HomeMy WebLinkAbout1682 ~E" RF NUN 1N'' 'OURCES , .
. Vi i n^^, t.?~:.~, _CiION DISTRICT OF COLUMBI._
- DEPARTMENT OF HUMAN RESOURCES
~asc Rt~d 1~j ~ 18 f
eriiflcate p"~ 2 ~~ERTIFICATE OF DEATH T3 •~117~
:artfully Fw xo.
F14E I)ATS
1. NIIriC Ol DI(t:L11sID Pint Vrddlc Guf !a. DATE ~IowtA Jloy 1'rn r 76 )lurr of I)euh
(Type br Pant) OF
DOROTHY RUTH BAI.DWIN uE»~TII FEg AICf 14 197 ~~0 P?A!
item OI in- ~ ggX (-OLOI{ OR ItA('E S. \rrtr Manird, Muried, ATFy OF Re}~u'js 7. AGE (/w y.aw 1 ' 1 t
tion shouldb~ \\'dorred, vtYOrr•'d~ wily last birtldo/) uat , leis (urn iw.
1 _ tt _
liy suppllred. X pI.ACE OF I)EATIt IV WtlfhinytOA. D. l'RUAI. I(E»~IUE:\('E: (N'Aen drrratrd lircd. ll iashhttww, nndrwrr bclwt
NAME OF HO`tPITAI., \l'Rt:IVC f10ME OR OTHER 1N3TITUTI0N a. t+TATR ('Ol'KTY od,wissiow)
(?J wut rw iwdurtiuw, /,rs tfrert addnu)
{:ALT~.R F.E~~ - e. cl•rY e. (NPECIFY•1'E uietl
n
should b. 1..... . - FT 1+tEADE (20'155)
e w t i ! 2 ~ a d. aTRtiEI' AUI)kE:~s (11 rrrel, /itt luretww)
i n t.d ~ n p.:- ?326D KELLh'lC LOOP
ti type blt?Ck 1la. l'3l'AL 0CY'ITPATlO}1 (Giro lied eJ u.rrl duos 101.. KI\U OF AL'SIAE»i.4 UR 11. AIRTHPLACk ('ITIZE\ OF N'HAT ('OI'VTItYt
iIVV ~tr.tL•t(iit of rvrlrwy GJe, crew rJ rettnJ) INDl::31'RY ar /A ~ {bt/Lt'iY4~°e,yw rorwtry) U
l7a. FATHER'S NAME I36. MOTHER'S MAII)EJS \AUh 1L1.1/~V1 11. \A~tE OF : I'It\'I\'1\(: ~I'(ri'~E:
GF.RRITT DEROEG DEC' D GLADYS 1JANSBRIDGE I.PrItdG .S~LA.S RAYIu~ND BALIx'JIN
cerliticat• bi- (S. F:r.rt a U.s. ti. ~0CIAL~ECI'RITitXO. 17a. IDSFORMANT RBL.(TIU\SNIPTODB('BASBD 176. ADURE»~4 Street ('aty 61ate
. a perrrftuf071t Nd"°`d F"t`r'' 331-26-0196 SILAS RAY?~DND P,~ALDYJI SEE IT~i ~ 9
retord whlA 18. CAQSS O! DGTH: IEwte? owl/ uwi rota Dr* lrwe for 16), ewd (r). 1 lrrtrn al I1et.rew (lrtart
~ anJ heath:
riy CxACUIId. PART' 1. I)EATII WAS C'Al'SED B\':
ISIMEDIATE C.\t'~E (a) ~~IO PULMONARY ARREST t
Cowditwwa, i1•wr. r
rAiirA yaae sue to UCE TO (b) 1
e to submit a abate eerae .at_ BR~' S'1' tanplCil'~;
iM tAe tawdalyew/ cows
uaSe of Death x )est. 1
a Depa:trrtent O 1)('E TO r
E!uman R!- ~ PART IL (Yt'HER t:IGXIFlCANT ('UXUITIOXa: anlubutrwf to death but nut Nti,. AI'T11PY 7 NL. It \'rr, \\'n.• Eln,6up ('~Kwr,lere.l
~i related to the tmurnal Jurax eorwlitww p,rw iu lwrt !(a) 1'E»~ llk \U rw lNt«ruuwntt ('a,a+e u( I>rwlh!
