Loading...
HomeMy WebLinkAbout2662 ~ `~.~2~:~5 . ~ MARYlANO S1ATE DEPARiMEKi OF NEAl1H ~ P OiY1f10N Oi 1HTAl RE~O~OSr ~01 Ml. PRESION STREET. ~ALTIMORE. MAR~LAIID 212~1 - ; CERTIfICATE Of DEATH i: ~ acE+~uo w?~t rss~ ~w t~ a~tE a a.rN ~ "o"e ~ ~t?'~ Robert t31en Karr~er I~a~h ~ ~~1 1: 30: ~ ,T ] S11 ~ tA(f S DAII Of iIRTl1 •!~".f ~(~w~ r~u~ ~ nr r u~on H rt ~ ~ . i ~ N Ma1e Wh1te 3 Fbb~lle,ty 190l~ ~T""°°" rK V y ~~ttMFIA(E ~S}ur~ a~a~ 1~ (i14'EN JF MIlUT (OUpltl~'? ~ WItR1ED NEHt W?ttND~ • C01/lir Of OEATN ~ ~ Iovn USA w+nowto~~~ o~raecEOp Muntgomery . , C~ tTi ~J (111 (?t Ii~AYtY ~4~SN n wura~v+~ua~wsmur~~u~w.+~,~ 17a USU1l O((I~AIION ([~nA e! waY Arny Ij~ [~IqQfM1S~SSQR ~ , o ~ethesde '»'""'1~'1'~`~Clinice~t Cer.ter ~~ti~'!~'^('ibttt'rd')°? ~~r~. u ~7o Uk~~l r~: t\~! iill~r~ d~tqfN ?v~. ~1 ~ntM~MO~ ba~Mrr~ A~lor~ Ik (IfY Of IOMfN ~b aup un urn+ 1~ Sftilf 4!q NUMhf! F~ f'!`brida 17° c011" ensen Beac nsC3 ~O 12119 Indien River-itr3ve I ;I~ y ' ' _ ; y u arntts wr~ ?.u ~ra. te~ is rorntRS rwoEN ~ r~•.~ ns~. ~ou ' `n ~ Jasper Warner Minnie Roller I ~ { ~ ~ T ~ ~ r~ M` ' " ~b w~s aceuEO Evte ~M u s nerco toects~ iw iocw s~cunn No i~ aaa~i - j V` _~r~,~.~+ro,.,,) t~~Mwr~w~d~rwN 168-07-T233 The Clinical Center, I~iIfl, Betheada, Md. 20014 ` q(AUSE OF OUNN (E~w. o~ ea uus. ar b b(ol M. ad ld ) av, w i._ ~ p~'. - rui ~ oi.niwu~c~o ~ h~ ~81ve astrointestinal hemorr e s a- • , o ouE io. a u ~ co~stauE~cc a •w - fo~~:+~;:.~~9••• Chronic lo enaua leukemia ars c~ 1 Y~Yff E• ~ u5~' we~~M.q ~w+. OUE T0. OR AS A(OMSEOUEN[E Of I p %~..r- 1~1 _S ~ { ~ i . F+ > • y, T t.Olllft 5~6MfK~MT (WOITIONS (OMTRIWTING 10 OEAM Mli NOi REIATfD TO f!~ IfRAYNM DISEASE Ot(QIDITIOM GIVEM M IAti 1(~) 1 • - - ~ ~ t~ • ~ ~ ~ ~~arE a c~ano~ coNO~raN Fa w~ ~ro?noN w~ rce~!~~o ~a ~u,ravs» 1'Ob IF ttS, wEtf fY1D~MGi (OMSWERED NI (Eti1fri11G ~ F, ~ ' . ~ ~ ~ . ~s ~ ~ p uusES a ounn Yea :.i :Q~-.~- ~ 1~(t US i 7 7~6 luA( OF W1URr 21c NOw IM111tT 0((llttFD (E~wr ectiw ef ryury w Ian 1« hn t. Itein 1! ~ ~ M (pSE Oi ~I/1~ NOIIR A M YoniA Ooy Y~a ~ ~ - ~ i~ rtler a~t~ M4ol n~~ ~ / Y ~ . j.~ ~ 7~~ e1,U[tf 0((URRED 11~ RA(E Of 1N1Ut1 /~r wK ~w tnu~ ~+non~ 211 IOZATION SacN or Rf D Mo (~ry a iow~+ (o~ru~ S?ote ~ r--t ^ Nn~ ~ Mo! .~.y ~ 1 a~a Iu~o.~ ~x ~ : . _..1 ~tr .e~k _ . ~ j~ p 12a I certify tiwt ~Q (this hospt~°~dhe daeased fnrtS . 19 . t6 , 19 . that jQ Iwe) lost ~ i/ r` saw t',e deceosed ol~ve on 19_, and thol in~(our) opmon death acurred on the dore and hour ond from the ;auses stoted obove. (we? (dd) Q~ new the bod~r aher dealh. w 17o S= u'~~ M~ :h 0~1'F S,GUn ; ~ ~rn?~ac eu~ sr.c~ ~g~h 10 1 ~ ac~[f n+n ? a~cra ? vw.s ~l s 9'Tl : ua r~~vc~x., n~ ~oo~ss e c en e~', ~ a on - "'~"'!`•Y~ Samuel N. Bobrov M. D. ~Inatitutea of Health Bethesda, Md. e~0014 ~ , , - : ~ a H~`~ 2ia 9~::L (itMAT~~. 1~Q DAR 1k MAMF 0~ (EMEIERr Ot (REMAiOt~ i3d l0(Af10M (Gh a la.,,! ~Cew~h; Iuofe) ~ 3~ ai C~v~?Y~~il~ 3/11 1 Cedar rince Georre Co. Md. ss tso r rtWSrR~us c Rt ~?~IW N'KS~~ler Funeral Hame-133t°D~ockville Pike ~"~97 ~°L,q~cs~.,(~-~~a,t,~d~ ~ Rockville Md. a? " - - 2_121 FitEO tNU REC~RDEO - iT. ~UC~E cOUM r ftA. ~OCER POtiRAi CLER~ C~KCUI~ CO~T IIECORD YfR'FiED.~.~ ~ ~ ~ ~ Nfl ~ ~ ~ Return to - ~ Ys~rgnrit lMarner - 12119 So Ind B~ Dr. Ft.Pierce,Fl~. ~~~K1y~ ~659 - ~ -