|
STATE OF ARIZONA ~~
<br />200905400
<br />ORIGINAL STATE OF ARIXONA
<br />AKA sTa,Te DEPARTMENT OF HEALTH SERVICES -OFFICE OF VITAL RECORDS pEATH NO.
<br />I I ~ ~ ~ I cape CERTIFICATE 0~ DEATH p-1D2 ~~I~WI°' . IMtw.,;~'+;:y!"-ice.
<br />N~ pF' P FIRST R MIbULE C. L45T SE% DATE. OF MONTH DAl' YEAP
<br />LJ DEQEASEp DOLORES JEANNINE SCHWEITZER FEMALE °E"T"DECEMBER 8, 2p07
<br />i _
<br />RA:.E 1e.9.~ w114e~ plAC. I tlrar. IspeCly IriGeletc WA5 DECEDENT OF HISPANIC CIRIGIN: IF VES'. INDICAYE MExICAN. SPANISH. PUERTb WIGAN, WAS DECEgSEp kVER IN u.S. ARMEC FORGES`
<br />SPEGFY ) f ~ (SPkCIhY YES OR Nb) A 1O CuBPN. ETC. (SPECIFY YES UR NUI ~.'O
<br />- ~._-1--~ I ~4A qE IY aC 5 'Y
<br />I pLAC6 OF BA.. L'OuNN 6W. TpwN OR CITY BC HOSPITAL OR Ilf RESIDENCE. GIVE STREEY AppRE551
<br />-a--L~ DEATH penal Casa Grande IN$TIlu1~A Hospice & Palliative Care ~C~EMEF
<br />6 -^ IN PATIENT
<br />PATE OF MOMH pAY YEAR Ape (YEARS IF UNDER t YEAR IF UNDER t OAY MARRIED. NEVER MARWIfp SURVPfIN(r tlF WIFE. GIVE' MAIDEN NAME]
<br />~~ 61RTH April 29, 1930 ~ST ~/'UAY, BBAAOS °"YS 9C HRS. MIN. 9 IDUWED, r4vpRar~1eP~CIFV) SOOUSE Lester Schweitzer
<br />STATE AND fu not In USA, name cournryl CITIZEN OF WHAT SWEGIFY SOCIAL SEQURn1 Nq 1mVI GVa1SVAL000I/PATION (C+'w kmn 01 work KMD OF BUSINESS DW INDl15TRY
<br />COUNTRY? pone roost of warktrryl lice. Cvan R ret;redl
<br />W "T1"4Fl~~i'eska Beaver Crossing 12 U.S.A. 5Q5-32-499Q ,4A Homemaker Own Home
<br />,,. ,46.
<br />U6WL 15A. STATE 15E. CAWNry 15C. TpWN pR CITY 16U. ZIP CODE HOW LUNp IN AitlZONA? EDUCATION
<br />II,~.J REST°6NGE AZ f Tool Arizona City 85223 ,S 31 Years „ HIGHEST GRADE GOMPI'ETE-
<br />u SYREE.'r ADDRESS OF R.F.U. INSIDE CfR'WMIT57 ON RESERVATION6 P US ATE ' "'' ' "~ ELEMENTARY SECONDARY CQLLEGE
<br />1gPEG 6e or No) fSPEGfY rNo) OF RESICTENGE (D-t2 (ta or5«I
<br />9438 W. Santa Cruz 81vd `y`es ~'p Nebrask~i ,~, ~ 2 ,66.
<br />i5E. ~ 16F 15G. ta.
<br />FATHERS A. FIRST' 0. MIpDLE C. LgST MOMEER5 MAIDEN A. FIgeT 8. MIppLE C. LAST
<br />NAME Jacob Oswald ~ Mabee Hobbs
<br />I 1B.
<br />INF RMANrS SIGNATURE RELA1'IpNSHIP TD ADDRESS STREET Np. Crri ANp STATE ZIP CCtpE
<br />Lester Schweitzer ~ q~{usbend 2~ 9438 W. Santa Cruz Arizpna City, AZ 85223
<br />L_~_J_.~.~I DECE ° -
<br />zt.~
<br />6URI.AL CREMATIpPJ, DATE CEMETERY OR MATCrFn - NAMEp60CATfO~Nro ~+ ry+ EM E 5 SIGNATURE CERT. Nb.
<br />L_:._.J REMOYA OTMERfSPKM1/~ WOOD R~VL~'R - MEI~iItIOIYT~)~ S.rEI~IEIFuRY r
<br />e ~. . ~ ~ x4. F12err1/~Uria ss.12/ 11/2007 2e. WO~D° RIVER NEBRASKA 27A # a ~~ tt z76.`~ (a p
<br />FUNERAL HOME. NAME STREET AOQR S" CfiY AND STAT! FV , ~ ECYOR or5~(S~ANRE) CERT. NO.
