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DIVISION Of VI1Al RllOR01, 301 SV. Nkl;lutl SINIEi, BALTIfAORE, MARYLAfID 21201
CERTIFICATE OF DEATH
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Susie G. Poole ~'t""r ~~1 t.~i 3 Aell-
_ S UAIE OF BIRTH A AGE (1n pars • "r„"r,u s `aus 1r "n
r ; i ts[ ~ / RAZE bjU.p(rdor -
~ ~ i ~ n.r"l1P ~~hite $(?Dt. 3,190 lost ) ~ renti n .as
' ; v P.cimUif ;Blase a 1'xN9" ~ F? (I111FN 01 WNAI (OUNIRT'! R MARRIlO NEVERTAARRIED(] ~ COUIIT ~ DEA1N
:f. 't•',r~ l end I1SA 1MIOOWfD? OIYOR(ED~ Montf*omery ild
r i0~ (pit tai tt:AY01 0(AiH II MIMtOIHOSPnAIORIN5111UT10N(Ilnolmhospld 11o USUA10(CUPAIION (Kmdol worn dory I~p MrhDOIBUSditSSOR
wioda~e~t - dot, mos of w w ctrl ,f rrnred) 1 T
` ~ ~ ;)n r•.•t~cus ~~/11~ )Ridr~e Rd. "9 ~ss°~:9 ~`aa~iler N011~unk -
` ~ s•. 13a ~~i a RE'+:Ctti(l j'/YMrr dereosed ~vrd. d ,nttAVnorr Rtvderxe before Ik CIiT OR iOWN Us erwos sm twns+ qe SiREEi AIID NUMBER
. ~ adn.svrnj~ stAtE 1)e~(OUNtT s nSQ No0 2 11 Rid a Rd .
'ej 11 IAtH(RS MAM( toll AYdde loss IS IIOIHER'S IAAIDEN NAME hsl 1Mlddlt loll
- 5 Je use Gue Elsie Y. Brandenburg
1b WAS Es4(tASEU EV[¢ Us US ARMED fOR([S~ Ibb SO(W SE(URITTNO 1) NIIORMANT Address
~ Yts. n0 Ot W+~:Wwn) ~r yr.yw.r/.f..w rl.w.~d
2] - 6-680 o er F Poole Damascus ~1d.
~ ~ u IR (RUSE OF DEA1N jtnbr wdT Dorf souse per Irw lar (o). (bl. ofd (r)I Is-w!s. wts uo Dun
- PART 1 aAtH WAS CAUSED BT ~.•ucinouS A~ienocarcindaa Terminal 7leuin Cecum jl
w IMIIEDU?tE (ARSE (e)
~ atE ro 8~61~i~arsft10E1tR8F with Abdominal Metastases. t Months ?
cona,nens. d arh. »k,rh Sow rot
~~u ro ,mn+edrote nose (ol.~ ~ i0.OR AS A (ONSEOUEN(E OE
.sonny she un~erlTrrty souse
btir h1
PAti 1 OIHFR SIGMSEKANi CONTRIBUTING TO aATH Bali N01 RILA(ED TO 1NE i(RAtIMAI OISEASF~OR(ONDI1tON GIVEN III PART t(e)
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3 ~ ~ do pA(F Of OPERAi10N ~MAKHOPEGIIONWASPERF MEO 10o AUI0PST7 10b N TES. WERE FNiDINGS (OMSIDEREO IN (ERI6TIIIG
~ ® wnESa aA1H? Prom Sur~~c
7 X969.; ~ - ~tl~~':$xPoloratory for ~ Iq •
- ~ W aY . ,
- t 1 o A( 1G(N s tMA1RT OCCURRED (Enter noon of •MmT a Pan 1 a, Part 1, lam 11)
~ ~ ~ ~ -lacar.wless~puliliat.- , ~ _';trr!!A tioi Tes>< i1o in ju ry
6 ill rnrhe.. ylsedlsd If
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j~~, ~ ~ -t ts~alrt, y~ rias. lrson.l 111 i0(ATION Sweet a R f D. No- fAy or Toans (owMp SW+a
110. 1 Rertif~ `.(f). M'deceosed jr arc 19 , to 19 , That (I) pall lost
sow ths,~a~~ttee~~~~dd diw on: ~ 19 O~and that in (mY) ((i4ti~ opinion death acurred on the dote and hour and from the
' (ousss srbtedolwlKr (n ~ (~iR) vievr the bodq aher death.
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C~ rn rn DATE SIGNED
A , ~ ~ v AFTIIIDIIK: MED STAFF
, Mein- r w ?DEGREE pHTS ? pRF((OR ~ PNTS. o
nd vttrslcwls n• ADDnu 9701 Church Street
~ - - IIA~arve~l• McYeudree~ /axe; O. _ -
n 13o BU¢tAl, (RIMAIN7N, 71N. DALE 73c NAME a (FMEfERT OR (R(MAioeT 7!d l0(ATION (tlh er lovrrsl ((•n'hl (S?de)
s' v' T•. FYIRRM DtEC10t ADDRESS 1Se RECD tT tEGiSiRAti 151. , ~ ~
Olin L. Molesworth, Damascus,` Md•• a,~(` ( `j, 19 d
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ROGER PGI 1 RAS
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