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HomeMy WebLinkAbout1076 COMMONWEALTH OF VIRGINIA - CERTIFICATE OF DEATH ~ ~~t~rr oF ~ni - suaEwu oF v~r~t ~ooROS ~m ~un~ sT~nsna MEDICAL EXAMtNER'S n~*~ ~ ~ 0~0 CERTIFICATE ~ - - ~ ~ U ' i soc L"",~ ~Ji~,~n l,~rz~~v u.~ z ~ E ~t o , ' ~i.~ ~ ~ .2 ~ ~ :.~-r~r; ~-.-~-r ~ oe~ ~ ~ ~jS~ / ~ ' ~ ~ iK ot ..~a ~ . 7, ~o~urtrtt Of DO~~r WBShi toD Hos • ~~4 ~ ' "r0"~ dr R~•• r••e~ ~ sn~ wooeESS oe ~r. Na. ' °'0~'"Frederiskstiurg ~ 0 ~~`I°`~'shington Avenue : ~t.~:~`°"~'~"'°f ~«,M,ro~~~~ ? ~s~oa+~ ~ ~2 o G ~ ,v ~ a~ ~oe+ce ar « a.. rr:et ~ ~ oe e~ ~ l''IiLFo o ~ . rw M~oH~ w~w~E oF a o~sm 3!, ~~~v N ~ C L~ ~ oF occ~ws~o G Fo G!G 1 V ` w„~v couaa ~ n wi~ ~ ~ ~ u ~ ~w~oow~, !J ~o ~ o ~v ~ ~i~u~r~Erz s , ,a,,,,et ~ ~ ~N..... o. . « 21. .m.u?cE p.u er ~ ~ -o ~l ~3~ "°~..'~.i~v ~l - ~ ~~i3 - i ~ - ~ R.a.~ _ a ~ • ~EAZCJ~fj~( , aw?wrw.na. ~Gn?E2 r4c. .~1'o•a w ~ ~ F~ wae or o~ ~r.. wr w w o.r i.. t.r ~ q..r ~q ~va ~e~ ~~a a owM wns uwsEO nr. ' ,,,~~~W Corona Occlusion °"~~"'D~o"~. ' fllEi' ~v. ' ' ouEto ST.IUC:I ~,+ii1~iY fl~. ! ~a~w~,~?idoown~ ~ .:~RAS r 'V i ?riaw cwu µj ~~p ~y _ : ; 'r.y~.~°"br' cueTO ,4,~ CLE~:t, i., _ ! ~ cFr:'~~ J=s'..:CC 'y` ~ U ~ ' uc a ore~ i ~ ~ ar+s c~ W erurr~t w ot~?rn wr raor ee~tm T~~ ~~0 ? ~ I wurNOaz~ I r wws n~ w r~c,wwcr w ze~ ocr~u cwus~ oF oEwn~ wws o~cn~ ~ww wiuer occueecc~. sr. i ?nsr ~ ~rns~ w••+•. ~n or von ` 0 ? O rnw~rp «coKrwurwcp i or wuer I~J l~r! b~Qf raxxr oa.u~ R Ml v6b ~d rhi~ Mn~A otfn b1dG. Mc) 1~ / ~ rx _ a.oeF ~ atx! ~ 1 g ""'~"~"~'e~s ~ O~ 0 D"°°' p-.~ r q ' ~`~`~"'~D p cmr ae ooa+rr o~ ~r~, ~ K ~ ~ . ~ l~ederickatiur y./~ 0/6? ~ ~ u~« d ~ ~ D ? ~ - = .~.~;,,~.~~~'2EEn~Lt9 c~ ,~04. t,~,v~ - 1~~. ~ = ~ r...d e.w. a,. - q~.a~ '''"""E ,,,,oR~u` /~/Y~YS ~/~VE ~1 q C.. x ~~a`_' ~ ~E ~ 1' ~ ~ . . .:i;'l. DATE RECO~p ~ s ~Jy ? t . FRBA ~ - , ~ ~ ~ ~ . ~ ~ ~M ~ ~i~ ; • 'e i ~[~~~~y.y ~ f ~ • V~..: jl.'~T'Y1~~~ ~~r.•-~ . . ~ ~_~tts~~~ ~fiot this is a true and correct reproduction of the origina! ~ re d"~i`~' cw th the_ Bureau of Vital Statistics ' Vir inia De rtment of . 9 PQ ~ H ~Ts;_(t~~'chr~iond, Virginia. ; ~ ~ ~ - ~ • ~ate Issued APR 2 1~7~j DEANE HUXTABL , State Registrar ~ ~ : ~ ~ ANY REPRODUCTION OF THIS DOCUMENT IS PROHIBITED BY STATUTE. ~ DO NOT ACCEPT UNLESS ON SAFEN PAPER WITH IMPRESSED SEAL OF THE BUREAU OF VITAL STATISTICS CLEARLY AFFIXE~. ~ ~ Section 32-353.27, Code of Virginia, as Amended. gpp~~~ ~~1p74 ~ ~ : - _ ; _ : ~ s,