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HomeMy WebLinkAbout2899 „ - , . , . , ' ~ .~...w,...,~~,.w~..nw.x ,~.n..,, . . . . . . ~ ~ , ^'~.r,~.. . . .~r~ ...,i..~,.~ . . i , > , r,... ~,;xPW~.~ . . , . . . . ~ . . . . ~Q4.'.~_~ ~ • y~ ~("v ~r. f ~ S / ir ~ 'I~ cE, ~i, icarE aF pEATH43oo- 0 5 d 8 7.~~~,~ ~a ~ UI~V,My ---'-j{x!r'f,7'ti;4tjl1-'-' St'ATE Oi CALIFORNIA-CfPARTMENT OF NEALTM i0'c~~ n~~~,i.~i,;~ti'C_5i."fl~na?i c'TAh~~tif(-ti ~~!t~- ~ b NANEO~ CECE~::.-fIR51NAk(~11 NIDD~[NANL ~Ic uSTn4MC 2~ DATE OF DfA1H-y~rM,o~+ rtA~ T HOUA Tuh-Yueh ; NN~1 ; LFE Se tem~er 30 1973 i 12:52 A~ ~ ~ ~ 3 SEl! 6 COIOR GA RACC S. BIRIHP~ACE '~"„'„~,;"'0""6" 6 Di~fE OF BIRTN 7, AGE 'N~~ ~'~~1~ ~ ~I4~ u i,rn t~ r.,:~ p.. I A M • le Chinese China October 21, 1904 68 a: ~ = bl C~ , DECEDENT S NAME ~tiD B~NiNPLA~E Oi fATHEB 9 IAAIGE~i NAME AND BIRTMPIACE OF MOTFIEA a~~v ~ ~ ~ PEADSA Aal Kinq Li China Hsien Kee Wu China =a?,~> f0 C~112EN Of WMAT COUNTRT 11 SOGAL SECURITY NU118ER IZ, Y~AAI[C. Mbl~ Y411AI(D MIDOMIO. I~ NAME O~ SURVIVING SPOUSE ~II NI1L URLA Y41Cd ~IJ~I J~' 4' 1~~( pirD«U~ ~ NlCnn !7 i. U.S.A. 059-24-4086 A t~farr,ted 2oen-t;yok-Shen Y~~';,;~~., 11 LASi OCCUPATION iS ~„a " ~6,~`~'~h0'~ ~S"„~M?lO~IAG COMIANY OA hAM q. KINO OF INDUSiRY OR BUSINESS ~ 4a N ~o Banker ~ 30 Bank of China Banking y~` ~ o~ I1~1 iUCE OF DEATM-NAMt OI NOSPItA~ 00. OTNtII IN~M11IbT iAC41Tf ~13~ STAEET AODRE55-~if7~IR Ab01NM1Ill OA IOtATIpI~ ~IEC ivADf Crt~ CO~MGR lMUtf ~'r u. ~ if~IGltT ttf D~MO~ 0'. Stanford Untveraitv Hoepital ; 300 Pasteur Drive ; Yes . r IEO, GiT OA TaWN ~~8~. COUNTI' ~lel. uMUM~u~~~wntp~ur~ ~1E6. uNU~nurtw~w I ~~W DEATN ~ ~ ~ , ' ?a~o Alto i Santa Clare i 3 ~ 3 , t~ 19~ USU~L AES~CE'~CE--iTA[R ~OOA[fS ipMtt ~0 MuntR OR ~OC~tiOMi ~ t9i iNSiCf CITV COAIOAAT[ IIMITf 20 NAME AND MAILING A~DAE55 OF INFONMANT cy U$UAL i~srtunru0~~oi . . , y i.., aESI~E~CE 1100 Sharon Park Drive ' Yes Peter Lee (Son) ~r ousM aa~•a r~ . n nfmn~ tsrt~ 19t. CITY CRTOM'N ~t9o, COUHTf ~19t. STATE 968 Trophy Drive j,ti ;~1 ~ ~wDt~:t tt"1tl Mn~iQ D~:~: i SLr M8~C0 j ~411F~~niZ ~ M.~...'::.~.;Tl ~~~.~'~i rZ~:~. ~4~4C _ r"'.q 0...~. ,2L CUMGbEN 11 ~2~~ PHYSICIAN ' " c..",,•' 21t,JdrSP iah Cp C6pONt - ~~••~wna~a.a tnu 121G DA~E SIGNeD - ~j N~ ' : ~ ~ tir.r«~~re.~rK ~H .n• n~~ n~ r~~:r vw~ um~ ' ~Gr~ H9 ~~i ^.