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<br /> WILLIAMSO�I COUNTY �a� ��
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<br />� � Georgetown, Texas �
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<br />� 99 10� �84
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<br />� STATE OF TEXA$ CERTIFFCATE OF DEA'I'H sTA7E FILE NuMBER
<br /> 1.NAME OF DECEASED (a)FlR87 (b)MIODLE (c)LAST (tl)MAIDEN 2.SD( 3.DATE OF DEATH
<br />� � Merna Mari� Hoa;.�ie � Vc;g.el £emale 2--18-1998
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<br /> � � �,TE�;.�L�i;.-- c AC_ e" '".�':•.•. -•��� TF[7►CET�d5TATEt7AfOqEIOpCUUNTAI�<T 7.SCK:IALtiECUAiTY►q:�
<br /> « �-2g-�y�� m+� �r H M Wood River, Nebraska 50?-30-�953�
<br />� � B.RACE ga.riA5 niE OECEDENT 9b IF YES.BPECIFY pJIXICAH,Us�N,PuEq7o to.w�S OECEDENT EVER IN 11.EOUCATION(SVEGFY HI6HEST GRADE ,;
<br />� C a u c a s i a n OF 111SDP�S OR�Z� RICNI.EfC� U.S.MAAEO FORCEFi COMPLEIED,ELEM.OR 3ECONDw�V
<br /> y � . . � � ❑1!ES� �NO 5412�COLLEfiE(t3-18,t7+) 1 3 � �,
<br />� O 12.MARI'FA�STATUS � � 13. UHVIVINq$PCwS.�(IR WIfE,GIYH MAIOE�J NAA��, �qa.DEQ 6EIYT'S U3UAL OCCUPATION 74b.YOND OF BUSINES3 OR INDUSTRY
<br />� �� � � �MARRIED BNEVERMAFIRIED Frank Hoa e � Bookee EX Edv.cation
<br /> WK�OWEb DIVOqCED 9 P
<br />� � 1S�.AESIOENCESTREETADORESS .. . . . . 15h.C,ITYpqTOWN
<br />� m 12312 Split Rail Parkway Austin
<br /> � �60.COUIJTY ��tSd.STATE ' � �� 150:LP G`ODE 15f.INSIDE CITY uM17S
<br />� � Williamson Texas 78750 ❑ves �o
<br />„ g 78.FA7NEIi'S NAME .t7.MOTMF.R'S MAIpEM NAME
<br />� � Everett Vo el Ruby Lippincott
<br /> 18_PLAGE OF DEATH CFIECK
<br />� . Y HOSPI7AL: �INpATiENT ��ERlOUTPA7IENT QppA q7}��� []NURSM�HOME QAE5IDENCE� ���[]OTHER.(SPECIFV)
<br />� � C t0.COUNTY OF DEAT1i 40.CT'OR TOWN(iF p1f51DE Cm'uMi75,C.�VE�PIi6CiNGT NO.)��21.NAME�,OF MOSPITAL OR INS71TU71ON(k not in Instituticn,Www s1n�t addro�s)
<br /> Wilifamson Round Rock Round Rock Hospftal
<br />� 22.INFOR T-SIDNATURE 8 RELATION6HIV 23.MNLINO ADDRE89 OF INFORNANT �]S O
<br />� � 12312 Split Rai2 Parkway, Austin, X.
<br />� � . � 2s. ODOFDI T� � 25� EOF�DISPOSi110M�.��O+��aacErktem. �. 25b.��� .� 29.NAME6ADDRESSOFFUNERALNOnne
<br /> CR TORY OR OTNEA PucEl 3sdion
<br />! p �,R„LL � ewa� Beck Funeral Home
<br />� ������c�TM,���� R0t ' 15709 ReinCh Road 620
<br /> �cr�""^n°" Temp1 Q, Texa s
<br /> �HEMOVAL FROM STATE p7,gIONATURE OF FlJNERAL DIRECTOR OR PERSON $� �US�1 Il i TX 7 B�J 1�I
<br />� ❑DONATION ACTINCi AB SUGH UnIV16wn�
<br /> � se.a►re oF as�osRan
<br /> r ❑OTHEH(SAF.^.!Fti) A,�{.•� w.�J�' 7 �I !f ��� �
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<br />� , . �� �CER7IFV�NG PHVSICIAN TO 7HE BESi OF aV KNOWIEDGE DEATH OCCURRED AT THE TIME,DATE,AND Pu�CE,ANO OUE TO TME CAUSE(S)AND MAt�KdER AS STATEO.
<br />� � � $'$ ❑MEDICAL EXAMINER pN THE BnSIS OF EX�MINA71pN ANOVOFIINVESTH3AT10N,fN MY OPINION.DEATH OCCUHRED AT THE 71ME,flATE,PI,ACE,AND DUE TO THE
<br /> �p' ❑JUSTICE OF THE PFJICE� �USE�S)AtiD MANNER AS 9TATED.
