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HomeMy WebLinkAbout1302 - pwt~ ~+IaiIS11R1 S1A11 qa - ~~1~i 8TATE Of COLORADO ~ ~ ` - ~ ~ CIERTlFICA7E ~F DEATH • - . lN~YiiC1AN OR co~oir>Etu OE~A5E0-NRiiE TMT STATE i11E NUVi[R OTNNRRUQ YI„at ~ a.3a SER OATS Oi 4(A1N wMl.~w W..a.1a~ ~..O/TtMT11 - Boss - Ori ALAICS Jr ~ Male .March 12 1979 «r. T.Tt? RAtE - OR1G11i OR OEStENt wcE - TAfT Y.a: • . a.n • • Ar?a Mw.Mtl ~ yO, Tw..~.-1M~a? ~Tp~TaTNO YaNl~a M• PATE Oi RIR1N COLMTY Oi pEATM il.»L< ~,taM W~.ft~1 . ~awltTR - poT wTs .rs vw~ - RTOO~f 4 ~ 1 L k . ~ 11Ra..wot.w giValpMlIOR~OCJg1Q11oiOEA ra. • MOShTAL0110iNERIRSi{tuTR]N-tr..a~.w~.+...~...a......•...I at+,CV O~Mi4'ST-. anra - 4 STATEpiRMTMr.n~.YRw gji2Ellpi*IIAICOyNTRr MweRIID:NEvERYARRaEO SIMtY1V SiOW'Ewa~a._r.....~...r..a w4SOECEDEN~[YI• - _.~`~w- V - wwrd ~ T1gOwEO.01VORCE011.a~+~I ~RYEOi01KE5'.•. • klah ' 31 cken aT es wr O ~[Wj~1TrMIME11~,-•• ~ ~ YAMlOd.1NAT10MaG..w.~..w...+w4r+.~....w RarOOtRNf~NE3SORWDUSTRV acs+~ ~ - - , rti- - ...~o` RESIOENLE•STAIE ODYNTt - Gi1I,lORN011lOCAT10N STREETANONIIYtER ~ -'[~R).~u -i ./M - ~ ~ _ - llaP12t Yr~/. a!a TU 1 Na ay ,V ~ fAiNER.tY1YE TIII.T ~ aM.O\! - _ - + l~a.T YpTNER-AiAYE iYafT ~ . • Ross- Orie ` --Blake Sr.„ Anna Smith - aAiJR11AI11•TNYE - - .~rc•a tie.a~ YAIIT A~OR[SS itwtltOAAroW d•+M TpMy f'aq . - - - - 80 } - " ..Bet Blake - Wife •.2828 Air r Rd Colo S s -Colo. 2 RYRN~„•QEY_ 11T!CIIMErOYAI QC1Tf a1twRAr.Y.a.t`. CE`~~ERY,ORCREWTORY-NAMEANOIOG?TWN ~ aT•wtaw s~art 1 ~ ' w C r Ma low Oklahooma • ~ ~ TIiNE Ot TOR _ - NAYEANDAOORES:OfiYME11AlIW1tE- aSpIETTOAATON0.CITT•STFtE,s+a -803 teTSErlsTaw ou.eTA ' ,oiaT OAtEMOwwtE 7a~CORONER-a~rvTE~~siOgswrr~AOrw~o o~A ooa,w~cowt ( _ w+IpRYtTOTIrt WpwTTD~ orTnEOA NaonxEAro TotIlEeusEa>~sTn1o s /isJ L Z - ~ w ~irw..... TM - ti " M OATESNy1E0 ow.t _ - OATS 51fiNE0 Irw.ow.rw • ~RONOIINCEO ow NAPE AIO CfJ1TTF M1/YSICIAN 011 CORONF Rht~.. a. T1r, .T+ ~ n•-David L: '-Edwards ~M.D. --1100 Balsam Boulder Colorado 80302 •.r,•,.~'•.: - REi6T,,R~Ii-. ' OATS REGEWEO,Y REGISTRARTYww On a..• T . • • _ _ ~ - rR1E01AiE i ~ ~~Y ~ ~ i/ERTER ONlT/ ONE CAIJ6E DER II/g~E'WR w. R+1. ar k11 ~~o` ~ ~taowmo.s~~ W t7~a1!i'•! OJNG/'/ .1'i~' Q~---i.~Q~~~t't ~~a[!ti ~ - ouE Ta. o~ ws wcoNSEauETTCE os - ~Ynatn6aYE ' _ _ . I - ' ouE,TgORwswaaNSEaliEntEOC-- - O -~,IART RSIGRIFIPJWTOOIAITgNS-o¦w«. a.....u,~.w...r....~.Y+~1MTaW ~ AuTOKY wwSC~SE alt: ,?a~w,r TO COfatY.1 Yl iy - -,...t ` ~ . r-. - ~ - x Yes Yes v AcsloErrrsxRC+oE.T.o.1IooE: owTEwIUUOII(l Y NOR rr<IIntI?00[71iRRE0 - • - i - 7k • ~ _ - RTAlRY wT ¦ORR aw. w hwCE OF MTJURY- r..~.-w..- IOGTgN NTweET ow w. o uo,arv pw Tc..~a_ ir~Tt, 1L w w M' - _ _ - - . - - ~ . . - - - - -13&Q Jki~-~4--P~ 12~- Y8 STATE OF COLORADO; -CITY' AND COlNITY OF. S6UL[~R ~ " -°iucr~~:'~T _ - ~ _ - ROGER OITRA~ _ - - C1#RK Ci2CU1T COWtT • t. he>neby certify that the above is a true, full and cor~ots ImF~ - -the certificate, in aly ceistody _al~d no?r on file in wy office, as required by 1arr.' tip-' Yitness ry hand and official seal at Boulder- in said State, this . - - - - • -`M_- date ApR L[.h_~g--- : - - - ~ . - - _ - . _ -John H.' Oomnel iy, N. D. , Di rrzctar llbt raid irithout- ~ - - - - - Registrar of vital Statistics - ~,::.1oca1-registrar's ~ . ~ , ~ Ci ty and Comity of 8ou1 der, Co] orado . : -seal = = _ - - r•-4~ ~ ~ . ~ Deputy - _ _ - - j • - - y - - . . ~ f' ~ of the- Certificate-'of Death for Ross Qri~ Blake, Jr c ~ - a_,.•~ and bounty of Boulder, Colorado. ~ ' - ::.~cPkes Mar: ~4Y I _ L,-.r- ~a ~ ~ ~ ~l sr ~ - ~ ELI BETH - M . MAI S NNEUVE g~ Notary for State of Colorado