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<br /> <br />...."..~~"""\\\\\II\\llt <br />/<Si"- 1I1/ll <br /> <br /> <br /> <br />$0 <br />I "'",,...', . ""',;' """,' <br />~ ' ",~ <br />\~ . . <br />~ <br /> <br />ST,-\T E OF I U,\ 1-10 <br /> <br />STATE OF IDAHO <br /> <br />IDAHO DEPARTMENT OF HEALTH AND WELFARE <br />BUREAU OF HEALTH POLICY AND VITAL STATISTICS <br /> <br />Date Filed <br /> <br />JANUARY 03, 2007 <br /> <br />2006-10126 <br /> <br />State File No. <br /> <br />DECEDENT. LEGAL NAME <br /> <br />.. <br />~ <br />.;WI <br />.... <br /> <br />SHIRLEY MAE DEICHMANN FENSTER <br /> <br />AGE <br /> <br />CA TE OF BI RTH <br /> <br />SEX <br /> <br />SOCIAL SECURllY NUMBER <br /> <br />FEMALE <br /> <br />77 YEARS <br /> <br />SEPTEMBER 01, 1929 <br /> <br />508 - 30 -8119 <br /> <br />i <br />! <br />~ <br /> <br />BIRTHPLACE <br /> <br />PLACE OF RESIDENCE <br /> <br />LEIGH, NEBRASKA <br /> <br />NAMPA, IDAHO <br /> <br />""'F1ITAL STATUS AT TIME OF DEATH <br /> <br />NAME OF SUFMVING SPOUSE W IMM. "",/~n nomoi <br /> <br />WAS DECEDENT EVER IN <br />u.e. Am.1~D FORCEC? <br />NO <br /> <br />MARRIED <br /> <br />DALE L, FENSTER <br /> <br />FATHER - NAME <br /> <br />BIRTHPLACE <br /> <br />PAUL T. DEICHMANN <br /> <br />NEBRASKA <br /> <br />I <br /> <br />.. <br /> <br />MOTHER. ""'I DEN NAME <br /> <br />BIRTHPLACE <br /> <br />VERNA MARIE BOTSCH <br /> <br />NEBRASKA <br /> <br />METHOD OF DISPOSITION <br /> <br />FUNEAAL SERl/ICE LICENSEE <br /> <br />REMOVAL FROM STATE <br /> <br />PERRY L, ZEYER <br /> <br />NAME AND ADllRESS OF FUNERAL FACILITY <br />~ ZEVER FUNERAL CHAPEL, NAMPA, IDAHO <br /> <br />~ <br />~ <br />. <br />~ <br />.:.1lil <br />- <br /> <br /> <br />~~~~=~~~rVAI Between <br />2 WEEKS <br /> <br />CITY.TOWN Of\ LOC:/\TION OF DEATH <br /> <br />COUNTY OF DEATH <br /> <br />TIME OF DEATH <br /> <br />3:44 A,M, <br /> <br />NAMPA, IDAHO <br /> <br />CANYON <br /> <br />CAUSE OF DEATH (undOflyi"Q .0u"IOot) <br />"CVA <br /> <br />DUE TO (or .!II a conHquence af): <br />b, ASVD <br /> <br />YEARS <br /> <br />.. <br />i <br />~ <br />~ <br />- <br />II <br />~ <br /> <br />DUE TO (or aa .. conHquence af): <br />e. HYPERTENSION <br /> <br />YEARS <br /> <br />DUE TO (or O. 0 eon..quO"'O 01): <br />d. <br /> <br />OTHER SIGNIFICANT CONDITIONS CONTRI8UTING TO DEATH bu. "01 roSllti"g I" th. u"d.rlyi"g eou.. give" .bo.. <br />THROMBOCYTOPENIA & ACUTE RENAL FAILURE & CHF & DM <br /> <br />WAS AN AUTOPSY <br />PERFORMED? <br />NO <br /> <br />""'NNER OF DEATH <br /> <br />NAME OF CERTIFIER <br /> <br />TITLE <br /> <br />NATURAL <br /> <br />HAROLD KUNZ, M,D, <br />CORONER SUBSEQUENT CERTIFICATION IF NECESSARY <br /> <br />PHYSICIAN <br /> <br />LOCATION WHEFlE I""URV OCCURRED <br /> <br />-= <br /> <br /> <br />i~ <br />~ <br />..iiiiIJ <br />. <br />... <br />~ <br />- <br /> <br />\ \) <br /> <br />\ \, 9 ;:....:Mf':"I.'. /1. <br />\0,', ',~ ,:' ~,... .'~ " ~"."~'."': ~:;:. ", :,....../ <br />......;-., ~~~,'..."~ "'. ::'.~.:~:~,:~',,:/~.,:' ~~/ <br /> <br /> <br />i::~:s;,~?, :~;;~.f~ <br /> <br /> <br /> <br />, ~ 1IIIt'\'~' ,........ ..... <br />-:;. "1'~I;';$ a trUll ana CO~I:8C;i\l,lr~ftuctlon of the document officially registered and placed <br />"''',,~;;;.. ~ith.1iI.~ jDA~~Bl'iR~ OF HEALTH POLICY AND VITAL STATISTICS <br /> <br />/FI/I)i:J1Vl Q\~ \\\" <br /> <br />11111f/l\\\I\\ <br /> <br />DATE ISSUE)): <br /> <br />JANUARY 08, 2007 <br /> <br />~7~ <br /> <br />JANE S. SMITH <br />STATE REGISTRAR <br /> <br />Thi. copy not valid unless prepared on angrBved border <br />displaying state seal and signature of the Registrar. <br />