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<br />1:1=-~:Du...]a"':U..'"fir.TtillJi'jl;f~IIA"'.:II~I~"":;I"ii'~lll~..]a':;II."1I.III.IJI'JliiiI~..Io."':J.II_'l~II.!r:'~""..:.1~Ir..:.'::I.I;I[flr.:..l.'ill..:.'.:I::II'tri1~l~_:['].'".:.'~et.''(..''Jl <br />iil''' <br /> <br />'\\ <br /> <br />ALABAMA <br />Center for Health Statistics <br /> <br />200902568 <br /> <br />28. <br /> <br />~:~S4{1~ <br /> <br />fnt ~ L.l~ (Ipll5l~mllll..pitiIsJ <br />Bruce Allen PETZOLDT <br />tOl'/, Tt4NlI.~RLOCAno.(lFW.T1U"DZlPCOOE <br />Fort Pa ne 35968 <br />I. fllOSPllALlSlBifr 1_lII.tA (I OIlll'1iIllll, OOAI <br /> <br />ALABAMA <br /> <br />CERTIFICATE OF DEATH <br />St.. fll.......ioo. 1 01 .... <br />DEATH (IIbdh. Doy, v..., <br />Feb. 7/ 2009 <br />~ 1m Cl1Yuwrs 6 PlACE OFDEATH-I<<lSPITALOR O1H!llI/jS1iTUl1DN-(lnol inoith.., ,o. ""'llIlll1lPrl <br />~~~~~ 5768 County Road 27 <br />8. (f "SPANK: 0IIlt! (s,dy YI$ (I Nol H Yes, Stid'f C.~.--'~~'- 9.l14ce--lSldl_iClJlIndii~ IIIi. 1IlitI.1tl:1 <br />MoO*,- PlltrlO Ri*,ltC. . <br />No Wh1te <br /> <br />09-03319 <br /> <br />~W: <br />~~ <br /> <br />3.0~~~ 1. <br />6'~ <br />19. <br />20. . <br /> <br />c...... <br />-- <br />-- <br /> <br /> <br />--" <br /> <br />ji <br />en <br />en <br /> <br /> <br />19.5TAlEOFIIlTIlII.. il>USA._lllofllJl <br />Nebraska <br />2UiSi~ em UI.tTS 2UlllEET AND NIJIj8!R <br />Iil!lciiJl'es00Nol <br />No 5768 County Road 27 <br />16. USUAl. otOJPA'lm Ill.. ij""oI'O'11t1"no dU"1IlI fIlOIIlII'wortiIIg lie..., ~ II1irodl'- <br />Draftman/Engineer Tech. <br />21FA1HER~ ~t!l !6IlI1o llIl <br />Alfred Petzoldt <br />Sl. DISI'QSIlJlN OF 1lOOY1s,.;i1yIkrIil. er.oilllllll, MIIbI 31. ~71WSMI <br />Donilillll, HoIliblll!sPoiil on~ ~ <br />Crematlon ~ 2009 <br />.M.FI.IEllALHOME-lillllllndAhs W. T-WilB::n f\reral 0l3j;::el <br />P.O. &Jx lB58 Rai.nsville M... 35985 <br /> <br /> <br />64 <br /> <br />111 SEX <br />Male <br />14. DECEASEO'S SOCIALSECUIlYNUMIER <br />16/ 1944 508-58-6296 <br />17. SlJMI'NG SPlMm I" wile. aOle lIIIiden Mqj <br />Candy Anderson <br />21 CI1Y. TOIVI, OR LOtATIlN AIlll ZIP tOIl! <br />F,ort Payne 35968 <br />26.IIIIORMANI-llII>IIl'ldAddIfl5 Candy. PlO'ltz 0 Id t <br />5768 Co.Rd.27/Fort payne/AL 35968 <br />27. KINO OF IlJSIl!S$ M IkOOSTll'i' <br />The Gas House <br /> <br /> <br />!1.Aiif <br /> <br /> <br />"111'1 <br /> <br />- <br />... <br />". <br />.oil <br />:=-- <br />.. <br />.. <br />*. <br />~~ <br />.. <br />... <br />*~ <br />.. <br />::II <br />". <br />... <br />.. <br />:iiii <br />.. <br />~,. <br />". <br />... <br />. <br />.. <br />::=- <br />... <br />.. <br /> <br />29.lIAIlIBl NAME Of 1AOlMEII- <br /> <br />Fill <br /> <br />Fort Pay~e <br />Midte Last <br />Neal <br /> <br />.' <br />- <br />-=: <br />.' <br />. <br />... <br />... <br />... <br />, .. <br />... <br />i:* <br />.-: <br />." <br />II::- <br />~. <br />... <br />... <br />... <br />"".1 <br />... <br />11.. <br />.-. <br />. <br />~ <br />... <br />~. <br />... <br /> <br />31 LOCATIlN-jtilj (I T"",,~.) <br />G.ntersvi.lle, At <br />3l DATE SIGNIO BY FUNERAL D11lECTl.f1 <br /> <br />..._,'n~u, <br /> <br />~ <br /> <br />U <br />l:!: <br />... <br />o <br />~ <br />~ <br />46. <br /> <br />MEDICAL CERTIFICATION <br />4& PMTL Ernrlliediwses. ifries.(ltam\li_nsthll"ilMllildtllh, Do 1I111n111 IItI a "'~, IIlI> .CIId~ urllllinlorj mil. Moor hll~fRilire. UST DM.YOIIE CAUS!ON EACH UNE. <br />r=~~~~lIilnllrliN ~ 1_.,._ HEART FAILUR~ . <br />IXE TO{OUS ACQHSEOllNCE OF): <br />l Hypertension <br />.- ,. . ., { DUE TO lOR AS ACOIISEOlIiICE OF): <br />S..-nlillr lilt eooilIilll1l, ~ ,",.1III~1Ii III .. <br />iounoIIetoCl",JnterUlalll:llNGCAllSE ~ D1abet 1es <br />.::::~~II in~illflll'llml D\J{lO!(llASACOIISEOlINCEDF~ <br /> <br /> <br />41. PART n. OtllRrligniliCI"oondi1blI~bI~lII '*" bll nOl rlllltirc ~ lhIlI\derlyq CRUl. a... in Pan l <br /> <br />APIlIOXlIIAl't IlilSl'IAL 8!W/!!1t OIISU <br />AND DEATH <br /> <br />~ WASlHERE A PREGNANCY IN LAST <br />42DA'lS1~Y..NAIIIUIt.I <br /> <br />4il. MANNER lfOEAlH~A;Q4n. Hlmicidl, Suicide. UIIMllrmlned CiMIst-. Pe......, NaMal Clustl <br />Natural Causes <br />52.HOWIOllYoctlJlRED(E"l>l,,,,,..."'injlOyin..~, Po~ 1..1M41.PonII <br /> <br /> <br />M. <br /> <br />49. ~ 5S.llWl\'ATlWRllSPo;iyYllIurNo) 66,PLACEDFIWIY-i~III1oniI,flrl\,ilml,tai\lllly.olf<tloJilln,lIcJ <br /> <br />66.~ <br /> <br />Thi$ i$ e lege I rel:ord Gnd mu~t be filed within five l51 days after death. <br /> <br />AOPH.H$ "R... 1 1.9:1 <br /> <br />This is an official <br />Statistics. Alabama <br /> <br />March 19. 2009 <br />