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CERTIFICATION OF VITAL RECO Pe edent; Name: Gender: Date of Birth: Date and Place f D Date of Death: City of Death: Location: Additional Decedent inform Place of Birth: R :srdence. Mantel Status: Armed Forces: Name of Father: Name of Mother: Informant: Disposition: Method of Disposition: Place of Disposition: Funeral Home or Faciiit Fadlity: Cause of Death: The immediate cause is listed o (a) Coronary Artery Disease Other Significant Conditions. Manner of Death: Natural Dea Certifier: Type: Physician a+'he: Dernar 0, Hill, M.O. Address: 388 South tiS tiigh±> ay 20 Date Filed:. ; February 09 2015_." Arthea Elaine Thorn Female December 04, 1929 Lovell .. 144• West Main ation: Lexington, Nebrassit Lvi.alL..1 mit g Widowed No - Arthur Edward Hall Eva S,Jackson .lathes %i Thomas tt 1 ttn tess pre STATE„ OF WYOM I NG DE " O F HEALTH CERTIFICATE OF DEATH Cremation Heart Mountain Crematory, Powell, Wyoming'' the frrsf line followed by any underlying Causes, o tlacurr�nf cn ta7g iri the oNicc. 4f Mat :d nn paper with an engraved brad State File Number: Social Security Number: Age at the "Time of Death: Tim a: ofDe asin, ihryoming, 82410 f; :.aeJnB9? t3rkie Deputy State. RPg titr ANy ALTERATION Of ERAS tIRE i VO {D THI CERTIFICATE ry tk 1 y, 520 -60 -0477 85 years Big Horn Interval: Less than 10 Years 07 :15 (Actual;