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i ~ ~ STA'1'a 4!' X1611 Ia7000, OOUNTSi 0!' QIAVES, M
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' ~ 1 Reodpt lia.~ 95.706
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CERTIFICATE OF DEATH-Msdkal irwd~cal~^vest~st°r Roawe
(IM~t~ MtlealA dtrB q aC~ddaw. suicide a tNtlbtown tstu~ ~nws~0+~od -
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w' M NAY 15,1979
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_ i !tK[~ RECORDED
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PLEASE USE ?1fpElMtrTEi1 OR PtiMT IN IIIDEl1~E BLACK BR
U H - CERTIFIED COPY OF VITAL REC~VfRIfIED
x w ~ STATE OF NEW MEXICO COUNTY OF CRAVES
w ~ a'{ Michael J. Burkhart, Director
~ ~ ~ 4'7988 •
a w ~ - Health Services Division
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p W N ~ Health and Environment Department ~
A o z ^ This f s a true and exact reprod of a .;priginal document ~
?a H to ~ officially registered and pia i~~~.; :t~lie Vital Records
w 4 a v Section of the New Mexico H~ ,~t`ent Department in o
~ Santa Fe, New Mexico, and is a~~i~thority of the ~
x ~ ~ N State Registrar of Vital S -f ,~.'~~~l=~•~ r
O H N f.. J ` ~ ,
c~ o PiAY 22 1 ` -
DATE ISSUED: ,
O w ~ ttG -y:'~ ~ el N. Ammann °ca
U AG V y~~~Mr ~ ~~~ps~?
to w ~ H cen ' 4~: Registrar
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,.~~7f,r~tii.~ . aY Statistics
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