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HomeMy WebLinkAbout2569 ~~...~.?«~~u ~~n~• v~rnw~~twu w nu~un S-.~S~f~2... s DIViStON OF VITAL RF(ORDS,101 W. HtESTON 1?REET, YAITIMORE, MARIflANO 21201 CERTIFICATE Of DEATN ~'7 5~ 8 ~ a ,:c~EO r~r,~t F~,~ µ.oa~. i~~ 1o DAIf 0~ GtA1N m ,~,:t r pr~M) ` ~ ~ Mo.aA oo r.w ~ d "x l R11(E S. D~11t ifi1M ~ AGE (t i r rwaiin~, t~?~nHwib, . r N~~ ; ~ ' . • ~1•~ ~ ' 3, , \ J ~ ~ ~ y) ytK. - } , ~ ~ ; -^~'i'r.~ C~{Sto!~ a 1we.gn IE (ItlliN Of M'HRi (CUNlfilf? 1. MJIRYI[D~Nl1lR MAQ::ID[] t. (OtMITY OF OEA1N _ ` + l f~-• . ~ t., . O , .;i ' _ .rL'~ L J ~ /7" wfDOiYED MIOR(t0 ~ ~T{' 4 • ~ ~ ' : ' • E'•~ Md. ~ a • ' ; i~ : C-lr uR 10 'N Of CEA1M II.I~R~'.fGf FtO~fi~UOR?ASiliUi~ON(Ifmtinl+os~:1d 11a USUU OC(UPAliON (Ku ( «t Qay " ~ ~~p~(upR ? ' giV! SItEN C~KS~ d n mos of wa~n : ie, er~o.i 1tU(d~'r 1 ti~ ~7~ _ ~ ~ A- - .~2r `L"ans~r. ~i~~. : : .:~:lC~ , ~ ~ ~ v;i'«l ~SiA1EI?(E (Khe~t c+Kto:ed '~ed. 'f JNTrutwn Restderxe lefo~ lk. (illf OR i01h'N iL ~.s.a c~i~ ianrr 13e i1R[[T AA'~J NUMb1t -/4 s~~ : O r~7 ; " - - : Y;h ~so Noo a . , ~ x ~ ~ `Alt!ikS NMIE frst' NLddM o 1 li. I S AUUDEN tU1V,E frst t'i , ~~T~ CS7 O?~ { _ ~iJ~/~i~v_-sJ r%~lSi„1.- ~~`f~ #'is~ift+~Ii!1~?'~~~ : ~ v Z ~ : v~AS DE(ERSED E'IN U.1 IUtMfO FQR(ES? !bp Sp(!At 5F(URIry Np 17 INfOBW?Ni . ~ ~>s, r.o, a wrcnpwA'' rM'M weeca, w.ae) f,~ . ` ~~f ' t~ .ts : t~ ' '~T~ ~ ~ ~ ~ 31 -~t'~ Vt ~s+`-: ~ ~ " t • t: K' - ; 4 : v~ rn ~ _ ` ~ i ~5 UtiSE OF OEAM (Enk~ o~Jy one ~cu3e pa ine la (o). l~~ ad l~1) ~ - . ur ua r ? ~ PxRi L DEA1H WAS UUSED Blf: m iw~,.~ou,TE cru~ ~a~ Thronbosis coronar lef t • ~ c~ Z~ : . - D ~ j.-: f,' DUE 10, OR AS A CONSEOUE~'(F OF r' ~i Y 1~ ~ ~a :c^!:~~ons,i(cn~,whicAqore Arteriosclerosis coronarv marked ~ a r~~e to immedrote couse (a), G~ .c•.^g tl:e cr.dtil~ir.g touse WE 1Q, OR Jl5 ~(ONSfQ..