Loading...
HomeMy WebLinkAbout0311 - ~ ~iV VVrU:.~ 3Ei~Q31 4~'~~ c~~~~ Ft~ s.~N pat~~ L~ ~ S4F~ C~acwr Cou~~ , ~,~~~`3~ . AEC!x: /£F~fK9..,..,,.,,,_._ !'~~t ~ I I 3 ; ~M'77 r~~, i s, ~ C~MMONWEA~TH OF VIRGINIA - CERTIFtCATE O~ D~ATH . pEMRTMENT Of HEAITH dUREAU Of VITAL RKOROS AN~ HEAITM STATtSTICt RlCHMONO _ t.~ CEfniCwit Str~E ~uE ;,'~•,,...~~s "uKSCe -7 ti.M•~a ~ ~ ` 0 ~ / ~ ~ ~ L ~ _ ~ _ _ syi~_ - (m~dJt~l .1001 SEI ~+d~ ~ew~o4 _ (:p ~---Cjarke •or) p/ w~rrrtY 1 rtAR tM+'JtR ~ U~~ Id~f ~r _ _ _ +c ~ _ _ _ _ ' ' S COtO~ ev~e;cr~ - ~7 ~ ~ aor b,.n ; n...w.. cx ~.qce : ~__-~"-~.~~a~._ _ ¢s ..~T.1 ~ ~ : . _ ~Q 3 t a lt ~ `r.tlll~ • - • _ 'at Of (~1 pr~. w yaNl~ ~ ~ CCGNif Q~ ..f .wfepe^6~•.~ ~e~, I~o.e A!er~) ' ti _ - y~ ~~')[A1N pEtfy -~L~-~_2~_11n~~0 ~a Nn 4 dT1;~~Q1~.._~ _ ~ . •_wv ~•{.wd. M~~MeI ~"~'dt«~ e~.n G-.r~7 V 'Ti(fi ~[H,NESSO fi !.p . rs~ ~a M ot~fE Oi OEAtM - - - - ~ - ~ ~91_ ~s~Zi~ n S~i ~_q,g D r, ':~CC~~•i1t~70~- - +1 CO'x~+ri.iDfCf~SEDS ~.~~•ufe~e~dsrooq.ko,.lro~~ - , .:~E1:'E~+C~~Q~To7Qnd ~FYPfwE ~ince Georg.es ~ f i / •'•w• ~~d a~~ t. t..v l~w.ts~ c•isE: t~fSS t~ RT N(~ ~ ~ ~.y s~ ?n ^o O~ ffS~L~ENCE . ~ i1P !'j7E . n ~ ~ -E -----r.~11~_~~2Q~~t _ ~ . IS Y..~!'+ET~ r:AtiSE C~ _t.SE' L ~ xO:Mr rr ,~,fC~+.5E0 r- • Aj~~`~,~--}I ~f ~ /1~~ yp L~ ~ y}~~t~ ~ yF~~fR ti~.AioetD 7! I~~ K F~tAi4rF~ i t v~'!tY:.Yi~ll~ ~ ~~L]t~.__ A4~ ~t O~y7?CfD. lE~ lll~r:t ~ ~ ~~nOr:rvFD Q O~+G~:f~ L) t. N~~ vEtER~ra. ..s~.e -o. w 1 1~ M~?~.Y~:E .•o.~ w cov~Fr._ J? OwiE O: &Rir (•w i tdori S~w~ ~~K~ pe«e~.~we wJ~. w+*o~e rli DECfaSfO M 9ECf~SfO ~~-2~ n ~ ~d~ J~~ s s JIln 5~1~~9 . : a5• Vao ar a•;u~rtsS 1S ;`~~o:kw!~.r ,70 ~p„~~ . t.• OR t+~+:S~Rr Ci ~viO~M~•~C~N • - ---1~~-.---~~ _ ----~3~~~3'#hu7~-~~'r.--~ . . - L•~.~ e'!~ o+e twne pr t.-e Ic• ~t,_ rl~, p~ wTtiv~l ltTwEEY :i.•«..•~CaoSED~r ! ~v5 ~~N ' / ~..~EOUrE C~~nF ~ j OuE 10 ~ ~ ~ _ . _...:~.e.:at {b 3~~ _ - ~ • _ ' ~ .r ,•o~.