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sWATE Ula CALI FORNIIA <br />CFI:7'IFICVTIO!\ OF VITAL I ECOI;I) <br />STATE OF CALIFORNIA' <br />DEPARTMENT OF PUBLIC HEALTH 202207391_ <br />STATE RILE NUMBER <br />CERTI <br />USE GALE INA <br />0 <br />1.NIMECR BECEDENr-FIPET MANE <br />IRENE <br />2 MIDDLE <br />PATRICIA <br />4LAST IFwM <br />QUINTANA LOPEZ <br />AWLALEOKNOWN AB-Mk1,d fug ANA FIRST MOOLE, LAST) aaOBQBIRTH mnNtlNagry <br />S. AGE Ypa,pR <br />02/29/1''' i <br />41 <br />Cr <br />ins 1918910 <br />F <br />O. BIRTH STATEMOREIGN COUNTRY <br />NAY, MX <br />1aSOCIAI.EECURNCNUM0ER <br />NONE <br />I <br />it.EVER WU.S. ARMED PORCEST <br />❑ YES L] No ❑ 1' <br />1x./MAIM ST1T P'MAwMM <br />MARRIED01/19/2022 <br />T, DATIIDP DEAN miaimyy <br />HOUR EARm.* <br />0810 <br />I .E011CATON-NMr <br />OmmftmeANIMM <br />BACHELOR <br />MUAE WOG DECEDENT IESININKLUSINOMIAENNIGIT DI Mpa OaMMAatanaa) <br />E4 YesMEXICAN"° <br />191 oacecs rsRAOs- us Is a mw eey be NOW DMMweYareanWdg <br />MEXICAN <br />17. USUAL 00 JrAT0N-fw.11 11f 611 4911. DO NOT USE REYFis3 <br />CARE GIVER <br />16 IONDOF BUSINESSOR INDUSTRY PD. GAMY Wa,roWearlmali .wrybWnMM WAG MM <br />SELF-EMPLOYED <br />12 YEPREINOOGIEYGION <br />8 <br />10. DEO IT'S RESIDENCE Rona IndAumbeLa0lb010 <br />511 W CHARLES ST <br />' <br />21. cry x2 �>.. `: YEARS IN COUNTY <br />GRAND ISLAND a �e � :. 43 <br />-`-1 <br />xa81ATFJPOREIDNMUMMY <br />NE <br />t <br />28. = <br />C. APACE QUINTANPRELATIONSHIP <br />i.r"..-^!Al9w1 <br />r . � .T�/AVI�Y <br />JJ 1 <br />1 <br />Ma NAME OP &ARVIVINGSPOU — w `"ASO. <br />JOSE MIGUEL� <br />IAMB ..'= �' <br />, <br />as LAST(AI . TT <br />RIVAS <br />911. NAMe OR _ <br />JESUS <br />m.ME LS - <br />7a LaSf ..i' <br />Q r <br />�` <br />`' <br />BM.eMTNgiA9e <br />SIN, MX <br />aaNAME aPGABINA <br />se MD=87.t98T <br />- <br />L <br />9a sere MIS <br />NAY, MX <br />asDISPOSn1ONQAT0 <br />''' '.' <br />02/03/202241. <br />ao. Pima OF PINALD1SPDaITalPANTEON MUNIC AL, RLBZ�� T, MEX <br />/ <br />TYPPEEOFS <br />CREMA TJRE8IDENCE <br />42.mawTGREDE < <br />► JEFF L FISCHE1�2 , �' . <br />'� <br />aa.WENN NUMBER <br />EMB8921 <br />*7'.as <br />PB�� ` <br />� <br />1ADW�aiaAE61 <br />FD898 <br />y <br />4E 91 10Se DF LCIMM.; <br />i a <br />47. DATE RYIWabepy <br />02/0312022 <br />�Q] <br />10I • Y ' i .. . , 108. .i,. <br />WWWW. i.#P H<'.'",. - p� <br />lY'C ts.. <br />I <br />IM OM! <br />DecedentsMEoaw <br />- Home <br />1091 DOUHTY ` - <br />SANTA CL kL• r4 .. .