~U l0•10 ubl ~~t~ tµ nWl IM OVN1//111~ N10~ NO b~I ~ tl1U0{I IN NfUMI ( a , PNYSICI;Y'S ~ r~ r ~ r'~~f.G~ ~ ,r~ ~ ~ 1 OR CORCNER'S `~°,~"~•"e~~,:.~,e•.~,~.~.~nua Lf.G:•4G~ ~ October 1 ? q. ~ ....~M N ~ N. ~~..~,.o.-~ , ~.,~..e s,., , ~ ~j 4i x .;~;~•,t, . ( CEa7iFiCNTiOy ~ ~i~l~i:c~~:t'~I`iin~ 2 AJDRE55 loln E. Hauser~ M.~~ ~21r un~i~u~a~ ('0 p 4 p ' Investigation ~ , ; ~ ~ i ~~~A~~,Ie?am+~.,.r~~~.~~'S;SaP:~rnm.~anJ:se ~A17615 a~. ..._.~~.T~*.'i^'it~^.3:Y1f(~~~ ~ . ~ ~~1~r:~'.~ :,r ~I, ti4 Z2~. V[;'f~ ~yb~~ {N}OYIY~M ~2b, DATE 23 NAb1E OF LEMETERY OR CREMATOAY 21. EMBAIM -Si4tiRtua! ~ p ~~a~M~o~ utt~s[ ,rurlR 0 ~ ~ FUhEFAI ~c~a~,a. I ~ r. OiRECTOR Aurial ~ 10 3 73 Skyl3wn Memorial P~rk ,,~y.,r:--,S'` ~~3 1~`'~ `•'f4~J!~'' v~' 1 I LOCAL ~S. b{ ~I Ol lU~dAAI ~IR(C10R i0~ ?IASOM 1CTIN{ A{ WLNI jb. ""m ~w v n a~ ~+n ,n ~.p ' Mil McUH~IN 4NfY~IPO f'~, ~if,M,r,N • .1 ' . ui.n.c.nomr..c.i~, Z7 IOCAI REGISTRAR • ATUAt ~ 28 lPt4tlYM1Y t REGISTRAR ? ~ " ~„~~~Yes p UIL~~~~?'d~~M'.~' OCT 2 19T3 p, 4~,' A~ ~ller & Ha ood ~ ~ . ° ~ 23 PAT AT I CuTM w~S C~uE[D 1?; [nt[A on~r O~+t C~u,t ?M unE IOA 1. AND C ~;Z ~ G' ~ IMMIOIAf[CIUS ~ ~ r,. , 'i ,1 i ~N c~? Arteriosclerotic Cardiovascular Disease ""''~A , ~ ',i , ; , ro MAT( ~ DUI TO 0~ Af A CONS~OUENC~ 01 ' FiEPY~ t CONOIf10Nf (f ANY. WNICN , ~ ~ CAUSE oOw~~ o wvt ~,st Tq TMc ~wwca• ~u oHStt QF AT[ C~US~ IAI. f1~TIN4 pU[ TO OR AS 1 CONfWU[NC[ Of o~uM = OEatH TN( UND[AltIN4 :AUSI ~ us,, ~c? . W ,.r•~vnn.~n:.~c~c~ ~rau wn~ n~i~.~.c~ew _ ~0. PART,({~ OfMII1:16N1(ICANTCOHDITIOHS~-ca~ewrm~eiu~.w+.ou~wuu~nn.n~maw~~a~~rrur~, 31 ~„cnw~w.mr~um~n~~v~cw~ 32~ ~n,mn~72t ~:,uiernv..~~w e~u~~:u.~a«onn n~aa~ IU~ppNP~~~MI{~~MpM i.,.,.~.,.~. o No Yes ~ Yes .z ~ ~ 7~. SPECIiY ~cci6lMT WKiA M M~KiOI 3I~ IYII~N 1,(1U~11p1~~1 M1o~t IINH 75i~~~; ~nu~e~ WGAr :6~, DAT[ 0I IH:UA1-~n~~. ur nN ~36~. HOUR ~J ~ 4 ~ N. u INJURT ~ e: ~oi ~ q~u u • n~i~~ ~~~rNr ~~in :t~i q~ pwu ~in iun~~on ttnl A PLACE OF INJUfiT ilnttt AeD ~u~l(A OII IOC~T10M AMO GiT OA MN'MI ~3~1 io ~0 tr ra~a ai. u~+,wit+r ~na+o~ 39 rcu .t.~ ~~tc.w yj ~II~DI~(1 ~r1~N ~VI(N~1111/M1 ~ ~ U~PORMATION ~ nut ' I t0 DlSC~iBE ~iGW IM7URY OGfUAF(D~~auuw~K~atn.~s.•a•.unm,..iw~.~anr~~~~~~+omehuync~u~un~ ~ I ~''r' iM.l Y:il .1~.::..~4 " e, - c. ~ o. c v. SiATE , f;~~, ~ r AEGIiTRAR ; _ r",~i ~