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HomeMy WebLinkAbout1079 C4MMONWEAI.TN OF VIRGINIA - CERTIFICATE O~ DEATH ~ OEpARi1KENi OF FtEA1TH-NJREAU OF VITAL RECORDS AND iiEAITH SIATISTICS-RICilMOND ~ ~ ~ ~ 3U'~'7!~'~ u""M": ~ ~ 9 Ci i ~ 3 ~ 5 ; ~ P~ : x: `p~ ~o~l ~ `p ~ ' ~ ? i R~ 4r1 N.a) 0~1 a wce p s uote fewt s woEa ~ od~r i co~o~ ^ _ ~ , . ~"-..r.~.. „ Q~~ 1w~ _ / l MY! O M~9~1 ~ i1 r M~rl ~ 7. COYMiY Gt W:.~Mw/..~ Ny. b.w M.+~) en c~ 1~1p 2iC~.~ a~~ torw .w TMai,v....wu s. ~ ~a~p no~ d ? u ~ • ~ , K~ p ' ' ~ 1L CdMI~ Oi 0!Q/IfEC'S i1 iiy+wM~+MI. Mw~ WA) ~ r 2 ~ rl ~ ~ Ct Y~C~1 i 1'~~ n. c.. aa r~.. ,i s.~er .aoass oe .r. .a~ 2Q~ ~ o.. a.~ R,~. 3a~ : ~t o re~o~ ~ .uoe. or V~~ +R~ ~ 1~~ l~ ~+aNa a ocaw~m ,f~ . ~ V~ ~ K ~pC7~1 q '17. rW~ ~ lEYE! M11tlt0 ~ 1L i M~W[O O~ wI00W@f~, - .r.~ L7 ,~"~'Y1 C~ rC Ct Y~' . ~ s vETwN. .«r..a. r- r~. r~iwuce n w~c or u~ 1r.~f b••~ }.wi~ ~ w ~rr OF O[W?S~ p ~[RAS(O - ~ ^ sc ~ a u~st ~y _ ~ M ~ ~ ~w~w~a~s as soNCt . l/~ ~,l ~.om ~l sAre v efw1N ~.r...lr.rww.~r i.atal.dq. - O~i~ w!o 0~[AIN ~ MR l~l/1fM MfAf C~Y9f0 t1~. . W N a w N _ ' .3. ou~ ~o fILED ~H;, {?".Cv~DEO ' - ~..+r.a K..a.~ra ~w. w IN - ! . _ .....sa.....w.w.. ~ ; -~...y,~~~...r.~ RU''C: =;~•7P~S / 7 ~ w~_ ~4'7 ~ ~ . j :R~~ A CI `RK vi.c~~,~IT NriU ~..I l ~ , ~wf L Ofll~I trOMC1~t4 Cdp110~4 CbM1~~1IfNG 10 Ct/1TM ~YI MDi ~4Ai~ 10 i~/M~M~' ~ 1f~ IAIOK71 ~ O~EA~ C'O~OQOM Gr1~M N MQ 1 W ' ~ ? ~ ' NlIMt OG[YfflO~ i~/~ wrr~ ~ ' ' ~ i Mp MEG?MNCY N CONfYWIM6 ~ • •r•r t+ rw , r M q ~ r ~ rt~w~ ~ ~ 6i EKRMMI 11pfM7 YlC. !i? 11~! Of NIIRf hrl i4/1 /~wrl tY. ~t1YfT OOCWqD ?ft_ RACE Of MlY~Y ~!i1 ~oy v rw~ 1u~+A 4~w1 AJl ~.li ~N ~r.? ~rwS ~li~ Yii.~I ~"'~'~~'tal w wk ~ ~ew~ ~ ~ / a fl~Q~1A~w1 . / „r~ . ~..~~..+....e....d.. awvwr..+»~....w.a... ~atJU ~ t N G RF ~ VA a V~' ~ 9 II ~tA[E ~ ~ QAl C~iM1? Of MI~M(.t.i<z.., I+r~~d~w~wf~~~yr~. ~ry~r/~wr~1 - 6rW ~ ~ r,:. ~:~,\E, a(~; ~ . ~ / C/ / I ~ \ ' / 4 MA~'~~MwWM - l 1~~, _ wwe a~ ~e.K ~ 1 ~ r` " - . r . 11 ~ 4 1~OrE NO ' Q n ~S ; ~ ~ ~ ~1~~ ~ r~ ~ ~ ~ , f ' i~~~IM1 ~ ~uD.~ ~ . _ 9 ~ - ~ - x• r'~4't~ 4~ Z4 i ~ This is to cer,~+fi~.thqt~:this i~ and correct reproduction of the original ` record filed witt~.ths..~' ~6~ Vital Stotistics, Virginia Department of Heatth, Richi~Soi~d ; Vi~ _ o:` , ~ ' ~ _ - ~ Date issued MAR 31 1~ DEANE HUXTAB , Stcte Regist~ar ~ ~ ~ ANY REPRODUCTION OF THIS DOCUMENT IS PROHIBITED BY STATUTE. ~ THE BUOREAU OF VITAL STATOI T CS CLEARLY FF XED. ~E60~~p.~K~c~ °~~1077 ~ ~ Section 32-353.27, Code ef Virginio, ~s Amended. , . _ . ; ^ ~ ^ ~ ' . w,.~~.. _ : - - _r ~ ~F~~