<br />I ~ 5imes Mortuary'- Casa Grande Chapel 1575E Plbrenc~ Blvd Casa Grande, Arfzona'85222 (r~T,CM/~ "'~' ~e ^~$$
<br />L ~ '~A
<br />TD THE EEST Of MY KNOWLEDGE. DEATH UGC~/RREDAT THE YIME. PATE ANW PLACE AND ON E'. IS C)F EXAMINATION AN-/OR INVESYIOgTIC1N, IN MV OPINION pEATH OCCURRED
<br />~, T DJE TO THE GAU561S1 STATED. ~ Sq~ AT TWfE ME DA'?E ANp pLAGE DVE TD THE CAUSE(S) ANp MANNER STATED
<br />30 SIGNATURE, ~, y r, ~ r { "a ,rGN4TURE
<br />~ I F z~z AND TITLE ~ ~~~r """ 5 ~ ~. y I An1U SITIF 11
<br />3 DATE SIGNED IMF. Pay. ye9r1 HpUR OF ^ W ~ ~ `u u ~ IYTE R NE- (Mo Day Y9ar) HpUR OF DEATH
<br />~~ /Z ~C ~~ a~. 10'~AM ~~"~~~~ ak I35.
<br />E~ ~, ~~ w
<br />S FROryp UNCED fyEAO (Mn., DaY Yaui i PWUNGUNCE- DEAD (HOUrj
<br />I I NfV1.E DF ATrENDING PHYSICIAN OF OTHER THAtr' CERYIfIER nype.oF prrrrcl ,° i
<br />t t I t ~ S5. ': ~.' qN '., li 38. AT
<br />NAME AWD ADPW6SS pF CERTIFIER. PHYSICIAN, MEDICFC '~xA~v~NG~R ln~l2l S1tA CENHL l a V~I~~TJ2 22 ' .AUTFIQRIXED FOR CREM,4TION MEDICAL EXAMINER'S SIGNATURE -
<br />J ISPECI~r~
<br />I ran~lclin 11 Saro' MD F1 r 4a ~r®S No; 4,
<br />DA7 o GIS RE REG FILE NiJ. REGI RA ~ SIGNATURE ;: REG. OISYRICT DATE REC'p IN STATE OFFICE
<br />47q. IMMEp1ATE ~CAU/SE (FINAL pl FA, E~'O^R CONDI RESULTING IN' ATH) IE ' N E CA EON l1NEl" `~''y
<br />Z ~ ~ ~iJ'/ , / I~~' ~ ~~ ~"V~' ! APPRO%IMATE
<br />476. UVE TO OR AS A CbNSEUUENCk pF'. INTERVAL
<br />tcs ~ is r' ;: ~ 6ETWEEN
<br />P~ -~~~ ONSET
<br />6 47C~ pVE Tp OR AS A CONSEQUENCE DF. DEATH
<br />. . -J PAS II. 777ptner Lenihant coRgljlp(1q,comrlbu[ing tv death but nol yawning In the unaeMyinq ~¢uye given rn Pan I ALROPSY WAS CASE REFERAED TO MEDICA{, E%AMINEP.
<br />I$pec~ yO or No) ' ISpaCify~ Fyoor Nn)
<br />I ( A6 ae ~j 60. ry
<br />~-~-J MANNEP OF DEATH DATE OF MU DAY YR HOUR InUURY AT WORK? DESCRt6E HbW INJURY OCCl7RREp
<br />^ CM.~S ^ FINOtF INJURY (Shanty vas or Noe
<br />5~, 53. M 54. 55
<br />ANDBJr IJ IrWT."11p4TICfJ PLACE OF INJ'JRY,AI home, farm, glreet. factory, o%ice builgrnp, etC.; WHERE LbCATEp7 STREET ADDRESS CITY OR TOWN STATE
<br />$PG"GIPY
<br />I~ y,.IOCE ^ Lr`[klEeMr.Eli %.
<br />Y) • . 51 5T
<br />$UpPLEMENTARV ENrWIp5 -
<br />TNBAL LAW j
<br />RCEMENT ~ '
<br />DRIri
<br />(Rev t•BY) , ~t r y A'~ ! ."%~yn~,~`
<br />('° /Y
<br />~ ~,
<br />i`~rf~''~~7E1.~ ~~O/
<br />~„ .y
<br />q
<br />Ar ~ ~ _ -...-.
<br />'This is a true certdication of the facts on file with the OFHCt OF VI"IAL RECORDS iPy r ~ "rte ~
<br />ARIZONA DEPARTMENT OF HEALTH SERVICES, PHOENIX, ARIZONA issued under ~ ~ PATR161 UJ1
<br />A ~'.STANI"STA'IEtFt~AR
<br />the authority bf A.R.S. 36.341, and by direction o[: .. ' ~ ; .~. ~ ° ~$.
<br />This copy not valid unless prepared on a form displaying the State Seal and impresser~~r}ix~i~e raised s~~l ~f ther(s3Li~t~ agency.
<br />• • .... a
<br />.r _ r , t
<br />
|