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HomeMy WebLinkAbout0940 ~ . j''y~,~+ i6ic. t ~ OATt 11tQ1tTt11ID~r~ y~t~ ' l1i ~'1.• ` STATEOFCOLORADO ~ ~P~,,~1~4 ;%t~1T ' CERTIFICATE OF DEATN DOCK ~ = 238-362 1?HYSICIAN OH CORONERI ~`,931 STATE iRE qW~E~r OECFwSEO-Na.~E ~u~sT ~~oo.~ un SEx O~iE Oi DE~TN r.o•.t..o~~,T~yn . ~-a`.'. , Ernest Robert Cook , Male , July 16 ~ 1982' - ' • • L ~ ~~CE n++.. r.... O~~G~N 011 DESCEN~ wGE -~~sr u..o~w ~.t•a w.c~~ ~ o•r OATE O~ ~U1iN COUnTV pi OEATM , ~R ,c.y M..wwww.l MI«.rr.~.w.~~Ir'. ~i~rwO~v~~.r.i ~Ol O~~s w~t ~wt ~rOriw.W~,rfw~~ ite American 81 .Oct 16 1900 Weld CITY,Tp'MiO~IOCAT1pNOiOEATM NOStITAIORO~M[RINSTITU'flp!{-~..,..~u..~~,.w+r.i•.ww.w.rw~ IiNQy.OA~IMST.y~s~Op,, • W ~ rw. M._ ~~n O * h s~ ~ W STATEO~l~ATN~u..aryi~. ~.ITI2ENOiHMATCOUHTPV YA11RIfO.MEVf11wAR111E0. SV~vIV~HGS?WSEu~~...r....r.+..-.1 WwSOE OENTiVE11111V,i, ~ swren~ 1d1 fO.Q~vO CEO~wc•4~ AIINEO~O~CESinw~,rM~; j W~ Kansa5"" ~ USA ~o ~rrie~ „ btary A. Price „ Ho 0 SOCUISfCUR~TYNW+lE11 USVAIOCCl1~AT10M~4..~+rM.v~N..w•w...~M...~.r KINOOFlUS~MESSO~IMpUST11Y • ry m.r~ ~ 521-18-8051 ~•.Retail Ice Cream Sales Retail Food ~ES~OEtrCE-Si~7E COVNTV CI~Y,YOwNORtOCA7~OM 2~~ SiNEETAHDNUV~EII INSIOFCITY I~WiSnwr~ . Colo:ado Weld Greele 8C5?1 1b15 8th :~venue Yes iATNE~I-N/Wf ~~wft ~~OJIt l~ff YOTHf~-NAYE t~wf~ r~001[ ?~S~ ~~i~9t~~ • Daniel Zaccheus Cook „ ~'hoebe Jane Hatfield 1NfOPYANT-Dt~.ME ' ~•~~~^+~•w MAtUNGADDRfSSftwiliWwrOwO C~rrpwrpwh fiwil I~~ Mrs. i~la A. Co~k Wife 1615 8th A~venue Greele CO 80631 Z/UA~AL.CAEYATIpM. REMOVAI OATE aM~~. d.. r.n~ ~E4EiEMY OR CREyATOpY-MAYE ~HD IOC~TI~N [~~r Ow iOww f~~it O ~f~.<.r•~ N,,. Burial ,,.Jul 19 198 Sunset Memorial Gardens Greele Colorado g ~UNEp C70~ NAAIE AND AODNESS O< <UNENAI HpME ~f~Mf ~ O~ w r D I+O. U*•.liwil.2~~~ o~ . fi2 ,mMac Allnutt Mortuar 702 13th St. Greele CO 806 ~ 74 ?MrSK1AN 5: q p e AA ~7. CORONER - OM TwE ~~3~301 Eaau~q~7qM w~.0/O~ lO TM( ~EST W V'~ S lCGt.OlwTw eetD • `~b~.4»e o.rt NO ~l~Cl 1NVliT~Ci~hya.1M1P~ M~NOOM Df~TM p~('VM(p l17 Y w.ro out ~oT ~ s~•Tto ON TN( OA« ~MO I~AC~ ~NO DVI 1O ~w( ~~y=(Ifl /T~~(D. ¢ ~ W l~y~wv~ N T.NI 1, v I~ I w~•~ ~N i.x~l ~ ~ DATEStGNEDr~r~. . rl DATES~GNEO~u«w.9.~.nr~ ~nOHpUtKE00EAD~w.On.•• w..