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°;;c krad D:STRICT OF COLUMBU DEPARTMEN? OF PUBLIC HEALTH ~
~ertifi:ait s! ~ t CERTIFICATE OF DEATH 'T3 1~ C~ 7 ,
1973 JU~: ~u P,,. l 3 ~t,~ r ~
.:~rtfllll~l }~u \a ~
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1. NANE OT DDCL1~iED Pint Viddla Iw+t i~. llATE VewtA D~y Ysn ~ lb. Honr of 1~tY '
~ c~a r~~,u Kathryn G. Lusby i~sA,~x o /7 7-3
~ i_ SEX COLOR OR RACTs \pw ai~rried. ~larried. DATB OF BIRTH i. wf ~ aw ~a.
• item of in- • ~ '
, W i W~owe~` s°`~" y 9 4 08
.tion shouldb~ j t
~lly suppli~d. ; S. PLACE OF DEATH 1.\' W/~~p~1, j~. ~'i. f. C3UAL RE3ID6.~1CS (fiAerr leres~ lierd. l1 ~itrfiow. nailewrt be/on
\A~f6 OF H0.SPITAL. \URSINd SOa(E OR OTHER 1\8TITUTI0~1 STATE Mar ~~~1d b~ ~L "`~nt ~
l~ut u~at~t tio~ ~iae ~trjst ~i nu) e. INSIDS CM'Y LID~(IT8
b S i b 1 e y~"remo r i a 1 Hos p i t a~ e. C1TY ~B~I~ Ysa oa ~o~ '
shd~a b. Washi ngton D. C. Silver S rin
' w r i! i~ a a. 87'RE~-r AuDRhBS cll n~s toror~)
:;nt~ in 9201 New Hampshire Avenue ;
~ti typt b1~C1[ ~-zL'AL O(.`Cl"PAT10\ (Gire 4ind oJ ~or4 ~owe IIb. KtrD OF BU81\~78 OR 11. BIRTtIPI.AC6 fi GIl'[ZE\ OF WHAT OOUNTRYt `
drnq xust ol ~s4iw~ !i/e. ~c~w iJ ntutd) INDL'STRY (St~e or JoreiA ~owtry)
' 13a. F~THER'3 \.?HE Ilb_ JtOTHERS alAIDE\ \A~16 1~. \AafE OF S[:R~1\'I~G SPOL'3E :
° Thomas J. L onard Annie
~ '
cer2i;t'.a2e b!~ i IS. E~-~r in L'. R- Ib. 90CIAL SDCURITY \O. 17a. 1\FORMA\T RBL3TIUNSNlP TO DSC6dSBD Ifb. AllDRk~ ~~Y State ?
s a Ferm3lf~llt ~ For~a.'
I~ 5-0 - 755 Leonard Lusb Son Same as 9
ieCOtd p~II ~g. C/?~ p! DFJl28s (S~ter owf~ one carre oc~ liwe /or (a). (b). awd - ~ Iaterrd BNwees Orct
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PART l. D£A7'H WAS CAUBfiD BY: ~_t
:rl j lX6CLi2ld. IJdSifiDIA'TS CAUSE (a) /0'~~w~~' ~
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Cowditiowa. ~J u~Y. ~ 1_.y„~ j ~,y.~~
rhich p~[s rias to DL~E TO (b) 1.1a.~~.•~r
nAore tows (e), rtat-
17Q 30 ftl~~mlt • inq[Attuednl~riw/eawe . ~ i ~~V~ -
tf:G03B O~ DfB~~I ~i fa+t. ~iwan.~~••~
:8 DepalialeII3 DL'E TO (e
PART lI. OTHER SI(i~iIFICANT CO\DiTI0~3: caolriAut to dhtd Iwf uot If~. AUTOPqY T 191~. It Yrs, N
en Fiadu~ Coasi~knd
Pub;iC Heallh U ~{At tu t e tem~unl diee~se ~tiu iren in part 1(~l~ . YE~ UK \U ~n l~et ~ s Ca~nr ot Ih~thf ~
:a 48 houss af- w ~
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I_.a2h a vi0• IF OPERATIO\ NAQ YE RM 10a• DA'fE OF OPERATIOr ro~nY~R
OR~f~D 'NICH OPERATIO~
j: ai 18Wi E"' ~~iPI.ETE ITEIIS 2~ ~
E T`:~:_ic: =f ~
i 21e_ ~ycrif~ if scrw3rnt. ~uie~d~. hwui- 216_ t[OL'R AXL D.~TE OF I\JCltti :\tont6, I~y. Yrar 21~. ~E
~R a~rrrn o/ ~1+,*y in Pas~l or /_ie?t _
`:Tlbld. ~ V cuir. or manner undetem~~ned `i ~
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ST~TE ~
V S~d. IX~['RY AT RORK: ile. PI.S
nF ~l 01i~e1Nr~ld:ep. t'~~ Fann. Factor~. 21t. I.OCA7'10~ CC('Y (70l'X'fY
A (SpcraJy 1'as or ~o) ~
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ti3 OUT ~ ~ n. t~.N;lr ~nat (n c~. eo.~wA a~~.a a.e.QS.a ~--------1°--------- . is----7. a.---------- -l
J; "~THIS saw tL~ d~aos~d alin ou ----~v- . lt~_ , aad tbM d~atL oxurrd trom tbt caus~s oa 1D~ dat~ a~d Dorr s1aW abovs.
-:OS?I:AL~~ 32F~. Ii 9'E S1 fiD
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PHY•, UIitF.CTOK ~ PHl':. ~ l •
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at:c:~ ~f these ~ pHY.~IF1A\'~ 1~Z~ ~
4 ,~.,E ~T~~, ti~ .r. F~d~ ~ ~~DIPRL Ry
. is punishable
ine or impti50A- Al"RIAL 23b. U~7`E 7•k_ X_~\tt: Ot' l'E~fETf:ltl' OR CREai.\TORl" 27~1. 1.OC:ITIOX (~~ry n~r.. ~.r co.¦rr) (Sa.u)
: 07 b02h. CRF:JSATIO\ ~ S~lver ~ rTn 1'Nnt ~d•
REJIO~ ~L 1 Gate f H n
Collins Funeral Home L•~fl~'~~T~~`~'~~~ ~G~~Tti'K~ `3-h. L'\LERTAiCF.k:~
21. Fl'~ERAL Ilq~ig RF.GI~TRAYlO\
XCaI I~F.R
.\I~URES>
xt:~f~~ts~: FIlEO COUNjY f1.~.
. R~~F.='•.'.',•t COUR .
~ , :--r.vs r~ ~fiK =~ED
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Jl1NE 20,1973 ~.~:~~:lt
Date lssued:_ • NOT A~{~ ~
~ " , {i, r' ~.i :
- , . , . , • - ~ z t{ ~1 ' . . .
~
Tii t S 1 s TO CER T~ n~?T THE Aa~vE 1 S A TRUE AND COR'~ N
THE ORIG1NAL CERTIFICATE FI tE0 fh ORDER .~IITH THE Y•~ ,_:COL-
~.OF'THE UEPARjMENT OF HUMAh RESOt1RCES, GOVERNMENT OF
~ 11M81 A . . ~
• - `--.o }r - -
~
<; ~ 800K ~:~7~G PAbE~~ ~ ~ ~ .
~ . John H. Crandall. Chiti
- ~ ~ -.t~ -i . ~ ecorda Sectio~ ~ ~ - -
~ ~ _ ~1~.. -,~~a., _ Vital R
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