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HomeMy WebLinkAbout1703~ . 513345 CERTIFICATE OF DEATH _ ___ __ _. _ ___ _ _____ STATE Of CAI.IFORNIA aun ~u~ MYV~f• ---- --;AKAT~iRYIIE ~tioznr- -i~esi;~ie.-~~~[11C@ Cayle ~"F~tIES - ----- - ~ ~ ~. S~ ~. IIAC~au S. ETHNICIiY ~~ i. OAif/QF~ptyjM, r y/ 1}/ ~~+ UFCFOENT 0. •i~~M~t~ct Of 7[ Yet~' .:ntt u 9. M~ra uo ~~~tr.uct ~~ ~~l«N • -~ra~oN~~ • ~•-~~-Te~sc~s Granvel V. :-':orin~/Texas DAiA . 11. cn~rt~ er ~rra ce~~s~~ 12. S i a~~:rr rc• r. t~. ^~nw sutr~a U. S. A. ~~~i-26-~92a ~ :~arried _ iS. -n~ur O:.cvriucw 16. ^•r~~i er ~a~~s Hou se~vi fe *-~~~-~~~~~ 17. [rrao~t~ lv att-.~rne~a~. to st~tts - - - 1lA. su.a ~ts~s[.c~-s~~a[t ~~~~tts ~fnur ~~~ ru^~a~ ~ B A e~ ia• o~~ 1190. ~ - 5~ zrron ve. Apace A- ~ -- . USUAL . ~ ~ RESIDENCE 19D cou... San Nateo- + tlE. su.a ~ California 21A_ ~uc[ os o[ar• ~ 21S_ counT• F E P ~ISER FOUiRJ~TION HOSPITAL ~ SAt~ tdATEO O DEATH 2~C. sntcr ~ooe[ss ~si~ur ~r~ ~r^~u o~ aoc.~w.~ ~ 210. ctT* o~ rov^ ~ i 50 V~TERAI:3 ~Ji1LEVARD i R~~100D CITY 22. ~EAiM WAS CALSEO 6r: 1 ENTER ONIY ONE CAUSE iER IINE FOR A. 8. AND C) IMMEOIAiE CAL•SE rAUSE I " OF DEATH I t 7 ' i ~ r I` ~ ` - s PkY51- ' ClAh'S CERTIFICA- i f TION ~ INIURY I4FORSIA- TION CORONER'S USE ONLY ~ 2!. ~-s ~t.~r nro~u• /d/Q ro co~o.u. , (A/ ~~l/f7'sf~~ I`~~ ~~..~~ ' /%4r •rrtoi~- ~~/~ Corp~rlO~s, 1f ~r~. •~?t -~-LK.. ' •..c. c•~[ ~n~ ~o ~•a to. o~ ~s a nMS[s~uct cr ~Ri[~~~t !S. ras ~~anr ~urc~r~~r r^~~^.~~urtc•ss[. tB/ CJ~~al~ki ~~'ft~ /1~l JI/~ ~ ~ ~~G ~[t~t[^ ossar _~~ fTU~~c tr[ ~~~t~- ~ . •MO •:l t0. O~ ~4 ~ COrffYJ[~([ 0I OE-iM Z~. K~S ~~fO~St -(~/0~~~~~ L~~ti~ (~Yt[ l~tt cc~ NO 2~_ Ot.u Cor~~no~t cc+~nwn~c ~~r Mor ^ •~~ ia i~c u~~o u~ ca~a~ or anr. 27. ^.~ or~.aao~ r~• or~ ro~ ur co~wuo~ ~~ n[rs rt ~~ a~• ~ty/~af?~~f'~l ~,P~ ~RcJ+~ ~~s~a.Q/ ,..~~ ~.. .l j°+ ~_ ~ .,,. ~~~~/ ~~li~ 2~A. ~ nrr T+.r o~.r.. occ.~~n ~i ~w[ ww~. O~sd 28B. -N~s uti-s.c• u~ .+o ~tu ~ o+ ru 1~2CC. •~/Y s~c ~ 2SD. rns~aati•s uc~wca wc.sn •-i.ca s.•~m r.» r.[ c~.s[s vti~. /~~~JJJ //yI_~` 1 /~'~ ~ 1 an~.e[o oir~x•~ L.,~ ~ 1 l.fi S~. otu~u~ ~.