HomeMy WebLinkAbout0563 • ~ - ~ ~
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- p~lARTIN~MT OE HTALTH AiHf NIENTAt HYWEIIE , . oa,~~~,~ C
- CEltT1~ICATE OF DEATN
c(i EASE~•MAFIE frst IttMe iacf !i. DItE Of 6fw11 7?. iq{tr
;i tre « prialj Henry A Ma j or• Maatb 4 reor 2A ~ ~ ~ p
3 ~f.c l RACE - S. 0"iE OF pR1N A~ (tw .KVa ~e~ i wr s naa H ter - r ~ .'T. 0
~ Male Cauc Dec- 25, •.191'4 m ~
~c 9lRitplA(E (SIaN w FMMRe A. U'12CA OF iIIMAi (01ltiI4ri is MARRIED ($ftYER MARR~EDp ti. (OIiMEY CF OEAiII - ~ h1 ~ .
Perna w+DO+MEo p ot><oR(EO ? Md ~
- ~ (ar Oe 10r1M OF DEATH 11. tIAFtE aF FK,SHTAE OR M~itltJlloii (K aoi w twsptat f ~ usuu o((UFATIOM (two el .«i ro.e Ilb. Ialq OF nFSrlESS OR
sueetadcess) du~uy sE or .wt e. • ~ uw ) tMDUSFRT ~ .
- - ~°u eri'"~4b~e'~~an~ Govt . - ~ "
:a u-SiiAi i:ii~OEM(E (~tl.«a decoasei Irfe~, i +wscewo~ RwN«. before t3c.(IiY OR TCYFN w eS!ei ta: s+m+ i3a. S11DEt AMO MW1iER - - ~ ~
fiT.as::"~ S'ATE im•(°u'n PGC ist N is s~sp Mop - 7805 Halleck Stxeet g ~ 7ma
Ma. ~o~
It. FATHERS MADE Fisl M~daa last 13: MOTHERS MAIDEN NAME Fist Mid/e lost
Har Ma •ax _ - Sue Aesch - - - ~ z ~py~~
!bo wu oE(EASED E11H D . AtIMO FOR(ESi IM?.soclAtsE(uenrMa t1. MIFOIIMAMT Muss as - {
cr". 4 1 s ~ El ' z beth' Ma 'ors s use same - ` ~ ~ `
.1 UItSE di OEATM (Eew es~r owe twee per fee Far 1a1(b~ aal ~ 1 - a o.~
eARt 1. oF11TK IA'AS CAIISEC 5'1: .L.iti ~ L° ~~"I t'
IMMEDIATE UIISE (a) . - - Z "a
-r ~ I3 - OIM EO OR AS A (OKSEOIIEM~ ~C ~ rs ~
andhiaws, i ah, rbirL Swe - ~ ~
nse to iweeliaN nose (a~. ~ ~ AS A C~11i5E0{M11(E OF - = - i O ~ _ ~
s•at~ng Ibe bniertriq cease y
~ ks~. kl - C a G ~ _
PARi t- OtllElt SlfiliFKAMf (OMDFiIOMS (OMERWIFNKr 10 DEAAF iDl MDT REtA1ED TC TIM iERAlINAI OtfE"fE Ot(OIDRIOM Glllrai M PART ~ • ^ ~ - ~ - C1"
~ g _ ~
9a- DA1E OF OpBAFIDM ice. (OIIOIFIOM FOR rMIG(N OPEilAl10M WAS iflFORMED IOa AUfOPSR lOb- f :ES,INERE F _ -D1 ~ ~,j
u _ ~ p ~ p GYiSES OF OEAUI't s s ~ ~ ~ z a
~ ie. Kt:ltElll ¦1S aetataasp ?Ik 11ME OF MWRT 2k MOW IMAD't OC(iMRED (EaMr auMa d iaNr? in M Tar- ; N ` • - ~ '=7 X
v a ausrsQ [Y'if OF REA1M iIODR AJl Mark Dar Tear ~ ; ~ ,F.~ ' . , . iz '~7 ~ (17 _
o b eAber, ~e~ioel eeariaer} ~Y ~ it ~ " _ ~ ~ ~1 ~ t~
~ ~2td RL!![+l OCfitbiED lie. t'IALE OF ~r~e~r
n4 rstttRt•~ 2iL l0(AT10M Seoss or RfD- Mo. Glr «T~i: , ~ : ~ v}
21
1 teAif~thot (1j- (thts htx~ilalj Kended t eased kom 19 low 19• • - .S_ , : • • ~ -n f t~" ~
sow the deceosed fve ah ' 19_, and that in (m~j (olxj opinion depth acurrel'1'pn th~¢tlfb 'oar ~ = -p
causes stated o re, (1)- ( Itntj view the body oheF death_ ' - - ' ~ ; o ~ ~ d
_ S16NAi11RE A1IEMDMIG MED- S1AFF - ~ "i t" H
` .-C •G
~ ixGREi Pars p oaaaot ~ PATS. Cl ~ - ~ ~ ~ ~ ~ .
1 .~a ~
~u„a) n.- AooREss Par an , ~ .O ,
~ i 11 Rd
~ FiiIRU?. CRFMATIDlL tab. DALE t?c MAtIE OF (E1IETERr OR CREMATDR? 13d IOCATIWi (Gr o? ~~1 l'~1 ~ 7a
I B~'~'i~°"''- 1 A ril 74 - Washin ton Natl Cem ery- Suitland PGC Md. 'a ~ - : j
oalt(Ta Robert E. Wilhelnera Hom ~ REro ~ _ ts~eEC,IsTRAR: swMATURE _ ~ - - ~ '
' 4308 Suitland Rd. Suitland Md. 2002 k+~`0 ~ 9 -
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