HomeMy WebLinkAbout0190 :~fetropolitan Government of Nashville and Davidson County ,
Richatd H. Fulton, Mayor 10 2 0 3 S 0
METROPOLri'AN HEALTH DEPARTMENT
J. M. Bt~TO~";;SN, ~A.U.. R~~+~ i krlk 3~ ~ 23rd AVENI;E, NORTH
NASHVILLE, TENNESSEE 37203
METROPOLITAN NASHVILtF (61S) 327-9313
=1',. _.'v C:..iN7Y
This u to certi[y that tlib i~ • true and correct copy ot Me record filbd
~Y 19~7 with Me Tennes~ee Departmeat ot Pubtic Health~ Ytal Reoorda, by the
Metiopofitan Nealth Depuhnent of Na~hville and Davidson County.
C1-~ F'~~ This ia valid only when Ne eal of the Mettopditan Health Department
~ of Nashnik and Darida~n County is affixed.
. ' _
~ y , r
CERTIFICATE OF DEATH
R 7 0 I 9 0 3 '°x~s~ °v~u~a'R °f "u?T" e~°"~,rt
.~~s ~teores • ~tw? VITAI ltECOROS ~,.T~ nu w
~c~dw wNnr rwow ta~- Mw*. w
cuTCO aw a~n oEa.~o-...r oe. w w.+..w
~M!-+~w ~rr.wr sr~,r. Mt~O~MTw~wRr.~w oM~ro~aac~~._nyr~ ~p
1 hE OA ~Mi MI ~rA~ ~ M fK ~I~Fw w~r~ ~frr !K Aticsn
. RItlL1MEMT MACt ML ~ 7L a f. s ~ .
?M M1. 10A 0~ T1011 Ur Y O~ ~ O?aMr r w?. ~ r~. r w~?
^~T~/~ hMpr~ v! On r01 ~~?w~~ ~a ~r~ wMt. wti r~. ~~rr r.n.
lr lJ/~ViW~J~~ AL f~.
~ p11ilO~ I~~w. OfMN100W~1A WI~M~1lM~~~~rr
~ ~A
uuw ~es~oe.~ee rw~ae oe- ~ TEN~ESS~E USA FMR}2
~l cWfo uVFa M oun~ oG ~~+ar...,, ~:.w~i..~ ..~.u..~ wr ~•rrw.....w aw~sos.aire. y•
CU~M1(p M MeTlfytl~ ~1~ '
,~.,,,E 409-10-2682 . MARIPES/WMII MI ~t T
; ~ ~o~a-s. e.....an. a~.oa..o~ n~a. n. a,n..w ~..y .ac. «u
I
! TEMESSEE N w. w. ~r
~ ~
R .
I~ 3AP£S C. ?EERSEY JETNIE COPELMD
.E~wr ~ w~a~ ~ .n~or,~ r~o~ .~...w..
i T~~r~pRfA1bM ~ ~00~ n 01~we~~
~o••~ow e.~a oR ~rt• BU2IAL . 7 1987 SPR H
I YO'VY /~Y t1A/L. F/C~~ M0. N~C~I~ 14
~ ~ C ~ i
~N~~A~A~j~ /I~~IVa~.q~lqiwrlM M~#rY4?
• ~
~ ?M~FOM?r rw~ wN ~~w ~11~~ .:I~ ~ O~T! ~1iR~
ers. t w~ rra ~ r ~
~ • ~a er~~ w~
; rteic'x awrEw-r.+r ar~ ti~wr~.+~ ~y~ r o~R rwwa r..w
E 4MR r~ /~1/ M~ M~
~ ! F pEI~TN MOT ATT'EIIpEp ak
E110 D
f Pr~y5~CW/. AtITN011QED OR mw ~ w.~. ry~ ~pp~~ aw~r w ui r . ww~. w.a~
~rs~aiw o~ ~o~x o~-
!t F~~~~` `1°" ~"4 TF~hWS B. MILLER M.D. 1210 RRAIRVILLE RdAD . k~bISON TENN. .37115
p T F 11CATE ExWST COwIE~E a iwr ~ enm wr e.rw~o ~r: r+.n¦ aa. ow e.ewr .rs u~r ro~'rr. r. ~o ~a) - - q;
a~n r w
AND EqN YEDICJIL CE14 ~w++ar -
T~FtCAT10N WITNIM " : t..., t~~ ~
E HouRS. ?OwE~ OF r ~ '
S~ONATUIIE GANNOT ~E ~r.~~~~~~o~ . , .
~ DELEGATED. sir+s r - ~ . . ~ ~ - . . ~
f ~e~~w r _ . . . . . _
( w.~.ww~ ~w.~w~.rrra~ , . . .
: y~ ~
~ ~..~o.~~.w ~ . _
r
~ ~T OM~ ~T 0005~~: COw~ 1~ A~Mt~ M~ A1Mw A Cir M~?Mi 1 W ' , MRO~ff
4
I! ~ „'`j' ~ _ ~ ~IA ~
i
~CGOEUi. ~MC~O[. ~OrC~OE. OuTt w~wa ~w..~e w01/1 011pU~[ ~OA ~l1~1~ OCCYMtD
~ ~ NO(Tf11Y1~t0 ~tsw
n~ arc r. ~
` wJ1R~ ~t ~pIR RKY Of ~R!\R~ .t ~F~. rrr~ ti[~. IOUi~ ~ v~~ w. w~. Mq
~ +MCY~~~+ Y/lf~[/K/A
VH t{S~
a:..sy~ <.c n• m n
~ ~
~
i za,_~.~, 10 2 0 3 5 0
~ '9Q JA!~ 22 Al t :49 . '
, _
~ s ~aov~~e nncox ~ ' ' ' ~
r~j ~1. h
Add Fe~; Sk L.urie Connty ,
nx Tax = ~ Clerk o! Circuit Coiut
;nt Tax i ~ fiy ~
~ ~ _ , ~„t. i~'s:,~k
i . •
! vN:i ~
~
a i y ' -.i: ~ , . . i ~
~ ~'r.-•`.!,:- .
, ` , - ,
~~ow 674 ~~E ~90
~
~ - -
_ w _ :
~ p- c. x, -~^~4~.'- ~ -u_ "5..7~'~ E~ F
n.r.a~:,~.,..cc.'~J.,K.F~'~~~:~'$~
~~~:~e~ik^~e..2.~~.ae`~
s~~.
~"sr,6"- '
..~a~s. ~,'r,-a~. :
~.:atsr,s