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UI <br />2 <br />STATE OF CALIFO <br />f CERTIFICATION OF VITAL RECORD <br />e.>kz_.ee""'r.''.m'm."?:m�• >t?m a s3Qa xm�,m�...o'„o 's.�nS „e.aL ma^. sy�'�2z % ^ m e sAe. .a+ o m sP>o m o.�".ien^,.,? <br />'ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE / <br />VUC1LLC <br />2 9. AMERI <br />NE .:: <br />ROBERT <br />3052014167118 CERTIFICATE OF DEATH <br />5111`5 OF LAUFUNJIA <br />0108 50 EJIOUPES.'k4DElWts 9P. nli'_ -rUi Ms <br />MTATE F1tE NUMNEF NS-I p11EV VOA <br />COUNTRY <br />13 E9fXiA7%Yi ,igl9eh:a'aeVA.a <br />SOME .COLLEGE <br />E1SUA3- DOOi3PAT <br />USINESS OWNER <br />EMPHYSEM ; <br />25. LOCATION OF INJURY (SITAR am <br />SECOND/AR <br />DEHISCE <br />113 WAS /OPERATION PERFORMED FOR ANY <br />LEFT PNUMONECTO <br />e. SOLI <br />07 -60- 6038 <br />of `slo. NO 413E T§E <br />PLACEQFN ?. <br />t ISER , FQUNDA 'ION i O$PITAL ; <br />COUNTY "ray: FACnrr1 " i6s5fla <br />N DIEGO.. 4647 Z�CkN AVE <br />C CARb AC ARRES <br />IDn'IONFNi ITEM Ito C <br />07107/20 <br />NKNOWNN;;. <br />NGNOW <br />EVER IM U.S. ARMED FORCES: <br />YES to ❑ UNA <br />`0 <br />a4 Faiy usFas nDN RE$IDENCE•OF ROBERT; <br />23 004 STOKES ROAD, RAMONA, CA 9208 <br />12 MAY3K 5IIU:S51'1 <br />MARRIED <br />- 3 LR&T 151E <br />MA <br />OF, 1 REG <br />YY1 1 <br />WOO <br />; f n SPE <br />ON WITH::ANAS' <br />18. KIND OF 8tt5NESS.OR INDUSTRY A. g., growy stare, <br />AUTOMOTIVE AUDIO <br />o. AGE Y <br />62 <br />8. DECEDENT'S RACE -I p o 3 <br />NHITE <br />24. YEIOS IN COUNTY 25. SUTFJRNIESON COUNT <br />3 $HF+T ?+YA <br />.FREISI =PI:: <br />42 CA <br />W <br />OVA' '6 , 5 <br />RATORY W ITH!'ULMONARY <br />3 TA E,11 <br />28, TYPE NAME. TRLEOF <br />3201437014170 <br />LOCAL REGISTRATION NURSER <br />02.811 <br />SA1 DIEGO <br />County of San'Diego:= Health,& Htrman services Agency � 385 jt c ecralM Street'`.This is to cernfythat, if beanc[g:fhe OFFICIAL :. <br />SEAL OF THE STA9'E OF CA ORNIA t jj e Q FFI ' AL. SAN DIED O COUNTY AND THE {R DEPARTMENT OF_ <br />FF C ... <br />HEALTH SERVICES ES1BOS ) SE /t,it(tjs 4 a dpy 9f the.Z)RID1NAL DOCUMENT FILED Regarred fee pard <br />01206024 <br />TA YEARS IN OCCUPATION <br />37 <br />DATE IS$U .D Septainber 25 20D R!IA 3 WOOTEN MD' <br />+�, CsISTRAR O VITAL RECORDS <br />c ounty of San 17tego <br />This copy not valid unless a&l/4n 211 a byidet lis1413 ti(' d stg <br />g seal and of IC`egistrar <br />1. iT � <br />ll , ;j1 It� <br />..AQQ 2772'0.0.8 <br />0. HOLM <br />1245 <br />n, 021£ 8821021+805 <br />09/1.1/2014 <br />1 J&PJITOPSY'PFIIFORME DI <br />ONTH L " Q <br />111 ly{?&0frgk%TE9n ^'>rI2J00A3 ,::- 30.1E FEMR.E,FREG1'kWN}CAT <br />i .. ❑ tE� 13C I NO <br />n1 ARdtilxE FrI AFAr 15.t CE0. EAA MEEK iri'7AT£ 81338 a <br />►VI3fS�114KAF A <br />�.. A73797 09!0912014 <br />VIJI SANKAR MO <br />07123!2014 091 12014 4647 ZIONA:VENUE `:SAN DIEGO CA 92;120 <br />�C11}.RECM3FSSI5TED. . x '1 23. INJURED ATWORKY t I1VJUAY'DATE 0088/my5 123: H OUR <br />� YE; > ffi � L°A ' <br />50188,38 L2,1 <br />° •°‘ <br />, g M tCCC' <br />r <br />0 <br />n_ <br />0= <br />