`EN(E OF C a C~ 1 S~ r' Cr7 ~ t:.Ri 2. OTMER S.'G~iFKA.4i (Okpi1101:1(OXTR~BUAt~u i0 C[R~N 6t11 \01 RElATf010 ti~E TfRAlSNU DtS4ASE ORCOtiD11~OH GIY'I!1 1N PART {(o) f1 a~' ~~~°z~ ;~c ~:TE OF OPfRJIi~UY rS~. (OAC~I~ON i0R Y'KftH aERA1VON IKU FERtORNdD 100. AUTOPST? 705. !F YES, ri'fRf F:FDt1:GS [Oh'St9fRkD IN (FRTIFtI1NG O~ ~S~ ~ O (AUSES OF CEAik? 2 ~ , C? +~~o R((IDENI M~i w~tt+:~tL] 21b TIME 6f (ti,uktf 21t. kDW l111UfiY 0((URRED (lr.te~ noh;t ct m;ury n Port 1 a'PaD Item IS' O~ t~ C m ~~~-~~•;O (IUSE Oi OfITN ~s~ ooy r~ G _ a!Aa. sNri~ rMKCI eu~~een P td ~~3 ~ - i:.!~;URT dUU~rEO tle. Pldtf 0~ ~411~RY ~lf •.~rE lc:fe 1'flFl.!Ktu41.1 ZII. LOCA~ION Street cv RF.D. fio. tdr a ToN-n [a,mfy Stott G1 ~`~t-~+ ~ ~~~z OHOfn:R~ G=;tE i:!~\~.EK / ~ ~ ~ i OTwC•i ~ _r ~?.-7 ! ceNify thnf (this hospiTCi) ct;e~~~d ri:o d teased from.__ :~tL 14 , to i~~r~~1-~i i~ thatQ,j1 .jwej tasr o~--' n^, J~ aw the detEase~ elt,;:~on _t9 and t"r inc;~•; (curj op:nion deoch ecccrred on the dme and~hour and trom the ~ p~~~ O~ ~ cu ses s to te d a bore~ ~•he' d~ d ~ d~ d not j ~-~ew t:e b o dy o fter deo!h. ~ t ~ r" t ~ : e ~k11[b ~ ??t DA?f u~t D d ~ ~ ~ Ai:Eti?:tiu Y.i~ S7Afi i -i x O _ " l~-~.~~ . L'r./,'-r v.iy OEG.iE PHYS a~E(t('~ ? PHYS ? ~s 'r' / Q ~T • r'~iY 1 S ~ •~'7 ~ A Y[RI~S ~ ~ ~ ~ ~ ~ n +C _ Y r.a~ G ~'~'~!~::i ~d"C.~i~ ~~~:'•r! fi.!T°= ~I'Ey / ~ ~ l = 0 Cf~EAw'.iiC.'{ .'se. DAii ??c !~nlAi 0~ (E':.E(ER1 Ck tic[6~~'1i;;RY 2-'.3 iGfAIfC,'f c~ Iovr c! O~ ~ i~n';.::.L S~c.~j l h 3 ((oJnhil t-c•e) O~ ~ " ' S/~/~1 i.arrsiite Ce:~:eter3~ ~~altiTore, :'d. ~ ~ . ' F''~'-'~ ~Q~i i-~ ~1~:'~:..~~'c cni.S 1,.~ J1DGn'ESS 25e. R f iSi 4K 1RART 1 D JIDG ~,~A'~ ~ ~ 19 I~- ~ " c ~ . ~a7idkh~~ S ,.i~0 WI~G AYE.. i~. 1Y. ~V~~'ri.. D. C. 2:.Ji6 DAif F~tF~ a~C S7 ZU~?[ - RfiO~ RO;:r ~JUNT1'~(A / F l; r, t. ~ ~ti r J! T R~~(,~R l v - 1' ~ ~ ~ g ll z,3 p~y 1Z 243~~?3 ' ' 600K ~1~1~ fM~F ~~JW : ~ > _ ~ u~"""~ r .s ,~..4 o:i:-~- ~ ~~rx *y Z`u~ 's 4 ~ ~ ~ ~`~s"~~~`y". . ~ . - - - _ ~ - .