~ ~ July 17, 1982 Nu~+EwHO~DD~E550iCEAT~~~FR1?NrSoCi~r+ORCORp?rEnl~r,w. . „ Williar,? C. Humphries, r1. 900 14th St. Greeley, Colorado 80631 REG~SiRwR O~TE AECE WEO B~ nEWSia~n w«~.o.., nr~ L~wM., Deputy 2,~ July 19, 1982 T. TEp OHIY OHE CAUSE if A I:NE fOR fa1. iDl. ~ne .1 ~7 a.r a.~ . rv~ w>w~ ?w~T ~w~EOi~iE C~USE 1 q ~ ' l~l fl.J(,~ ~~.til ~-,~-~W"L;; ~ ~~L ca.anori ~r ww+ WE TO.OA w5 A C +SEOUE~+CE O~ ~~.~.r w~....+...n w a...+ ...~Kw e.re ¦~u ro 1 S I~wlM~tl ~ (pl - D17E 70.OR AS A C SEOUEr+CE O~ e.~...+r~. w wr• a sr.,~..c T..i u+Otw~~~rG ' 0 uuu ~•zr kl ~ LL ' 0 ~~rt OTHEIIS~GNIfIC~?MTCOMO~TiO~+S-CMS.+-.<r~~s~M~+r.,•s...w.~..+u<«..~»+-r.~~~~,~ I~uTpS~ w~5C~5EAE~EApEO u+ ~ ...we~ 10C~RONENn..rW~ ~ ~v ACC~DEN~,A1KiDE.NOir~C~Df, O~iE~wDHOunO~itixipr » ~ NO OfSCRtlE HOw IHJURV p~~UNNED ~ UNOETfRM~MEO.?EMOiNG ~NVEST~Gwt~O?i. ~W ° ~ ~ , ~ ~ ~ ~ /MJURY AT Wp11K i~n~. r.~r /l1?CE Of INJURY- ~..e... ~ IOCAi~pr+ rir~t~~ O~ p?+ c•~. M rpr.r a~arr~ ~ .wr. ..w. ?~s~y ~ ~ • ~ I HEREBY CERTIFY TNtS QQCUMENT 1~S A 7RUE AND CORRECT COPY OF 7NE RECORD IN MY CUSTODY AS REQUIREO BY LAW. ~ `t;r~l~~. Wi tness My hand and Seal ~ . Thi s 27th day of September NOT ~'l~A~i~Q ~{~'~t~nf.~~ . 1982 ~ LQ~~L.~, k~G I STa1~;~S ~ ~ ~ Deputy ~ SEAL ' ~ = ~ - ;J _ L C L RE I AR VI7AL STATI TICS ~ - ~t= ' ~ - ~-'j Regis[rati n District Number ' 23g ~ Ra~p7~ ~R 41ool~q,:. ATj:` NPH ~ ~ K~~?~at•~!*~'~,CL~;; . Greeley Color~do ~ wEC~, E01~t~YA .t' PENALTY aY ~AW ~ f I DEPARTMEhir'`t~f' NEALTN ~~Y Person alcers, uses, attemp[s to k usc , or furn i shes Co another for decr_p~ i ve use ~ny v i[~ I ~ ~ . ~ f /'a~? , a ? \ ` ' Q1 / . . . t. P FEF NO. ~~~~Ji? . ~ . , ~ v ~ . ~ STATE OF ARIZONA, Couhty af Sanfa C~uz ~ ~ A r/~`-1 _ /j I do herEby C~rtify (hdt t!1e WtMjn JIyF(Yr~iO~w 5 filEtl dntl recOtdetl d! the r?que5t Of g 7'7~t.~ Y ~ _ -~'r- ~ Af~T 1 Q1Q~ a;R ige ac 9_s ~~c~ ~ ~ ~ ~--~i-~tl--+~--- F^~---..~ ~ ` Q _ o'Nock - h1. Docket No. Page 133 ' ~ 3Y ~'.ecortl5 of yanta C~uz County, Ariz~ia.~:F p.'~ j WITNE55 my hanct ana officiai seal the tlay an~ year f~rst above writtrn. 6(~93~9 ^ .J f 1 : i ~ `IARY OLT G. SAINZ, COUNTV RECORDER , ~ B Y ~ - - ~ ; ~ ~ ~ . . . ' . CHIEF Deputy I , . . • F ~ ~ rt ~ ~~i~~ ~ : ~ . v.a~ ~ -~i.~~ 'S~ 5,. • ! : , ~a tv~ xra.~-Y,y,zi'~'...*~m~"'~'?s/s~~~.is`h`"z~~'~ `~e~-r~s"~y~5