~y ef.e _ f ~ __.~~..v w OUE TO i ~t ~ I ~ '-'0 <<K+Vi CG'~L`!T?~vS CO":?~:EJT~ TO OEAfM Q'~i NOT 1[;AT[D ~O i~F TEi~t'!i?~ 7Aa ?UTOPSY'~ : m •r • S CC~J11qq f ItN IN itRf 1~A; AUtM~4~TE0 ~ ? ar ' y:`f_1's ~ pq~f,~:AfKr 1G h E a`E a i CAIrSE. ti vll~5 7M GEX~tlf ~'C~a' W.'iY tkCU~QFD ~t~rer r,o~,,.r cl uqvry .w p~ 1 a pn.~ E ~ ~~~ro..nn µ _-.~t ~~t~:w ~ O . . t •.~•f 1 F•':~.V C~~tSf '+O'{r W~ I~~r.V1 / 4. ~ ~ ~ ---~s, ~,,,o ~ r~7) t~eo.t 7t~ w/U~r OCC~MrfO 2 ?~ACE Of iNl'NY ;~.re ~u~~ ! a r ..!ie wf .A~4 ~ ledo~y. sueN. oH.~.. b,.10. Mc ~~?hA ~01, p b~n~ -';.cw!yj lsrot~~ ~ _.__~~~V . , _ o~ ..o~ ? a ~o•ti ? ~ ! ~ / ~f ! , er•. -a r~e A'.eo.e.1 .lorv _ _ _ _ b_ _ _ '•~b d N•n~ decfn «~wr.d a~.Ll- v~ _ ~I;PM~ l.~w •Iv ~<vu s~ortA ouo.e ; . , _ ' _ _ _ _ _ 1 _`~~YE SS _ _ ' ANQ SIA~c ' _ ' _ ' _ ; _ ' ~ SfC~NF I y' t i . ~ ~ " ~`~.N MO.' ~l ~f~ /'L l # - - - - ~`_~~~~LT1..J~ _ c__ ~ 4 ~ _ _ •1 (i l wIK3N i5 ?L~CE d ce.~e~ery cr c.e~o+oryl ~ _ i"1 01 Y~InM. _ t~•y er io.r^h) ;~•ore) ~ -~-.J ~rt6"rl _r_ t 1 ; . / • I.•e el ~~~p; C,.~jyM~ y^o ty~h ~ HAM.( Of filN[~~l ~ t.Ori ~~IIl@I'~. 1{OAIQ 3 "I / i'' _ _ ~ . - -a- ro~ ~yo tori V3.2~i'1n ~ - _ ! 'L'- I .oo.E:s Ar _ ~a ~ ~ L~~-- ••~~•:a.) Y v~ OA E REfORD ) ` - , 7 Iter.: 3 corr rr c ~:err ~ ' - NtEO - - _ `7~71,~~~] tiU ,.t ~ ' : i ~ , ~ . _ ' =b- ; - - r+ ' . . t k' . . . • , ~ • This is to certify #~'iat,'~fiis~is~a true und correct reproduction of the origina[ ~ecord fited with the"-$ureau of Vita{ Statistics, V'irginia Department of Health, Richmond, Vi~ginia, ; ~ s ~ Date Issued ~~1~~j ~i r, DEANE hUXTA6LE, State Reristror 0 i~7,~ 6 f ANY REPRODUCTION OF THIS DC~CUMENT IS FR4HIBITED BY SiATUTE. ' DO NOT ACCEPT UNLESS ON SAFETY PAPER WlTH IMPRESSED SEAL OF € iNE BURE~iU OF ifiil~t STAi1STiC5 CLEbR[.Y ~FFiXED. ~ ~ Section 32-353.27, Code of Virginio, as Amended. ~~~~~C~ ~~E ~~9 t Q_, .uv - ~ -