<br /> ddd� C N
<br />! � 31.SIONATUFE a TITLE OF CERTIF�ER ,�J 92.DATE SiC�� �9.T1ME OF DEATH
<br />�� �� 7C�l �+t� a, t� S 1 :4 S aM.
<br /> � T� 3a.PWN7Efl NAME 6 ADDFESS OF CERTIflER � �
<br />� ��h Kenneth E. Hunt, 2300 Round Rock Ave. , Round RoCk, TX, 78681
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<br />� �. ���� 3S.PnqT/ ENTER THE q3E115E5,IWUii�S OR.��COMPLICATIONS TNAT C/1USED TME DEATH.p0 NpT ENTER 1HE MODE OF DYINCi SUCH AS ; Approidm�N
<br /> ; CAROIAC OR RESPIRATOAV ARREST.SHOCK OR HEART FAILURE UST ONIV ONE CAU3E ON EACH UNE. ; Inbrvd B�fwN�
<br /> � � � Omtl uW Drth
<br />� � IMMEDIATE CAUSE(Finel disatae �� 1! � !��-t'A•t�l � �
<br /> i �" a conditian rewkirq In dstlh) � �' E TO OR AS A KELV CONSEpUENCE OF): ` � �r
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<br /> �M b. �wl s�
<br /> Spu�nlialy Nst mndlfona,H any, � WE�TO(OR AS A UKELY CON9EqUENCE OF):
<br />� $� � MaOinp to immodirto c��ao.Enla � l�, � [ l'1 l S !
<br />�i c G o UNDERLVINGCAUSE d.sMa� Y�n�-��A�FM1'*�t l�t/45�r C44CtK�N '
<br />� �� p ������"����KS DUE TO(OR AS A L1KEtV CONSEWENCE Of;: N �y r
<br /> .� � resWt6g h dsrMJ U1ST � �
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<br />� x s � pART 2 OTFER SIGNIFICANT CONDITIONS CONTRIBUTtN6 t0 DEATFI gUT NOT RESULTIN(31N THE UNDERLYW6 36a AUTOPSY? 3Bb.AUTOP3v FaN01NG6 AVNUIBLE
<br /> +�'g GUSE OtVEN IN PART i p.s.,�W�tr�oe abwa,d�batw,s�wlu�g,�,) PqlOq TO COMPLETON OF CAUSEdF
<br /> �• o�rr+7
<br />� � �� . . �� ❑YES �NO Q YE3 L�NO
<br /> � 37_DID TOBACCb USE CONTRIBUTE Tp OEATH� 3H.DID ALCOMOL USE CON7PoBl1TE FO DEAi}F 99.WAS DECEOENT pREGNANT
<br />� ,❑�,/YES ❑PR08ABLY ❑YES ❑PROBAHLY AT,i1ME OFOEATH ❑YES �NO ❑UNK
<br />�� 1.1�NC ❑UNKNOWN QqQp ❑UNkNOVPN . .. .� WRHMJ LAST 14 MO ❑VES �NO [�llNK
<br /> ' �O.M/tNNEROFOEAIY. Ita:DA7E4FIT1,1i1RY �1G.TMEOFWURY 47s.INJURYA7�Y�q9K 47d?LqCEOFINJURY-ATMOAIEFARM,STREEf,FAC70RY,OFHCE,
<br />� �NATURAL . �• U YES G NC�
<br />� ❑ACCIDENT 41r.LOCATIpN(9TqEEi AND Nt1MBER.GITV OR TUVYN,�STAZEJ����
<br /> �i ❑SUIGDE
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<br />� �H?diL'IOE �N.DESCRiBE HOW II�UUqY OCCI#iRED
<br />� � []PEN�IN(i INVES".lGAT10N
<br /> N ❑�GWLp NOT BE DS��nMINEO
<br /> � 12a REGISTAAfi FILE N 42b.OI1TE�NECEIYED BY LOCAL RE(315TAAR � Ki �RE O�LOCAL REG p
<br />� � 01=0104-:_� February 18, 1998 •
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<br /> i State of Texas
<br /> rCounty of Williamson
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<br /> � ��; � � !�i� This is to certify that the above is a true and correct reproduction of the original record as recorded in ����-���
<br /> f�1 �� ,�y�� the office�of the County Clerk,�Willfamson County,Texas. � j��� �
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<br />� � � i<<C<���i � � �
<br /> 9 �L ELAINEBIZZEL4�C untyClerk�� � i
<br />�� ���������� Williamson Connty,Texas �� � �
<br /> .� �i�'� � Date��� a • � $ ' � ��� 9 s � � �
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