HomeMy WebLinkAbout2281 , 4 ~ / I / ! ' J l~..,C f ~ iC C l' ~ O ~
~
~ ~
o° i. CERTtFICATE OF DEATH ~ A~~
STATt O~ CALIIORtd1A-OHrARTMENT Qf N[ALTM i
' ti. t • ERY v r
I
L N A N E O i O E
C E
1 1 5 E D--/ M
S
t 1 u Y
E h 1kODl[ ~u k. U?tT w1r~ ~ OJ1TE OF DEIITH--rortr t. rua ~2~ HW~t r
0
_ " ~ Lero ; Nov. 17,197~+ ~ 5: oo ari
a ~ A M~. SEX 4. COl01l OR dACE S. dRTHPIAtE ;,TM,,,., ' OATE OF 01RTM A6E ~ un Maw.~ s u ~ ru~ w~ ¦
o~ ~ o Mals Cauc . Mich an Mar. 1 0 6 ~
~ ~ A S. NA11E ANO OUtTMPLACE Of FATFIER 9. YAk~EN NANE ANO &RTMPIACE OF MQTMfA ~
a~ e Trumeen Ler~y 7~rler-Michigan - Ros Anrla Ketchau • Ohio
~ 10. GTIZEN OF YI?HAT COllNTitY 11. 50GA1 SECURITY NUMBER 1~
f
e
v c
c~* ~ wwa moown. U NAME Of SURVIVING SPOUSE ~r ~rc oea ~w~or uwit~.
d~~ U. S. A. 382-1 4-o35z Married Winifred Johnston
~
? A~ 1!. LAST OCGIlPAT10N ~ IS- .`~"~s
a~'a~~•i
w~i ~ 16 ~ur~~~ ~Si ~£~ul4w~ COr?~Nt OR iMM 17. KMtO Oi INOUSTRr OR lUSU1E55
,b, ~ Saleamari 23 '~I. A. ler Real Esta e Real Eatate `
~ ~ A ita PIACE OF DEATH--wwc w Nosnt~i oR ornd w r~n[tn s4cam tAa STREET ACORESS-~s~cn uo ~ o~ wana~ ~8c. ~nwc cm coroun ur~s
~ ~frEtM~ ttf O~ r0~
~ Weatm~nster Conrnn. Hospital ; 200 Nospital Circle ; yeS
9 1l~. pT1~ OR T01KN - ~18t COUKfr ~18?. u.w.~ruu.cwin+vwr. ~1la ww+.«a.,~wrw .
M ~=.Weetminster ' Or e i 1 ~ 1
M Z i;14~? USUAI RES~OElKE-ST~EET ~DORESS ~sran uro ~n~n oa wunoo t9~ dKwE tm Co~rpu?TE uwTS 20. NANE AMG MAM.YW ADpRE55 OF qfFpRf1ANT
w 7C 1~srtcrr rEa~ Mo. .
~ o+~f9702 Bolsa Ava. S.80 ; Yea Y!sra,_Y3nifred ler f.
w~~. cm ort TowN cowm n~~ ~ 9702 Bolsa ~Ave p.155~`
p A~Westminsteir ;Orange ; California Z,Testminster Ca.92683
~ w 21R COROt1ER- a~-n r.a: 2b PMrSIG1AM ••ntn aur~ r~* ~u•r xcan~ 2k rNT3K1 OR COIqNfR--wwtMer~~t`w.t`e~~mt
~ - tt•n occewta u rr ~ •.a .e.e wn aa .a.n snru wn t N6AN~ R ~~1Y 1211 ` SIGkEO
T wt r~ K?'[ narn WM ~w~ nV ~ r.~ uzfts f+•~is ~i~~ w hr• . m~~ M Mct+f~a
p~K~~6]~~Yn~~.r~l4et~M ~
~ w A~Yy M M~M~ M ~[Mr1 w W I aR~ M\~~ M• ~{Y t\i!~ ~0~1 Y~ RY y~}~
`W ? ~ "
~ . ~ ~w47i16~; ~i~r. 21G AQDRESi •.~w:y.sw~sr~
~ l tt'1~"l~f It~M~'~'~ i~~1~1y ~2 ~ ,':~.~22~ S
bb~S L-c:~eh G~x ~ ~~t
s = 22~ s+c~tT,~uw~ mor~r 22a D/tTE NA OF C Y YAT 2~. ER--SKtu?nNtE ~s ~oe* aw~uco~ uCEKSE NursE~
~ ~ «~~..±aR=, .:-i~ - + ~es"~mins~~~~`~an.°~ark • ; •
~ ~ n ~ No 4 • ~ . : . • , _
^ ~ e ' . .3` " 'oe rcnor ~crr~s ~s ~na~ 26. a:r: r.~a~i~i+i'~c~ci,ii~ 27. IOCAI RfGISTRAR-'iKNATURE 2S. ~W
~ f.~an m o~ n. `
~ ~ . ` .
