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IF DEATH OCCURRED IN A HOSPITAL: I * 2 w 2 0 O I 1 5 0 0 4 0 4 0 0 0 1 '1 8 4 4 5 11111 7 STATE OF OKLAHOMA CERTIF CATS OF DEATH STATE FILE NUM V j 2015-018457 1. DECEDENT'S LEGAL NAME First Write Las Suffix HARLAN HUGH HARRINGTON la. LAST NAME PRIOR TO FIRST MARRIAGE 2. SEX MALE 3. SOCIAL SECURITY NUMBER 505 -26 -7231 4. EVER IN US ARMED FORCES? YES 5a. AGE- Last birthday (years) 89 5b. UNDER 1 YEAR 5c. UNDER 1 DAY 8 DATE OF BIRTH (MolDay/Yr) DECEMBER 17, 1925 Months Days Hours Minutes 7. BIRTHPLACE (City and State or Foreign Country) ARAPAHOE, NEBRASKA 8a. RESIDENCE -State OKLAHOMA fib. RESIDENCE -County TULSA 8c. RESIDENCE -City or Town TULSA 8d. RESIDENCE -Zip Code 74137 Be. RESIDENCE- Inside City Limits? YES 81. RESIDENCE -Street and Number 10405 S. SANDUSKY AVE 8g. RESIDENCE -Apt. Number 9. MARITAL STATUS AT TIME OF DEATH 9 IS Married ❑ Never Married ❑ Widowed ❑ Divorced ❑ Married, but separated ❑ Unknown 10. SURVIVING SPOUSE'S NAME (If wife, give name prior to first marriage) JOYCE DARLENE GRAF i 11. FATHERS NAME (First, Middle, Last) HARLAN HARRINGTON v 12. MOTHERS NAME PRIOR TO FIRST MARRIAGE (First, Middle, Last) HAZEL MUCKEL 5 13. DECEDENT OF HISPANIC ORIGIN? NO, NOT SPANISHIHISPANICILATINO n 1 E a 14. DECEDENT'S RACE WHITE 18 DECEDENTS EDUCATION BACHELOR'S DEGREE (E.G. BA, AB, BS) 0 16, DECEDENT'S USUAL OCCUPATION (Indicate type of work done during most of working life. DO NOT USE RETIRED. PETROLEUM ENGINEER 17, KIND OF BUSINESS / INDUSTRY OIL COMPANY 18a. INFORMANTS NAME JOYCE DARLENE HARRINGTON 18b. RELATIONSHIP 70 DECEDENT WIFE 18c. MAILING ADDRESS (Reel and Number, City, State, Zip Code) 10405 S. SANDUSKY AVE, TULSA, OKLAHOMA 74137 19. METHOD OF DISPOSITION: ❑ Burial IS Cremation ❑ Donation ❑ Entombment ❑ Removal from state ❑ Other (specify) 20. PLACE OF DISPOSITION (Name of cemetery, crematory, other place) MOORE FUNERAL HOME AND CREMATORY 21. LOCATION - City, Town and State TULSA, OKLAHOMA 22. NAME AND COMPLETE ADDRESS OF FUNERAL FACILITY MOORE'S ROSEWOOD CHAPEL - TULSA, 2570 S. HARVARD, TULSA, OKLAHOMA 74114 -4661 23. FUNERAL HOME DIRECTOR OR FAMILY MEMBER ACTING AS SUCH CHRIS PENN 24. FH ESTABLISHMENT LICENSE # 1292ES IF DEATH OCCURRED IN A HOSPITAL: I IF DEATH OCCURRED OTHER THAN IN A HOSPITAL: 26. FACILITY NAME (If not institution, give street & number) 2 27. CITY OR TOWN, STATE AND ZIP CODE OF LOCATION OF DEATH 2 28. COUNTY OF DEATH 29, DATE OF DEATH (Mo/DayfYr) 3 30. TIME OF DEATH 3 31. WAS MEDICAL EXAMINER CONTACTED? 3 32. WAS AN AUTOPSY PERFORMED? 3 33. WERE AUTOPSY FINDINGS AVAILABLE TO 34. P CAUSE OF DEATH (See Instructions and examples) 3 35. PART II. Enter other significant respiratory arrest or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary. Onset to death r Due to (or as a consequence of): the cause listed on tine a. Due to (or as a consequence of): injury that initiated the events resulting in Due to (or as a consequence of): 1559864 s 36. MANNER OF DEATH 3 37. IF FEMALE: 3 38. DID TOBACCO USE CONTRIBUTE Thun .. 39. DATE OF INJURY (Mo/Dayfl'r) 4 40. TIME OF INJURY 4 41. PLACE OF INJURY (e.g., Decedent's borne; construction site; wooded area) , 4 42. DESCRIBE HOW INJURY OCCURRED: 4 43. INJURY AT WORK? Q Q ly CD n 44. LOCATION OF INJURY: State: City or Town: Zip Code: 4 45. IF TRANSPORTATION INJURY, SPECIFY: _ 48 CERTIFIER (Check only one) 4 47. NAME, ADDRESS AND ZIP CODE OF PERSON COMPLETING CAUSE OF DEATH (Item 34) " 48. LICENSE NUMBER 4 49. DATE DEATH CERTIFIED (Mo/Day/Yr) ( 50. REGISTRAR'S SIGNATURE D DATE RECEIVED BY STATE REGISTRAR (MulDay/Yr) N >t. ore• ;., E;RiT4I ClAritE- Olt' V I iAlI KI C,. R c+ 25. PLACE OF DEATH (Check only one: see instructions) EVISION 4t xVO °I DEW €ITH OUT WATSARMBARjK OR LF A(LTjERE M, E?R ,YSED