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<br />202000622
<br />STATE OF OKLAHOMA
<br />CERTIFICATE OF DEATH
<br />STATE FLE NUMBER
<br />2019-028410
<br />25. PLACE OF DEATH (Check ally one: see inbrucIons)
<br />1. DECEDENTS LEGAL NAME (SPA Middle, LA SAO '
<br />JOYCE DARLENE HARRINGTON
<br />le. LAST NAME PRIOR TO FIRST MARRIAGE
<br />GRAF
<br />2. SEX
<br />FEMALE
<br />27.'CITY OR TOWN, STA AND ZP CODE OF LOCATION OF DEATR
<br />TULSA, OKLAHOMA, 74136
<br />3. SOCIAL SECURITY NUMBER
<br />451.80-9227
<br />4. EVER IN US ARMED FORCES?
<br />NO
<br />Se. AGE- Last birMday (yeas)
<br />93
<br />5b. UNDER 1 YEAR
<br />5c. UNDER 1 DAY
<br />8. DATE 0f BRTH (Mo/Day/Yr)
<br />JULY 9,1926
<br />Months
<br />Days
<br />Hous
<br />"«e'1°8
<br />Onset b death
<br />7. BIRTHPLACE (CM and State or Foreign Canny)
<br />DONIPHAN, NEBRASKA
<br />8a. RESIDENCE -SW
<br />OKLAHOMA
<br />8b. RESMIENCE-Carey
<br />TULSA
<br />8c. RESIDBICECNy a Town
<br />TULSA
<br />N. RESIDENCE -Zip Code
<br />74137
<br />8e. RESIDENCE -Malde city Laws? "
<br />YES
<br />er. RF.sithiiJ E Sh eelmnrt Ni mbtlr '
<br />8887 S. LEWIS AVE
<br />8g. RESIDENCE -Apt. Number
<br />806
<br />0
<br />m
<br />9. MARITAL STATUS AT TUE OF DEATH
<br />0 Married 0 Never Married ® Widowed 0 Moab 0 Married, but separated 0 Unknown
<br />10. SURVNING SPOUSE'S NAME (hire, give name prim b is marriage)
<br />c11a.
<br />c
<br />u_
<br />FATHER'S NAME (Fiat, Middle, Last)
<br />AUGUST RALPH GRAF
<br />11b:FATHERS LAST NATE PRIOR
<br />TO FIRST MARRIAGE
<br />GRAF
<br />12a. MOTHER'S -444E MINN (MINNLael)
<br />FERN GRAF
<br />12b. MOTHER'S LAST NAME PRIOR
<br />TO FIRST MARRIAGE
<br />HARRIS
<br />a
<br />a
<br />a
<br />c
<br />13. DECEDENT OF HISPANIC ORIGIN?
<br />NO, NOT SPANISHIHISPANICILATINO
<br />14. DECEDENTS RACE
<br />WHITE
<br />15. DECEDENTS EDUCATION
<br />BACHELOR'S DEGREE (E.G. BA, AB, BS)
<br />CD
<br />..c
<br />16. DECEDENTS USUAL OCCUPATION (Indica type ofwork done cuing most of working IN. DO NOT USE RETIRED
<br />HOMEMAKER
<br />17. KIND OF BUSINESS / 9WUSTRY
<br />DOMESTIC
<br />t-
<br />18a. INFORMANTS NAME
<br />BETH MCKAY
<br />18b. RELATIONSHP TO DECEDENT
<br />DAUGHTER
<br />18a MING ADDRESS (Shed and Number, Cly, SW, Zip Code)
<br />10405 S. SANDUSKY AVE., TULSA, OKLAHOMA 74137
<br />52. DATE RECENEO BY STATE REGISTRAR (MblDeyA )
<br />OCTOBER 1, 2019
<br />19. METHOD OF DISPOSITION:
<br />O Burial ®Cremslon O Donation ❑ 5tlondmant
<br />O Removal from slate O Other (sped ell'
<br />20. PLACE OF DISPOSITION (Nave of Ansley, aanrbry, other plea)
<br />MOORS FUNERAL HOME ANO CREMATORY
<br />21. LOCATION - My, To and Sire
<br />TULSA, OKLAHOMA
<br />22. NAME AND COMPLETE ADDRESS OF FUNERAL FACIIJTY
<br />MOORE'S ROSEWOOD CHAPEL -TULSA,
<br />2570 S. HARVARD, TULSA, OKLAHOMA 74114-4661
<br />23. FUNERAL HOW DIRECTOR OR FAMI.Y MEMBER ACTD4G AS SUCH
<br />CHRIS PENN
<br />24. FH ESTABLISHMENT LICENSE # 1292ES
<br />25. PLACE OF DEATH (Check ally one: see inbrucIons)
<br />E DEATH OCCURRED N4 A HOSPITAL
<br />SI bpelad 0 Emergency ROOWOulpellent C] Deed on Arrival
<br />F DEATH OCCURRED OTHER THAN IN A HOSPITAL:
<br />0 Hospice Fully 0 Nusig home/Long dam pee NOM 0 Decedent's hone 0 Obex (specify):
<br />28. FACILRY NAME (d not I sdVlan, give street 8 number)
<br />ST FRANCIS HOSPITAL
<br />27.'CITY OR TOWN, STA AND ZP CODE OF LOCATION OF DEATR
<br />TULSA, OKLAHOMA, 74136
<br />28. COUNTY OF DEATH
<br />TULSA
<br />29. DATE OF DEATH (MoDey/yr)
<br />SEPTEMBER 26, 2019
<br />30. TIME OF DEATH
<br />13:20
<br />31. WAS MEDICAL DIMMER CONTACTED?
