202203017 - Laserfiche WebLink

Browse

CERTIFICATE,f ft BER:*'20204OS$46 FIRST AND MIDDLE NAME($) MAX EVERETT LAST NAME(S): HENYZ COUNTY OF DEATH: CLARIF DATE OF DEATH: FEBRUARY 05, 2020 HOUR OF DEATH: 04:11. AM‘ SEX: MALE AGE: 90 YEARS SOCIAL SECURITY NUMBER: "50840-1429 • HISPANIC ORIGIN: NO, NOTSPANISHIHISPANICILATINO RACE: WHITE ERTIF1CATE OI DEA LOCAL FILE NUMBER: 700! 4 J 0 9 OATS ISSJEC 02111/2020 FSE NUMBER PLACE OF DEATH: HOME FACILITY OR ADDRESS: 5669 P STREET" CITY, STATE, ZIP: WASHOUGAL, WASHINGTON 98671', RESIDENCE STREET: 5669 P STREET CITY. STATE, ZIP: WASHOUGAL, WA 98671 INSIDE CITY LIMITS: YES COUNTY: CLARK^ TRIBAL RESERVATION: NOT APPLICABLE' BIRTH DATE, SEPTEMBER 27, X1929 • BIRTHPLACE: KEARNEY NE MARITAL STATUS WIDOWED SURVIVING SPOUSE: /VDT APP„LICABLI, OCCUPATION: IRON WORKER INDUSTRY: SHEET METAL EDUCATION'HIGH•SCHOOL GRADUATE' OR GED, COMPLETED • US ARMED FORCES: NO- INFORMANT: 'DEBRA K SEVERSON • RELATIONSHIP:' DAUGHTER,,. , ADDRESS: 3075 MCNAUGHT STREET WOODBURN, OREGON 97001 CAUSE OF DEATH:,' A: CONGESTIVE HEART' FAILURE INTERVAL: 1.$ MONTHS ,. B: AORTIC VALVE STENOSIS INTERVAL: 7 YEARS FATHER: HERMAN HEINZ MOTHER: EDNA PANGBURN METHOD OF DISPOSITION: REMOVAL FROM STATE PLACE OF DISPOSITION: ORLEANS CEMETERY CITY, STATE: ORLEANS, NEBRASKA DISPOSITION DATE: FEBRUARY 12,'2020 FUNERAL FACILITY: EVERGREEN MEMORIAL GARDENS FUNERAL CHAPEL ADDRESS: 1101 NE 112TH AVE CITY, STATE, ZIP: VANCOUVER, WASIIINGTON 98684 FUNERAL DIRECTOR: SCOTT A BOWEN, INTERVAL: INTERVAL: OTHER CONDITIONS CONTRIBUTING TO DEATH: CORONARY ARTERY DISEASE DATE OFINJURY: HOUR OF INJURY: INJURY AT WORK: PLACE OF. INJURY: LOCATION OFINJURY CITY STATE, ZIP: COUNTY: DESCRIBE HOW INJURY OCCURRED: 90 TRANSPORTATIbN INJURY SPECIFY NOT APPLICABL MANNER OF DEATH: NATURAL AUTOPSY: NO WERE AUTOPSY FINDINGS AVAILABLE' TO COMPLETE CAUSE OF DEATH: NOT APPLICABLE DID TOBACCO USE CONTRIBUTE TO DEATH: NO,., PREGNANCY STATUS IF FEMALE: NO RESPONSE CERTIFIER NAME: JOHN R.SWAN, MD TITLE: PHYSICIAN CERTIFIER ADDRESS: 700 NE B7THrAVENUE CITY,STATE, ZIP: VANCOUVER WA98664 DATE SIGNED: FEBRUARY 05, 2020 CASE REFERRED TO ME/CORONER: YES FILE NUMBER: NOT APPLICABLE 'r ATTENDING PHYSICIAN: ,NOT PPLICABLE LOCAL DEPUTY REGISTRAR: 'KIMBERLY St,CYR . DATE RECEIVE't?:: FEBRUARY 10;2020 NOT VALID IF PHOTOCOPIED OR ALTERED ".