Loading...
HomeMy WebLinkAbout1008 i I Registration Dist. No.. l~~ ~ ~ l_ ~ - ~ - STATE OF SOUTH ~AROUNA 240034 b ~ ' Rfgistrar'5 No. ~ ~ ' ~ ~ iOAiD OF HEAL7N ~ I~ ` ~ " ~ CERTIFICATE OF DEATH ~ ' PA~r+i IN Bicih No. s~•rt mi Ha.,~e~ r NF..1 INK OFCFASfD N~+~.!f +~eu ~•3' SEZ OAiE Of DEAiH ~ ~otir~, o.., •u. , 'i~.,iGOK F0~ . ;,:rRUtrwtis , L.~ :1`C~il '•I. Lc`tit~~i: ;i SF' . t 2`~?1,"~ ~ .lr•.i? 1~ ~.~i v RACE ~'~~+e. ..[a~o. ~~e~~=+r+ v.m.~, ~AGE-~~sr un~e~ ~+e.~ 'u~ct~ + o.._~OATE OF 61RTM ~+Ov' . oae. '~t~i\ GF DEAtH ~ - ~ .e.~s~ ros o.*s t »oo.s ~ ..tn rt.e , C._ t i• fiC. ISIfC~~~~ ' ` 1 )M ~ . h ite -1' ~ is~ ~ ? /z~/~_3e< C!'•=='~F"' ~~n - CIIY, ~OWN, OR ?OCAI~ON OF DEATH w1~Ot C~~ ~~~*s HOSP~UI OR O1MER WSTIiUT10N--NAlA£ N nos in [~•t~ on~e srtu~ ~w ti~.~t~ ~ YIC~~~ ~t1 O~ H~ ~ CY;~i-.-1?stc;n~ •`•t;• r~ Yes r~ I~•t3.y. (:h~rl~_ton Co. t;ost>i~.:? - - - - - - - - S~AiE Of liRTH ..oT ~r u.s CITI2EN Of wHAi COUNiRY MARRIEO, NEVEA tiuRRtEb, SURV?V1NG SPOUSE ~~F M r[ c~vE ..1~ct~ r..rc ~ ~QUNT~\ 1 W WED, QIVO .CEU ~ srtcur ~ ~t~~t..~t ~ ~ .C . U .F . ~arrie~~ n Gero~~icr, - - •-i~l Otcl~SED - ' - - ~~t" i~ DE~'h SOCIAI SECURfTY NU~'tBER . USUAt OCCUPAPION lGivE ~~wD O~ ~0~~ D4~+[ DU~~tiG +Oii Or KWD OF 6uSinE55 OR ~riDUS~'itr ~ _~~ttD ~N MORl11K l1it. N!w 11 ~FTi~f0/ • -~~~~•~~~E ! 'C-Q26' ~et: ~^ie£ : ~ -e i~eFt. Chlrlc:~ton Air f'orce Base ~'t•',e..C! ~ErO~e ~7 ~ ' ~ _ ' _ ssc.+. RESIOft~CE-ST~eff COUNTY CI11I, TOwN, OR tOCAiION u+swe an ~u.~!s SjaiF: AND NU!~t6ER ~ ~sr[on .ts oe .+o~ S.C . Cr~G. ~k Ch~G. Heig'r.ts S.C .~~e No ?~13 L'orse~• h~•e. Fwi~iER- rv~vE r~~s~ ~uoo~E t~sr M01HER-~~~tlDfta N/~.MF ntu ripott u~s~ L. Loi:t~,~~n izabet?~ Nerron m ~s k INfORMANT-N~linf MUILING ADDRESS ~ST~!!T O~ l.f,D. MO, C~~~ O~ TOMN, St~TE, [MI t~ U r'~ (n ~l~ , • `i Ei C`?? C9. i~ • i^~ltt1~ E.rl ~n ~~1~ _ OZ',52~ l~V~; ~ ~ C}1~.7'Zc~~tCZ2 ~@1~'flt~~ r ~Ci • _ - PART I pEATH WAS CAUSED 6~~. ENTER ONtY GNE CAUSE ?fR ~WE iOR o', b, ANO t } ~?nG~~w~rF - e - . - ~ _ [ ~ ( i 1 ~I ~UMQM oHui . i> wr[our[ ~avs[ - - , o ` ~o~ Cprebral Va~cular Accident ; i~ .--f o, o. .s , co..uout~ce or~ : H - ~ ~ :~i.ic~~~c. i nse +o (b) : ~i S.' ~r.eo~.iE c.uu im, - - - ~ . - A V sr.uMC ~ne u..ou- a+~ *o. o~ .s .~oaiEOVe..u e~ ~~IMG ~,IUS! l~S~ / PARt U. OMER SKsNIFKANi CONDIilONS~. ep.o~hy.s eo~~n~un..G ~o ot~rH wr r~07 ~[iwteO t0 UuSt CrvtM rur ~~o~ AUTOPSY 1F TES ~+e~t nwo~~ IRS O~ h01 yDt~ED IN O!~llr~a.- q OfAIN ~w NO ACCIDENT. SUKIDE, MOMIC~DE, DATE Oi INJUR~ IrO~+in, 0~~. ~URI HOUR HOW INJURY OCCURRED ~lME~ ti~tU~t O~ ~N1YB ~~7 1 O~ ~~tf N, tter p~t UNOfTERMWED ~v[cnn • - 70a ~ ~0? Ik M ~0! INIURT AT WORK IIACE Of INJURY.f wOr[, ri~M, itati_,l~o~~, ~OCATION ~sr~t[r o~ ~.r.o. MO., an o~ toww, s~.te ~ ~ ~ s.«,~, ..s o. ,.o, a.,« , ~.E~,~ ~ .c.. ' ~o~ ~a + i'°° g CERTIffUT1pN- ~.o.~Tn o.~ nu ro..m owr ~e.~ no usT s.w Nw/n[~ wu.t o.. 1 OW/D~O wOT v~M MI DEATN OCCURRfD u rn[ ruce. 10 ra.rH wr iu ~00~ ~Ittf DE~n~. 1»OYlr o,n. •r.~, ~ wneNOta r~[ p r~ t1~ oea•sro nor +76 t~. 11~ did ZI~ Pri M. ~o me uus~~ CERTIf1ER-NAMf ~nn o~ n~.+n S E oFCn[ w~nu IDATE 51GNED ~+o..m, o• ' n. KGnn~#,~i Cht~e ~~Corener~CC ln~ 4/24~1Q7~ MAIIING ADDRESS-GER11F7fR s~ f o r ~n o MN s~~n ae ::r Chr~rles`~e31 ~ w;ty SE 2j~01 a~o Y WR~At, CRE?MTION, RfMOVwt EMETERY OR CRENUIORY-N~ME IOCATlON un w snw*. s~•n O~o ~ha?•leston Eei^ht~ G C ~ t~`°"~'urial ~ Rivervie~r Nemvr' zl F~rk. t,, ~ ~ ~ OAiE ~ ~ o• •~i fUNERAI HOME-NAAtF AND AnGGRE55 ~ suen oe ~ ~.o. r.o., em o~ ro.+M, s~~tt, tn+ 1u W tM April 'i~10 J~ Henr~• ~t~;;1i.r, Ir.c. ?.?2 houn St. Charle~ton S. C. 7 Z ~U~~F~~' CI.~ ~~'~ir51GNAiURE EG1~jT(j/. GNAf . G D~~F RFCfrvED !r LOC~~ ~EGISIRAR ~ _ i! n ~ r zu ~~~1 ~ ~ - - y ~ ~ i I ~ ~2`. ~ x.._,.~_