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HomeMy WebLinkAbout0324 . s. e~ .~i~o~ (-_NI~LYJ\O o~sis~ci ~S C~i~- ~~w'~uKK STATE ~ = r..a •._..~i \ ~ ~EPARTMENT OF HEAITN j~ ~~I ~~~Q~ BUREAU OF VITAL RECOROS V(„j~Z~~ ~ ~ ~.=~s suB- ~++~'O CERTIFICATE OF DEATN ~+nc i O~v~s~0~+ wai~src~ ruu~cA 1~- ~ 5~3~ TYPE ALI. ENTRIES OR PRINT IN PERMANENT BLACK INK. _ , ,___L.J r M~a;/. > l. NAfd~: F,INi] MIODLE 1.AST 2. ~[a ~-]R t~•e u~ 6~~*~ 3P/~ ~ . ~~~t rc..•_t ..~•~.To'w.T.~~.~ Z J: 1U -s...~si~tk o~lT~~er ; ----r-t---' ~~l ~ ~ . ~ s Q G ~ g 1 ~ 75 _I P• ~itit~ ~ w~t[. tw~~t[. w[c~0. S. •ca uwpcw t•w ? u+oU t n• rtruww o~ U.S. ~~.~[o r,+t[f• ~6B .r •~s- n~~: •e h~~. '+A , ' ~~+i~.ca~. ~+.O+~w. t~C.~ 'YOMTMS O r1 Ou~s' YIM. ".v awrt~ or . :c W ~ ~ ?~S 4 :AV ~ ,.t 5 { zultite GI ; : , O ~ _ ^ ti ~ . ~ W 7A. to~Y** 1NY3/ ~78. rOw~ , 7C. c~rr ow r~:~~GC ~ 70..crGTw or iT~~ :w ~7E. ~os?.r•i :,r ~.sr~r„'•o~ '~11 ~ ' TONA. 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