<br />YES
<br />32. WAS AN AUTOPSY PERFORMED?
<br />NO
<br />33. WERE AUTOPSY ENDINGS AVAILABLE TO
<br />COMPLETE THE CAUSE of DEATH?
<br />■
<br />CAUSE OF DEATH (See katrrrctfona and mammies)
<br />x 34. PART L Enter the lain of even* dseesa, injuries or canpialau -that direcly caused l e death. DO NOT enl®rtemiel events such as ardlec areae
<br />Awoximate interval:
<br />35. PART I. Enter other ggigiggrg
<br />cordials annelids to dealt but not
<br />LI: titsilafon the D0 NOT ABBREVIATE. Enter ihe. Add Ines I necessary.
<br />Onset b death
<br />reepirabry chest or veneiaia withal shoeing virology. only one awe on a addMmul
<br />`' IMMEDIATE CAUSE (Ebel !issue m
<br />a in death 4 CEREBROVASCULAR EVENT
<br />UNKNOWN
<br />resoling n the underlying awe given
<br />in PART I
<br />HYPERTENSION
<br />oandMon moiling a.
<br />due b (or as a co maquero a of):
<br />0
<br />n Sequentially int condition, Many, leadlrg b.
<br />Z3 bthe cause Ned online a. Due b(or asaconsequence ot):
<br />7
<br />a
<br />r - Enter the UNDERLYING CAUSE (disease a
<br />7 Or inlay that nalated the everts resulting in Due b (orae a consequence oi):
<br />a death) LAST.
<br />0 d.
<br />1967444 D e to (or as a consequence of):
<br />38. MANNER OF DEATH
<br />.o ® Naval 0 Hanidde 0 Avxidea 0 Sulfide
<br />7: 0 Pemltg bveslgalah 0 Coil not be delenuined
<br />37.6 FEMALE:
<br />0 Not ;vagrant *bin pest year 0 Pregnant* erne of death 0 **pregnant.gha, but t Min days of dean
<br />0 Not pregnant. but pregrsM43 days lot year before death 0 U knorm I entrant wilih the past year
<br />38. DID TOBACCO USE CONTRIBUTE
<br />TO DEATH?
<br />0 Yes 0 No [Probably ®lkdmowah
<br />c 39. DATE OF NUURY (Mo/Day/Yr)
<br />E
<br />0
<br />0
<br />40. TME OF P1JURY
<br />41. PLACE OF INJURY (e.g. Decedents hams; a nsVt A cels; wooded area)
<br />42. DESCRIBE HOW INJURY OCCURRED:
<br />43. INJURY AT WORK?
<br />44. LOCATION OF INJURY: Stale: City or Town: Zip
<br />o
<br />Skeet 8 Number Aparceaht
<br />Code:
<br />Number.
<br />45.6 TRANSPORTATION INJURY, SPECIFY:
<br />0 OreenWeala 0 Passenger 0 Pedestrian
<br />0 011ier (specify)
<br />46. CERTIFIER (Chac( ony one)
<br />ATTENDING PHYSICIAN: 0 Physician in charge of the pellets care 0 Physician n attendance at time ddeall only
<br />and due e carse(s) and meaner ere stated.
<br />To the beet of my knowledge, death occurred at the time, deb, and plea, ab th
<br />RI MEDICAL EXAMINER On the basis of exaninaliah, amd/m immigrates, in my when, death Imo ocomed at the Idue
<br />and )niece, and due b the cause(s) and mems staled.
<br />staled.
<br />47 NAME, ADDRESS AND ZP CGDE OF PERSON COMPLETIIGCAUSE OF DEATH (Item 34)
<br />JOSHUA LANTER, MD
<br />1115 WEST 17TH STREET
<br />TULSA, OKLAHOMA
<br />74107
<br />caller JOSHUA LANTER, MD
<br />48. LICENSE NUMBER
<br />262950(
<br />49. DATE DEATH CERTIFED (No/Day/Yr)
<br />SEPTEMSER 27, 2019
<br />50. REGISTRAR'S SIGNATURE
<br />c1-
<br />52. DATE RECENEO BY STATE REGISTRAR (MblDeyA )
<br />OCTOBER 1, 2019
<br />1 i .'F. �`ALTER,ED OR E� 3I SE!D*'7,V?`
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