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HomeMy WebLinkAbout0863 3241 ; ~ : ~ ..,,"':3'~ili~~'4"""r`u... . . . . . -~.-,.F , , ~ S°I 1. , ~ , . • ` . ` ~uRCE DISTRICT OF COLUMBIA . . ~ ~ '~i i~Y ~EPARTMEIVI' OF HZJMAN RFSOURCFS ~se Rad ~ ~ , f: , - CERTIFICATE OF DEATH '~4 (~2~~$ ,~r+ehU~ ~974 , . ; . ~ F[LS DA1'S Fus N~. 1. 11A7R Or DDCiA~ /~int lf~ddle Lod L. DA7'E ~l«itA Dw lMr ~ s. 1MR d . m'°' p'"°`~ David JoBeph Casey D~'s'$ ~pril 12 1974 ~ 7=SS p.a;~; . E!~ 1. OOLOR OR AACS ~Ser~r ll~rried, l~duried, DAITs OF B]R1R A(i~ (lw ' ' ,~aasso~ldb~ !~lale whita "'~°~i~!!° ~ Kar~h 31, 1913 ~ ~ -~Y uT ~ a rtr?c~c oX nsnrt[ u~r Washloolon. D. C. L'SUAL R88IDS.~ICE (IIAwr ~erri liwi. t/ i~wtihifiM. ~IMt1 1~A1~ NAl[S OF HOSt1TAL. IdVR,81I~iO HO~tB OA OTHER 1N8Tt7'UTION 8TATE h OOUNTY ~fa~i111w~~;`~ (JI ~re is datwtiw~. ww .tn.e .tin«) • . e. CITY a IIiBIDB ~ s~outd D~ Nashinqtaz Hospital Center , t~Y~s o~t~ :;1 ~lashi ton 20009 • w r i!!~ n d. 8TRH1's7' ADDRE88 ttJ ~t.. ~ P~• 2480 - 16th St. t+lUl A t 20 ~ 3~ 1~.9CAL O(.`CUPA't10N ((:in kid el low~ lOb. H1~1D OF BtiSINS38 OR 11. BIRTHPI.ACE fi C177Ett1 OF VYRAT COUtiTi h`f Retid~'roducre ~erk ~ Kl~a~ Gian~~ood ~~~~ass~ ~•rry~ U.S. ~ ~ - 1~a. FA'/'RER'$ NAMS Ub. atOTHERf! ~dAIDS~T ~A]dS 11. NAldS OF BUAVIVP.~id dPOU88 Tho,mas H. Case 1`'.arv O~Brien Juanita ~ase C8~f3Cit~ ~S. E.•er ia U. 3. 1~. 80CIAL 8~(.'URI1Y I~iO. lTa. 1NFORMA~iT RBLATIO\SNIP TO DBC6A3BD lid. ADDRffiS 8treet City 81at~ P~~a~ 02 -Ol- 02 Juanita Lase wi~e) satae as above xseord ~I~1011 I!. CAIIii OT DL118~ (Y~t~? od~ m~e nws ~er 1'u~t !or (6). ~d Ltee~Q B~t~er 01Y~t ~ r1Y lXKt~l~. PART I. DSATH WA8 CAII88D BY: ~ " ~~~V: ; 11I)dEDIAT6 CAl18E • ' L /t- ' ~ CuMiitio~u. ~J aY. 'I~ ~ ~ rAirA N~s riw to DUS TO (D) / • ~9 ~..r ' ~C. ~ ~ ' r~ !O ftlb~ i eboee ~sras at~t- i~~ tAs ~o~dairiy caws ~ J ~ ieat• oi Dsath ~ ro~. Dv8 To (e) ~fC ~ ~ . I e Drpart~a~o! " ~ H~~ ~ PART 1[. OTHBR SI(}NIFICANT 00.' 