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HomeMy WebLinkAbout1826 ~ . ~ ~ . ~ - . ~..,.,.,.,.«,~ran.~!+CMMMx+narr,M~~rnwM.,~.«..,.,. _ ,.~...~.~,wm~,~~ ~ ~ . ......,..w+,......_.:.~ . . ,...«wrmwa~rn.~.w~w,...:.~,. . . -,.,...auwawM+!'~Mw~ww......,, . ...'-,.........waa*M'rM~ak~wm~. .....,w.~~~.M~~r+,^~unwiro.+M~~.,.~..,...., . anfiq'r1M:"N7M"ni~1".~1wn~[ws ' \ ' ~ ' . , , i . ~ ~ . . . , ~ ~ ~ . Of 1. . CA RESEAR AND RECORDS, 30K W PR 1 Vt f1lALYM .:.~,~f . , ~ DMSION OF fTAT15Tl ESTON fTREE~, YAL1'IMORE i, NIARYLAND J,~ ~ CERTIFICATE OF D~ATH ~I ~ ~ 1. ILJ~CL 0/ DEATM 2~ VNAL ~LBID~NCt (Whnn d~o~wd Ilwl~ M I~IIIWNni INld~ne~ Mlen ~d~nirbni ~ CWNSY a STATE A~ COUN11' `w ~ o Prince George Mn„rr~ Maryland Prince George b. CITY OR 10WN (M euuld~ aNonN Ii~{U, e. L[NOTN 0I STAY IN 1b a l'ifl' OR iOWN (u whla ~wio~M Il~lh, wrlM IUAAI ~n1 /i~+ nwnp bwn~ ~u~~•"~ ~~w C heve r1 ~ , ;a a Cheverly , , , - , ~ . is fy , 1, NAM! OF M0511TJU. 01 INSiITVTIaM IN M In MpI1N, /fw MnN ~d/nrl d. STIIEET ADDAESS I~~ ~ ' ti o~ 6405 Landover Raad I 6405.Landov¢x R4ad,,~ ~ ~ w ~ v ~ .~.m_.~Ly:.~<,..~..~~,~,,..,.~ ~,.m~.,:~ . _..:.i.ii. , . 4. DAtt , ~ Me~~ D~'~wr ~ ~ ~ ' W,a fr G AME Ol (~ip M~ ~ ~ ~ DCCLABiD • ai~n F8b 20 19 ~4 ~ I aM w" a~~•«n~~~i MU~tIAL ~ M. A+tIGHEL _ ~ 1~ DATF OF EIRTH 1~ AG! pn yrn II IRplR ~ YlAR N UNDEt 2r1~1 ~ , ~=?'p ~ ~ S. SEJf COlOA 01 AhC! MAW[D~N[Y(A iAAAqlD ~ y~ WlhdrYl MonIM D~Y~ Noun ~ MN~, ~v~`~ ~,r~ ~ 7 Femaie Wh~:te~ ~w~oowro~ ~avo~c~Q MarCh 5, 1~92 ~ bl ~m. ~ , n. a n x~ w o? w a ~ r c o u~ i ' e 4 F tW~V W ~ 10~. USUAI OCCUTATION {Ww U~I M wal 10b. KIND OF IUSINtSS 0111~USTt'f 11, AIRTMPIACR (~unry i ShN, a bnNn w~Mry~ ~ ~ 1 e.n. dwlny .aw d waUM IN~, wu R MIndI x ~ p~ ~ , °d' ~a ~ Houeawife I O w n H o m e I B a l. t i m ore, Mar qland U. S. A. ,~o W,~""'~CY~~ ~ H (t~ M. MOTNCR'SMAIO[NNAM! Oa6 : 1„ JQ 13. fAT11El'S N11M[ ° ~ Annie Simms ~ ~ ~ 0 , ; . ~ Fr2.rik Rouad ~ , . ~ea~.. _ ~.13~ WAt DtC[ASED lVEt IN U.S. AAM6D f0~CE3T td~ SOCUL SlCUf1TY W~. I7. U1lOUTAMT ~ ~EQ, ai ~ ~ no~~"~~~ ~'~'~'~'~«~a~~l ~ne Robert E. Michel Sr, ~ Same ae ~f2 {Huel~aad) ; ~ ~E. w ~ 0 ~ ~ , ' • ~ ~ ~ or+s~~~o~~ ' , , ~ u. CAU/f~0/ DL177[ ~ M r.