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HomeMy WebLinkAbout1078 CC~fiAMO[~E14l~~t,TH OF VIRGINIA - CERTt~~~ATE O~ DEATH t;,/ DEPA1tTMENi OF HEALiN-ttJREAU ~F VITAL itEGORDS AND KEAITN StATlSTICS-.RICFIMOND • { - ~ ~fG~S1fAf1CM ' ~ CftTtlICA]E . - - h^~y ~ S/AlE t4E ~ A~IA MMYE! NUM![t - Se ~ INAUt! : • ' : ~ . t ~ l~J ~9 i 1 ~ ~u?sto rnd ~,~:r.?ti, c~w, . sc: - t {,.1 - ! p ~ , r»~ r...,. v~.J ~ ~ ~ ? y a?r! w t~a~) 4~) wcc cv ~ ~c wn~ ~ rew[ • 1M0(~ 1 OAY s, caoe ( ,i ~ v ~ ' . ~ /'1 ~ / _ OECt45ED - ~ ~w~wiM T-~i~i ~ 1wn wrM~~ O[ UCE _ ~ r«,+ ~ l l1ME p MCMMi~Ot S~( . w Yar) ~ 7. CWINiT p . . OC~7M W.+l~r~J~.~ cy. lw.~ til..ti) ~ ~ric~ 1~l~i~c2~c~-~~ . ur~ _ a ur'r o~ 1owt+ (d.r..1. .aa) _ i..:i.s:+~..~...wi~wt R SltEft ADWLSS Ot q. NJ. or ~cnrn ~ C' . . O ~ or r:wcF t,~ ~wrH ` _ 1 ~ ~ C`~ ~ n a~ ~oe wetx~.+~ c~razn a . ~f_ coum or oeccr.stas r~t LJ~p~w~+.t ey.1..+~ ?4w1) ~ ~ ~ ~ r (Z ~I r~ ~ C~ Y'~(v ( i Y`~ C~- IL ~ Ot tOYYIi - irri~ dy ~r r.w iw:nT 1~. iteRT ~60~SS Ot !T. N0. . . 2a b N~ _ o . _ ~ ~ R,~ , 3 ~ ~ ~ lt IMM! Oi iAl - . Oi OLQ4SED ( ~ . y~ ~ lf. i~tM t+AME Of . _ . . . - V VU ~ ~(/l Y _ MOTN!t CM O[CfAfiD - _ . F A? . ~ ~ . ~ - ~ ~ • . K 04lLWD CRfZOi Of 'i7. MAIIKD ~ lEVft MA~RiED ~ IR ¦ MA!lIEO Ot WIDOWE.~, ~ . W14T CONi1tT - MiWE OF 1~ - . _ - ~ M'DOMlD ~ ~ DNOtCEO ? . ~ _ r'e C _ . - J ~ ~ t0. F~'{TFt~t~i wea w~r 4' - . 1I. ~RiM+IA~E ~r ) 2i_ D.~?Tf Oi tttTN _ ti••Q••. «h:»,..r er acc~=t~ os efcusco w~1 cr+~ , -1 ` a~~ n`p ~ w~i~u iz MiO~MiO~m Ti N SOVKf . - i ~orn ~ aa wAe af oun~ e6+...+r•~...... r•r r« w. P~ .n~ lq. eaeevw~ anwlr~ ~ _ - ' Ni4 L 0[.AT!{ MA{ C~USEO ~Y~ _ _ ~ ~ ~ ~ ~ o- t , , ~ . O~tSfT ATO DfATI ~ WFAlD1AtE G~YSE (11)_ W . - ~ ~ ~ - OJE TO . . - . . - . ~ . - . • ~ ~..~..~K..,..~.....?.. ~s~ - F1LED Ati ; ~i:Gu?DED - ~ ~ ~to 3~'~7'~4'7 ~ R[~~::t.~:=:_+~7T~/+ASp /-~/']~/~J) ~ J - - ' ' [Q . - . C~.~iIX G1.\Y~~Ii VJUIY / ! t? , ' ' _ ~ _ rw. a. ons+~ srawnc~rr canort~a ca+reevtnc to awin sur ?ar a[urt~ ro fc+Gd~t , • ~k wutors» ~ ' - oiE4~E CO~Ot7rOM GrYt+~ M Mtt 1 (N - _ . . _ - • _ ~ " - ~ki - - - f ~vr~onzc, _ . ar. a~ s~ wtis nss[ w nEC+.•,+cr w ~k ~ E~cscwu uuse . rt w~s or ~+ow ruver acvcaa h~ »y...t MiT i I~OMfldy ~ ~ . +Y+~1~ rn ~ w r.n p - - H4U?Rlf - ~t COlR~NViNG - . ~~^!'M O M O ~1w~,.~ ~)O GVfE OEAM ~ . . . - ~ ~ . ~ iRi CRtF!!{A1 lhf1~Y }1Lp [IUit17E " " - ria 1'wE OF !lJUtY (~+J (bl! (re.~/ SM. i~UVfY QCMtLD - - 1f~. HKE OF MlYtY a•wy (ar~ ~ 76h. (C+y w p..w) ~csunr7) , (.~y) . _ Al.~ ~.1.L ~ . . .X~:- - _ fJil . ~ wN ~1 ~7. ~bsrL Nfw W4. ~1c,j 1 - , ? _e., ? j / aa~i cmrT ro+ ~ - - ~r,.~ a'.~..~n..,.a w uuu nw r».. m,....~..a .s._. ~s : ~ _ . . ~ T~~..~~~ ~k I~R~°~° fTAIi1 ~ DAR flO~l6 ~ _ ~y ~~c~JU ~ i o-~ G t~ R E~. ~ VA ~ l~ - ~ 1_ . ~ II •,e - wiwt .urwK cu.~~ . .tACE _ = . . : ' - d ~r w1s ,1 - - t.~ey . . I~ ~ ~ _ . . F~~ ~Y ~+Yr$ k+ «swnv .v-~r. ~ t~..,~ . . . ~ i f~j f• : / rV I , ~ ~ ~ ~ LJ I ~f hi+w~l iirwfr ~ - _ " _ ts' ?i ~ ' ~ n~ - ~ vu ( ?'Y\`e - _ , ~ ~ h ~ ; - . ~ . ° . / ? _ -1~ i : rua - / ~o ~~1 ~ 3 . S ~ •r`' ~ i ~a ' _ - • - _ . - - f^'1*,~~~:' r; aY~~? . This is to cert~fy.tilqt;this~i~~~`~v~ and correct reproductiore of the ~riginal _ _ record: filed wi#}~-ihe•$ ~ .~f Vit~l Statisfiics, Virginia Depcrtment of - _ _ Hea (th, -Richr`fiond,;lfi~,_ c: ` - . _ _ _ . _ . _ _ : - - - - - . ~ ; ~ Date Issued 3~~'~j - DEANE HUXTABLE, State Registrar _ ANY REPRODUCfilGN OF THIS DOCUMENT IS PROHIBITED BY STATUTE. _ DO NOT ACCEPT l3NL~SS 4N SAFETY PAPER WITH IMPRES~SF~ ~j~} OF -n - ~'HE BU~EAU OF VITAL STAT{STICS CLCARLY AFFIXED. 6~OK~cJi7 YACF1~_~77 ~ -Se~fiion 32-353.27, Cale of Virg~nia, ~s AmEnded. _ - -