HomeMy WebLinkAbout0913 ~ WEST VIRGINIA STA?E DfPAR7MENT OF MEAIiM-DIVISION OF VITAL STATlSi1CS
n r
M.~
~ ~ CERTIFICATE OF DEATH ~ , ! ! t;
~ fuft Last SEX ~AiE Of DEA1 month. ~y. ye~.)
- OPHA L T ~ z. I•fAT.~ I 3. Jan. 6, 1972
~~M=''~~. ~~o. /~n~rKM B RI DAY (ycua) Unde. 1 ye~~ ! lMder 1 d~r '~Y.Eye~i ) IQTN (mon~A, I COUNiY' OF DEAiH
~ ~h) Moa_ O~Yf I Mours M~n. ~
'"`k~u~e I s.. Isb- x. I d•.a - 21 189(? KauaHha.
~ IQ~AIIGN OF DEAiK ikSi~E CiTf l! :!:15 HOSP:FA: Q4 Ai!!Gq INSi1TUilON-NAME l~f not in e~tht~, q~vt aVtet •'~d number)
(SC"~ity yes a no) ~
r?` Charleston Yes ~a. Staats Hospital '
.
~~i~ Q/ ~ItiM Gf no~ w+ I CITIZEN OF YYMAi C~UNTRY 1VMRRIED, NEVER MARRIEO, SuQVrv~kG SPCUSE GF w~1e, 9~~e ma~den namel
y ~ ~,~,y) I WIDOWE0. CIVORCEO (sved~rl
USA i~o. 2•arr~ ed Freda Carver Parsons
. , k.Ya. 9-
~ fECURITY NUMBER USUAL OCCUPATION (q~ve kMd of work done du~~~+9 KIND Of 6U5~~1ES5 O~ INDUSIRY
moar of warkinq life. even if ~crire~
: ~ I ?a.. Retired ;•lerchant Groce
-Sute County Ci~y, ~own, o~ loutbn INStDE CIIY liM~15 S+ree~ •nd nwecer
i f (specity y!s or noJ
~ Y~~'a. I~.b. Kanawha I~k.Charleston I~<a. Yes 86 0
SIRiHPIACE (st~rc or MOTHER-NWtOEN NMAE BIRiHPIACE fstafe or
tamf~Y) { cou~try)
E T.H. Parsons I~sb. ~1.Va. i~e.. Laura Roll.ins ~eb. W.Va
j ADORE55
yyq dece~sed ever N+ ~F+e U.S. umcd forces? INFORMA T-SIGNAIURE
; ~~~r Ynkrown) (~f yes, qive w~r or dates o( 3tnliCl~
{ ia ~ ! ~ ~eb. Charleston :~.Va.
~ Qf pEATH ~enter oniy one c~use Per lirx for (a), (b), u+d (c)) Appro¦~mate ~n~c.vtl
S I bc~.reen onu~ a~d de~~?~
~ p~?n~ w~s cnuseo er:
' °~33 f Cerebral thrambosis ~ 1 month
y IMMEDIAtE CAUSE (•1
` s t"`''°"'• '"Y' Arteriosclerotic heart disease 23 years
~ .,,,e, y..e rise w~ o„e ro tbl
~ M~~ tauat (a).
~ ~A i~e ~x+der- _
..y s~,u a.,~ ~o ~d-
~ ~r +s. OiMER SIGNIFlCAItT COt~tDIT10N5: coadn4ons contr~bvtinq b deatb buf not re7ased ro uuu 9~~en ~n Da~t ~ 1+) FUtOPSY If yes were find~ngs
~ ` ;yes w ro) considerod in detvmmipq
~ NQ uvu of de~rl.
Diabetes I ~oa.
~ ~_+~~T, SU~CIDE, HOM~CIDE. OAiE OF IWURY (mo~th, d~y, ye~y i HOUR HOW INJURY OCCURRED ;ente~ npure of injvry in pan 1 0• W~t
z , ~i N~OEiE~M~NEO (wec~fy) item 19)
~ ~!4 I 21 b. I 21 c. M. 21 d.
~ . AaRY AT WORK PtACE OF INIURY AT HOME, FARM, SiREET, tOCATION (street or R.F.D. Pto., citY o~ ~own, st~te)
nnoif~ m p ~o) I FACTORY, OFFICE BLDG., EiC. (speci~Yl I
1
~ i2{a z~f. ~ ~ z~9. 1an. ,1
~ ~ t M~ad~d ~he dece~ud fran ~C • 1 7~ a Jan . ~ ~nd I~st saw ~l+e dece~sed ~lir~ o
~ ~ OS A. M• m on ~1.e date at+fea ~bove; •ni ro rF~e best of my 4nowledqe, irwn tl+e c~wes st~hd.
~ ilCsNATUQE (Deqree o. ti~~e) ADDRESS OATE 51 NED J
"1 ~ -t -zu~ { z~. ~ /9
~ CtE1MA710 , E AL CEMETERY OR CR 70RY-NAMf IOCATIOK CITY OR iOWN STAiE
~til~
p:; Burial. ~ z,b. Suns e ~::em. Park z.~_ South Cnarleston tl. Va .
'~f (rtwmh, day, rea~j FUNEkAL HOK.E-NE.M.E ANO ADDRESS /t~~~et o. R.F.D_ /io., erfy or row~, st~+e, x~D)
~ ~ 8 1972 Bartlett-Eurdetts ~neral ~?or.~ Charleston ~J.1~'a.
IR URE DAiE SIGNEO I DASE REC'O OY IOCAI REG. REGISTRAR'S SIGNATURE
- Garnet F. e ~%i' I zk. Jan. 18, 19~~a.. .
_ ~1-t~e) ; . •~i,'
fi - - - - - - - - - -
p~~, t ~ I hereby certify that the above is a true photo-
~ . , z- . static (p hotograp h ic) copy o f a recor d fi l e d v
r i t h
' ~ = the Division of Vital Statistics, ~'Vest Virginia
`;y~ S'; 9;~S T i C S = State Department of Health, Cha rle ston, VJe st
Y.a . . : ~ Virginia.
~ Witness my hand and seal this ter:cii
~ ~ day of Dece:; ber , 1 9 74
.~a O R
so0x~7 P~ICE 91~ ~ r
~s N. H. Dyer, AQ. D. , I~'I. H. , State Registrar
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