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COUNTY OF SAN PATRICIO <br />!) JUSTICE OF THE PEACE, PCT 6 <br />20040`829 <br />STATE OF TEXAS CERTIFICATE OF DEATH STATE FILE NUMBER <br />v <br />Q <br />i <br />d <br />0 <br />G <br />W <br />N <br />Q <br />N <br />H <br />rr <br />cfl i>'i <br />C <br />w� <br />¢ .1 w <br />3 J: <br />sf `� <br />N <br />' n <br />C Q� <br />41 <br />U') <br />G7 <br />LU <br />W <br />Ix <br />[V <br />tl � <br />I! <br />1. NAME OF DECEASED (a) FIRST (b) MIDDLE (c) LAST (d) MAIDEN 2 <br />2. SEX 3 <br />3. DATE OF DEATH <br />BONNIE JEAN RANGE ;Range F <br />Female' 7 <br />7 -5 -2003 <br />4. DATE OF BIRTH 5 <br />5. AGE I <br />IF UNDER 1 <br />1 Y.E. I <br />IF UNDER 1 <br />1 DAY 6, BIRTHPLACE ( <br />(CITY & STATE OR FOREIGN COUNTRY) 7. S <br />SOCIAL SECURITY NO. <br />MO D <br />DAYS H <br />HOURS M <br />MIN <br />8 -22 -1927 ( <br />(IN YEARS) M <br />Cloud NE 5 <br />506 -28 -7999 <br />& RACE 9 <br />9a. WAS THE DECEDENT 1 <br />IF YES, SPECIFY (MEXICAN, CUBAN, PUERTO 1 <br />10. WAS DECEDENT EVER IN I <br />EDUCATION (SPECIFY HIGHEST GRADE <br />OF HISPANIC ORIGIN? R <br />19b. I <br />Ill. E <br />EM. OR17E' SECONDARY l <br />White ❑ <br />❑ YES E10 - <br />-- ❑ <br />❑ YES IN NO <br />COMP COLLEGE E <br />12: MARITAL STATUS 1 <br />13. SURVIVING SPOUSE (IF WIFE, GIVE MAIDEN NAME) 1 <br />14a. DECEDENTS USUAL OCCUPATION 1 <br />KIND OF BUSINESS OR INDUSTRY <br />MARRIED � <br />�I NEVER MARRIED <br />114b. K <br />Christian Book Store <br />15a. RESIDENCE STREET ADDRESS 1 <br />15b. CITY OR TOWN <br />'= e <br />..,..�,.. .. .,. Hart <br />THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT REPRODUCTION OF THE ORIGINAL RECORD AS RECORDED IN THIS OFFICE. <br />ISSUED UNDER AUTHORITY OF SECTION 191.051, HEALTH AND SAFETY CODE. <br />DATE ISSUED: <br />CHARL LEWIS, JUSTICE OF THE PEACE, PCT. 6 <br />SAN PATRICIO COUNTY, TEXAS <br />I <br />1 <br />i <br />r <br />i <br />r <br />00a <br />y�(lCE co <br />PGT. 6 <br />N <br />a <br />