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• <br />ti <br />ra <br />STATE OF SOUTH DAKOTA <br />(_DEPARTMENT OF HEALTH ` <br />CERTIFICATE OF DEATH <br />201707 <br />FACT OF DEATH NUMBER STATE FILE NUMBER <br />567 <br />::::...4 <br />� 304vCO <br />14Q-2017-OtI4562 <br />DECEDENTS ;INFORMATION: ; <br />DATE FILED: 08/01/201:7 ' <br />NAME: WILLIAM LYLE LORE <br />ALIAS: <br />SEX: MALE SOCIAL: SECURITY NUMBER: 521.42-0463 ARMED FORCES: YES <br />DATE OF DEATH: 07/23/2017 DATE OF BIRTH: 06/08/1934 AGE 83 YEARS <br />PLACE, OF DEATH INFORMATION: <br />TYPE: EMERGENCY ROOM;I OUTPATIENT.. <br />FACILITY NAME OR ADDRESS STURGIS REGIONAL HOSPITAL STURGIS MEADE SOUTH DAKOTA <br />DISPOSITION: INFORMATION: <br />METHOD: CREMATION <br />CEMETERY: <br />LOCATION: <br />CREMATORY: BLACK HILLS CREMATORY <br />LOCATION:: STURGIS SOUTH DAKOTA <br />DEMOGRAPHIC INFORMATION <br />RESIDENCE: -5652 VALLEY ROAD, ALLIANCE: BOX BUTTE NEBRASKAX 0 <br />PLACE OF BIRTH: NEBRASKA UNITED STATES OFAMERICA` <br />SURVIVING SPOUSE'S;NAME, IF WIFE MAIDEN NAME: MARY WILES ..: <br />FATHER'S NAME: `'HOWARD LORE . <br />MOTHER'S NAME PRIOR TO FIRST MARRIAGE SADIE WILKINS ;. <br />INFORMANT `jNF O R MATI ON <br />INFORMANT'S NAME.; MARY::LORE..>; RELATIONSHIP . SPOU$$E <br />MAILING ADDRESS: PO BOX 94 ALLIANCE, NEBRASKA:693Q1 ... ; <br />F ERAL HO E : BLACK HILLS FUNERAL HOME AND CREMATION SERVICE 1440 JUNCTION STURGIS SOUTH DAKOTA 57785 <br />ARITAL STATUS: MARRIED <br />1 <br />irs ... <br />FUNERAL, SERVICE LICENSEE MONCUR DEAN:L <br />CAUSE OF DEATH PART I: MEDICAI. CERTIFICATE <br />SUDDEN CARDIAC ARREST NOS <br />PART II: <br />CORONER CONTACTED: YES . AUTOPSY PERFORMED: NO'' <br />ACTUAL OR PRESUMED TIME OF DEATH: 1229 <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 />LICENSE :NO 1534 <br />INTERVAL: <br />AUTOPSY AVAILABLE. <br />MANNER OF DEATHf AA: CAUSED:: <br />• <br />TIM.E::OF INJI'RV ' <br />CERTIFIER: DEYO CALEB A <br />CERTIFIER'S ADDRESS: 1400 MAIN STREET STURGIS SOUTH DAKOTA 57785 <br />$p: LICJ <br />f ti f,l)� <br />s . a <br />This is a true certificatiod:0f the bfffcial Vital Record h7ed �p fhe Depar1menl:of He Jth as provkIerd In Chapter <br />34-25 of the SOUTH DAKOTA CODIFIED LAWS. • ` <br />ISSUED BY MEADE COUNTY REGISTER OF DEEDS. <br />MARIAH R POKORNY, STATE REGISTRAR <br />DATE ISSUED:. AUGUST 02, 2017 <br />RBGISTER .OF: DEEDS. <br />- - -.. w . .,+...�—_- V••*4 dANu�11�'f�'IHAal1 :(i61 1`,1-!��- uM.... µ� 'i.•!. '.• 4 0 <br />ANY ALTERATION ERASURE. OR DUPLICATION VOIDS THIS CERTIFICATE / <br />O 644366. <br />n <br />IVA <br />ALI DDVALIDV <br />yALI.VAI-IrVAL <br />.I (VALID <br />DVALI <br />AALI <br />VALID VALII <br />,L10 <br />VALI <br />VALI DVALALI <br />V <br />