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HomeMy WebLinkAbout0251 r~ . ~ . ~ ~ ; ~ ~ CERTIFICATE OF QEATH OF ROBERT ffARRY RTKER , y "r Z'~' . • ~ ~ STATE OF OREGON - HEALiH DVISION Ytsl S+~tistin S~ction r F:a ~wTe.. ~ .:ERTIFICATE OF DEATH ~ • St.» Fiw H,~6.. ~ aEC[~?tEa-.t~rAME itru At~ddl. laN a?Ti oF o~wn1 I~noeuh. d.r. r•«) Robert Harr Riker ?.Se tember 19, 1975 ~u?a ~vn;N f~w9.a 11~..k«, M~n. Aa~-UU u~a.. ~ r.K u~d.. e.r a?n a satn~ (~N~. d+,r. w«) 3~ whi te mal e 65 ~ s"" a October 26, 1909 EASED couNn o~?n~ , owN. t ut+ o~ o~?rn ~e. • t~a w ot on+a tNSrmmo~-w~w (~h r.s a eo) G~ ~a in .tfh... 9iv. ana .nd ewea..) lane Eu ene ,4 es ,d Heart Hos i tal x~« STATE Of ~IRiN ca~ of ww?r couNmr w~eR~~o NEVei ~ua ~ of srous~ Y:~,xe nr nw in u.s.n.. ~+m. ao~,nMr) w~nowEb; avoRCEO tw.c:M ~r N_etfi a_ Florida 9. USA ~a married S ivia E.. Riker ~ ~nit~- SOCIAL SECY[11Y N{IIAtR IfWAI OCC'IIrAT1af! (Yiv~ O de/k du/'tnY KIMD Of WSINlSf INDYSTRY ~~,betor. ~ 010~1 O~ ~h. f~rM ~f MiI~ ~Z 574-01-9419 ~a.. Build n Contractor Nousin REi1DENCE-STAiE OWiTY . i IOCAi10N Im:d~ C~M liiwib STlEEi ANO NtIM1Q O! f.f.Q Ore on ~.a. Lane Eu ene es 40 West 23rd FAiNER-NAME firu nwddM 4sr MOTMER-M~id~n N«n~ fl~ ~n1ddN laa INiORMAMi-NAME and n4ria~d~b a d~a~wd ~a S lvia E. Riker wife .oo•o=sa~w i~nn,.~ r~Rr ou?n~ wws u?us~o sr. (ENTER ONIY ONE CAUSE PER IINE FOR (bl. ~nd (y) bNwMn o~wN and d~ad~ 1 B. ' N ~,wM ~ r (a1 v ~/S dut to. o~ +s ~ oons~q~w~no~ of: Cond'tioe~{, if aehr. - whid~ 9~w Iia~ b t(b) ~ U 5 E ~~diaM ~au~ (~l. j d~ to w a ~ oompueno~ oF. stniny t!~ ~x~dea wi~q cwr lat ~ (~I ~ART IL SIaNIFKAN~ inq b d~aM bul ~bNd b cwr Y~~ in Vart 1(+) AUTOKY IF Y w~rt i'r~dinq~ oonsidered J~ ~ ty+s o. no) in d~Mn~inirg c«... e1 deaM -r=-1c 19a. n0 IOb. ACC DENi - OATE Of NOYt IIOYr IpJtMr OCCIIRREO (MN? nNwt oi N~jwp h p~rf 1 ot part tl, iMew t~ - l~o.dh r•s or no3 t.wnM~, d.r. r.+r) _ 1'Os- n~ 10b. 20c A~ 10d. INJUR AT MI Oi at ho~. fsnq. atrN4 K~wY. tOCAtWN (~eeMr w R.F.O. Na. d~y w lowe mw~tp. We~) lfverih b~+ ar no) offiw bWp.. ~w (+wcihl - n0 • CERTIfIGllON- nwn+A d~y pw aw~~h dy ~ar ~ ls~* Him/IM~ Al:v~ 1' Did Not DEATiI OCCtIRREO H 1h~ P~+o~. on tM PHYSICIANa • d+f? 7~ virw (ho~rl d~M. M+d b Mt 1 i»a~cled tlr afur elsath (~pKifvi baf of my know4 Z~ f.~: a_ y- ~y - ~ S- g- ~ 7- 7s' Z 1:33 a~. ?MI?SIC 7' (MV~ a v~~) d~9~N a TitM DA?i fIGMEO (e~ond~, d+t?. tiea?) tI~tER ~ ~ ~ n.. Herbert C. Baker M. 0. - MA1 ureet ciy o~ lown dsh =ip 495 Oakwa Road Eu ene Ore on 97401 ~uR~w~. eaaurwN. awovn~. e~r~er ae ur+~uta~r-wuw~ ?oewrwN wr o. w~ wM o~?~ e~.. a+r. r+«t Nu?us. tw•~h ~~A~ z.,_ ~uriai z.~. Lane Men~oria~ Eu ene Ore on 3.d 9/22/75 fUNERAt D QOR-SIGNAtURE WqER/1l MOME-NMI1E ANp AOORESS (unM, ei~1/ a~arn, aN~, riP) n.. ~ ~~-2 ~~i!r-~ Chapel of Memories, 3745 W. llth, Eugene, Ore. 97402 REGIfritAR~t~',NATURE _L DATE RECEIVED tY IOGI REGISTRAR OATE R~IVED iY STATE REGISiRAR , ' 3 t+cr ~ - z~ ~ RESERVEO FOR REti15TRJ1R'i 11 i ~ VS2 R-0N . ~ = .*"-~~~e:• ~ _ . -t.~`~~ : - ' ' . , 1 . y y~ _ . . . . . ~ STATE OF OREGON . ~ `r, ' ~ - - + ss : DATE IS?~ G~ctober 15 L1975 ; Ca:aty of M~il~omah ; - . ~ . ' y _ . . . i r- . . , I he.-eby cera fy tbat ffia ioregoing copy has ber~ ~4ntpared by m~ ~.~~$w origi~l dx~ant aud is a true, tull aad cocsect ~copy oE the att eect~~ca0e a~ ~s;aanti apptais as f3e: tn thr Vital Stac:saics Secj[~c8~~ 0-egoa Sta~Tg`,~~ nivi~'.oay~m._st~y aEficial .car~aad cu..-taIy. F:LEp ANv itA. ~p~__' - ~ St.IUC~ TR~S ~ ~ ~r_ ~~.r" _.Q . : L kO~C ~ IT CvV ' : . ~za31o ~ ~RK•C~~ . - ~ . ~ ~ . ~ ~ - r,r~..-,. . „il~. ~ . ~~T ~6 ~O k4 ~H - ~ , . . ~ ' L P.F:I.~TR9R +c + . - j - - NEILI ORIFPIN JE~FR!ES S lLOVO ~ ~ ' i•'. r . _ '.4' :..fn'f . ; ~ . _ . T[:'t`..'._NE l-_'.~ af4 ' D~1li~I~V~ %r 1 ~ f.,i,' l.•(,~'~ i . . g _ . , . _ ~ ~ : _ ~