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4•.1.73 CERTIFICATE OF DEATH
STATE OF CALIFORNIA
STAY[ fllC rUMN[t IOCAI t[OISTNaTIDN OIiTNI[T AND C[l Tlf Matt NYNS[•
IA. NAME OF DECEDENT-FIRST 110. NIDDLE T1C. LAST 2A. OAT[ 01 OtA/N trove, raT, star. i0. rcrr
Anthony 1 bieem ~ Ferryman July 19, 1979 ~ 2400
SCX QACE S. ETHNICITY i. DATE OF FIRTH 7. A4E a rwu 1 oar n r.nn t• roes
rOY1"f Ntt MOOaa rlrrttf
Male white American April 23 ~ 1899 80
T[..f _
D:: EDi=NT S. •,nrtaact et O[ur[rT Ifrnt or Nar[ •rr Nuiw•a-act CI faq[a 10. Nntr N•rt ANe Nutrra•ca e? NOTrp
F'EDA7AAL Columbia
Fred rick R! hlerr an Niar land Gear is Meem elan land
jt•~• t . ? Yfrq Cerrut 12. Secua Stcrtnr Murrtr U. Marnat States
u A ii. NAN[ CF SYNYWINC SMYSt W Nv[, [rap
067 05 0344 widowed
15. hlrarr Oeeer•ucN ti. N,gtr w Tau 17. ErneT[a Vr [nt•[rnot[r, sofet•rty, ~Onal 16. lun w INrusn et Nrauts
Tr,f Occr?ulor t~ d b
_ Service Writer 35 Western Union Inter/ Western Uni>t~n
19A. Ysraa N[s,epc[---torn awt[ss [au[aT are error oa aecaT,on (190. fgt. crtt et Torr ,
USUAL 8935 Stain s Road ~ DOWney
f?ESrDEhCE 11D. count IIIE. star 2O. NAN[ANOAOD\[SSO[INFONM?NT-tllaabrsr,•
- ' C liforni Marilyn Skeene -Daughter
21A. I[IC[ Of O[ATM 215. COUNTY
`oF ~ ZT.A. ;Ledical Center I Los Angeles 8935 Stamps Road
DEATH 21C_ SINE[TADON[SS(sutnuewrrtroaa«•nor, 121D. unoNTOrN Downey, California 90240
_ _ 5901 E. 7th Street , Long Beach
22. DEATH WAS CAUSED BY: t ENTER ONLY ONE CAUSE PER LINE FOR A. B. A:ID CI ~ 2i, ras r[arr ¦troertr
INNEDlATE CAUSE - o corow[ar
tAl S ySTC ~ ~ ~a ~ Arrto:l• n0
r ~ USE to. r, no.:. ?.r, - _ ~ ~ R•TE
OF r.,_ rat To. o[ •f • carst;r[u[ m ~ /rt[rrac 25. ft•f N,arsr ?[noT.to.
v c,.[ •,S[ la
DE ATY. nc ~•wt;~ut c•~u, lB/ Sr ~S/ s h o
s[tN 110
c-E rf'
ir•n"z r.t c~s1+ aMD
rD[ T7, Oa of ? LOSS[OV[rt[ O/ DEATH 26. war Arrerl+ ?p?or.u•
lr•w; [aa of • - l~
- - a, ~-/u" LT//~Gl~ ~C-' Cil/3(T'~ -r.Dn n0
21. Orr[r Cor;!nor: CorrtnVnrl Nri Nar Rlaar[r To 11[ Irr[mu[ Carst o? O[air 27. r•s o?unroa+ utOa+ r r r art CorN7wr rr rtars t
S / ~ ~ u !3)cri;~.d G, ft~i`~/-,zr`'d~`t.~~ tFj~P ~ a wtt•rror G~ran~o$om~y .,t~j4Y~
- _ c- lotomy and Tra~heostou~y 10/i8/~8
_ _ 28~ i:nr. ":r cur Occru[r at rr[ Now. DaT[ - 2iB. ?NTSICIA -s,u,roa a.a rtcr[[ or rna[ 2iC. uTt s,crtr 2iD. ?rn¢uN•s uc[rs[ r~rttr
PHYSI_ •.r run Sr•rrs fear nt ursts Srntr. I . , I
('I.AN $ TrAr*[rrto Dccaotrr s,.cty~asrs•. o[ctrt¦r A„r[I l~j~~-j`f~ ,~t~--1-~iD 11,pV~~*~~`((~t ~ ,x ~
.
C%F'TIFICA• .[.rtero oa ?r 1 1 t[,.rtrra. aa. rr./ I 26E. Tt?E?NTSIGAN"SN [ANDAODNCSS ARCHER D• PlfAlilti.'Y~. •
TlON
11 21 78 i 7 19 79 j V.A. LIEDICAL CENTIIt, 5901 E. 7th Streetslfong Beach Ca.90822
- 29. s?[crrr ?CU O[rr. sru,r[. trc. 30. rt4t[ of INJYlT ~l_ urrrr n rot[ J2A. Nr[ or IrJrn-ro+ir. p.. s[a¦ J2B. NOUN
r:~u;~Y Accident at home no August 10, 1978 i unknown
i`:~- ~,RMA-
Trov J3. [OfAT10M ,sratn aro rwr[r oa lOCailOr arc ::rr oa aG.V Dtt. O[SLRgE NOW INJURY ocCYtN[O [[toss tact r[f4lTW 1¦ N.vt,
c J~JVER's 8935 Stamps Rd, Dovmey Fell at home and hit head
U ~E 35A. 1 t[•r•,r ir•t O[arw ocrrrtc ar Tr[ Norr. D•r[ ara ?aac[ suits froN 135B_ tG iOKER-sl4raror[ +.r o[cut or not
^;sLY I JSC. rat[ s,crto
rwt Carf[s Srar[o. As lwru[o n t?r T Mar[ Ntia aA (Ir~of sr~lr?[sncan oal 1
1 1
1
_ r +r nnav 37. oats- rorrw. ra.. rc.a Narc as t::a s--r Lpsr[tr o• t• o•. 39. , n s tuts[ rrq[r ur s,c a[
~ueen off` heaven "emeter - ? 500 $o.
3t:~ia1 2.~ 1979 St to loo d - Po>cl ano ac Flar _a~
<7 or rrrpu mttcwr ,or •u a. acnwc as sac+• IL wut raar[ar-s,cwa? 12. Nt[ accnto~r: rrtu ?ic,sn,a
t? t ter-L:c i{inley blortuary ~ f U~ 2 11~~
STATE A. B. C. D. E. F.
E:~~!STRAR
. _ ~ i ~ s.~t•r
4 X1'73
THIS IS A TRUE CERTIFIED COW OF
r FTLEO IN THE COUNTY/ OF LOS APKKiELE~ ~Ai?ftRENT
1980 Ni?R 12 AN I~ 39 ~ ~
;R~ ~RVJCES If IT 8EAJ1s tlfls sEAt rN
FfLED ANO t+ECWzDfu ~ JUL 2 7 1979 ta~oo
S
ROGER
PO!?RASA
ttERK CiRCUIt CC T/~ ~ •
REG'M11\ERIEiFO___~i._ - i
1
~Nerr? ~ iwM S*rfo[i W ~r
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