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Home My WebLink About0982 ' ~ ~ ~tw,.. •.o. STATE OF ARIZONA 1 ~c?~RiAIENT O~ HEAL7H-OIV~SION Of HEALTH RECOROS ahD STATISTICS D IOZ• 1`' ti I~ Cv~' V.: CERTIFICATE OF DEATH '.a~.+E O ~t~Si ~~OOIC C. Lnl1 SEX RI.CEORCOLOR •T Oi wCVw Ox. •E~a JL'CEASED EATN Carl H. Grashorri Z: Male White _~'oj!. 9 1971_ - ' a. er.~•i~r ---e: *oe:~ ow ~~~i ~~svTiai ow Tis eei~o~we~-:i~c sra~er aec~i... . =s - ~CE OF wsr~ru~~oM •TN ~ • V ~ I`5 Maricona Phcenix _ _Good Samaritan Hospit.al ~ 1~~ ~ E OF YOM7M O~• .[~w GE :~=ais it u~0iw 1+[~w!~ v~D~~ O~• ?RITAL STATUS SURVIVING i~s ~n~iE. c~.[ :ea p[ti tia..f~ ._~RTN q lt:[V:~o~r ups. Da.s ~~s., Ww. ~y~w~~cD ?rrtoowcO~POu~~( E^~Q t S_ Se~t• 2/ ~ ~v t_ _Qr[ct~ u~w.On~vt~CEO. q_ a"+~+~jSre V OZeA ~~~CE OF .'.r~~~~«urlwr 1T12EN ~~~A a[~• SOC~aI SECUR~ Y NO ~NSy : ~S1Ah7~r r c5 ~ELEaSg7 +.=_-_~s•_• d:RTH OUNTRY~ llE3 Y~L ~ Ye$::`.°4 '~`lc: ir7isconsin USA ?_526-O1-6975 A J,,,.~P~oyee ...SUAL ST~fC ' ' tOONi? ' ___TAM~M Ow CIT~ L. Z.e C:_i i ESIOENC~rizona Maricopa Phoeni~c ~ 8~015 _ " s aaEV+OJS S?~TE ~,T~.EET AOOF3E55 OR NCIT~ t1~.~1T5 01N I.ONG I.IVEO IN AR120NA =~_F~D. ~T V• 3[NT ~OD~tS3 N St~TC ~F pES O \CE ,.f. 4202 N. 16th Drive 0 I Yr'$• ~sd. ~ 3?rs. ,Q_ Mic~i~an f 1TY. R 5 f~w3T C. I~ST tOTMER'S ~Iw3 t. •+I~L:t . l~S' ~ +?tit E . A~ D EN ' Carl a. Grashorn e"""E Unk. ~iTashburn i'-.rpqr,~A~l7•S SIGN~TVRH ~ w[.w.i:va+~r ro cowESS s'•`ic' w0_ a~- S'a'[ O[LC~SCD ;~Iar aret Grashorn r~• ~-?l 1 Wife 202 N 16th Dr Ph A ~ •dEO1CAL STATSMEN7 PART 1. oE~T?~ ww5 CwUSED Br- IcKruort~ tiE C+~uS[ Or Gw l~aCi iKs~~'~~*`-~ l;:~Li~ OF CAUSE OF DEATH / o~~~T EZT~ n_t c:* •awt •u__• A- IWAEDtATE CAUSE / ~ I ~ - li ~i[C[~Si7 `a3 a~~LT .•[w IMUEUI~T[ C+~u3E OM DUE TOOR AS • ~w ~ A r[vatE. w~S _-i c~SG- - or..twowct~~~T~T~*t B,_L,ptvSEQVENCE OF: l ~J sa•.T •r o~ s~• s~Si: ~wpy~= !f G~V£Y C`~ T{vC {M D~~TtC~is •[S. _ bG. Y!YR\OAw. ~..~wE~s ~~D C sccact7~~[a~' DVE TO OR AS A - ~es: v-:o~wv~c: c+:.se L~s1. ~~OYSECVENCE OF: 21_~>FC•r.- PART 11. / ~uro?s~+ ~r ~F5_rEK«~: ti~~cc. .-~r [w cO.v!*nrs ar 4o.ir~ur+r ERi t~~F G:.N ~ Or. W TtON~ S Jt ~ • c•~o sT_':<•- ..cc~Cx, a~vCArwK[ CO:iw~t?.c /1~ / ~ D E= cs_~c cr_c~*-' -~x~n. euT~orantn.wu.r~e ~ ~~~~p'i ' v ~22t.SaEL.r.• G ~•1•[V~~f ft~5[ . " MANNER OF DE• ATE J1~ +•o- oa~ •w_ NOVw w* ~Gwa m~ w NOrr D~O erluw• C-+e-'-•='+'•C~` •~r-~" ' ' INJURY • 1MNRCO~fLS.NO.Urt. GCCYR~ ~ U(/~CCID[MT ~M~tVwAl Z~a. 