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HomeMy WebLinkAbout0967 : ~ ~ UIPARIM[NI lll IIIAI lll A111~ A1lN1AI IIY(,IINt 248409 CERi1fICAiE U~ UEATH ~ ~ ~ 1 lH,l~UutiANt Irtl ~dd~ Iut1 }r (MI! Qi (.1UN - - ~ ~j, ~MM~ • ,`i ~ ~ ~ ~i~~ a ~ 1 ~ ~ ~S . V/C ~1S ~.O ~'le 1" M~ % Z ~ Tw~~ T ~ s~x ~ Iuct i o+tit p~.ttN ~~,t ~u r~ H~ . =i ~ ^ I ::/7/I~/~..G ~ ~tl.~/ ~ . ~ _ d3 Im~ ~~y .,.~n iin ~`x rn t ~ 'r ca~n~~; ~tKE (Sar~ a faa~ n nnt[M a w~w cawrrrr ~ wenfo ewu~a town a ou? ~ ti.~~ U,s. ~o°~"`~EOo rn~„ ~~~~.Ry ~ • j' ~o cnr a iow~, ~rM n?u~rt a MosniK oe wsmutar ~w ~a. ~ !2a USUAt 0((WAfM~i (Krid ol .c~? d;,.w ir r~ro a?~n+h[u Qe u• ~ 9'~ J~ i . t dw~e ro~~ a ~ratp9 ~t • r~~ m ~~errea ~ i`~0!lS1RY , o TaK.•-rnq~a• o,s ` c_J . N , I~o USU~k RfS+OFN(E (N1+ert Mcto:al tied. A ms?rrK~a t~s.dea~ Ik (IlY OR TOWN ~~un ~a't~ 13e S1tEE1 AIA NUY91R ~ _ ' ; ~ ..r odartt~on) SUtf 1~ (a1AlTY 1~ ~ D~ 1 ' -l: ~~a ,t rn _ . . I~E'Y '7Y~ ~ . ~s'.ISJv~LtJOr~~ i7o~.1. . C? J{'-_ ~ N fAiM[R S kI1ME F~nl M~dd~ lost ~ ti tf1ECS M+{10FN M411E hst 1L~+ tos? t ~ ~ ' c • ~ ' ' ~ c• C,Y~.~ ~ 5 1 ~ ~ o ~~a wAS OFtfASi~ EYER Ni U1 AtMfD fOR[ES? 11A 50CW (URIIrMO 1). INiQt11AN1 l l~d~iest _j.., ts. a Ire+~ro a~ t+~«~.....w.~~....y ~ ~ j=~ _•/.~O a ~ _ Q~ QrTS C~Q h~ I ' r'~T' 1~ (A~ Q~ ~A111 ([n1lt MIy OM tOYS! /!t Mnt ~(Y~, (b~. Ond (t~~ I aTr v~iu. .~~Y ~ ~~'r'FF~ b15i1 ab Ofip % ~ o 1r1RI t OfAiN WAS (WSEO !7: ;,y a, w+w~ourE tws~ t~) t a 11s~J • r y/ ~?,~,jz4~~}t c h o~ r o j~ ouE io. OR AS A(OMSECI~N(E Of ~ _ : y y (ondaaws. d o~, w~A gm (b) Q rQ t° ~ ~+?4 C G ~t . Yn „'th ~ ~ q „y h u t o ~n w t d a t t c o r R s 1~' uoewg IMe u~deriY~ng ~ouse ~ T0. Ot AS A( Oi 1 4!,== r-. tos~.._-'~ ` l~) 1 t`~ ~ ,~J~!~ - i10NS (QNT?1QU1WG TO OfATN MfI Mpt RfUiEp 101iE 1FtMWR OISFASf OR(OID1110N GIYfM R FlltT i(o) t ~ a T : $Fi ~ ~ -i•-•~ J ~~l~ a•'' , • ~ 110M iQR NMKH 01EG110N 1N/lS ~fRFO[M~ED 20a AUIOPSTt _ ~OR fF 4ES, MIERE fiN01NGS (JAS+Df Rf0 u~ (ERiIFrWG t .-i , h ra Mo? . t c-~ 3;• UUSES Of OFI?Tif~ ' cJ~t,y ]u. twE Of iNltlir 11c tqw w11M^! 0(ei~tED (ENer aauw e1 e~ry w Mn hn ~re~n 11) 1 r i~+l _iR 11011R AN Yo~M~ Ooy T~or ~ ; ~ ~ti ~ ~ . r .r i, rt~ur o? _ p Muur ~u ~r. ~.d. s~ t.c~o...~ zn. iounoM str«i «~F.c. No. u~, « r~ co„~ san or~a ws. eK w V ? •~w ~ ' ~ S~' ~ ; ,--i ~ ~ ~ ';"f~i} ~ ' ) oitended the deceased (rom ~ • 1 b . to - 19 , thot (I) ~j^bst ; ~'~a'wyt _ e`osed dive on ~Y 1971 , o hut in mr) (wK}qynion deoth octurred on ihe dote and hour und trom iht ; tauies stote~ ob~vt, (1) ~we~ (dd) (didoo~ view the bodp oNer deoth. ~ r . LGNATIRE 2It W1E SrWifO ~ ~ ~ ~ p, ~?u~owc 0. STAFF , „ ~ - , _ ~ f ~i~tceEe n~rs ~oar~aa ~ mn D '~i~-/~ - / . f ~ na ~++n+cuN ~ - ~ . f rn~) i1'- "°°~ESS ~ ~ ~ i n/ ~.G':~~ 1;--c' t; ~j:: ~ ~ ~ t~3c~ 5ilRi?i RFa1.Ait j,~. j3c. pAME QF 1(_RTY/ (REIMIOtY IId t ~~i''~ (C~ ot T~'`") ~(oun Si~ ~ } ~ t'~~~pr~t 1 ~l ~~7y ~'lL ~'c ZCh~ ~=L'C~ l~J `i~/v' ~ ~ z~ ~ ~ ~ x ~ Sy~`~S ~ ~ PR i91 ' ~ ; R~ ~ _ . ~i-. . , 248409 ~1LFa a+~t R~ ~~.~uc~c f4uri~ f°~ ,p ROCE;. F~:1.T~s U- u e~ept.~,-.~~,:rcauRr !~FCO~i~ rFp~ f~ 16 9 42 AM'73 3oox ~~l r~cF ~ _ - _ _ ~ _ . - _ ~ ~ - ~t . - . , v .r o