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CEi3TIFIC,4TE aF DEATH ' ~ ~ . ,
S'RTCTR"~'i:vXCl~~ STATE 0~ CA~IFORNM-DEPARTMENT OF MEALTN I.bf~'~l'~~iS'1eAtioa'U?.ii,f14'jL[qiJi;i'i'h;w',~~~
~ I~ NAME OF DECEASED-1insT nawt ~ U wiDD~I eu~t ~ Ic us1 NAM[ DATE Of' DEA1H-~anti D+~. r[4~ ~ eOUA ~
~ Tuh-YUeh ~ N~`i i LEB Se tem~er 30 1973 i 12:52 A~ C}~
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~ SEX ~ 1 COIOR OR AACE 5. BIRTNP~ACE ,,'p~„~„~,"'o,no» 6. OAIE OF BIATM 1 AGE ~w~ m~.u~~~ N CrDf~ ~~1~A n w^r~ t~ r.e~ ~ i ~
le Chinese China October 21, 1904 68 ~ ~~no Qr
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DECEOENT p, NAME AND B~NTMiI~CE Oi FATHEA 9 MA16E~I NAME AND BIRTMPLACE Oi MOTHEA c~i+r~t~dv n {~j'1 ~
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PERSONAL King Li China Hsien Kee wu China ~p;;;>`;~'
DATA ~0. CITIZE~I Of WHAT CQUNiRY fl SOCIAL SECURITT NU'd6EA 12.. r~reito etvt~ y~~~it0 wio0w~0 13 NAME OF SURVIVING SPOUSE n~ M~r4 urt~~ M~md ~uK? ~ ~
onowao~sKCnn tu' '
U.S.A. 059-24-4086 A Married 2oen-ryok-Shen p~~Qlx~,• (~j
11, LASi OCCUPATION ~S. ;:iauai+~ " 16 tUN( 0~ UST [MP~OtiIAG CONIANI OA /IIIY 17 NIND OF INOUSTRT OA BUSINESS -J~ ~ J~ ~O
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Banker 30 Bank o£ China Bar~kinq ~
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=E Stanford Univereitv Hospital ; 300 Pasteur Drive ; Yes ~ e~
DEATH ~Cp, CITY OR TOWN ~iB4 COUNiY ~1lr, uwr~rm~~awnrrmr~ ~Iso, un+.rm~reu+nw~ •y
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?alo Alto i Santa Clara i 3 ~ 3 ~ ~ , vi
USUAL ~9~, USUA~ RESIDEhCE-stRtR ~oo~tss nrein ao m~n~~ oe ~ounoM~ ~19~ ~NS~o[ citt coAro~~f[ uNifs 20. NAME AND MAtUNG ADDRESS OF INFORMANT v~ b 0~ 0
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n+rtr,'o+~ri :.ru ~9t. CITY fA TONN ~19o COUtfTY 19t, STATE 968 Trophy Drive ~ r ~ a.~ ~
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CERTIfIC~T10~+ " ~ ~~+il~:t.~.'!';i lohn E. H~user, M.O. i u r c: * ~ ~ ~
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2t~ tr~;ft ~r1~4L (VTO~IY(M ~2I1, DATE 17 NAME OF CEMEIERY OR CAEMAiOAT 21, EMd~SIM' ~GMATUA[ ~ 10 t~u~wtm UCEhS NuMIG ~ C~ U~'^ M
FUKERAL ~c~c~n,p~ 1
DtRECTOR Burial ' 10 3 73 Sk lawn Memorial Park ,..`.,.,.~...T~.~3 ro F
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