•• o•w• ~ M~•~, ~e1. , ~ ;4' O ~ IAlti L DtATM WAS CAUSlD IY~ .u,~'L(.vt /`+~7+ 7 ~ ' _ t'~'~~ ~ ~ ' ; i ~ r~ IMMlDIAi! CAUSE 1•i._.. ~ , ~ ~ ~ ~ vC ~ ~ ~ ~ ~ H ~ Dp! TO ~ ~S~~1/ ~ l~Wv1" ~ _ ~ ~ Z ~ ~ ~ (J~ ~ WndNlani. W~nY,'wAkh ~p~~ U~6rd G2.CyG~~ 4 ~ I A Fa - Nw dN 10IIIIMAIN~ i1YN ` ' 1~~, ' ~ ~ a+u, DUf TO - - I ~ , Wtinp iM undwlr~M '~tC~~ ~ wt6 ~C) ~ ~ M M~~'~'~~' II.OINER SIGIAFICANT CONDIilONS WNTAl1UTIHG TO DEATH IUT NOT ~IIATED TO TME TlIMINAL DISEASE CONDITION GIV[N W tMAT 11~) ~f~ ~E FORM~}r ~ ~y ~ r Q~~s~ ' : ~x :bf~ , ' ~ ' i YES U ~ ~ , i rr ' ;h ~ n ~ ' ~~ri r WAS IMIDERLYING? 70b~ DESCAII! HOW IN10AY OCCUIIAED. (LIIOM MIYM O) IIIW~Y (II I~A I N I~A II OI I~~T II~~ , , ; ~My ~ 11A~G L1 CAUSE OF OEA~fH I ` ~ (~j .y+ ~`.1~, U6. f,k^".N. ,tY~MEDICAI EKAMINER) ,~,T~ ~~,~'t j~ 8~! Q l1 M~n~h, GY, Ywr 10d. INIURY OCCIMALD 90~. ?LAC[ OF INlVAY (Xonw, hrn~, ' 2q. (Clh' a lovre~ (Cou~1') , r ~V„ ' v. . I Whlk Na WhH~ anar, oRle• Wdo" ~IeJ ~ ~ ~ ~A . I ~91~ 1, N woA ~ ~ d work, G r , a~ ~`i', ~ •H~r. IM d~cauid hom:,..., ~ 1.,, ro,., ,f,,/...,,.;~'~,...,,.,, 1S~,k,, fhaf (i} (we)1~d' k ~ ~ } ' tr',t SAluf (I) (fbii hoi ' ~I~etlmd~d ~ ~C~ ~nd thaf d~alh occurred ef .„A~M, from the uuses and on IM dale spted aban, , , ~ s~d ~liw on„ ...............:.................1~.,..~ H ' •w. W~~ 7~b. pAR ~ ~ a ~ ATi[MDING MED. STAfF II ~ , , ; ,V!!~6 , ~ M:^,~ ~e~ M,o, r~vs. DIAECT01 ? ?Hrs. ? -~2I/6t±, ~ ~11d. ADGR SS ~ r, . y> ' 51GAN'S Y,. ?uM~ mo~i Till Bexgemann 53 A Crescent ~d~ ~I08, Greenbait, Md. _ . ~ , ~ • jp IUAIA4 CAEAUiIOH, 17b.'DATE TMIAlOI 7k. PIAMl~ERY OR C~ih~1~T0AT »d. lOG1TlON (CNy,bw~~rowM'I ,(S~) ~ Ru~c is,«~? ~ Colmar Manor, Md.'_ ~A ~ Bur~ 2124/64 I Ft. Lincola - ~ s:w ucro ~r uwsrM? ssr. ucnt+a~~s s~cw~nn~t ~ IH ~ ~t ~ ~ ~ 1/ NINtiAI DIRCTOR'S SIGNATUII[ ~u • ~ ' ' Fraacie Gaech~e Son~ H atteville, Md. DAT ' ~ . , . , , , . ' , , ~ ~ ~ ~ , , ~ ~ ° ~ t ~ ~ , ~ ~ ' ° . ~ ~ ~