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HomeMy WebLinkAbout0959 • ~p~ ~ 1ry ~ r.~. ~ SiAiE OF TEl(AS bC7.7Vb I CERTIFIC.4TE OF OEATN Sir,tE Fl.E NO. rU1CE OF OEATN USUAL IIESiDEHCE ~N'ke.~ dxa~wd ~:.d tl ~~~r:~~r cv+ .e.dMCe be~o.~ edm »~on~ . couNtv ~ Da11aS ~ . sint[ 'j'CXSS e-ccun:rr U811a5 b CITY OR TOWN j~f o~ri~.ie c~fy 4n+~h. q:.~ pr~c:ncl no ~ ! t iF~:31H Of 5711Y ~ c CITY pR TOW N(If outtd~ c~~.fy 6m,tti. q~.~ prec,.~c~ no.l Dallas "'b Uallas d 1:~r,~. OF ~~~.i ro~ ~ Msc~tr q~.~ st.ee~ edd~esil i, d SiREET AODRESS ~!f rwe!. gva bce~~cn~ ~~r:r~~c°~ Baylor i{ospital 6211 West Northwest Highway ~ :J ~5 ~LI~CE OF DEAiH ~NS~DE CiTY ltuiTS~ ; ~S RFS~DENCE W9DE GTY UM~1S? f 1. IS RES~DfNCE ON A F~RM? YES(~X t10? I YES~ NOQ ~ YES? NO(~ ~ l NAME CF iet F.zt Ici M.dj4 1<) lesr 4. O~1E O' DE/1TH ~~asPo ~ t~{aude Margot tlumphrey ',July 16, 1978 ' I`. SEX ~ 6 CO! OP, 02 RnCE ~ 8. D/~TE O~ 6!RTH ; 9. ~GF p~ yeen ~F UtiCER I Y ~ ',i U'+pER ?a ~ ~ Me.ned tJever I./yn.<7 ~ I . {~U D~FdeYi ~ Mcv~in~ ~ Ceyt ~ Han M.~,.•e+ Female White v;;,~~ p,,.~~o , June 3, 1903 75 6I ~0~. USUAI OCCUDAT!ON~G.~k.dcf..xkc'ton~~ i~. KtND OF B'JS'NESS CR INDUSTRY ' I I. 9~RTiiPUCE ~S~~teo• (o.e.qncoxtry! ~ ii C~T:ZEN Of W'H/1i CO::rNRY~ ~ ~ du~ ^q Rosr o{ . ~ i~ie. ~.en d.ef ~.ed) ~ Nousewi~e tiome ' Ireland U.S.A. .nl il. FAT.~ERS NnME I Ia MO?HfD~S Mr~i7fM N/1ME ~ Neville Henderson ~ Dessie Graham ~-5. CE/+SED fvER ~N U S. ARM.D ~ORCES' _)6. S(?CI~L S:CUQITY hQ ~ 17. WFORMnMT R/~~ -~`f''y`~'y__- G`~^^~+~~`'~~~-~ I Q!Y„. ~c c. „nYro.~~ y~s. q:.e ~v c+ de•~f o! se~r.ce) / p • / ~ ~ No None '494-14-4412 : Betty Sava e ~ ~ ~8 UUST OF DEATH (C~•r cr'.y ~+e cem~ pe. ~~~.~v la ~a). {b!. ~^o , o.ur ~rµCE•"~ 4~ 7NR. pfqTH WA,$ cnus~o e~. MN~~,~r~ is~ Complications of fracture of femur , ~ =.i c„~~~.. .~,~y. . .~a,.;, .~o oi ~ s ~.,'-~:e . e.;e ; j: ~ OUE iQ Yt: < s~e t~~~ ~-ycr. ~i .J~ r"?:9:» ~!1 ~ . O~! ~:'ii T~j , <I 0 D~2T p7HfR S~G!:~F~C~~:T COhDI7~pP:5 Cp~~i."'2UT!~;~ TO CiATH 6UT NOT RELATED TO THc TE2M~NAi G~SEASE CONDITiON GIV[N '4 P/~RT q~j , io Y:~i ~JipPSV F~R rc ~ F_:cA~EC~ ~f < ~ I LL 'riS~ 2•?e ~C.~'Di`aT 5~!~~~~ HCu,C~~pE 200. DESCRBE HOW MJURY OGCURkEO. ~E~tr oF ~~~,vry ~e 7~.f i o. Per+ 11 oi Pe~ 18 j ~ SXX ~ C Fall to floor , < 1~- Tr~AG ~',F Nc~~ M:,.1h Cey Yee. t ` . U I 0 ' 1.'.~~ ~ . . 6: OOPM P m 7 2 78 ' ( i ~:`JJURY OCCURRED ~ IJe PUCE OF ~ti1URY ~e ~ n or ~bouthem~. ferm, (ec'aY. , 2W. C~TI'. TOWN, pR ~OCATh7N CO(~NTY ST/~7E seree• oi~~re b~~ C~'u e`: ~ i I "c x~c Residence Dallas ~allas Texas 11 ' 8 ZO 7~, ~ 1 ~.erebl <e••~1r ~~et I e~t.n~ed !~ne decea~r! f ~ •uP. S P. 'n ; ~ ~ . ~O ~4- e~d 'att u~ }Fe decee•.w ~ . 19 Dee~~ occw.ed e+ n• ~n. on ~F.e def~ ft~rsd ebo.~. end to ~M be~f of m 1+=.'ed e I~o-, ~•.e ce~«s ~~e~r~ ~ ?7~ A 1 SlOi . . (Dp.e. o. e~f:~) ~ 22~. ADDRE55 11~. pnTE S!GNcD ~ ~ , hledical Examiner ~ P.O.Box 35728 Da11as,Texas 75235 8/10/78 ~ ~ 23~ BU .i. !AnT!ON. REMOv,1l ~Spel~f~i 1 73e. DATE I 23c. N/WE OF CEMETERY OR CREM/~TORY ~ ~ : j Burial - - y--7-18-78 Hillcrest - - ' - ( 3d, l1TlOk ~C~ty. ~o.~ o~ ca ~ty~ ~Srerai 24. FUNERAL DtRECTOR'S SiGNAiURE ~ ~ I f-if~?~ ~ ~ ' / L. ` ~r~~ - llallas S rkman/tiillcres N ~ j IISe. REG'~;tR/~R~S H~E NO. ~,'I56. OATf RECU BY l A~ REGISiR.tR I? ~FG~S7 R'S 5:6NH7~dRE ~ ~ ~iu ~.3 AUG 11 1~78 ~u~~"-~ , .~~~.~c~I ~ ! ; E;~966'7 ~ . ~ ,~w 24 :aa ~ ~y~I WHEN IMPRESSED WITH THE SEAL OF THE C1TY OF DALLAS, F1LtD THIS IS CERTIFIED TO BE A TRUE COPY OF THE PERP~IANENT , ROGER r:_ ~,~w RECORD AS FIIED IN THE B EAU OF VIl"AL STAT TICS. ~~ti ± ' ST. LtJC~t c, . . . ~ I~~~~ ~ ~~~R.w~!,. ~ ` r ~ , ~ssuED• : ' ~ OCAI REGISTRAR DALLAS HEALTH DEPARTNtf~NT,• _ - : ~ - , ~ : : _ r - " . ~ . . , r~~ ~ ' I t.. . , y • . ~ ',K454 f~~f~F 957 ~ ' . ~ ~ ~ - r w ~~x < ~ ~r ~