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HomeMy WebLinkAbout2214 . . . . - - ST W~~~ ~~UNTY ~~A. J [ T._ ~~~LIC NEACTH IIOCER POITRA: ,~1' ii;,.l. ~~~C0f.~1S QI`~ISION CLERK CIRCUIt COtIRT ~QK RECOR~ YERIFIEO~....~~, t,~1 r~rl, i7 P~1 3 DS3TRIC? OF COL~JMSIA DEPARTMEl1T OF POHLIC HEJ?L~ I' SS ,Y f~' CER'TIFICAY'E OF DEATH ) M ~ ' ~ a. a~_ iYoa~`~'~ 70 ~_I.? V V~ - ~-;/AlIL OT DLCLAfED t'int 1f /e l.~ • t~. DAT1? A1Mfl~ D~ll Yer ~ Ib. 1luut ot IIe~(4 • , • ~ b ve « Prmt) A 1' oF ~ ~ ~ ~ ( , ~,%Yv i . ~ DT:ATH a ~'e EX COI.I?It l ii ~ 6!. X.h~r \furra4 \I¦r~e.l. 1)ATIi Ul' Dl T![ L~U1S (lw y~n f_~ '~w lln. %n^~ \ Krl, Ih~ti 1: fy 1o.r ' Ad•~) ~1 ~Y~ ~ra rw. • ~ ~ •!'1.tCri ~?F 1~8.\771 1\ Washinglo:s. D.C. '~ll. I. tF~ !~l'6 (N ~n rrta~td firtd. l1 ~+~N~liuw, naid~wtc br/•Ke ~.\'.tF•~~t' Itl~vf'lTfl., \l'1t~1\l: IIO\It: Olt (Yf11F.R l~Iti7lTUT10N 1'T.\1'b ` L. COl'NTY ~wininw) ~ . (/J ru1 u ~wihtw~ ~~ta sh~rt ~Jdrt~s) ~ • CITY -J, II1G1~}: (71T,Y I IafIT.~ } ~ ~O ~ Q "M /~'I"~s"' - I~ ~v .t• : 'SJFY yf:ti Utt \V) - J. STRF:}:T .\I?I~lila.'~C rrt~1. pie~ 1.K.~twMj . ?.7:?F-Portor St. , N.'.f. ~ i~~t .l ~ \I. ~l't'Y.\TlO~T ((:i~r tiwd oJ ~rurk d~wt 20b. KI~iD RU31N OR tl. TtIP1.ACl: 1!. CITIZ$X U}' N11AT ~UY7'Itl'1 e.il uJ rvrk~~y fiJr tit ~ ntbd) \)C 'RY. ~ /wuyw tmuby) + i:IF I: A~lF: 1.. \lOT1ik:R3 \i. E~I ~iAa1B 1~. NA]16 OF SQH~'IYI\G tiPOCSE j rt ; D-. . :1'. u/ ~v . ~ t: •:•.r m F' ~(;I.IL~t:CURITY~O. lia_ 1 bka \.'T RSI.41IU~3 ~ PTO/ SASBD Ilb. AUDRh.`19 3tretl Cily Std~ k~(!•~F°'K'•' ' ~ t-. Cal'SL OF DE1lZ1[: (~t~r owl~ owe nrse ptr liwc Iw :(b). ~rd ~ 1~ en~` BNreea Onxt Y.~ItP l. llE.~TlI W:~~ CAI~SED BY: • 1•~ .J blh: ' la!\lED1ATE CAVSE ~ . : . ~ P~.~ddwRS, i/ a~y ~ ~ ~'s..A co~c ~ nst ~o DL'E'PO (b) _ _ [J~Q~j~ 1.G/~ I . t'~ rf ~~:LY O ~ ll~~- ~~~:A~rsdrrf~~w~rarx} ~f~~' I j t ' ~ _ ci...,. nrF ~ro c~ ~ ~ ~ . ~ ti' PART li. HE tiIG\IFICA~1'C C'9~I~11'10\3: lri tin~ ~ 1la. U P3Y? IN.; Ifl'es,Ne~~•}~rliepConsi~kce.l i s ` .ut..l tu t nu r 1 di+eax cwwluwa t~~ u~ yut a - ~ Y 'Q ~ w lMmu,auyt C~~oe ot Ik~thf , . C • ~ ~ .s ^ ' _ Lt~.i ~ ' . ~ } ~ ~~PF:It.