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STATE of CALIFORNIA
<br />CERTIFICATION OF VITAL RECORD
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<br />COUNTY OF MONTEREY
<br />Salinas, California
<br />CERTIFIED COPY OF VITAL RECORDS
<br />3052011014154
<br />STATE FILE NUMBER
<br />CERTIFICATE OF DEATH
<br />STATE OF CALIFORNIA
<br />USE BLACK INE ONLY / NO ENSURES WNITEOUTS OR ALTERATIONS
<br />VS-11GREV 7/061
<br />201901001
<br />3201127000102
<br />LOCAL REGISTRATION NUMBER
<br />DECEDENT'S PERSONAL DATA
<br />I. NAME OF DECEDENT- FIRST (Gvem
<br />ADOLFO
<br />2. MIDDLE
<br />E. •
<br />3. LAST IFamN1
<br />ALVARADO
<br />AKA ALSO KNOWN AS Include lull AKA FIRST MIDDLE, LAST)
<br />- - -
<br />4 DATE OF BIRTH mMONccYy
<br />10/27/1957
<br />5 AGE VIA IF UNDER ONE YEAR
<br />53 ' Mon. ' Days
<br />IF UNDER
<br />Hours
<br />HOURS
<br />Moines 1
<br />6 SEA
<br />M
<br />9. BIRTH STATE/FOREIGN COUNTRY -
<br />MEXICO
<br />10. SOCIAL SECURITY NUMBER
<br />557-79-6094
<br />EVER IN V. ARMED FORCES?
<br />Ti.S
<br />. /is X Nc L J.
<br />eS.,
<br />12. MARITAL STATUS/SRDP'fat TmUR
<br />MARRIED
<br />7. DATE OF DEATH mnd/ccW
<br />Jd
<br />01/18/2011
<br />B. HOUR (24 Hou n1
<br />1003
<br />13. EDUCATION - HghestlevelMayee
<br />0tom 9 wow MmP oN
<br />14/15. WAS DECEDENT H ISPANIC/UTINOIA/SPANISH?(6 as. see worksheet Oackl
<br />©'Es HISPANIC . ND
<br />16. DECEDENT'S RACE - Up t03 lAeea may be At. (see smasneel onb4N
<br />MEXICAN
<br />17. USUAL OCCUPATION -Type of Work for most Ol lite. DO NOT YAP RETIRED : •
<br />BUSINESS OWNER
<br />18. KIND OF BUSINESS OR NDUSTRY (eg., grocery store, mad constmcbon. employment agency, etc.)
<br />TRUCKING COMPANY
<br />19. YEARS IN OCCUPATION
<br />11
<br />0 0
<br />RI
<br />' a
<br />20. DECEDENT'S RESIDENCE (Street and number, orlad t,AN
<br />11720 RICO STREET
<br />21. CITY
<br />CASTROVILLE
<br />22. COUNTY/PROVINCE
<br />MONTEREY
<br />23.ZIPCODE
<br />95012
<br />24 YEARSIN COUNTY
<br />30
<br />2S STATE/FOREIGN COUNTRY
<br />CA
<br />Q H
<br />g I
<br />28. INFORMANTS NAME. RELATIONSHIP 22 INFORMANT'S MAILING ADDRESS Street and number or mai route number. city a (own wale and op)
<br />MARIA A. ALVARADO, WIFE 111720 RICO STREET CASTROVILLE, CA 95012
<br />SPOUSE/SRDP AND
<br />PARENT INFORMATION
<br />28. NAME OF SURVMNG SPOUSEJSRDW-FIRST -
<br />MARIA
<br />2I: MIDDLE _
<br />A.
<br />M. LAST (BIRTH NAME)
<br />LINARES
<br />31. NAME OF FATHER/PARENT-FIRST
<br />JUAN
<br />32. MIDDLE
<br />-
<br />11 UST
<br />ALVARADO .
<br />34 BIRTH STATE
<br />MEXICO
<br />3, NAME Of MOTHER/PARENT-FIRST
<br />SARA...
<br />36. MIDDLE
<br />-
<br />37. LAST (BIRTH NAME) "
<br />ESTRADA
<br />38. BIRTH STATE
<br />MEXICO
<br />FUNERAL DIRECTOR/
<br />LOCAL REGISTRAR
<br />39. DISPOSITION DATE mIvdd/HRYy :
<br />01/22/2011
<br />40. PLACE OR FINAL DISPOSITION CASTROVILLE DISTRICT CEMETERY
<br />8442 MOSS LANDING ROAD, MOSS LANDING, CA 95012
<br />41. TYPE OF DIEPOSITION(S).
<br />BU
<br />42. SIGNATURE OF EMBALMER
<br />► ROBERT STRUVE -%t3-J
<br />4, LICENSE NUMBER
<br />EMB7774
<br />44 NAME OF FUNERAL ESTABLISHMENT
<br />ALTA VISTA MORTUARY
<br />45. UCENSE NUMBER
<br />FD 2050
<br />46. SIGNATURE OF LOCAL REGISTRAR..
