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<br />CERTIFICATE OF DEATH
<br />New Mexico Vital Records and Health Statistics
<br />State of New Mexico
<br />United States of America
<br />
<br />200700514
<br />
<br />IOEcEoENrsLEGACNAME
<br />I
<br />
<br />--- -----I~iE;iMi""~' ---
<br />. <<<>>> , -
<br />, sEx"""!sociACsiicURifYNUMBER'
<br />
<br />J9Q.~:~2-7~_~m_
<br />
<br />o~iE~~~~?Hl;rich$1rQ!?s?,'?,'?,', ""'" "",TiMEOjioiiATH'
<br />I
<br />
<br />Q~f.~mR~L 14J.5.QQ2.
<br />MARITAL STATUS
<br />I
<br />
<br />I
<br />AMIZI PMD I
<br />
<br />....._..........m_.._~98:QQ_..,..,~_,.......__._...___.__..._~_!Y1.?J~__.
<br />ISURVIVING SPOUSE -Ifwlf., mald.n name
<br />
<br />Married
<br />ATE OF BIRTH
<br />
<br /><<<Patricia K Williams>>>
<br />'jBIRTH PLACE"""",..,.,.".......,..,"
<br />
<br />.. ""'siiRvEoiNuj,i:i\RMEoFORCES"'"
<br />
<br />..~9D.~.~.rY..1..~.,J.~.~~"""".m..".."."
<br />DECEDENT'S RACE
<br />
<br />Nebraska
<br />TRIBE
<br />
<br />v.. 0 No IZI
<br />
<br />",.1......,..........--.-... .....................-,......"."....--.---.
<br />,HISPANIC
<br />
<br />v.. D No IX!
<br />
<br />White
<br />ECEDENT'SRESioENCifcOUNTY'"
<br />
<br /><<<>>>
<br />
<br />;
<br />ECEDENT'S RESIDENCE STATE
<br />
<br />Hall
<br />MOTHER'S FULL MAIDEN NAME'
<br />
<br />Nebrask
<br />FATHER'S FULL NAME'
<br />
<br />,,~"~wmmm__mm~'_'._ .!<:<<Eilbh Struss>>>
<br />.......,...;......--;;J.;"00\1riiSPOSifiON..LOCATiON .........~"~~.._m_.m~'..m ..................................
<br />
<br />(] Removal from Stat. ., .<:.:::::": ,:,::~':",:,:;~:'"i:',,' "'::':, ',' ,,, ,,\~' k
<br />
<br />..................~ m...~t~.r.(.~.~~~i~)'.........i,.~~~.~~~,. ..!,.,..;";I,c.G,.:..:,:.~,"~..!:.jl.1V:{~~,t.'.Cl'!!f1...9~f11~tElry.....
<br />i".;..;,LPOUtlTV OF DEATH
<br />!~, , , 'Ii, I' I"'" \ ',i,:<"'''~""" U :"':"<':":'ii' ,"
<br />
<br />Aid tt P F I H 'i'ilil,,',;,,:>;,::;::,:, i"""'",V . 'Ifax
<br />PLACEe~: D~~H Om~rQL....\:lD~g~~gml!l..~". -"'-"""'"-'Trypi~~ .'.",' 'lNAMEOF PERSONCERTIFYING"CAUSE OF DEATHm,m ...,..,_.,,,
<br />
<br />................................................I..~.~~~it.I:~~.r~~~~~..;;;~:;~tP.ti~~t....'~~~~~....~"ff:~~~
<br />
<br />< <<:l::t~I.~-"_Clf'g!r~.g?> >
<br />METHOD OF DISPOSITION
<br />
<br />)I( Burial 0 Donation
<br />
<br />o Cr.mation 0 Entombm.nt
<br />
<br />FUNERAL SERVICE FACILITY
<br />
<br />MirlEl(f),c;:glf13)(..M~gig:;)tGElrlt~r.,. .
<br />
<br />MANNER OF
<br />IDEATH
<br />
<br />18I Natural
<br />
<br />o Accld.nt
<br />
<br />o Suicide
<br />
<br />o Undet.nnlned
<br />
<br />o Pending
<br />Investigation
<br />
<br />o Homicide
<br />
<br />"""''''''",''.,"M^'''u~~m~~''~=m''~~ "".ffl.,'^,.~,__...,'"",,. , .. ',',w"~'=mm'mmm ............. .... .._,...,','".,~~,~~",'w.w,m "wmmm'=~mm=~'mmm~WM..' .......... _..._~-~~~,~,"'~.~=y
<br /> .._...._"'_._....."~~.~.',~,~=~,=,~,~,~
<br />
<br />CAUSE OF DEATH
<br />
<br />PART I. Ev.nt. .uch as dlseas.s, Injuries, or complle.tlons that directly cau..d the death.
<br />
<br />I a..CardiacArrest
<br />
<br />b.
<br />
<br />..CAQ~~___
<br />
<br />e.
<br />
<br /><o:::o:::~~?:"_~~~....._.. "" ....M
<br />
<br />d.
<br />
<br />PART /I, Oth.r "gn/f'eantrlllndltlon. contributing to d.ath.
<br />
<br /><<<>>>
<br />
<br />
<br />FII. Number: 2006-013525
<br />File Date: December 28, 2006
<br />Order Numb~r: 20061200487
<br />
<br />II;'
<br />
<br />
<br />.... i
<br />I
<br />
<br />.i
<br />
<br />
<br />
<br />CERTIFIED COPY OF VITAL RECORD
<br />This is a (rue and exact reproduction of all or part of the document
<br />officially registered and filed with the New Mexico Vital
<br />Records and Iiealth Statistics, Public Health Division,
<br />Department of Health,
<br />
<br />S~j)~
<br />State Registra7'
<br />DATE ISSUED /J.'!2%-~
<br />
<br />Lot Sixteen (16), Grand West Subdivision in the Citv of Grand Island. Hall County. Nebraska
<br />
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