# PAS UR !� . , <br />FORD <br />107. CAUSE OP Dank" 1' '-. I ...9IUw,WAYR. aaa91l61bI ...I IMMO II M <br />Or MOO <br />1s6t l081®mCORONON <br />1111 yes 23 NO <br />IMMEDIATE 0Allen LYAtiPH <br />MIMI domes or conditionmwatlng" .• <br />in drip <br />$ ..' <br />/ <br />r ,ai ,. _ _ <br />A9Aiw Xx <br />UNDERLYING a. <br />CAUSE '>t -. J <br />ftp : <br />I* Al{TOPSYPEPIORM®P <br />Q YES ®ND <br />Iy�y�1yIr1 iL ,. 1m ,.ri <br />IIIIaNMd16lnn1e 101 } '3^" .. . F x, " _ _ <br />pawning in death) LAST s r a . <br />7' <br />Pt Ofi�L11MOOaeEa <br />Yoe . N0 <br />hboagitiONiFICOSTCONDRIONE I. • � 1 .. ; . <br />11s memo/toe PE FORLISO FOS kW WN01neM1S1 Al t <br />NO <br />LISA rr9att I0NRM NMETYBVN <br />■ TM ®"0 II a« <br />111.Ic01TPYTNVTOfNEeDsTOFtmemELxg1EDBaN0 <br />AT1NE1101M.008,AN0PUCE8MiaD7RONIIICAf19Ea81iaa1. <br />OMMMPaq mended Grim Deaden! LAP Eealµw <br />»a' ... IlaIV,, . -- <br />A ^ <br />11LAUREN SHI2U MAED AM, AAD <br />//a 41L'@ISE auMeER <br />A100890 <br />117.0815 mnVdaMOyy <br />01/19/2022 <br />tro elmroaeew *OM <br />9 01/17/2022 01/19/2022 <br />118 TYPO ATTEDDaeawrveDwEs14*916 auNDADDEMe 2*000ELAUREN SHIZUE <br />300 PASTEUR DR, STANFORD GA 94306 <br />MAEDA, MD <br />ifs ICERNEYGAT NMTOPNgNOWMO3CUIMIMTNGMEL °MEMOMDES000PRONGSCPAENggEGG <br />MAMMA OP DOAN0 rmad U ocomip NAMIEDE p &Mp Fa, Zanan U d a <br />INJURED PMAKE <br />Li'l Q NO D" <br />121.NAAp0016 leo el NEL *OUR 114180* <br />_ Ili <br />i125 PLACE OP INJURY (PAS NEdS. Oonstomlon 9N.11/013*W MI, <br />S 104.0E8CHIBEHOWNJUAYO (11 In <br />1 1291 LOCATION Of wAlUa/ Wrest end number. or Nathan. mid DIM M E ER) <br />laSIGNATURE ORCORONER / DEPUTY 17 4ER i <br />127. DATE mM1daroeyy{12. <br />TYPE NAME, TITLE OPcomoNER/DEPIRYCORONER <br />STATE <br />REGISTRAR <br />A <br />a <br />0 <br />D <br />6 <br />INIIIIIIMIllanfinn 11111111111111 <br />PAIL AVTN.91 <br />OENSLMTRACT <br />This Is to certify that this document Is a true copy.. of the official record <br />filed with Vital Records. <br />DATE ISSUED <br />al 30 2022 <br />JAMES GREENE MD MS <br />STATE REGISTRAR OF VITAL RECORDS <br />This copy is not valid unless prepared on an engraved border displaying the <br />date, seal and signature d the State Registrar. <br />CACDPH--01 <br />LIFORN <br />DANA E. MOORE, MPH, CPH <br />STATE REGISTRAR OF VITAL RECORDS <br />II1IIIIIIIIIiIIII'I'IIIIIIII <br />0 0 5-5 2 1 0 6 4 <br />ANYALTERATION OR ERASURE VOIDS THIS CERTIFICATE <br />