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- 3iATE OF tExwi 4 ~1Q~ CERTIFICATE OF DEATH suiE FILE No. ~
RACE OF DEATH_ t. USUAL RESIDEt'FCE ~Vtlwe deceeeed led. N nn1:b1:• •~.d,•ce beieti.d~aa7oe~
~~+TM 8exar ••STATE Texas ~ Bexar
h CrtY OR iGMlllpEorlwdec:h_~h.4`wPncitlw~ c. It T~~S a~ cGITY CR TOWN~t~iQ ~g~pKy••• y 78G~~
FOrt Sam HOUSton ddy $dt1
d NAME OF ~iF a0f ir, /nEpH,I, yu. skeA.ddrees~ d STREET ADDRESS ~F rrel ' loceser j - -
~~,~i~aake Army i~iedical Centex ~ 4438 Bik~i Drive
U ~tS RACE Of DEATH WS:pE CITY lMTS? - e. K ftESK1EhCE fNS+DE CITY UMITS? - -f~L AFS:DENCE CN A F/UIMT
- ~ YES? + ~ ~ YES] HOU YES? li(~]
N 3. NAME Of ~eiF:ret R+lµ~ k)Ln/ DAtE OF OFP.iH
Ross YOUNG ~ 9 January 1~`l9
,>i S- f: OjOR OR RACE (7. _ ~,nrrd ; B, Ou?TE OF BIRiH 4. AGE (aw +ean , 'F- ~ R 1 ~ ~
Urn 1•
o ~a1e (M~ilte ! Mda.eap ~~p ~31 Juiy 1915 ~ -X63'?~°••: la.ri ~I~k,
~I!!~ Ewi•1 OCCUPATION(G:.e?'rtlaF.eri 106- KRSD OF WS+NESS OR RJDUSTRY 11. RNtTFIp1At:E~S•deafasgecawtry} --+t C'iiZEN WFtAT CG•JNTRYE
~ R~r'trLU~°+brfY~tt~fR'~ U.S. Artgy exas tJS~-
j E3- ~.i. 1~oung 1,. MOTHEQ'~ MIUDL?, t~ME
~ ~cille (Unknown) _ -
IS. AS _ IN U wrt . CESI ifi SOCIAL SECI.rRTY NO. f wFORF.tiwT
~ r« s-~-a 1939~Bet~~460-64-3016 ~ ~~7~~ /~c-.Ly ' ~ ~ .~.s-c _
F i - It. CAUic Of DEATH (Eater owp owe rrae per liw For W. ~,rd(c~,] _ w- ~ a~.EEs
\ I h Y PART t DEATH WAS C/1USED RY: uaET.+e cy. _ -
~j{ -Acute cerebra] intraventriwiar hemorrha a '~u~"s
o wY~AEOrATE cAUS+E e o o~~ L111 nam, an croscop c peildin ~ -
Ca W c.edl~yq x.e. _ 9
;:j i eb0ue ewwe OIR: To ~
~ d stetrq 11r ~edv- ~ - - - -
L~ ~ W 1F~9 u~» IeEF-
i--~ ~ n DUE ip 1_
~ X ~ PART B. OTHER SIGbBFFCMFT GOFiDIT10FC. CONFROiUTL`2G TO DEATH RUT NOT RELATED TO TF# 7ERM:NAI DISEASE CO.~lDIi~ON 61YEN :N Pt.kT vai ~ 19. Y.'AS A~Jip?SY PEif.
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U K 3Ca ACGDfiiT SUfC10E HOI.(iCiDE y 2pb~ DESGttEE HOW L~/.IURY OCCURRED- (Eatp r~eise of :;.iry ~a P•rt 1 or P•.f q of Itre. 11.1
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W 0 ~ IOc iWE OF Flour F./orrLL ~ Teri
a4 Ei W INJURY .~n 11
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40d. tN.RJItY OCCURRED ]Oe. PLACE OF N.N.'RY~e,~}++a.bawaane.i~aE,4+ctory. 70F. CITY. TOYVFI. OR LOCATION COINiiY STATE E
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14 DesM or!Yrred of • • n 0n 1 Ee s bo vd .t ~ my ea0~ievex. F.pn rile cwr_es eyted
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6iRtiTT, CPT, MC ~ , DO Fort Sa~I Houston, Texas. ~9~ Jan 1979
73e. BURIAL, CRE/,AATK>rl, REMOYAL~Spedl~ 236. OAiE !?3c NAME OF CEMETERY OR GIIFEAATORY - -
_ Burial ~Jenuary 12, 19T9 ~ Fo~et Sam Hauatan Neti~nel Cemetery
- 730- LOCATION ~GFl,tra.,tier~ ~SHeJ 74. f1A~RAl pRECTOR'S SIGNATURE
. 3229 ~ Fart Sam $oustt~n Terms Sunset Funersa. $~mie ~ G}'
~ RE61sT 2Sb. DATE RECD RY LOCAL REGFSiRAR e g i~ ~
> JpN 15 79
~ Angt;st 7, 1979 - .
STATE OF TEXAS
CITY OF SAN ANTONIO:
I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT :COPY OF THE RECORD AS FILED IN THE STATISTICAL
SERVICES _.I~I~~ I02J OF THE SAN ANTONIO METROPOLITAN HEALTH
DISTEY~~`,°' TOl~'IO, TEI>AS.
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r ~r7/e7 J`F~ ~ ~ e,7~ ,
FILED AN ~ CGRUcO ~1~5
~~i"~.-:. ,s,~,-~. -a:. STLUC fly` -
fE COUMTY.ftf,.
x,'11;;.;1 ~ ROGER POITRAS
• ` • - ~FAK CIRCUIT CflU
RECORD YE41FICp~-~~~~~ F~
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