~ within 48 ~U+
after death rwc IF OPFRATIO\ WA.R PERFOH)IF.I) ?Oa. DATE: OF OPF,RATIO?( 706_ (YI\1)ITI(1\ Fult N'HI('H OPERATIO~i
vtoltttiOII O~ 1•! (-Y)MPLETE ITE~1S 70r awd lot. \tAti PE:kElttt\IE:1)
wa of the Dis. IW~
of C01t1Rlbla. Clt 7L. ~peri(y it aeeident, wieWe, humi- 716. IIOI'R AKI) DATE OF I\Jl'It\': \1.,rrth, Ihy, Yrar tic l1Er('RIkE HUW 1\JI.TRY O(Y'CNNED
rrde, ur nurme[ urwtrtmnnieal (Ewtn ?.etur?e uJ /grry rw lart ! ur !'erl
tD tld. I~IJI'BY AT WORK: !!r. PLA('E OF i\Jl'RY: (.(t Nuwe, Ferw, Fettury, tl(. !.(K'.\TIOV ('!TY (Y)CI3TY STATE
(3yt`rJ/ Yes or Nu) Street ur O!(re Brddu/, Etr.)
"IFI~R W
s o 1~ T ~ n. / «~r uen ~ (thla e.. yyy + ~.e.n~.d _F~ffiJAHY - 3 - - - .1! _?5 . to F~i&1AFCC_ _1tG _ - • u 5 trm ]p lust
1R ""THIS aaw the dauaaed die. eoJ~~ ~4- • . 1! _l~ ,and t6a! dwth occrrr.d from tl.a caws and ou tha daN oiad hour sbtad aDotr..
j:OSPITAL'"
naL SICNATtIlE rn.. 1?ATF: SIG\F:L ,
M/~ \TTF.XDI\d \IE:1)1('.\I. A7'AFE'
III~rl1r•. unlel-rule D PuY~. D FEBRUARY 15 19?:
?icn of ihll! ~ PHY~ICLt\'S 72d. _(tggtE~~ , _ • ~ ~.,.'riE~
XA111E (Type) EI7AARD Me ?SHd ZA ?.SC WARD DOCTOR - iliAI'Ti:R ~'~U t~°.~ '
~ is punishable
:2 OZ in1pTIE0II- BURIAL 27h. U.\TE •.Jr \.\~IE: OF ('E\1F'{'ER\' K ('kE:\IAT(11tY ~•I L(K'.tTl(t\ ((•ity, torn, ur rwty) IStutt)
or both. ORENATIO~i e - /~J / / //jam
fiE~t;)\'AL ~ ~ t ~i h~~~~ ~ell0/171~+ 1~'? ~7 i
~ 7(. Fl'\ERAI. IIO\1 H~~ 2Sa. .'U .IITA ' :R' ~)GNATURE: 25.6. 1'\UE:RTAIiFk :i ~
1 kF:GI~TkAT
AnoRESSRT 1 ?5 GAt~'mRLTS NfARYI.AND ~~~t G~~,,t.~( xcalkl:l: i-.1
RE~IAIIK~: r Censtn Tres \o. I).C. Guth \o. (ir leas tlt.w I yr.)
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99 a A + ,w...~.` '
• ~ ~ FEBRUARY 18, 1975
Oet• Issued _ ~ NO= • YAL I D M11TH • ~4 'IS£D! ` L
TH IS ' I S TO- CERT 1 FY THAT THE A80VE 1 S A TA'lIE AND C s ~EPR . , ~ .ION
' OF THE OR 161 NA.L• CERTIFICATE FILED I N ORDER WITH • . AL T S,
D ! V 1 S I ON OF THE DEPARTMENT 06. HUMAN RESOURCES, D t ,T~ ~ , C , B A .
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~ John N. Caen • 11, Chief .
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• Yital Rsoords Div'sion
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