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HomeMy WebLinkAbout2705 ' macitanu ~ia~c uernK~m~n~ ur ntn<<n ~ l~ ~ r~ DIYISION OF VITAL RECORDS, ~0! W. PRESTON STREET, dAITIMORE, MARYIAM~ 21201 ~ `J C E R T I F I t A T E O f D E A T H n 1 I:~ i : ~ rr?~[ ~.s+ r~aai. ta a?t~ a o~?M x eotnt ~ ~ ~ ~ ~ ` .,''"a'? .ARROLl~ G- A"°w~ r M:~ r i: x a< ~ ~!A~(E s rou ~ rt.+ r ua~ H w Q'* i DAIf Of l~tiH AGE (M Mp1~.E C A veaS1 /~/~KC'~'~ 3 ~ Y ~ hu ~~ama an ~ r+. ti' -r,A[E (kcN a fongn n utuu~ a wrw touirtm ~ MII~D ~NEVER MARR1fDQ 1. COIMir Of OEAfN t~ ~~i ~j ~~:.ti~ NC~N . V , w~oowco p OIYO!(fD ~ ~O IVTC•o M E R . : ` ~ . . ~ ~:i IGAN Gi GfA1M 11. MAME Of HOSMfAI OR tlK11TU110M (N aot n Iaspfd 120. USUAI 0((UPA(ION (I(r~d o~ woflC' i 1'A KIIRI Qf \fSSQ~ i=' . :~~rNL~bA ~sh oddr ' inoitol akmgwh.sv ' L~"I ' , F-' ~ - O ~ ~ Pti:G4ti:E ttlr.a~ deuoud M.eI, ~I unt~tunorc R~s~dwK~ bdoh 1]c U110R TOWM ~ot tm irns~ Ue. SiREfi V •,~E,. ; s•~ y 1- . - : su;t~.HR ~AN ib tr ~s"s-•-- , ' , Y o etinE ~THc~~ res~ ldG~ H~ ' i,4fih=;=; ~ f ~i~S ~iRME (rtit MYdAe L IS. MOi?#RS MAtDfN MAME f+st ~3 ;'~~t . ^ , vi~ ~ ; ~ . ~ r, G ~ AR1Zd~t, 1.s~~ C'EOKG.E H~_tr~~ p' .;s. .M~I,,. ~ . . . ~ . ~u atEASED EKP IN U i AR1IlED FORCES? 11b. SO(W SKIKIiY N0. Il. ~ ' - . _<,a~,..o.~,~~ ..r.w.~,..o, ND N M~~IC~.IAN IKr ~=~r~,'t ~ 'e~ . J . F • ' 1 , + /~-~.,~'.,~w k ._t ~4ji ~ . " ulISE Of D[AiN (Fn!er m!Y ane cws~ pa Iw~ lor ~a~ (SJ, ad `~lr`: ~'+~.'4.i:'~~+ iM N . i ~Ai? 1 OEAIM WAS (AUSED Bt ~,L~~C-jC ~O 't~ fli ' . . ~ IM.kfOUIE (AIISf N) '~~{~'t : ~ • , ' - ~ I.' . , ~ . ~ N . ouE ro, a u ~ cowsccuE~cE a ~ ; ~c ~~~ns. o~jr. ~rnan yur. ro) ' • , j ~'a~amed~ah~ouse(o?.~ ~ - tAt ur~t''ymg tovse 01lf T0. Ot AS A((NISEWEN(E Of / ~ ! ' .lc'C CvL~~-t~-t"9'L`. JC-eil,....~ . r - ' ,r~ 1 OtHER StG~JKAqI (0l~ITIOIIS (OMiRIW11NG 10 DiA1H 6Ui MOf REIAT 0 THE TEtMINAt DISEASE Ot(ONOlTION GfYfJI W tAtl I(oJ ' i . i C - _~ilEf~OFERAf~O~+ t9s (ONDII~ONFORMrHICHOPfRA1?ONWASPfRFOR1IED !Oa AUTOPSt? 70E. IF YES, INERE F?~qINGS (Ot~DtR[D ui (ERn~r~!tG y i (AUSES OF OEATHt ' " ~ ' ra p p ~ ~ , a ~ , , : A~ iDEN NA UND(RtYlk 11b 11ME Of ItWRY . 21c MONf INIURY 0(CURRED (Enta mhin d rywr M Pan 1 a Port 2, It~m 11.) _.4. I t ? ~ ~ : , r•, iotac p«ne u a.~~ HOUR A M. Mon1b Dap ~~or ~ '-,er, r.a~~~ meE,~d taunsr.et) VAl a+ . ! r,~,E~ 0!(t~iciED 11• PU1(E 0~ IKIUitV ~T r~~. 21f. l0(A110N Areet a Ri.O. No. Gy a iowm (oun?p Srn~ t ~ f ~ ~ !~k,~ ~n ~a~u raowc~ nc ~ ? t ' . - . ot wc~k ~ ~ - I ~ I certify that (I) (this hospitol) ot ed the d~ceoud ' , 19 • , to 19.~_. ~hat (I) ~we) lost I' , sor~ the decwsFd olive on ~ 1`y 19~~an that in (my) (our) opinion deafh otturred on the dote ond hour and Irom the r~i ~ : couses st5ted a5ove, (I) (we) (didj {d~d not) view the body after death. y.« ~ : r.:~~:f ' ~ ' 77i Oafk v~~to ' r~'~ ~ / ,~nE?~c ~n. sr~v? ~ : ~ • i i ~ ~ -r~t-i~.t~= `.DFGREE ~~r-~.`- i ! ~ _ ar % ~ ~-I PHTS D1RE(!OR ~ /MYS ~ ~ ~ / C ~ , , ; ~ I?e ADUR[SS ~ L . ~ ; ~ ' r:t,~rti - ~ .y ' ' ~ Mr ~ 1 . £ _ ' - - I ` 5 ~ Ii~, LATi %L yAM! ~)f ([1AlItMr OY ~i!MAIURr ?~.f lOlA11UY (l~t~`~ r,+.N - - ~ ! ~ t1 . ~ f~~_ t.{_~a l~l~~ --~'~'~7-.!~,~,~~'~~.~_~r',~,~n.n~~ fy~,~?;,~-~ ~ f~ ~ ' ' - - - - - ~ - - - - ~ ; . wi{•~ _ ru n H. r~~.~~,uA~ ~ . , . i ~'j.1~.~~~~~ ~ ~~,`~/~;,f,)r' ~ ~ F i'r ~~~~J~•Sr111 l.'f~~t ~ ~ ~ - . . • F 1~ ! . . , ~ # .w.: _ L-. r f«La ~`"~.-o~~zti FiI~- ` ~ St.WC~- ~-•.a~s t ~ ~)R~~~ER1f1E0 vJ:+•~~ ~ 6e~'.~~ ~ ~i~ ~ 5 ~n42'72 ~ooK2~35 ~2704 ~ ~ y , - - - ~r~ L ~ _ . -