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HomeMy WebLinkAbout2517 . - - - ;t - ~ - " , " ~ } a , ' , ~ ' . - - . , 26412~3 ; ' . ~ ~ , - - MARYLAN~ STATE D~PART~NENT Of MEALTH ~ pMSION OF YITAI RECOR~S, 301 W. PRESiON SIREET, BAITiMORE, NARYlANO 21201 t ~ g? tERTIFICATE Of DEATH : ~ ~ R ~ Yr Yf~~ . ~ ~R1' Y~ ~ - _ ~ ~ ~ ~ ~ - 4 • ~ ~ I ~ / 7/ ~ "Ti 4 y 7 Sfl l R~[E i iM l~ • n?~ •_re H~~~~ O ~C ~ / ' i ~ ~O~ fK 'S C) o la ptrHVUC « t««~ n!/ ~~m ~ w~o ~rtvtit w~~rtnQ t. townr OF OFAnI ~a' • t , w~oowEn G ono~o p ~se. ~ o a c~ r. i~ iowr a r~ u a~osr+iu o~ ruu~aN ~a ~u~a ~n us~w anvnna~ ; ro~. ~m ~~a ws..fsso+~ .y ~ ' . °°b"') j~~ ~"'y mati r . LI ~ ~ rNrd ~ °'~"i-,~r,/~~~~- a:: ~ U a - p: U~ 13o UYJAI tE (WMen Md. ~I Msww~t t e bebw UT~~j TOM ut Ik AlfflliA t ~ ~ v ~ y ~ adrsson) S1A / ~Ip~ • . ~ ~ ..p. • ?-7 ~ Il f~{lrttS IWIE Frsf ridM l A` li MOTMflS MAME f+st ~dl~ lW P-1 ~ H m ~ ~'l. ~~L~ I~l/ ~ ~,"j.~ ' - ~ ~~a w~s otc~to tvu w u.s ~ Foet[st ~w saw sEUwn ro_ »`~~r Sv d /j..~ . Q ~Yn,... ,rriw..~ a~.r............w b. d ` : ~ : -a • o Il ~AYSE Of OfATN + ~.•.w a.~:~~.~, ~ wr ~ mw w ~ NL (~1 ~ (d) / n~.~. a~a +.o , N~ o" r~t i oum w~s c.u~n a: ls-y2e„« ...t. N urr+foutE twsE Ml • } : s"~ m _ ouc ia: a~s caaEa~~cE a ~J , s ° y ^ " .r ~ 7 . f ~ f"N""• ~..p..~Y ~.n n ,L~,tL c ~e'yt~C~sti 6i^~~T - - v. q ~ u ~sradi~a una ' . ~ - - _ _ _ L _ ! f-1 r-1 . - s~"! Me w/«~r~ - ~ ~ - ' - - - - • ~ - ~ ' . F ' i ~ , 1nt. ~ ~ - i . ~ ~ fA[i 2 OTKR SIG1~i[AMi (OI~RIOA6 (OIiiR~i{A1~16 i0 Df~Ai ~liT l.Oi sfUlifD i0 T?E iERY.hK ASEASE Ot(OMA1U011 GM81 ~I tAiT 1~ ~ : f.~~ ~ • vc _ - - . _ ~ - c~ ~ ~ s ~ta out o~ ov~e~tpN ~t?. co~atpr ~ wacN oPturaw wu vteEO~r~o ~ iwror5n 1od s+R w~ ~ to~aroEt~ a tttr~raw - ~ ~ ~ _ _ ~ ~ ~ ~ c~?u~a oF ounr~ ~ 1 : ~ ~ ~ t~.. u[~ut ris .+~a*xp 2te twiE aF w~Kr Ztc MOw w~llRr 0((~etED (Ee~. iw~ d.*e~ . M 1 ~ M~ ba. li) . ~~i ~ Mcwn.~cD cAIIfE ~i IEN~ NotRt AM wow D.y r.ar ~ . o f~ «tf~r. ~tlp ~el~ol s~~erl N q".~ ~ i1d M~utr Oc(I~ifD 2k flAtf 0~ Ot1UR~ ~aia F•cpeT~ ltl. tOU;~OM Serd ~r ttD_ I~ C1~ a iow t.M+~ S~ . W i 1IYA~ MW ri+ie b-~ y a w~e~~ Mw~rt ~ ~ o~~. 220. 1 certifr that (Q (t ~ ) mtend~ the deceased irom ~ 19 , ro 19 thot (I) (w~ bst g?-~ sow the deceoxd dive on 25 19~, d tnat ~n (my) (s~ op~non deoth octurred onlM dat~ ond hout or?d (rom th~ W causes slcfed obore, (l) (we}{~d) (dd not~ view the bodr aher deoth. ns s~c~u?n . nc a?tt sw~++ : ~ , ~ l •~..0 oECe~ i~ L~~ o"E~°Ra ~ n~"'n ~}~.~~-~'s 2 ~ ~ 7/ ~ i ~c~.ys ~ m w~ESS r ~ . ~ cnQ ""~t'r,~? tD G.: ~ ni . D ~ o/ ~ GG~ .%fi~' S : ~ ~ t ~ H II~ ti1~W.( 2 DAIE I3c titME OF (E "~ERT 0! iEtaJ?ipiT !3! lOGi10N `Ge~ I~ o~a~q) ~State - 3 ~ ~ ~ " ~'~~y . jy7~ ~i~YG ~s, L'c;~.t _ ~':~l:vzlx[ rst _ P ~ . s~ ~ , ~ b a - S/ ` - . ~ ~ . . r.ass ~ ~ ~ y are1AR ~ ~ 1971 ~~,~C~- 17~ _ ~-i ~ --j ~ - ~ ~ . . - ~ ~ ~ " ~ 2;64123 ~ Thia is to certig,T t~ha t a, trrie and e~iact copy of the arigintl ~ , death certificate. ~ - . aoEO ~ ~ ~ ~ • ' ~ ~ECJ ~ • , ~ • f f~lE~ C;,IfMT'~ flA- ~ ' ST.LJC~~ ..:o,AS ;r ~ " f~GC~;' _ T COUR7 t ~ $ta~ Or ~~''::-Y`:;j/ a qfft~p~,;`.~ ' ~ ~ ~ ~ ~ ~ CiO11IItr31 OZ ~ ` ~ ~1[. ~ ~ ' ~~4 . ~ ~ Zp ~ S6PN' 3 ~ , ` • t ~ ~ - ' ~ ~ ds oi d 1973 ' ~ S~ba d ~Dd '~~~fo~i~ ,~It~ _ 3id A . n7,7 • ~ : - - 8~218 ~~2~14 . ; . r y ~ ~ ' - ~ . : ' '4 i ~~d . s ~ ~ . . sK» ~ ->_~~~.s~. ~~:a~~ _ t. a ~""a~ . . . 3 y~ • . ~ -