\TIU. ~l'AS p}{ZppHaflZD t0~. UATE OF PEItAT10N lOb. CO\DITIOY FOR ~1'HICH OPSN11TiQ~I . . ' •q h:"~![•l.?Tl; ITFSS~ 7Qa am! IOb K'A`.S Y~lIFURAIkU • E ' K - • : t• i ~~-c~fy i( arr~:.~nl, anicNl~, lKwui- 216. IIOI'll ANU DATE OF 1\JI~Rti': aluetb, D~y, Year tte. llE3('RIBE H01~ I~iJI'RY OCCURRED E ~ r:• , w~uanner YMIeIMnu~e~I (Awftf Mf rltK 4I Iwt1Py ~w !iv! 1 0? !bt ' ~ ~ dI ~ C' 1~'t'RY AT H'OltK: 21e. PI.ACF.OF IVJUNY: (Af Uuwt, Parw, Farlur~, tll. I.OC_~TIU~i C1TY OOl'N7Y STAT~ ~j l.~FvnJy !'a~ ~r Yo) S~net vr O~e dr~lduo. E/c.) _ . wi ~ s.1~' 1 a~tif~ ~6at p) (tl?b bwPilnA aM~ad~d tM d~~d tra~ H----_. 1~------• Q~at (1! (w~) las! wn W~ d~cw~~d ali~~ oa If a~ mat dsat? ooedrr~d trov ~h~ ea~ws aad o~ t1~ da1~ a~d ~~1abd aDo~~. S1G A ~:°ii.~ . . 11ATE SyCk1F ~ I 1 .:.t (~1 ` _ _ A7'IFVDIN(3 ! I It~:C' [)R PHl A~ 't ( ~ ~7 / f i~ ~ ; P41 ~ICt.\X ~ ~ .i-~d:,>.: ~*;fir,;, . i2d. ADUkF_C> - . .,.,f: ~T>,Y, _ D. C. CORUNER F~I ~ ~ ~ i - . ~ . - " • :'t'l:1.1t, ~ 236_ LATE ~~R~.",~iA'PORI' i3J. lACA71U~i (Cifr. turcw, ~~rst~) lSlatc) ~ ' :t! a11TlCi` ~ ~ S 1~ 1 ~ Anna olis Md. H'~:~.e.~l. ;~lal Iey m~ _-~r.--.~._ . ueuT.~~;Ea•s 41CNATUIt}; u.~. L~ufa:TAtCER'3 S • - _-'ri: RF'Gla'1'ItA7'10~ ~ ~~.;~~ee-, j~:t . R~i ni e x' . i> z: . xi•a~t+rac ?.Q 6 • . ~ . 'y_~ ~ ~r.u~~«: y _+`i t ~ c.~`l= ' ~ , ~ E \ / ~ " i j' _ i. =~F • •i ~ ~ ~ ' . .r- ~ v,:- ~ ~ ~ - ~ li - _r ~ ~ f e~ . ~ _ - ry ~ r.~~+~-~ ~ t - . . . . ' . ~~r ~ a`. . ~ . L.S.~.~.ii~ - -i:. .r- " - ~ °-~~-iZ:_.. ~._.S ~~'4i'=~_~S . ~ I CE'2 ; 1 FY that the above i s a truc and correct rc~F~r~~duct i on ot' the ur i g i n.~ I ~ ~ cert i R' i c.~te f i l ed •i n order w ith the V it~l Records D i v~s i on, ~~.~,r i ct of `~olumhi~ Department of Public Nealth. ~ ~ . t . ~ j t ~ , . ( ; , ~ ~ , ;tl~t~G*~ ~ ~s1 ; 1':• ~ ~ 1M~E~~ , ~~~?n N . ' I I , CI~ t I' ~i ~ Cr.ii~ {pata I~ hQT VALID WITHCUT RAISED SEAL Vit.~l R~cor.l~ ni~-isi.~n , ~ , ~F n ~ J - ~ . _ ~-.-.x 1 - Il~~p-_ •.y2~' ^dn ~ . r ~~~5~~3'..:..~ f`..y?`...' _~S~~~a . ~