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Sr• tn17: OF %0)1F1'll <br />--DEPARTMENT OF HEALTH <br />FACT OF DEATH NUMBER STATE FILE NUMBER <br />6781 140-2018-006642 <br />DECEDENT'S INFORMATION: DATE FILED: 11/05/2018 <br />NAME: ARLEEN B OAKLEAF <br />ALIAS: <br />SEX: FEMALE SQCtALSECURITY NUMBER: 370-26-5241 ARMED FORCES: NO <br />DATE OF DEATH: 10/26/2018 DATE OF BIRTH: 11/17/1927 AGE: 90 YEARS <br />PLACE OF DEATH INFORMATION: <br />TYPE: NURSING HOME / LONG TERM CARE FACILITY <br />FACILITY NAME OR ADDRESS: GOOD SAMARITAN SOCIETY SIOUX FALLS CENTER SIOUX FALLS MINNEHAHA SOUTH <br />DISPOSITION INFORMATION: DAKOTA <br />METHOD: BURIAL <br />CEMETERY: ZION LUTHERAN CEMETERY <br />LOCATION: HARTFORD SOUTH DAKOTA <br />CREMATORY: <br />LOCATION: <br />DEMOGRAPHIC INFORMATION: <br />RESIDENCE: 26208 463RD AVE HARTFORD MINNEHAHA SOUTH DAKOTA 57033 <br />PLACE OF BIRTH: SOUTH DAKOTA UNITEDSTATES OF AMERICA MARITAL STATUS: WIDOWED <br />SURVIVING SPOUSES NAME, IF WIFE MAIDEN NAME: <br />FATHERS NAME: OTTO LEE <br />MOTHERS NAME PRIOR TO FIRST MARRIAGE: TOMENA THOMPSON <br />INFORMANT INFORMATION: <br />INFORMANT'S NAME: DANIEL OAKLEAF RELATIONSHIP: SON <br />MAILING ADDRESS: 45307262ND ST HARTFORD, SOUTH DAKOTA 57033 <br />F - L - •ME: MILLER FUNERAL HOME 507 SOUTH MAIN AVENUE SIOUX FALLS SOUTH DAKOTA 57104 <br />FUNERAL SERVICE LICENSEE: TJADEN TERRI T <br />CAUSE OF DEATH -PART l: MEDICAL CERTIFICATE INTERVAL: <br />DYSPHAGIA WEEKS <br />CEREBRAL INFARCTION WEEKS <br />HYPERTENSION YEARS <br />LICENSE NO: <br />PART II: LUPUS, OVARIAN CANCER, HYPOTHYROIDISM <br />CORONER CONTACTED: NO AUTOPSY PERFORMED: <br />ACTUAL OR PRESUMED TIME OF DEATH: 1445 <br />INJURY INFORMATION: <br />DATE OF INJURY; <br />INJURY AT WORK: TYPE OF WORK: <br />PLACE OF INJURY: <br />LOCATION OF INJURY: <br />HOW THE INJURY OCCURRED: <br />NO , AUTOPSY AVAILABLE: <br />MANNER OF DEATH: NATURAL CAUSES <br />TIME OF INJURY: <br />CERTIFIER: REES JOSEPH SD NO: 8090 <br />CERTIFIER'S ADDRESS: 1325 S CLIFF AVE STE 4421 SIOUX FALLS SOUTH DAKOTA 57 <br />This is a true certification of the ofidial Vital Record filed in the Department oSe8Ith as provided to Chapter 34-25 <br />of the SOUTH DAKOTA CODIFIED LAWS. <br />ISSUED BY MINNEHAHA COUNTY EGISTER OF REEDO <br />MARIAH R POKORNY, STATE REGISTRAR;'" <br />DATE ISSUED: NOVEMBER 06, 2018 <br />'"+%rrANY ALTERATION. ERASURE OR DUPLICATION VOIDS THIS CERTIFICATE <br />