HomeMy WebLinkAbout0985 ~ ~
. .
I
t
~ ~
NORTH CAROLINA OEPARTMENT OF HUMAN RfSOURCES
nn OIVISION OF HEALTH SERVICES - VITAL RECOROS BRANCH •
. ayistratta+
Olstrltt NO. ~~lCo~+~ No. CERTIFICATE OF ~EATH }
TyD~. 01 W1111 •flf~ O ~af~0 sKM M~~ l~st •x tf O t IwMR W11. rM~l ~ i
DOROTHY MARIE BEISWENGER F f1AY 29. 1981
Ci~tk {nk 2
olw or ac~ ~t~ o u ounty o rt ! o ~rln M ••M+. ~ •'a"'~
U.S. COUnlry) . l„~ N~InOJ~1 pwlM rf MW~~ ~
~ CAU• S,. ~3~.~.• sb. COOKE 6 6-2-13 67
I~C~ O Nt oun y IlY a own Nsrt?~ O/ HoSOrt~l O~ InSt~Wt~on u' "'~t. IMIO~ C~Iy .
.~w .o~.~ne... ~ e~t~r~~ ~.ro..u~.~w.~ ISMay~r~f~Yy~?.F~. 11w1 LHT111 I~n.~ h..
111R'•• ss.
ea. J ACKSON e e. SYLVA a~, C• J• HARRIS HOSP •
~ ~ n1O~nc~ • SUt• ounty uY or Town U~tl ~nd NumbH or i o: Nw Inf~de dy ~
FLA• ~~m~~`S
9~ 9D_ BOWARD ~ FT • IAUDERDALE 90. 852 62ND CT • 9..
Ci112~1~ Of What ountry. ry;dow
a. O~vorcia~(SD~cify) Surv~r~~?y SDOUSe l1 w~ ~v+ a~wn n~m~)
lo. U=S• i~. MARRIED ARTkUR BEISWENGER
Soci~~ S~cur~ty Numb~r Uswt Occup~GOn ~K~^o o~ .o.• oo.~• ew~~w KmA ol Bus~n~ss or InOuflry w•. o«rw~.+.•..e v.s.
.~oN ot i.~e. ~.en H.pn~p A.w~N f orus'IV„ w ho)
1,. 339-24-2995-A House Wife ue. Own Home ~s. NO
atnsr's Namt Motne. s ~~tlen am~
16 ALBERT STOBBE DAGMAR HEGGSTEAD
~ in10rT~nt'• am~ ~nd tltl~esi Rt1~tlOf1 l0 DICMNO
~ ~s,, MR• ARTNUR BEISWENGER= 852 t~ 62ND CT• FT• LAUDERDALE, FLA• laa HUSBAND
'AOma~.~VN Iwq~u~ ~I
~ PART 1, OEATH GAUSEO BY: ENTER 01vLY ONE CAUSE PER LINE FOR • O C ~~+h^~^~ ~p~~°
~ co~a~t~a,s, u ~~y ,mm.d~,~. c,,,~.: TERMINAL PNEUMONIA 5~~ ;
0 whlCh ya rlsa tu
J Imm~tliat~ uuse (a),
:t,e~~ in. ~~o... ADV • CARCINOMA ~ OF RIC,HT BREAST
Iyln~ caus~ Ias~ e
(b) [ks~ to, or ss s cons~qu~rx~ of:
19. (c) Du~ to, or ss s consequsnct o~: WTTH METASTESIS TO BRAIN~ LUNGS ~ LN R
i PART 11. OthN Si9nlfkant ConGftlOnS Conirlbutlnq to D~~t~ Dut not rel~teG to c~ut~ qlwn In Pa~! 1(~).
! 20a.
AylOp1 11 yf~ ~frf t~n0~~`~1 lOnlM~ifO ~n pflfrlT~nln~ [JUM OI pt11n Was cas~ ~elsrreo lo Mblul Examine~ ~vei o. NO~ Tim~ ol Daatn
' ~v~~ o. ~o)
E zo~ NO zo~. Zi. zz4 ~00 p~.
~ NOTICE: STATE LAW iiEQU1RE5 THAT AI,L DEATM~ DUE TO TRAUMA, ACCIOENT, NOMICI~E, SUIGIDE, OR UNOER SUSOICIOUS,
UNUSUAL, OR UNNATURAI. CIRCUMSTANCES BE REPORTEO TO, AND CERTIFIEO BV A MEOICAL EXAMINEii ON A MEOICAL EX-
AMINEit'S CERTIFICATE OF OEATH. ANY OEATHS FAI.LING INTO THESE CATEGORIES IS WITHIN TME MEDICAL ExAMINEQ'S
JURISDICTION REGAROLE55 OF TNE LENGTM OF SURVIVAL FOLLOWING THE IJNDERLVING INJURY.
p
(Wrt?~ ~ntf TKI~ of Urtllier (Type w Pn~l) Adaress .
I 23a, - N. R. El Bayadi, M• D• 29D. Skyland Drive, S lva, NC ~
~ SIS11aW/f OI Cl/l~Mf Dalf Si9M4 ;
:a~. N•R• ~1 Ba adi, M.D• 2,0.6-8-81 '
~ urNl, ~~maUOn. Utht~ Oslt Nam~ of C~m~t~ry or Cr~malory LoGatlOn ~C~~r. ~ o~n « toun~~l Isua1 ~
ISp~c•~r) - ~
BURIAL h~°'6-1-81 AOe,FAIRVIEW MEMORIwL ~ GARDEN~~..o,~.~~SYLVA, NC No.
FunM~~ MOm~ ~
ss. ~14 ~Y;F~1NE L HOME~ SYLVA, N ze. ROB RT A• R '
~~5 Sq~a r~ ol Rpistr~r S~qnatur~ ol Empa~m~r (It ~mpo~mWl LK~e+w Na ~
Fo n~ ~ I ' - ,;i. • ' ~ JOHNNY PHILLIAS 535
Rev. 7/79 ~ , ` _
i4
~1~.K f,,, ~ .
t ` _ :
~ -
ot. - :.~,'~."Y ~,,•.x.
`i~ :i~+~ y,
_ , .~.~~~~~._.;~~'~-~c;~ _ . . . . . . . . . . . . . - . . . - . .
,
•'S'1<%~ y= C
~ T r ~
~3 . , ~.~i. ~ i ~r ~ sJ
' 602'7i
~ . oMfi~?lfiet tN! I~ 8 bt~ illd f7uLt 000'~ -
~ o~ tn. swt-' ~~n r.oora 1a tnis ot~'ioe. Rec«dea ~n tp~s oma i9~-~AR 24 AN 9' 02
~ voMn+e ~ . . 1~t ?s
~ MfiMess +~if hmd tAis 19~~ ~~L~f ZN~: ~'GCrRa'~fl
= 5~.~uc~f ca.~~ 1r. _ : a.
~ n~;Rro+~n: s
RE6ISTER CLLRK Ct~GU4i-C~iLF ~ j/c~
~ / : ~ c,>r ~~~g,~tf t1 _ \ -
v
~ $0 K J~ PAGE :lp~
~
~
~:y,,.~.~.~,va.. ~~~Y : F . _ , -
- - ~~..SH~„- ~