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BREMERTON-KITSAP COUNTY HEALTH DEPARTMENT
<br />Bg~~TQj~ WRSHINGTON 98310 _
<br />79~L~355~
<br />~ertifie~ ~o~p e~f ~eAt~j ~ertific~t~
<br />The original cer iificate of death from which this ce:~tif ed copy has Deen made .rill be permanently tiled n'ith tho
<br />A'aahirgtun Siatc Dcpart;Ttent of Health. Additiaral mT:iSed copies :nac be secured From Sw~eau of Fital Statistic_c
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<br />r."Y. +5 ~ tSO IEvv v i6~. WASHiHOTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES
<br />tHEA t9`.; BUREAU OF ViTAI STATISTICS
<br />EAUi EN~T~~w"` _- 354 CERTIFICATE OF DEATH
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<br />OEGFA$EC nag- rNS .+_wEE U'_* SEX DATE OF pEATM •.wx.tn par •Ean~
<br />M rtle _ E. Forth !> female ~ ~ 13, 1979
<br />FA'E nw -- .v. _an A.a`[ ~ A - c - _ PATE OF &RTH :.h-wlw ~.ar (;OL)tiTY OF DE TN
<br />a~White ;._ 90 i~-'~~" ~~~{ ^'"~ ~E July 29, 1888 Kitsap
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<br />Bremerton -, yes ~ ~.: Harrison Memorial Hospital
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<br />Nebraaka`~ U.S.A. ,.,vidoved i,~.
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<br />William -- Tompkins ~,E Letitia - Nichols
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<br />-z Kra. Margaret Larson I,_; 5174 Wilson Greek Rd.$. E. Port Orchard, WA
<br />FORT': DEATH NAS CAUSED BY TFR O,viY ONF CAUSE?FR L%NF F, R~6: ;p'AND•_:~ •°Fi-n~a`k wrfu.l
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<br />This`is ttitertify t~trt'~ Ste fortuvinc ~t a ?rut- jolt, and eGrreet capy of it:e c,rigina2 certificate
<br />Gf death nf_ ~ ~~ :~•- pOrth _ _ _ _-.,,.._.__,,, temporarily on fife in this olhce.
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