HomeMy WebLinkAbout1000 r
31`-~+11~ ~ ~"ry ~i~tlf q~.
l~: ~ rr`3Y
b ~4.=/~-, ~ ':.ate: . • E ,3;
~ . - STATE OF - - -
; OEAM NO
L;~.' \T O~ OEPAfiTMENT OF M SERVICE -VITAL RECOROiB SECTION D 1 OZ'
t°~ - -
`1`'°' ~ -iAYE ~ A sR51 ~y\pYpOO~IE~y~ ~C
ly~,~~ SE)( W1TE OF YU.rw p.r •E Y+
yY4 :CEIIlEO g~`~ ~1/K1L~11.1N1~ ?7[/4E10[l OEATN
nJEEA[W
~ M 0.'EEtb, w~ Aitrrrtllt Ytdlfr. ~1t 1 WAS OECE~..-• ~ YES. NOICATE liEIOCAiI SPANtSK WAS DECEASED EVER N U S ARMED
~ . ..•ECicr 01[011 IVES. NOI SPECir IUERTO pCAl1. CUBAN. ETC tSVECEFr YES OR NDI
I~ti ~it8 ~ S ~ C g Zvi
ra;~l _
t:;~~.~ '-{ACE OF A CpElEtr • rOwEOA Otr C ~
i 011 1~ 11fS0EMCE MR SnEE/ AOOIESL _ D O OPE~EA
t` Yarioopa Sin City ~l Yml4r ital 7~iyr.n,r•t
r--? >TE OF EIOMM tMr • vEM AGE ivfMtS f 1/+OER t .E+R i tlgEw. pAr YAN~D. NEVER MAi~D. SlJf1Vt11rKZ ~i MK! GnE YMOENNWE,
~.qTN W1.111•p~rl EE0.S DAYS ?WS 0!1 WiDOWEO.OTVORCEOESPECIFYI SPOUSE _
Jtme ? 1921 •A 5? s c • Widowed
t0
,TATE OF p no/ n USA. EET/M ~r111 C1TtZEN OF LARIAT SoEdf r SOCrAi $ECUirTY NO_ OCCIaATgN tDE1r. tEnO d won tuND OE BU$NESS OR NOtISTRY
_'i aRTN COI)ETRYy _ .rONdrEOr4sfptAE.•r.ftlrAtnn21
;j ~ Cpl t2 1J 5 n/-O~p~~ EAI? t~t e Petroleun Co.
;.-%J'J ':UAL A SUtE . CgNlr t tOrW OA Qtr D M fY)OE
{ -
Sy TREET ADDRESSOR .1510E CITY St ON RESERVATION NOW LONG N N.ZONAE - PREVtOE15 STATE `
~..\1 , , E D (SPECIFY YN of Not ISwc~Y Yb d IEOI vEANi rDNtNt oA.s OF RESIDENCE
~E t5F t50 to » V la
,THE . ~ ~
IIiJD~ - N~RS Selen ~ ~E dOrl sOn
r' '.EOFtMANT~S SIC>71ATTJIE 11EUrIK7u4+?t0 AflO11ESS SHEET NO pTr ahU SrarE l~D r-DOE s.~.
Lester J. Hayt z `~$orney n 10421 No. Goggins Dr. Sim City, Az. 8.5351
;Fil/ILtS1EWTgff, OntE CEYETEAYORCREWTOIIY-NAYE EM MgE55tONARMiE CERT NO
;:,,F' 3 YAI. sP.oEr1 228- Cedar Crest CEan. COllbran, Col ~ 27~G A
.w
\ ~.'EgEiE wOER NM/E StIEEi AflpE,SS Otr AMD SEAtE FENERAI.OIAECTDR Ot • xEr,p AS fuCM IStGNATUREI CERT NO
bun ~ 1.1211 Michigan Av~@. Yotulgtavn, AZ. . y2 - q _ .
