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NORTH GAROLINA STATE pOARd OF HEALTN ~~~.y~s~
O~FI~ OF VITA~ STAt1iTIC..s !b ~ ~ ~
CEFc'TI~'lCATE OF' DEATH ~
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Dusmn~ Acut~ Mvocardidl Infarctian 4$ Hrs ~i" _
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j-~i ~DUBTO(el Artertosclerotic Heart Dlsease -
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2~s. f10NATWIE~ ~ s ~{,Y~`~_„ :.(1~OR~t 1i14) l7~. ADD4Bffi W a y n e s v i( I e N~ C• l~s. DAT~ ffi(3YSD .
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7~. D.~7'Y RECD DY lAC~L fL 1~0 ~ QfOltiTfTRS I~ f1. lUN~L DiWOC[~OR ADDltEBB "
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-~-:<SREBY CE~IFY~~'T: TEiIS IS A TRUE AND ACC~URA1'$ COPY ON RBCORD IN , iT 2 SZ Pri ~
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S MY HAND ~AND ~ OFFICIAI. SEAI. THIS 1 UAY OF ~~..1972. r:
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