a= • z. r b ~ ~i.a, NOV 19 1974
i 17 ~ . _ -
~ ~ verca o~r o~rt ewsE ?a~ soa ~ a iwo e
.
i. x•- rc cwsE
y = ; ~ , _ CG~?w - iRa0x4 fc,~c.tw~ ~ Car~?w « $I~ncl~ 24 Ns,s
<:.i ' w?rc
o r , : p1 Af A COVSEO~lENCE Oi
n ^ l,~ 111TE11YK
~ _ ~~~~n~ ~ _ ~(,1/~C CX~~~ 1~N1 '1.~, rt- sErM~
j • o~
m~ ~ '1~ I f: '•-oR:as ~ oo~wvrcc ov ~ TM
~ ~ . NE , .'=J_r . - - ~ -
« ~ . - , - - fl5~to ~
Yf ORY7~ 0~ FOM~ ~[MO~N~ IO~ ;1~Pf~ 1I Ri NK ~AMG1 ~tl~
o ~ A!~ k pp~11r1bMS-- ~an+iw*+.c a ws wn .«.aam *w .wwn crM aw. r wr. 31. 32~. 3L.
~ ty ! t. + 1 f., s' 'v co~wro. ~ me» o~ a~smn rew• ~ wao ~ xn~ws
; /~i
a ~v ~ 1 jf aar.s a~~,e~ wans. .ts r M~ ~ cau er u.nn. s.tcr. ~o a~
~ =~-i`..~• 4 # ~V~ +,b
~ • •r ` ~ iMM tY~ ~?_LON ~
~ ? 3~.' Y.~ a Mordet 3~. wKE or ~RNt :wcu. rcw~?. svrr•. 3~5 ~~NJIIItr `T NWpt 36~. W?TE os ni~M+t- o~. r. .w ~ 36a HOUR
en+a wrar~s oc ~
M 2 ~ . _ 1
1 w
O M~7~. PIACE OF NiAIRr ~szttT w Ar~O o~ Wca7q~ ~M an 0~ tOr~~ ~37t w.~+u no. ~aa a~ u~~nn ran wr w rws 39 we u~a.rsr rms
+~+M~ ~ Yliti M~K Ul1t~f ~ffCl~ ~p M N~ JOtl W~ LLCO~OU
M ' wwnct m~ .arcon ase~ ~e~
O • ~
> 1 -
~ 10. OE7pYE NOM MJUR? OOGqtltED ~~aa ae~w~a a noes sa nswn~ r+~r. r+wc a wr ~ew~ s unao ~ wp
a ~
~ e C -
I o ~ C. D. E F_
' i
,
- ~(Y 1.~.f]fpYK~~ -
~
I
c fltt~ :,~I`_ k~ ('iti.~'iflE~
, ST. ~C~fi!:r`~Jt7kRAg tll.
ClFFS r; ~
p::•,.; - _ C.~URT ~
~ .
~ ~cv..,..,...~ i
~ s ~ 3 s9 PM •~5 '
31g~
E
[
' ~
~
~
1
~ !
- ~U~n
~ q, L ~.~~`9 t ..r*~>w, t~.
ZroY§" ~.r.~4 n~ ' . ~a ~
~ ~~~~,~'~'r~ r:~. . ~ _ ~