HomeMy WebLinkAbout0872 Q C.OEPf. dF P~R .
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CertifiRcad ~,~~,L OLS;. I.. I~~ ~I D:STAICT OF COLCERTIFI ATE OF EN?~ PUBLIC HEALTH
Carcfully BI~TN x0. - ~o. 72 Q° 46 5 ~
1. NRI[t O~ DlCLASED t~.,.~ .~t~~dr. /.a~t h. 1)ATE ~/owtA Uey 3'n• ~ ffi. Hour of 1)tatV
(TYPr or Pnai) (?F
J0~8~i J. KENN EDY t,s ~rH Dec . 11, 1972 ~ 11; 00 a. m
yr lftiri Oi lII' i. ~~X 1. ('OLOII OR R~CE S. ~~~~~r \farrinl. \I~r~n+l. i. UA7E (1F HIRTH 1. .~GE (fw ycan T
aiicn :hould b~ Y.'doxed. Lh~o~ced: ~~+.~~fy bit birfA/~y) . o~t p arn ~w.
Male White Widowed Jul 31 1917 55
ttllj tupp~~. ~t PI..~('!i OF UEATH 1\T M/~h(p~tpn, D.(,". f. lt3UAL REti1DE\CE (N'htn der~a+td li~. U iiWifwtiw~. nwlewrs b~lors
y~~ VAJ1E OF N0.~P/TAL. lYURl31KU HOA16 OR OTt1ER 1\:~TITliT10\ S7ATE b. OOl'~ITY dwwiow)
lIl ~ot ~w wtif~tiow, ~itY Nrn! ~ddrtu)
~ c CITY e. INSIPR CI7'Y Llldl'I'8
:as s~ould b~ Ro ers Memorial Hos ital ~~P~~ Yes OR NO)
Washin ton D.C.
~ Q~ i~ i=~~ 70 Mass. Avenue, N.E. d. S7'REl:T ADDRESS u~ •ti+t..rK ~.+:o.)
rinf.d in p~r. Wash. , D.C. 20002 6516 Hansford St. S.E.
~nt lype b1~Ck ~p,. p~-C~•pAT10\ (t:1r~ kiwd o/ rr,rk du¦e 101.. KIXU (1F Al'SIV~38 OR 11. BIRTHPI.AC£ 1!_ CITtZTi\ OF V~HAT COUN'PRYt ~
Jrna{. w~wt oJ ~rurkroo l~Jt. ~ctw i/ rtt~rtd) - C LGSTRY _ _lSe/awft Q:JO
_yv„ curwft~r) U~S~A•
LC~K 1V Y 1c
13a. F.\T11EN'A \A~fE I~L. \1fYiHFlI:: ~fAll)1's\ X~~tE 1/. ~iA\fE OF SGRVIVIKG SPOISE E
ohn Kenned Theresa are none
ter2ilit82! bf- 1; F.,-r .e 1'. 3. 1{. SOCIAI. SEC:URIT1 \U. 17,~_ 1\F(~H~IA\T RS(r.ijY(t,iCNlP TIJ IIRCBASEU I71.. AUDRi~~4 Street C~tr St~te
s e perman~a! ,lnned For~ea' blla /
092-OS-2974 ichard M. I~enn
-reord whfu ~ ~ Inter.d Be~.eenOtiet
18. CADEi O! DEAlgC (EM/K O~IY o~ rar.e ,pwe Jo? (~l. (b). ~tid (~1. y
erly execuild. i•.1BT t. UEATH KAS CAtFSED BY: 6 ~ / I~~:
~ba~e6ta•rE cr~~E !(~..l~ftns.~.C~t, ~~~cC'(~~~c~t i
I'„nrl~fa~e~. i! ewy. ~ /•y ~ ~ / ' .