~ ~
I' TO THE lEET OF YY KNOt/R.E00E, OEATN OCCIMYED AT ?IE Tr1E. DATE Alb OM TIE M!N OF ExAEIS1AT10N Afq/DII INVESTWATi01E. N YY OiMON
KALE AND OYE i0 TIE CADiElf1 tTATEO. OEAI11 OCCIMMlD AT TDE, OATS Alb ELACErNO OUE TO TIE CAIKE(Si
~ i= j nT > SIGNATIIftf AMDYANIEAST .
1 StONATl1RE y// ` ` ~ s _ -
' e ~ Z ~ 3AI'ID TRLE , 'A~ TTT E / G
j(~ ~-fl~ L-lt-v~ L ;
a! t DATE S1GNE0 (Ab . Oq. YArI NOl/R OF OEATN 't ~ QI?TE 90NED AEO . DN. YEElf1. ~ NOUEt OF DEATH
,,=,ti' E~~ s „ _May 24, 1 9 „ 5:00 a.m. ~ -
> a NAME OF ATTENONG pNYSECIME IF OTtIEA T?IAN CERTiIER (Type or pM ~i PRON011iCE0 pEAD IND. D.Y. YEw) PRONOIJNCEO pEAD INO~i
! p, May 24, 1979 39 AT5:00 a.m. _
- . AtAE ANO ADDRESS OP CERTi1EA PNYSICtAN OR YEOICAI EXAMEaER (Type or prerq y
. X20 S. 6th Avenue, Phoenix, THOM 1ARYIS, Y.D.. UARICOPA COUNTY DEPUTY MEDiCJLL EXAYI -
+LE
aE~Gd*E1rf.D IE4 ilE MD EECr~EnM / It6 06rAGt OaiE R.tirD N 5'aiE O~cr.E
~ pxei A •EMEDIATECAUSE fEbrEtlOlarOf4 orr t _
~ ~~~s E an uinat ion
_ ' z - B OIIE TO.OR AS A COHSE OF 4AT E ,
F MTERVAI
- ~ noised wounds, WristB eETV?rtEN T,:
- ~ ~ bF p C DUE TO oR As A coNSEa1EEA1cE of of NAt
FF i i
~A11T1.OT/ERSKlNFICANTOONOItONSAIA~ORENVIRDEMIENTAEFACTORS(aa0~rilAnyyrrasEerppwy.+sr+pri.DOraYS AUTOE'SY WI~SCwSEREFERRE0i0YEOICAIfXAM•.fR E''-
~ a~.~Y ~ s1510etJY Yn a ,>o) e s
~ 1 ' AN»ER OF OE/1TM DATE OF EEO DAr rw g.+ NAMIY AT YYORI(~ OESCRi9E NOW /I.AMtY OCCURRED
~ ?ACCOBEt ~ SN.AiRY 5-23-79 9'
-T~ ~ `~"'"~°"a' ~ cut Wrists
- ~ PI ACE OF NJl1TY {AtItOnM. yrte, Ste W. NcbrY oMU YY?IEAE EOCATEM STREET ADDRESS dTY OR TUVYN STATE ~f
D~# ? E`'~
o~' ""~~Y Home ~ 10015 Oakridge Drive, Sun City, Arizona
; ~ JPCIEEABETARY EIETRIES
_
a y ` -
CERTIFIED COPY OF VITAL RECORD - -
a~ .iii ~ ,r f.. y+'-,
j~~ ` r'.. r ~ ' a , . e ~ - "a. :.L, E... • EV4RIMFNT ~~fTH Sf1~/.E~~Er~ES//( A~` • 1
I~- 2314 _ .E- ,ti: E~t;;~; ~R~:~
t~,..
Tn,E [opE ~Cf .ah0 u„tfs p,rDa,eQ on rJfN1 Rape, O+Epyrmq Rafe uai ,n [.^b• a~a Ynp,ME!/ ~IfA •i$N•~~~~(t~0 a,encl ~
•
3 ~ ~ "u i s+~ T '0.'.:f • [ • :~~•~M ± * ~`j~