fKt i WN4 OF MRiN l AGE (1~ r Mru i wt ; bq ~ ~ O ~ ~ : - /%"1~.~ . _ ~ ~ '3='~.~ ~ : r'~,PUCE tSiw r 7! (N1~II OF MNT ~QIMIItYI ~ M~IEp IIEYERMARlIEO[~ ! ~Oi/IIY Of O~A1M :S, ' . : +~`4 ~ ?~t i:~-~~,` ; -~l ~o o~o~~? -,.•4,~=~~ l`~:~~-~;::;~+i: " ' d t/~ t..~~ o~ wwNa o~ ,~u.wu~a~nKawsmunospw:~ ~ta uwiu acu?~?rwM ~w.~ ~wt ~Iw.~;• ~s,aa~of ~a~-~ .:~.r, • ' ; . ; !w +MM ~i~cl r. . , ; : - ~M^M.~s~ ~f watiq lil•,..s. ~f rNir~lj~.~ : r ~ ~ [~J ~ ~"C : . . .z ~ / •'••i . • a i . , . •~~,?~'i'._. ~~s~:u eES~OEMCE . IK.n.+ tnM, il l~I~u ~c. an Ot lowM ~x .ea an u~ q.. mEEt IYa IMMrfe -~a ~n.~. o!-~ : e~.~v+} StAIE 1~. (OINif~~ f~~~ YEf~y MO , , ' t ~ ~ _ /I' . lJ. ? `*;,i- d' i.: ~~n '+J i f A1 nER S NAYf frsl IUtb ' l~sf / YOTI~R'S NAME Fttt .:~Yn. ,_;~W T,, y, s 5 ts1 r. ; a ~ . ~ O/N S / l ~/q/ i. i'= ISTPL LP. ~ I4 NP_~~~ a~ t ~ ~1~5 Of([AS[D EYE! M US. At~ED fOt(EA 1N. SOCW SEpROY q. //ORM~Mi AiMu • ~ ` ~ . • ~ ' ~ :t A i ~ t ro M~~+.r~~~tiry ~ << - ~ ~ r - t.,ou~ s R ee o ,t ~t O 'YY1 cQ ~ . ~ w { e UUff OF OEA1M (fA4r adr a~ a~ ~r w br ( 1 ~ (c}) ` ~ ; ~ ~ ?,~r ~ ou?r~ w~~ ma~~gnant tumor of left femur with » : ~ ~ 7~ ~ ouE ra. a u~ cawscart~ a~ i " ~ co~e,t,~~.aw,.w~... metastatic nodules in both lungs. c~ i ~.z.io ~m~~d~t~art~(~~ M , . t-+ :ic!,,~ tM u~ cais~ DIIE 10, Ot AS A(016EOIIfMtE Of ~ 7~~ ~ + asr ~1 . . "r OTi1[t W,N~IUINt (OIOI110Mf tONIR1IUIWG TO DEA1M Mfl MDl tElA1E0 i0 iiE TfRMWAI OISFASE CR(OIDIiION GIMQI rl tARi 1(~ 'a~t : ~ ( o C. ~ :.3 . sa LAIF Of OIE~ATIOM H6. C01~(f10N ff~R 1NNi[H OIE~AiIOM YUAS IERFORII~ llk A1110PSri 2~. ~ rE 1~E FiDY1GS L r ~ f IR S, OMSIDEt4D N(ER11F~N6 ~ _ ~ ~ ~ a (~lSES Of OfA1NT ' g Gi r ~T ~ ~ r r-+ :k~ :7 c Ac IGEN w UN r ilk TWE OF MNR1 llc NOMf IMNIRY aCURRED (EMr ~s a! i~ry w M 1~r M~ MM 1~) _~acan~w.~ptwstaoow NOIRAri Yoni Op 1Mr ° O ~ N ~ ~ t eut.er, nytd ~w,drd uonwrt) tJl. ~ 1 ~~iuk? 0((u?1ttD ila lINtE Of IMIURY ~o~ma~'~ ix~~ =1! tOWIOM SwM a RiA Na (ilr w i~,w ~~h ~ '~=7 t t a fir~c oNawA1~~ ~ ~ ~ ` w ~1 ot r~A~ ~ ~ J i~a. I urtifY Hr,~(I) (this hospitdj tt ode ~!w duws'e9d rom . . to ~ .19 L~-, ttwt (tI (we~ bst ~ + sow ~he dreeosed dire on ond lhol in (my) ~ow~ opinion d~ath curnd on tM dott ond Fwur a~d from th• ( causes stutEd obov~. (1) (we) ( (did nol) view IM body ohK d~ath. S r''~ n, ~ i,c S:GhAt - - . 7It. DAIE SlplFO ~ ~ : . M. D. ~~NOwc ~o. sr~f 9 11 68 ~ t, - ; ~ -ti__ l ac,a~ n,rs. ~ ou~aa O n+~ O / / ; q :[3 F!1 .t(IAMS n1 AD~REU rWi. ~ ,~u~u~,,,~~ Hugh Ire M,D. Z1161 New Hamp.Ave. S.S. Md. r~ ~ ~ ~ u. c~tru?•,w, ri~. w?t ~x. wu~ a c~rci~er a ce~ru~oer t~a. tautaM ~try « rf'~ K~r) 1~+~•f ° I',•",'~f~' J%'f~~ ~~'PT ~'~~~~~i QUR L,lr AI~:~C.•_JS ~ca~~w1 5ii. 7} ,ti~- ~ ',::~t J1~~lci~ 1/ ADOtfii s ~So tf('D /Y REGISIRAR 7Sk R[pSIRA S kG?tAttlR! t.; t? ~ l...!/i.'. ~ r- •i.,:%t' 1~/Y~)1Lt. y~J/J/~ ~CI~T. I~~'% ~ '~J ~ - - - - - ~ - - - - ~ o,?~~ SFP 18 19 6 ,t~~~~sC r _ _ ~ , _ - - ; _ . , , ~ ~ . ~ ~ac~r,,~ _ _ _ ~ Lesibili ~ ~ . A ~nti tr or .~-i tios, ~i~s or ~ ° A A O ni tmsa~fataatory in thia doat~nt tor ~icroZf 1~,~~~ c, n ~mz, ~""~~-,v n !O co ~ ;nc~~„ ~ ~ c~ , ~D .C ~~.~-~~7~p CN Q~ O"ntil ~ N D~ eooK 1$~ ~ ~ &E 953 ~ F_.__. Y`-~~;" ~ : a:~~ . " , ~ V-_ ~ -