'S' 25 i~ ~ (_,_J SVItICt `„~titA• P JV~ ~F IMC+f.St9~E.~KtGw~.s~[[T.[TCJ lMERE IOCATED~ Sf7~EET a~[~w~~a A~D STA~[ I ~-+v1r:E0 , L~..o..~c~oc a~. svcc~s.: ze. ~ !~r!YSICIAN QR MEO~f.aL EXAMINER C ON R ~ t 1~T7LnD[Q7'!~1 D~T •[~A I !O. •f j~A fROV Ci~lIIM~T~Q'. Ls iNC oGD? ~ti0'O~V• ~•.VE!~IGI~~IOV. IN V• O~'-~O!. •ME DECEIISED (FS4u! ~1= J ~I T~ ~ ~1 1 OC~iN OCCJ~AL^ 14 ?'~F. MLY4lA AMO ~:Y9lA Tw( C:KcNST/YtCES ST/~T[~' q.. ~ ecce~sco w,~< uo. oa. •c~e .«o.tw ~ 1mo~ •VO~1~1 MO. O~t Y(~¦ MOu• 1 1~ ~ PROM'JVNCEO rIC7~ i'-? li~_P ti~?.~~ ~L~t•. t~ST ~iih3v.~ p[~DU~: DtaTw. TI4[ CNL II g ~I ~ p.. O[ATM. 3L• ^ M : J~- ~ L~~w ~.CIJA~[D vti :w[ ~i~( ~YL~ !~1~ sl~~C I~~TE a~Otl[ ~MD 7~ TMf SIGN~?TURE ~z~-•~ _ ~yT. e~c*O{~~••MO ED f aMDO1~0~'SS/OMKNOGw[NtOi1E*G ~~-~~iCf€,~O~NTYf«, c.v:cs s. .~ric apGt:. Ft~IT~f$ _ 9:3oA...- ~ c:. ~r ~ ~ 3~. ~~~~,.,~HE p~~. a v ~ . nR~~ irF " .";E~} :?C_ ~~rv! ~~•ea ..Ewt~ B• V• L7~i~reY~ •1• :1e_•rtoE MnuE w[~£• Y %i; ~LDNLSS AtE 5~4tiC0 ti'~~L +~DDI~CSS f =tt! ~ G~=. ~ 3,. ~t. to•7/ JUt. 5 I ' .~s , P~_.....-,.. _ 1 ?5 a ~t'.. t•.~-i_ ; aT[OSD~SOOSITIpM :F~•ETr~• C1n ce r~• f"ba_••-a S•G..a'_~! _ ..w~i:G•. OR '•J.~~~ C~E•i~!^_~• ~ ~ - ~ll~i.~31 l~~_ZZ~~- •a.G_~er~wood M p 39` Ew~~ .~Gra[ S:~[tt •Ot~tss U+• a•._ -uif ~c~fwx~ C +~ECTOw S~G•.' - _ ' . A. Z. Moore ~ Sons 333 ~est Adams P'hoeni= Ar'i2una - - :rr are~~rinio wee. s•;e n0. w[G~STAAw•s e~eHwrcw[ ~~e. v.:w~ i - f I~-1 ~ I~.. o~ .s.? p_.~~ ;6_ 07~3 i__ 0~ ~ ~.Z R~.. ,Z_E, _ CERTIFIED COP'~ OF VITAL RDCORD ~ STATE OF ARTLONA ) _ - ~ ~ ~ SS Date zssuea ; ~a~, 3 ~ cow~t oF ~wx~copa ) _ . ; ~ This cooy is a true and exact reproduction~o.f;,`t~-'do~vment officia?ly registered and p~aced on fi~e in the DIVISION OF~~.VITAL Rr~C6RDS, hRIZOATa? STi~Tt". DL~e~~TI~L.NT Or li£r~Li'~I, FHO~X~ ARTZONA~ ~ _ ~ - ' = _ Issue~ u:.~er the autY:~rity of n:ZS 36-341 a: d by cii.~ec~ion~ of: = - ' iCV~J C• :lGJS[.°~1~ Ii.D• O~ ~r.~{~?~..t~.~J~~~~. , Co:,:~issicr:er o~ ::~alth B~K~ p~ ~ AssS~zt~aht'~t3te Registrar ~ - • ",'=;;IS CQ~~•/ ?;OT' +/~~:,ZI? U::L:::~:i r: EYtili.c.ii C)?: SnF't~^l FAP£:2 .''sI5Fi~t~YZIw ST~1:' : Su.~=, ' ~ . ;'::2'_:~JJ.~.~ YI1_l:; :L'.1C~.27 .ci~1L Uf ~JJl:i1~V r.~JLI~~V - ~ . w- ~..sr+. .r._~ - '-w,' ' - - - a~:::.~: p,,.~;.:?~z~. :xy,'3.~, ti.:~:." - . _ ,YS'.. ~ P ~ - _ : .=c~.~.:-::r~_: _ , ~ _ . . . . .