1'[10vS : eoo ' uis b th but aot 1f~. AUTOPSY T IID. It Ys. Wae Fiod'uP Ca+idwrd ~elated w thc te~mi~l di~e~se eoodition pre~ m put I(~) Y~ OR NO iu IMRmioms Gre ot D~af?t : ~ V ~m ~b IF' OPERAT[0~7 VPAS PERFOAMED ~y DATE OF PBRATa..t~ON 70b. Ca~DITIO~t FOR V~ OP RA?l0 viCittiOn O~ COMPLETE ITF.atB !0~ ~nd f0A I f ~ l/L wA8 PBRFOR)dSD / t~. ~ xi oi !Ae Dis• ~ - ~ ~1 - ~ yc ~~Lf/~-^ ~ . Of ~Olul~~i. tle- 3peeit~ it aarideut. wicide, hani- 31 . HOUR ~!U DATE OF I\JL'RY: ]ient6, il~y, Ynr tlc• DESCRIBE HOW ]7N U~Y OOCURRED a cide. or maeoer mdeterm;aed (S~ter ~wrras oJ lywy iw PMt I a? Art ll) . Ji (4j 21d_ 1\IiTRY AT WORK: ile. PLACE OF I~JI'RY: (At N~.~w~. Fa~w~, Paclory, 21f. I.OCAT10\ CITY O~U~ITY $TATB I'IFIER rp (~~'ijy Y« or \o) Strcet or Ol~~e ltrdduy, ttc.) . ' -..a. L 3S OUT ~ ~ 22. I ustil7 tLat (n (tEis he~Dl ~d • d~c~awd - 1l------• - - 1~- - Qst ~ )R "TFiIS w.. ~n. a.o.as.a an.. os l~ ih~t sroo oas~jasa on ie. Lo~ ~ :OSPITAL" ~ ~ tm.~D CNHD 22a. SICl1ATQaE s ~ ~ A7TE\DI\ \/F.DiCAI. STAFF (J ~ L • ~ ~"f ~ r~iti•s. »utECroa PHY~. ~:tion of lhese 2ic Ptil'~1CfA\'S ' ~ 1 231. ,1DDRF~S . ~ \~~f~ (Trr~) /r~I,~ /G ~ ~ . !rG.~~I/{%/f/(~ I'"r?' _ . is punishable i or imP=~tt' BI;RIAL tib. D~7'E 33r- X:?~1ti OF CE~IF.Tk:RI OR CRE~fATORY 23d. LOCATIO\ (Ciry. to~rw. w corwti) (Si~t~j ~ • ~ or both. CREJtAT10~1 i Su' ar_3 !~ld. a~a~ocni. ~ 4_ 4 Cedar hill ~remat + 2~. FC\ERAL IiO~fE r„1,y~_E, • L'Sl~ ' S/S ti 'RE 25. LNDERTAKEA'9 .~~H Z~S 5~_..ls 1~~... ~ ~ v~ \~Ih R TIO~i Z .1i)DRFSS ~ ~ - - X. itti\f ~RKS: Ceasus Tnet ~o. D.C. Sirt6 Na~ (if ler tA~a 1 y.) , , :2 ~ 1 . ~ . ' - . :t`~j_~. . ' : ~ ~ ~ :='~`;J.~ ' ~ F:~.a.r.. f -i ~ -yf1• i' ' j~ ~ j~~ ~ '`~t ~ ~ " . ~~j ~Y:~S 1- 1 ~'~~f~!' ~~.3`f t • APRII 15, 1974 ~ _ . . j- Date Issued: _ NOT YAl1D; ~'t .f~ ~ - -t- .e... , ~ ~ t ; ~THiS !S TO CERTIFY THAT THE ABOVE IS A TRUE AN OF THE OR I G 1 NAL CERT I F I CATE F I LED I N ORDER W I~~~ . : ~ ~ . ` ;:i : ~ D IY I S t ON OF THE DEPARTMENT OF HIJMAN RESOURCES;~. . ' . ~ ~ ` ~s' ~ ~ ~ ` ~ , t ~ V i ta I HReci ~ ` ~'l ~~iai ` ~ ~ ~ . --u . ;g~. ~ . ~ ~ . . . ~ . r . i : , . ~{s . . . , ~ 'V ~ ' r ~ ~ . ~T~WCIE COUNIY - ~ ROGE~ ~OITRA3 ~ CLERK CIiC1i1T RE~ORD VEF'/tE~ ~ ~ 5 !Z so PM'16 ~ ~ , 8~ 324 w : ~ ~ i i 6J~ K i ~~vt i : ~ ' 1- J ~ ~ ' _ 1 _ s~1~ .l ~ .elrs~is.~~~f 3_~"~T+-rY..J baK_..~c+J~ . ?r~~'r~,s7'1= id