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• OE~ARTMENT OF HEALTH AND MENTAL M~6lENE
~ ' CERTIFICATE OF DEATH REG No
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C~' ~ +il~ , iMEA S{GN AriT.C c ITgNS CO~'Q'BUTMG TO Dc_ArM 6U1 NOT RELATED TO THE iERMNAI DISEASE OR CONDIi1pN GIVEN IJ VARI La
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1` - - ~ ~ j .it S'uti-'l DEGREE 7It DATE SIGNED
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y ~ ::1 ~n~SauuSt~.AME pr»a»wq 77. ADDRESS
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- ~ .aEMArrpN,REMOvA( Ij? DATE )k NAME Of CEMETERY ORCREMA:ORY 73/ IOCATIGtJ
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~ ~ .:rc~~(ation 8/8/78 :~~etro~olitan Crem• Alexandria ti'irvinia
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