~•[~ ~~I~ I •~ j //~ 1~/. ~/~ t O~ ~~~~(fJ ! "•*~ ~~. ~• , ~,~•*~• ~. •• _, ~ 2sE. Tt-C -tits~cuN•S w~r ND ~100~[SS F. DEBORAH JOHNSON M. D. ~`! ,~ ~~~?/.~"~ 1 1150 VETERANS BOULEVARD, REDWOOD CITY * CALIFORVIA 94063 2!. s-~eo~ ~caec.r. »rcn[. [re. ~0. -t~t[ Os ~alu~f ~I. ~uur ~i ».a ~2A. ~•n oi ~..r•~-.o... •.. •... ~ ~28. wo7• . ' 1 1 3]. lcC~noM ~snir. ~.s au.~u o~ aocuw~ us cnr e~ ~o+.~ ~~. OfSC~~~E MOi IMlY~1 OCCY~~[O /t~rwts ~rccw ~~s~at~~ i~ u~u~~. 75A. ~ turnr t^•~ Or.e. oe~~~te ~T t~t Mo~~. O~t[ ~wn tt~e[ St~~as ~~a~ J~50. [e~ovt~-s~e~•ir~t •.a ~ae~u o~ r.r.r i~SC. ur[ s.e•~s r.i c.~sn s~.n~. ~ti ec:suce ~+ u~ 1 M~rt M[U u Itww~sr.tn~tnunan I ~ j 1 n ». ~jri~.~;.r. ~~.• ~~~~~~•0~~~`•Segg~'$~ k ~ ]!. ~r~.~ru s ucu ~ ~o n~ ..~ s~c~.rr~i r p n s D~~d~. Fremont~CA not em~a~med ~ ~~r`a'~i'E3 a0 ,..~ or r~^c~n M~~cie~ 101 I~~tO~ ~fhK ~t SYCA~ II. LKII ~lG~tf~~f SKNfll~t 12- ~~u .ua.n~ n~x.a .ausn.• '~:emorial Cre:nation Society ~~ ~~- ,~,,~J~~ FEB~ ~2 9 198~J ~ SAN MATEO COUNTY DEPARTMENT OF ~PUBl~IC ~HEALTH At~D WELFARE ~ 22 . ' : t _ ~ ~~h .AVENUE . SAP~ ~ ~~~~ .FARNIA 513345 mIS IS TO CERT~ -~ NG THE DEPARTME~~T SEAL, THIS IS A 7RllE,= NT FILED IN 7HIS OFFICE. . ~ ,~;.. '~; _ 1981 J"N I 3 P'~ f2= I 7'':'` '~ .' ~~ .~~~~i. o~~ _ ~ ~ ~. r tt~~r+c «coKr~~n ,~-~.'- , .,,.fTCEt~ AND LOCAL REGISTRAR ~ S .tUCiF CQt14TY.Ft;. •~ w~:. •; _ ~t1Gf_R POITRAS ~ '' ~' ~~r~~ >:- £ fft( C(RCUti CG11Ri !t`~.~, :b~L^: " ~~,:;;~:~ ~~~-,~ ~ _. ~~~' _ •~ _ . _ `~ March 18, 1980 ~ ~ BU~K ~4V PAGEis~ ~f ' --~~.~~------ -- -- ~~4__ _ ~n.~i ^~....~~~r~nwn~.~~~cr~~a~~~n~u~~f YV~\[• ?A. ON[ Of Pf~iM ~~.,~.+. ~~~. ~t~~~ ~ 211. ~w• FEBRUAFiY 27., 1980 ~ 1710 7. pyE v ~~~n ~~~.• // ~~H\ l~ MOY~1 55 ...,.. I ...~ .~., I .,.d,.. n.n 10. ~~.~r r.rc .w~ eu~wuai m ror.~• Lucille Iola '~lyly/Texas ~1. hl4[ O- SYfY1~IMG SMYf( t~ ~. ~[. f~~[• •~•~-•~obert S. ~ries t~. [u~ ~-1=s-s--r- ~st~~a:: tlc. u e. o.. ~ec~wood City :~o.b~~o~oo.;:s~:..~riesyhu sband 855 Barron Ave. Space A-6 Redwood City. CA 94063 n~~:~=~~~