rl.~~A q~~e •ue fo ` fs j tt'L''Ll! ~~?~j L1
nM.~e ~ar*e i!u!- Dl'6 TO (b) ( { ~ f (~i~' G' / . - ` -1
:t~ 10 S11b[Dlt a rnq fh~ rwderf~nwy ~arcrr} ~
' iicate of Death x ta.r_ ~
O llliE 7'O (o)
~:e Deparirifen! .y
' Pub11C Health ~ PART 11. OTHF:R ~iG~i1FICA\T (Y?VI)IT1f/XN n,ntni~.it~ryt w dnth Lut n~~t ila. .~CTOP~I'? 19f~. 1[1'es.N'rnFud~npCe~wdered
, ~i re~lst~t to tb' tm~uml d~x~ee condrtN~n prrn u~ {.a~l I~a) ]'F
~ OR m lhtetmiamt C~usr o( De~tL7
' in 48 houn af- V
i rr++
~'_ea2h is a~i0- 1F (?PF.R.\TIO\ N'AC pgRF~?R~iF.U b~. l1.\TF. OF <1PtiK~T10X 901~. <'(1XUITIO~ FYIR N'HICH OPER:~T10~
f n oI fh! TaWf C!)~lPI.F'ft lTF:~f~ ~ RMI ~Mr K'A~ PE:tt}Olt~f~l)
~ :.e Disf[ICt O~ ~
:~":Li~. V :1+. ~~+~~t>• if a~~wl.nt. aui.Hl~, h~~n:~- IIL. Illrl'll .~\1) I~.~TF: (?F' IXJI'Itl' \1~.nlh. I)a~~. 1'~ar ri.~. 1~E:('RIHF. HO~ 1~`q P~O(~
~ rKti ?I)
ewlr, or unnner urNlrt~rimne.1 IF'nltr FYIY~~K o!n a
a - ,
i V 21.1. IXJI'11Y AT ~~ORii: 4t~. PI..~('E (~F tXJI'Itl': L t 1!•,.~~. t',,.w.. Fn.~„~v. 11f. l.t~('.\TI(?\ l'ITl" C~CNTY STATE
G : ISpa~u/Y Y~a in Jo) tiI~ ur //~fr~ Nu~(J~ L'. l:'I..)
~ i :FIER ~ W ~
~ 'J$ OUT ~ 'Z' 22. I c~rtilY Wa1 (q Nhh ospibl) a dM ~ d~c~as~ tr~ 12 _4 _ _ . U 7- , b - - 1l.----• ~et (n (w~) last ~
- -
::R "THIS ; aaw ~a• a.c.a,.d on i__ 1! • and that dw1~ oecurr~d trom caus~~ aud ow tL~ dab aad 1w~r slabd ubo~~.
:iOSPITAL"
; 22?~. DATE 31G\ED
zz<,. s~cx~TUiu?,f . c' ' r~t .~rrexu~x • ~ita,ic•.i~. ~-r.~tt 12 11 72
e ~ . <<< • / /
~ " vtii-~. i,iet:c`rue p ptiti'~. ~
; n•~ i~~~i~.,u•i.ax~. n~~. ~~?u~tt~.
,:fion of ihese ; ~.~"F; ,T,,,,.~_ fjr~ genjamin Pecson Ro ers Memorial Hos ital
~ is punishable ,C "
:ie OI imprison- {~!"It(~i, i~ U~7E :3~ X.\\Il:e~f'('1:\~::1'hItY~1H('l1E\tAT~rHI' Yll. L(1C'.\Tlf?X /!'iry, t~~rn, ur ~ur+~Y) (Sle~t)
~r boih. ~'"F~"'T1O` ~~pec72 Resurrection Cemetery__ Clinton Prince George, Md.
~eF•Vn~'.~4 i
~ ' z~ r~-xt:R.~r.nu~iE:Robert E. Wilhelm Fnl Ho t~tiuF:e~~sF:us~~~'R'11F. 23.h. i'\DF.RTAI?ER:K
~ .~uu~ct:.s Suitl~3nd, Maryland /::r~!f'~' ~ t L" HEGI~'i'R.\Tl0\
_ xi•.iHt;tc 65
s 1 FUED
3 NF:\LU:K~. :.h~, .•tGU
~ ; $T. t ~ : ~AS
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~ tsr.t C: f: ~~i-~ ~CJRt ~ ~2.1 ['"'~~C~ I
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RFC~.-~ ,
¦ ' Awt ~ ~~1~'~~ ~ • ~r-~.r, _ _
aa~~
f - December I 5, ~ 972
Date Issued ;,At" WITHOUT RAISED SEAL
; ~'~r.~~` '
~ TH I S ! S TO CERT I FY THAT THE ABOYf~ J~ A~ .T~tlf a, p`~.ORRECT REPRODUCT I ON :
~ j 0~ TH E O R I G I N AL C E RT I F I CATE f I ~1 fl~. ~R~ I°
T~
i'~ ~!E V I TAL RECORDS
= ( DIVISION OF THE DEPARTMENT OF ~AC TRICT 'COLUMB,IX.
_ ~~~~~''r~~'. , r
. _
, ~ i ~ ;~R : ,~t
r 'S ; T , ' ` C , .
~ ~ ohn H. Cranda I I, Ch i eF
. . Rnnr 2~ ver,F ~~~1 ~ ~"'t V i te I Records D i v i s i on