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HomeMy WebLinkAbout1662 ~ ~ ; t` i L I ; ~ 3 f' 7S^~l.ti4i./A+~`r.""sMN?wR~F"'~'y'r'~. w•• ~ ' y..`.... .w. ~ ~ - • . ~ t . . . r ~ . . e - ~ ~ ~ . Y::LID 4NLY I HE:?EF3Y CS}:T~Y TI~AT TH3~ ATTACF~?p IS A TkUE COPY OF A~:ECUnD ir~ITt{ Otl ~`'I:~~': 7'ifi: DIVISIOt: Oi~ YITi~I. P.Ir:C~)ItDS. ~ I.~iPi~r.SSF,Df OCT 3 t~~ j~ 3~a~(~8 ~.~j. ~ , j I~1`_T~ I s: . TI~1'E I~~G '1'Y.AH OF VI'1'4L N.E(~2tJS _ ~+'AhNi~a~: _ It is illee~l to dup'_ic4t~: t~i;s copy by iiotustat or ph~to~raph. ~ ~ . _ j _ f r i~'~# '~yr L'-yi•; '"!l'ES!~~,""rj'~:#~ c t-~'~.'~S 3i 3?.'k~~~~`Y.S.~ ~ s i ',i.:'r F ? ~~.j~,, ~ a ~ •y+.- +'4C~'E~q • ~.4 ...~vi.r: a: ~ ~ M :Y"" ~ "'~Yf. } ab` `~~t. 4~ _ . j ` s ~i f i. - : }~Y. `~~!t~,~t~ SS~....ar~''%.'~~~ _r ~ . c.a.~t - ~,8e - a , -r• _;h'i ~ MARYLAND STATE DEPARIMENT OF HEAITH ' DIV{SfON OF VITAI REtORDS, 301 W. PRESTON STREET, BAIT{MORE, NIARYLAND 21201 ~ ~ _ ~'~`-~s r,04?Q CERTIFICATE OF DEATH - ~ - ~ 1. OEtEASED 91J~ME Fusf MLddle lo~ 2a O~iE Of: Zd NOUR i s~ + py~. « p,;a~ J rt~' ; Rii ~ , . M - , z; nu swouHKs 1 SEl( l RACE i OAIE Of Btk . : n ~ E . ; ; Fetnale ~1Jhite -1 - ~ ]o &RTHPUCE (St~ a fae~e lb. (11tZR! G, :.~u.~ :ii~,aiki7 i. ~R~~ ~ ! - ; F u' } ~ ~ r~ar land USA w~oowEU O oNOe~a , • : - ~ - " ;t - ue. ~ =:a cm oe ~owK a o~aiH n. wu~:[ a eos~~u ort wsiuucw.r ~u++oc n no~p+d ` p5~ . .~eu5~[ssoR Ta~wson 9~e+treetuddussl_t. JOSe ~l r ~ . 'ilrent S ~ ~ ;c !',a USURI RfSlDEK(E (YYSere lecemed h. insl~tufwn Residence befon 13c (IIY OP. TOWN IIpt4Q - _ • e } .~a~rnsr~oa) SiAT~.T e~ 1 LOUNIY . "`~i"',~ ° " ~ S ' 1 ; - ..d.21218 - Balti.rnore ~ _ ~ tt EA1t~tR5 NAF~E FN ALd~ ~ last IS. 1101MER'S MAlOfN Y~ s ~ ~ ~ . ~.y ~ L. ttalter Jen'.cins - ` ~ -di`ioi~ _ •~:~n lEo_~~OKE~nD EYER iN` t1 ARM(.~~[S~d 16b.50(W SECI&I1T N0. il_ 11ifORMANi - J~V RO d ~ i:°5 214 03 997 ~l~lter S. Leontie ~ 8 v- 11 UUSE Oi DEATN (Er.w air one cwse pa kx I« (e~ (bk ond 1~~I ~nr,~~ aYCr m~uap PAltf L OfAIH WAS UUlSEO BY: - ' U1Mt01A[f tAIKE (o) ~ • ~ • ~ f~~' jJ WIf 10. OR AS A CUttSEWElKE Of S9~'I',8.