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<br />STATE OF COLORA 0
<br />
<br />HOLD TO LIGHT TO VIEW WATERMARK
<br />
<br />STATE OF COLORADO
<br />CERTIFICATE OF DEATH
<br />
<br />STATE FILE NUMBER
<br />
<br />200801607
<br />
<br />AKA: Eldon W. Lepp
<br />1. DECEDENT'S NAME (First, Middle, I,(ilsfl
<br />
<br />
<br />3. PAT~ OF D!;:ATH (Month, Day, Year)
<br />
<br />July 20, 2002
<br />
<br />7. BIRTHPLACE (City and State or Foreign
<br />CDuntry)
<br />
<br />Wallace, Nebraska
<br />
<br />2. SEX
<br />,Male
<br />
<br />Eldon Wayne LEPP
<br />4. SOCIA~ S"CURITY Sa. AGE - ~asl
<br />NUMBER Birthday (Years')
<br />505-03-4451 87
<br />
<br />
<br />,>:. UNOER 1 OAY
<br />Hrs . Mins
<br />,
<br />
<br />6.0ATE OF BIRTH
<br />(Month, Day, Year)
<br />June 25, 1915
<br />
<br />8. WAS DECEDENT EVER IN
<br />u.s. ARMEo FORCES'
<br />XJ Yes n No n Inpatient D ER/Outpatient
<br />sb. FACILITY NAME (Unot institution, give street and nllmber)
<br />
<br />:' W~~r~ing 'Home rJ Residence [) Other (Specify)
<br />90. CITY, T9wN, OR ~OCATION OF P"ATH
<br />
<br />o DQA
<br />
<br />9d. COUNTY OF DEATH
<br />
<br />Cherrelyn Care Center
<br />lOa. DECEDENT'S USUA~ OCCUPATION
<br />~d~i~f;:B~~~d~()ne dvring most 01 wvrkirl(J life.
<br />
<br />Littleton
<br />lob. KIND OF BUSINESS/lNDUSTRY 11. MARITA~ STATUS, Ma,,'ed,
<br />Never Married, Widowed,
<br />Divorced (Sp9Cily)
<br />
<br />Arapahoe
<br />12, SPOUSE (If wife. plve maiden name)
<br />
<br />
<br />~. Elaine Bahr
<br />
<br />Owner
<br />13a. RESIDENCE-STATE 13b. COUNTY
<br />
<br />Fa rmMachine ryBusine S.s
<br />'3c.. CJ. ,TOWN, OR ~OCA TlON
<br />
<br />Colorado
<br />
<br />Prince St. Apt.#1009
<br />16. DECEDENT'S EDUCATION (Spocllyonly hlg"'''
<br />fatg~Q~~h~JzfcdJ,~;:(;n~~~~~;ri1~ngi77+ )
<br />
<br />13e. INSIDE
<br />CITY
<br />LIMITS?
<br />~~~s 80123
<br />
<br />12
<br />
<br />17, FATH!;R-NAME (First, M/eJdJ8, Last)
<br />
<br />INFORMANT.NAME and relationship to decealiled.
<br />
<br />Rutl~dge. ..... E. Elaine Le - Wife
<br />20b. PLACE OF DlSPOSlf,ION (N'a:me of C8r1t9fl1ry; ~fe'matofy.",Ot 40C- l;...OCATION. City or Town, State
<br />othf/fPlfj,ce) , , ".
<br />
<br />Louis D. Lepp
<br />20a. METHOD OF DISPOSIrION
<br />o Surial 1i CremaliOn 0 ReMovaI1rom,Stat,a:
<br />[J Donation 0 Other(Speci1y)~._."",,.:..,__,_~.._
<br />
<br />Pearl Street Crematory
<br />
<br />Denver, Colorado
<br />
<br />2~
<br />
<br />
<br />NO
<br />
<br />21.. SIGNATURE OF FUNERA~ OIIlECTOR OR PER50NACTlNC/ AS SUCH
<br />
<br />:I'b: NAME"'ND "'DDIlESS OF F"'CI~ITY:
<br />dnkwine FamUy..:Mortuary,
<br />itt1eton,Colorado
<br />
<br />999 W. Littleton Blvd.
<br />ZIP 80123
<br />
<br />bAtE fttED (~(Jt'ttn. Day, Year)
<br />
<br />JUl 2 3 lOa
<br />WAS CORON~R NOTIFIED?
<br />(Yes orNo)
<br />
<br />....:I:..I.=tII;;I=~
<br />
<br />TO 8" COMPLETED Y CORONER
<br />On,the basis of examination and/or In....estlgatlon,ln my opinion death occurred at 1M
<br />tllnG, date and place, and I;:h,la to the cauSe(S) and manner as stated,
<br />S/_gnatiJfe ,.....
<br />
<br />29; DATE SIGNEO IMonth, D.y, y..,)
<br />
<br />30.
<br />
<br />3
<br />
<br />So. Holly St.reet Suite #437, Litt1eto1lP, co 80122
<br />31. NAME Of=" ATlENPlNG PHYSICIAN IF O,THEA THAN CERTIFIER (Type/Print)
<br />
<br />
<br />4
<br />
<br />33.. OATE OF INJURY
<br />(Month, Day, Y/iilarl
<br />
<br />33b. TIME OF
<br />INJURY
<br />
<br />33d. OESCRIBE HOW INJURY OCCURRED
<br />
<br />32. MANNER OF OEATH
<br />
<br />5~
<br />
<br />~atural
<br />U Accident
<br />o SuIcide
<br />o Homicide
<br />
<br />33f. LOCATION (Street and Number Of' Rural Route Number, City, County, Stale)
<br />
<br />o Pending
<br />Investiaation
<br />
<br />o Undetermined
<br />Ml:lnner
<br />
<br />lal
<br />OUE TO
<br />
<br />l::'~
<br />
<br />Inter.....al between onset
<br />and 9llo~ , / ""
<br />/Vl /A#~"
<br />
<br />Interval between onset
<br />and death
<br />
<br />Ibl
<br />DUE TO OR AS A CONSEQUENCE OF
<br />
<br />
<br />Interval between onset
<br />and death
<br />
<br />Ie)
<br />
<br />PART OTHER SIGN'lF1CANTCONDITlONS - Conditions contributing to death but not related to cause in
<br />II PARr I (e.g., alcohol abuse, obe$ity, !).mQkar)_
<br />
<br />36. AUTOPSY 36, IF YES were flndlngs considered
<br />(Yw or No) In determining cause of death?
<br />
<br />NO
<br />
<br />CORRECT COpy OF THE OFFICIAL RECORD WHICH IS IN MY CUSTODY.
<br />
<br />DATE ISSUED
<br />AORS-16 1-89 (Rov. 1-91)
<br />
<br />JUl 2 $ 1.002
<br />
<br />~S+~
<br />
<br />RONALD S. HYMAN
<br />STATE REGISTRAR
<br />
<br />Do not accept unless prepared on security paper with engra.vedborder displaying the Colorado state
<br />seal and signature of the Rcgistrar. PENALTY BY LAW, Section 25~2~118, Colorado Revised
<br />Statutes, 1982, if any person alters, uses, attempts to use or furnishes to another for deceptive use
<br />any vital statistics record. NOT VALID IF PHOTOCOPIED.
<br />
<br />ililil"ill\"~'.~'~iJli),
<br />I'~~~ii;'",'):~fi)\~.~
<br />
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