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HomeMy WebLinkAbout2894 ~ a , ' i . CERTIFICATE OF DEATN ~O'~ ' -i-:r~r~~o~rr-- sT~~ oF c~u~or~u--o~~r~rt a Pwut ~u.n+ NAME OF OECEASED-N~sT ~rE ~ t~ ~potE ~urc k. usT 1u~r[ • 2? DJ1TE Of DEATI~-ro~nM a.. .w ~2~ MOUI ` ' ' 2s3e a ~ • 1. COIOIt RAGE S 81R711PLACE 'n~f!rewus+ 6 QATE OF lIRTM 7. ~w~ ~ n v ~ lre~nl Cat10 I`t.8 • 15 188 86 DECEDENT ~ 6{IrT1tPlACE OF fA f MAIDEII NAME AMD N11?lNIACE OF MC'TNLR ~~w~ ` ~I PERSONAL ~ 1 ~ i~ p~~~i]~ \%V~ DATA ` q. tYl1Ai COllIITR1i tl. SOGAI SECURRY NUYER 12 r~~ anc~ r~~o w~o~n 13. MAYE 0? SINIVIYUKi SPOUSE ~r +rt e~tt~ uNr~ ~~utr MvOau~~~narn • ' II.S.i. - 0~-12-9003 D Wid sd u usr occlRAno~r ~s ....u: '~s »s~~nr~o~wc w+r,un a rrw KINff ot arotiST~r at eus~ncss 1~ d 1S~ PIACE OF DEATH--N~[ 0~ MO/tITK OA OTME~ M tAT{tNT fKlifr ~Ib lTREET AOORES~i--~~n ~ r~w a~oc~rar~ ~M~f ~0~ Coino~+tt~ Ull~ri P~AGE ~ . ~ U~ ~ DEATH ~0 T~ ~Itc G ~ ~I~? ~1~+'~sM~ewnN•rYR~r• ~iN u.r~u.nc~a~w~ ~ 1 1 USUAI 1!~ IiSUAI IIEStOENGE-srR[E? ~oo~tsa ~sr~[n ww ~uw~. w wa~+o~~ 1 s~'ru~~ c~r~ a~ f[ LIMri . IfAYt AND MA~UNG ADDRESi OF RE5IDENCE ~ ~ R~ ~ . oi.r+ acwno • N[ lTATt ~N.w~. ~u »c. cRr on Towa ~w. cou~rtr . ~ . ,4p7 S.W. Di]cis A~emns . +is+u.a ~.oa aoo~seor. ' 1 24?. COROPER ~ rw~. n jb IMI~SICIAfl' ~ r~ • 2k w~~at . ~ e :..~...cc~~..nt ~ r.+ wn ~r nra ~~~a~ rs.~ '~ICNI. PMYSICIANS w~"~"""~••n"~ea~°n'"~I.s.~~".~'~awm~aao~w.,u~.,~~s.rwua~ ~ ~ ~ ~ OR CORONER'S ~~w~~~~Y•~~~~uw r~ tQ ' ~ . ' e~ frr~r Maw~ r w~~ :~ta ~ r.+u Y~ tiY ~an ~in r. nr ~ . O 2k. ~:~w ~~r.r~ CERTIFlCAT{ON ` ~ • '•~~r• JUSTfC~ WS 11?Ip[lii j _ -,i~tlta+ f.:~wqr' ' 1 ' 1 22~. ncus? arar~ir 22~ OATE S „ 2! NAYE Oi CEYET~CI~ ~ EA 'w ~ ucuut MaM[~ FUNERAI. car~e~o~ ~ 1 CIRECTOR ~ 0.,~ • AN~i e.n .~ti•,o.w.u+•~.n~r LOEAL 2S. N~rE Os NhENA~ pR[tio~ ~o~runor~twwiuw~t~r 26. ..~M.°~rr~irw~~~caew'~'r 27. RE ~ t~ 2 C~~~~ - .wtc/s +o o~ ~n REGISTRAK 29 PART 1. o[~rM w~s rr OrtE~ aar oN CAUSE ?E~ 'fol~,~~ ~ J [DU? wSE O ' C~~.~ ~M~Oi1- I C~ . ns ~ co~sc , a - e~co ~c ~ cowarwMi ~s u.r. w~ ~ ~ ?C l A _ ~ ~ ~ ~ cnuse ~.,,i(R~, ~ Q wvc asc To rMC ~rrca ce ' OF ATE CAYSf ~A~ STATIMG DEAiN Z TNE YNOERL~~MG C~ulE ~ T~ A COMfEOUEME bi ~ DEATH ~ <C) . . = 30- VA ~ OTNER f~CIp~K~urt COMOrt~ONS- ~un wn w* r.un ~e r.a .~rrn u.~ a~wi r~.a.e±~a~i~ ~"s+a~ » a~ ».rice. n2 ~ p M ~ 32~ ~•'~~:a i~c+.~ n+ ~a ' Y ~ ~ ~ ~ L ~ Q mc;...... . .o..~. .w ~ 36~ HOUR 33. SPEpFr ~ccw~xr swc,u a Mo.~aa 31 w~u w ruw~:.n.. 3S. AT ~rdM~ 3iw oAtE os n~?wRr- M~G ~l+s tY ~ , ~VlC~I~ OL~~ . . ' . , ~ a - J ~ 1 hJURY 37~ PLACE OF 1NJUR1f ~ srr~t uw w~w o~ ~nunow w~ ertr o~ wn ~ 37~. ro w+r ~ a"'~"~'ow. ~wv. ~ i~ 3!. :i ~`~e.~., ~ .ar..cc m. • .~cc.. W - Q ~ ~ INFORMATION ~ wo 40. OpC~IrE 1101M WJUR~ OOWM~ED «•ru owaa ar ~n.n ~.ri .nwnr ~•.w~. ....r a.w.. e.ow~ r orm w~rt~ w~ ~ ~ • STATE " e + o. 3.1 p~'~ r.~~ S 9~ REGISTRAR . ~'1 . u~ ~ -~s.~ v~.,^ti:~"~.`g'~= ~~}J~:1 ' >+~c~;~' ~ r ~ ~ ~ f ~ _ ~ y i{ , _ ~ . _ _ . . . ~