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~ ~ C:P~nTh1EN1 CF HEAtir AND SJCIAI SFRYICES ~~7~
~3~ CIY',S:CS 3f y~EAITH STATE DEATH N0.
~ ~ocAi r,:E Mu~.,BER ORIGINAL CERTIFICATE OF DEATH l~'~'~~~'~i~~~c ~~=z~'S
fE:(aSEC•hA'dt M.+~ ~~nr`__._..,._.._ ._-..._h,-d:l~ otit ~ ~ ~S-E~- CATF Oi CEAi Mont~ DoY Year
w ~ ~ o ~ __~dc:cud _ S•:___. ~rue.~l~c I, r"~_'~ ~r}.v6ere, ~0 1973
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w ~ ~ ~ Yean - OF BIRiM /y~
t'~, al ; ~ W' 66 ,v,o~,~~rL:rs Mours M~nute~ pV/ ~ ~~~~~~1
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t'ilU6F ~~u !:cancr, I~C,~e Ttwr.t~l~i Insid~ CitY or hOSDITAt OR CTHFR INSTiTUTiON-NAME
A ~ ~ W(lamba~ of CratA) r1' Vdlapf (imiN (H Not~n E11ner,Grve~Ireet cnd Number or_location)
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~ ' i ~ ; 9~ IW STt1E DF B,NTN ~ UTi(FN al'hhat
(curtry M~orried n Ne~a Morr~ed SUAYIViNG SYOUSE Uf~Wde, G~re H'mden NOmt~
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~V C d ~ ~,z.~89- 09 835~ I,~a..~~S'"° t~lSal~i e~
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a 0 ~ s 1 Attend~d Thr io To ih~ Ceuse~s~ StoteC.
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