Laserfiche WebLink
OC „ <br />I iA%TNAMI <br />m <br />� <br />Broxn <br />.•E <br />o <br />� <br />6 DATE OF BIRTH <br />Feb. 27, 1883 <br />h <br />r•1 <br />U •yQ <br />0 b <br />O ri <br />Housewife At own hone <br />— <br />14ew York <br />United States <br />- T - --- <br />13 NAME Of SPOUSE--,, <br />$41 V TJ rl <br />Abraham Beekman Neti1 York Sarah Van der Vaer Urknor.m <br />__ <br />Q C'I <br />14 WAS DECEASED EVER IN U 5 ARMED FORCES <br />— <br />" [ „No„ <br />I <br />h 0E OD <br />u •our3o <br />O h <br />James B. Broom <br />O <br />17e LEN IN OF STAY <br />O ti <br />San Diego <br />3 years <br />San Diego, <br />- <br />” ^..„ <br />IT FULL NgME AND ADDHE S9 OF HOSPITAL OR INSTli U71ON j <br />61erc Bospital Hillcrest Drive„ <br />San Diego, Calif.t <br />I8^ STREET ADDRESS,,, ­Al ­1 Ioe..em„� <br />$ <br />�r <br />7930 II Capitan Drive <br />a THn ­E' <br />La Mesa <br />alA <br />� <br />r•E 9 <br />M <br />pp <br />N O <br />(/ ///� Ai' I'S O %IMATE <br />MM <br />N . <br />M <br />$e <br />-7 <br />.00 <br />b <br />�1 / <br />a. <br />oo�.oy <br />o <br />A F <br />F <br />I. <br />_ - <br />.. _ RI <br />z-01 02Y -,,7fT <br />REGISTRAR '5 rVDTICIre T! A! A!AT STATE <br />I^ NAME OF DECEASED ANSI NAME Ix MInPIC NAM[ <br />I iA%TNAMI <br />I'll N11 <br />2. DATE O- DEA7N <br />Jane i Burniston <br />Broxn <br />July 23, 1950 6:15P <br />J SE% 4 COLOR OR RACE 5 ":o:fYo "'�`" ` ^" .00w.n- <br />Female Yihite Married <br />6 DATE OF BIRTH <br />Feb. 27, 1883 <br />7 AGE � n n.„ „. M <br />67 <br />BA USlyol OC voIPi. TaON 7'Y..� y „� ' Bn KING OE BUSINESS OR INDUSTRY <br />9 BIRTHPLACE co��:. °.” "' `" <br />10 CITIIFN OF WHAT COUNTRY, <br />Housewife At own hone <br />— <br />14ew York <br />United States <br />- T - --- <br />13 NAME Of SPOUSE--,, <br />— - - ------ <br />II NAME AND BIRTHPLACE OF FATHER 12 MAIDEN NAME AND BIRTHPLACE OF MOTHER <br />Abraham Beekman Neti1 York Sarah Van der Vaer Urknor.m <br />__ <br />James B Brown <br />.._ ._ -- -_ - - . _ <br />16 INFORMANT <br />14 WAS DECEASED EVER IN U 5 ARMED FORCES <br />— <br />" [ „No„ <br />- - ---- __ - -._ <br />IS SOCIAL SECURITY NUMBER <br />„ „ »„ - [ „ "1 V <br />None <br />James B. Broom <br />I7^ PUCE OF DEATH Cllr oN To -�- �. „o „.., „....., <br />17e LEN IN OF STAY <br />17, COUNTY <br />San Diego <br />3 years <br />San Diego, <br />- <br />” ^..„ <br />IT FULL NgME AND ADDHE S9 OF HOSPITAL OR INSTli U71ON j <br />61erc Bospital Hillcrest Drive„ <br />San Diego, Calif.t <br />I8^ STREET ADDRESS,,, ­Al ­1 Ioe..em„� <br />I8, CITY OR TOWN _� "': (.i'�.V.ow.. ":" <br />._s „ „ ^ „� <br />18, COUNTY '8: STATE <br />7930 II Capitan Drive <br />a THn ­E' <br />La Mesa <br />San Diego Calif. <br />ooT IP 1 DISEASE OR CONDITION <br />^oi[ac DIRECTLY LEADING TO DEATH <br />(/ ///� Ai' I'S O %IMATE <br />^ <br />yhsR <br />- - - -�,/A_,(' <br />-7 <br />•,. Gi ly ANTECEDENT CAUSES <br />ft,. Y6 �( <br />Naomi, Moaeocoxo no „s r ^„r cv„c DUE TO,, <br />�� ECAq I�t psE T. 1„1 .- -11 ^1111c <br />V . oe•i, „e <^use • DUE TO: <br />' -'2 AND <br />19 p O7�IEtt Slu".NIFICANTN CONDITIONS <br />„ o., „a.o r „[o[ ^. „•v. <br />CEATH <br />—A JAFILQ, /OPERATION 20. MAJOR FINDINGS OF OPERATION <br />Z. <br />21 •AUiOFS• <br />0 <br />1Ak ACCIDENT 2,, 1 All Oi INJURY 2, LOCATION n on rows <br />«uN.r 1•.t <br />HOMICIDE: <br />- <br />22o TIME - --Y <br />IN.IUR1 OCCURRED I._ <br />HOW DO INJURY OCCURS -- <br />- -- - - -- <br />OF INJURY <br />3x3 „.e.c� <br />.. 3, ADDRESS — p'r npTE SIGNED Q <br />I i <br />EEEppp u- — ' <br />�RC BI `p•, Lq RCG.SI1 <br />L 5 E7���vQ <br />CERTIFICATE OF DEA`T'H <br />Dart. of P.zbli^ Health <br />State of California, <br />Jane Burnistop Brown <br />°tare of Nebiaska <br />C:un ?y of F:ad1 <br />i-- r:tered on i urnerical Index and fiieJ <br />for record in Office of Register of <br />-•reds on the -3 ---------- day of <br />PTarch 9 <br />- .- _. x_55_ at ---- ----- <br />- <br />o'clock axed . -. - 10- minutes __A�__l�i. <br />and recorded it `oo!; ____2 -- ---- of <br />QPa. ...... at pari i:------------- <br />Register of �eeda <br />By -D <br />- <br />-- -- t - -- ------------------ <br />"ty <br />Few �- 2..2�_ -- <br />gm roihers Mortuary 770 -4th <br />goo.” <br />DEPARTMENTNT OF� PUBLIC HEALTH <br />