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CERTIFICATION OP' VITA L. RECORD)- <br />- <br />DEPARTMENT OF HEALTH AND HUMAN SERVICES <br />DIVISION OF PUBLIC AND BEHAVIOR4t. HEALTH f1 1 r�C <br />VITAL STATISTICS 0 J J Q <br />STATE'OF NEVADA DEPARTMENT OF HUMAN; RESOURCES <br />DIVISION OF HEALTH — SECTION�OF VITAL STATISTICS <br />CERTIFICATE OF DEATH [1002U Q D. j 0 <br />DENT <br />1. Devon C. <br />CITY, TOWN OR LOCATION OF DEATH <br />3b, Las Ye as <br />C e ... White, Black, American: <br />. etc:) (sy) <br />5. ite'. <br />STATE OF BIRTH <br />(It not U.S.A., name country) <br />9a. Nebraska <br />SOCIAL SECURITY NURSER <br />0959:. <br />mwae . rest DATE OF DEATH (Month, Day. Year) <br />LEPt UR6 2. ' ,December 19 <br />HOSPITAL OR OTHER INS1 TUTION- me (if not either, odds street mut ',amber) Hasp <br />a& .1700 Raiunide Street } 2e. <br />or Inst. indicate DOA; OP/Emer. <br />Rm. Anpefient (Spep'ty) y <br />CITIZEN OF WHAT COU -. <br />TRY <br />sc., • S. A. <br />KIND OF OR , <br />Assisted Livin' <br />tasF...�::. <br />rlotte auswel t <br />Meet or R.F D ;No: , w:, or Town. Sato, ZIp).. ... <br />1'1tr 21:51 N.i.Eatewai `Rd, Leis #e } as Nevada '89115 <br />5!T1ON <br />a. o the of my "'^' ' Mt the me, <br />ue to the ca <br />(Stiktfil OP:. A...4 <br />GATE DA -re si NED • , Day, Yr <br />21b. � # ®,a 21c.. r, <br />'NAME OF TTENDING PHYSICIAN « RiT AN€ <br />1 <br />OR irlfrefur Mt) <br />a_a. John Ellerton IID 21#20 W. P 1c aino Las .Vegas Nevada 89106 <br />REGISTRAR <br />24a (Signature) 1 <br />25. IMMEDIATE CAUSE <br />.AOC., SUI[ ID H•M., UNNDET .: <br />OR PENDING INVEST. <br />) <br />DESCRIBE <br />28d. <br />111 <br />11 �' ��'IIlyil <br />CERTIFIED COrV OF VI <br />Th's is a true and exadt'rep eduction otiheedocument;slfdally registered arnt <br />placed on the in the office of the State Registrar and Vttal Records <br />od7SUD: ..SEPTI. 3 2023 <br />E REGISTRAR' <br />Z <br />Th s Copy is trot valid unless prepared on engraved border displaying date. teal and signature of. Registrar. <br />NE VAD %MMA .you: <br />stn <br />h"`4yy'u,'u`4'aA'AA}R 9'M'u'A44,Py4n h'Me1'h,. ..,4hM'Al K4' '4444 'A`N+:1'>AN.44 <br />ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE/ <br />44.44.4.4•4,,A1,4 4,4 <br />_,� <br />