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STATE OF TEXAS CERTIFICATE OF DEATH sTATE RLE No.
V 1. NAME OF (aJ First jDj Middla kjLasl 2 SEX DATE OF DEATH t
oecEASeo Arthur
[?voe «a~+tj Coday Ma 1 e Feb r
~ e. RACE Sa. WAS THE DECEDENT Of 5b. tF YES, SPECIFY MEXICAN, 6. DATE OF BIRTH 7. AGE jw? can tF UNDER 1 YEAR Ic UNDER 2i HRS
1~A WIl 1 to SPANISH ORIGIN? CUBAN. PUERTO RICAN. ~ ~~deYl Mw+tns oars Howe Mvwtes
7-10-26
Q M. PUKE OF OfJ1TH - OOUNTY CITY OR T01AIN jN owside ei1Y knits, piva t>c: NAME OF pl not n Msptal, 0ivf Street address) ao INSIDE GTY
Da I l a n aecnct no j IloSwtAL oR UMITS+
Da ~ INSTITUTION pa rJ~l a
~ 9. MARRIEO,NEYEA MARRIED, 10. BIRTHPLACE (lState« ii. CITtZENOFNM.AT t? WAS DECEDENT EVER r15URVIVING SPOUSE pl wn e. 9rve maufPn time]
~ ~1rI'led D~pec/hl N
w York USATRY, INUYesMEDFORCES? liar aret G. Goodlett
W to SOCIAL SECUWTY Nl0 tSa. USUAL OCCUPATION (Give kind of work done durtrq lSb- KIND Of BUSINESS OR INDUSTRY
~ most of wo(kmp kle, even it rNiredj
~ ~ 7 (r 5? President Lock Manufacturin
m 16a RESIDE -STATE Clip. COUNTY 1Qt. CITY OR TOWN juoutsidecitif limits. 16d. STREET ADDRESS pt rural, pive bcal~onj f6e INS`DE CIIY,
I Florida St. Lucie Ft~ Pierce 1120 Boston Ave. Yeses
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a 17, FATHER'S NAME 18 MOTHER'S MAIDEN NAPE 19. SIGNATURE OF INF
• Julius Coda Mathilda Tractenbux Mar aie~u~~~~ ~ t ~'1-
= t G. Coda ~ .fl•
O 20 IMMEDU?TE CAUSE ]Enter onh one cause i>a Irre for 1e1.1E1.IcN , Interval twween I - .
z 37 : PART w _ Gunchnt wc~ttnd p~CheSt. ;andeeatn
~ Conddons, it anY, DUE TO, OR AS A CONSEQUENCE OF: Intent Oetween onset
wh~th 9aYe hSe 10 ~ and deilh
rrrr~ldiite CiU3e
0 ~ stitilq the U11~Y• ~ i
. ~ irp cause Iist OUE TO.OR AS A CONSEQUENCE OF: I Interval ONrreen once!
M W ~ r •1 T! .w^.alh
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F O PART OTHER SIGNIFK',/WT CONDITIONS - CONDITIONS CONTPoBUTItiG TO DEATN BUT NOT RELATED TO CAUSE G=YEN IN PART I UI 21. AUTOPSY?
~ ~ es '
n O Yb ACC.. SUICIDE. HOM.. UNDET.. 22p. PATE OF INJtK1Y 22c. ttOUR OF 22a pE5CRt8E HOW N+JURr OCCURRED I
I OR PE NG jNV S _ Isvecihl Yr.j 1 Y
~omJc~ide 2-~i=~`1 :11:30 0 Shot by assailant or assailants unknown
22a. INJURY AT WORK 221. PI./tCE Of tNJUpY-At hone. farm, street, Ixt«Y. ZIq LOCATION STREET OR R F O NO CITY OR TDY(N ;TArE
Ist>ecih Yes Or no) othce hu.w~ny, etc ispeahj t
1 no Unknown Unknown Unknown Unkn n TX
23a To the Ces101 my knowledge. death Occurred at the tune, date, and place and 2Sa On the Dasis of exam+tition and.'or ~ sn tqn. ~n mY Opmgn dean
due 10 the causetsl Stated Ott«red of / lMne. dice. errd pl and ~ 10 the CaLSt+S) • f alyd
T~ jsgnatrxe end Trllej ? ° j5rgrgl ~j
~ °W 6,~LL~,,r~d J 'r cal Examiner
W = quo Charles S. Petty, M. D. J
ao_ o<a
W _ _
rair °vZ t IJb. DATE SIGNED jMO, DaY. Yr.j 2TC HOUR OF DEATH - ~ JQ 2aG. DATE SIG`IED (I.b.. DaY. Yr } lac HOUR Oc DEATH
~ s¢
aF M. Eo February 24, 1980 3:21 a.m. M_j
V 23d NAME OF ATTENDING PHYSICIAN (TYDe a prmtj 2b VRONOt/NCEDDEAC ?sa PRONOl1NCED DEAD two,: I
(MO.. DaY. Year
• oN 2-114-80 AI 3.21 a_m~
p 25a. BURIAL, CREMATION. REMOVAL (Spec:hj 25b DATE 25c NAME OF CEMETERY OR CREI~AATORY
a0 {
25d. LOCH?ION ICi1Y. town. «countYJ [State] 26 SIGNATURE OF FUNERAL pREC PSOt1 CTING AS 5
27a. REGISTRAR'S FILE NO 27D DALE REC'O BY LOCAL REGISTpAIi 27c SIG T OF O(;AL REGISTRAR
;;~a ~ ~ MaR 4.1980 •
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482846 ~
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1980 APR 14 A>1 ~ 24
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gA1fJl~ WHEN IMPRESSED.VYITH-TN~Sf.AL:QF.-~fE CCfV OF DALLAS j
THIS IS CERTIFlED TO 6E :T8 ~1~1f OF THE PERMANENT
RECORD AS FILED IN THE"B U; F VIT/,l. STATy1~ICS~~~~
ISSUED: .t______
(M AL REGISTRAR
BQOK ~ PAGF t~V~, DALLAS HEALTH DE?:1RT! iEj ' r