<br />► HUGH STALLWORTH, MD, MPH ,:g<%
<br />47. DATE mNdd/ayy
<br />01/21/2011
<br />101. PLACE OF DEATH
<br />Ze STREET
<br />102. IF HOSPITAL, SPECIFY ONE
<br />. IP. ❑ CR/OP. DOA
<br />103. IF OTHER THAN HOSPITAL, SPECIFY ONE
<br />❑ Ho51%0'0 • HI/H ❑ Dttr'lr.'s © 0ther
<br />Home/LTc Hdme
<br />N W 104. COUNTY
<br />d o MONTEREY I
<br />105.. FACILITY ADDRESSOR LOCATION WHERE FOUND /Street and number. IX-bcet onl
<br />HARO ST AT:MERRITT ST
<br />108. CITY
<br />CASTROVILLE
<br />107. CAUSE OF DEATH Error the coo, MWR+'s-:•Ise' omp4 ec/H caused n. MONO/ enter to cn
<br />caropc arcaaneresters/ meal . or venbc,as 1id,Raxrn waroal nevcwa5 Re eIRbgy. DO NGT ABBREVIATE•
<br />I silo YdenweenM.
<br />alart
<br />l d lean
<br />coas
<br />IDEATH REPORTED TO CORONER,
<br />YES NO
<br />IMMEDIATE CAUSE w ASPHYXIA (ATI
<br />fdit ltCresulting MINS
<br />X
<br />Q
<br />20110047
<br />CAUSE OF DEATHp
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<br />MINS
<br />109. BIOPSY PERFORMED?
<br />■ YES © No
<br />(CI)
<br />I/O. AUTOPSY PERFORMED?
<br />NO
<br />YESDI
<br />NI
<br />IDT(
<br />111.1)5E0 W OETEAMFRNG CAUSE?
<br />. YES ■ NO
<br />112. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING IN INE UNDERLYING CAUSE GIVEN IN 107
<br />113. WAS OPERATION PER MED FOR ANY CONDITION IN REM 107DR 112? (II yes, Nal type of elm an0 date.)
<br />1155. IF FEMALE, PREGNANT IN UST YEAR?
<br />. YES . NO ❑ UNK
<br />w g114. IUERTBY THATTOTHE BFSTOF MYKNOWIE'IX:EDEATH000URRED
<br />AT THE HOUR. DATE. AND PUCE STATED FROM THE GWSFS STATED.
<br />SY Decedent URST2ed Snce Decedent L. Seen Ake
<br />SIS SIGNATURE AND TITLE OFCERTIFIER
<br />►
<br />116.. UCENSE NUMBER
<br />117. DATE mMdd/ARW
<br />WWY l} (A) mMdd/RAWSe
<br />IB) mMdNayy
<br />118. TYPE ATTENDING PHYSICIAN'S NAME. MAILING ADDRESS, ZIP CODE
<br />119.1 CERTIFY THAT N MY OPINION DEATH OCCURRED AT THE IN"N;R, DATE. AND PLACE STATED FROM THE CAUSES STATED.
<br />MANNER OF DEATH.' 54051 l © ACC,idenl❑ ReasciOe 1.Sunder .-nvesligzCbn III dill r.„7.,led
<br />120. INJURED AT WORK?
<br />© YES IIINO IIIUNK
<br />121. INJURY DATE miNdaccry
<br />01/18/2011
<br />How
<br />HOUR 124 Hce)
<br />s)
<br />1000
<br />CORONER'S USE ONLY
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<br />126. SIGNATURE. OF CORONER / DEPUTY CORONER
<br />DANIEL B ROBISONaw
<br />12?. RATE mmfdd/ccyy
<br />01/20/2011
<br />120 TYPE NAME, TITLE OF CORONER / DEPUTY CORONER
<br />DANIEL B ROBISON, DETECTIVE CORONER
<br />STATE
<br />REGISTRAR
<br />A
<br />B
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<br />FIIIUIIIgI111IIIIIflIII111III1Iuu111111IIVIIIIIIIIIIIIIIIIII fltJI
<br />'010001001688890*
<br />FA% AUTH.N ( CENSUS TRACT
<br />DATE ISSUED
<br />101,11 111111ili
<br />This is a till
<br />This
<br />PINCOIRtieI IDI&
<br />Ict reproduction of the document officially registered and placed on in the Office of the Monterey County Vital Records.
<br />not valid unless prepared on engraved border displaying seal and signature of Local Registrar.
<br />r o,000)L CC„$ ,. /.•$4154 o4eiet,i / /,,Kee. ei C$vr,)PCC CLCCio12,PC'GGCCTI +"$a$e (;fv„re.ide sAia(Yevaitr ?DC;vv 'v YCCCVCe,. 05040/5(0
<br />ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE/
<br />.>..e. . r � . v e -. _ _ A '?k;it::.: :; e i" 1. "- ';0,,;
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