~. ~ ~ ~ L'r (WId/1iWlT, t~ OOt. M~R1(b QQYf ~ _ ` `y rae to immed'ate cause {aj, ~ ~~.;s stcting the und~ilym~ corss ~ to oe ~s"cor+~o~~cE a eonpleta ocelision by recent thror~us ' € a~~. - { i~ P1Uti I. OTHER SIG!:;"r~Jtlii [01~9filONS (ON1RiBUlt!~ 10 DEAiN CUT NOi REUTE0101t~ T[RIkIHAt DiSfASE dRCOl~IitOi! GiYfN W PARi I(o} t 4 y. : py,~ r Q f9o.~11IE0E0PEiU1fON 19b_(OI~OtilOMF02VrfiKHOPFRAIlOl~WASP[RfOR11fD 20a AUIOKT? 40b. IF YES,YVEtE ftNBlttGS(0l~SIDt£40 W(ERIIFTI~iG t= rfS 110 (kISES OF OEATii? ~ f ~:4~ ~ ? , : 11~. A((18fU[ wAi ~e'*~? 21b. ItSSF Of fNN1RT 11c MOW U11URY 0(CURREO ~fMd net~re ot inpry in Part 1 ar Port Item 18~ ~ `a?9~ ~~cistcm~rc? fA1lSECfDEAiw IIOURAII Nbnth OaY Ytor ; o!N eil?e~. NtAy ~e4ta1 ttri~etl tM. 1~ . 11d +T11U~TT Ci(URicfO tie. PUICE Of INiUR'f ~u~irx~~iu~~. ~~~~w:,1 41f. LOUI110N SUect a R F 0. Na Gqr a{own t;Rmh Sro~s ~ t YrY.~le Not wMe 1 • ? ? ' 22or t certify thut~l) (t}us hospitalj ottended the deceased from~Ia , 19~],-. to~T~n~~_, 19~j_, thot (we) last ~ ~ wvi the deceoseJ olive J~n`~- {9~, and that in mY~ (our) opinion death ocarced on tfie dote ond hour ood irom the t causes stated nbove, (1) (we} (did) (did no?j view the body ofter death. i:b SiGM1UkE f 7lt. D1~Tf 54G~sD ~ t ( ~ e ~L DEGREf p}jn ~~~G C.~ ~R~(i0R ~ PttTS. ~--A O~.'~O3"~3. ~ # i:d. FhY Et t' 12a ADDkESS S . ~ _ ~ Ferdinand C. uez 7 20 ~fork Rd. 21204 _ -:s BiF?~:.1, CD,lMA110N, 73b. DATE 13c. ttRkrF Of ((k,tiER110R t¢E1dAi0tt~ T3d. tOCAlION (Gry a To«nI (Countpl (Aate) ' zuri~~`°~'~ 1-6-- 1 :oreland Ir:eraorir~l Park Baltir~.,ore Caunt•r .•.»rvland ,4 iC. Fti1~fRA! DIR[CfOR 21 25a. RECD 8Y R(GISlR4R RfG1SiRJIR:S SIG!JAiURE _ E ;~li liar~ L~. Johnson ~~r~il~oLoc~ld°~y~~~lvd. r . I ~ . 4 _ E ; ~2~5'U44 ! ~ I ~I ~ ~ ~ FIIEQ ANU E~ECOft0E0 ~ Sj. WC~£ COllMtY ft~• ~ ...-^aS ~n c 1 ~.~~RT _ f~. I V = ` ~ ac` t ~ ~ 3 52 e~'z5 ' E ~ ~ ~ ~a~K ~4~ ~ 16`~ i ~ _ ~ ; - - - - _ _ - - ~ ~ . . ~ : _ _ ~n Y . __3