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<br />~ ~ 81 --JU Off.. 0 5 ~ STATE OF COLOpADO
<br />.. Q CERTIFICATE ®F DEATH
<br />gC ~~<) ! 5~. `~(~, f~ IPMVSICIAN OR CORONERi
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<br />DATE REGISTERED 8Y STATE REGi4TRAR
<br />tatAR 1 0 1978
<br />002540
<br /> DECEASED-NAME RoB~t Eugene WeCV ~~ `°~ I SEt DATE OF DEATH rtnonrw, unv ~rEaRl
<br /> ROBINS E. 4f~IN ~,Ma7.e I , February 22~ 1Q78
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<br />m ORIGIN OR DESCENT 'AGE - LAST , rFnw w , DAr DATE OF BIRTH T~pUNTV OF DEATH
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<br /> C1Tr, TOWNOR LDCATION OF DEATH -HO$RITAL OR OTHER WSTITUTON-rr,• .......... .... ... ......... ...-e M..r+.. IIf HU$P OR INST. ,na.cm nna.
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<br />.a AeiRIEO_JEVERMAggIED SURVwING SPOUSE ~:r+.+.. n... ,...,.,.,, ,,..,., WAS DECEOENTEVEq INUS.
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<br />CI 5UCML SEGVRITY NVMBER ,VSUAL OCCUPATrON ~~, .~ w a rn. .,r.„v. ~y KIND OF pVSINE550R INDUSTRY
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<br />,E. Nebraska ~:E, Hnll k Alda 68810 I.b 106 Comet Ct. ',>< Yes
<br /> FATHER-NAME ..air vrCOLF ,. xi IMOTHEfl NAME -rnsr ..:.,c.,F Lair ~VA,nENr
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<br /> INFORMANT-NAME ~•~., .. ;.,.x.+ ~MAIL:NG?OURFS[•,Tptfr:,wna J'.~ .-.•na rnA!: 5-aiE Z,a
<br /> ~:,, YA Fios tal Records Denver Colo. ',~.1 Clermont St. Denver CO 80?20
<br />Z rtIAL. CREMATION. REMOVAL
<br />BV GATE Rae.an, Der vA., I CFMETE PY OR CRFMATDpr -RAME AND LOCAT+GN
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<br />V RAL DIRECTOR .ir VAME 4N04DURESSOf fVNERAt ~eOME [r .aa ~,r~rr _i .E ir.•
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<br /> a~ ~:, OT4T~ MORR~JARY 16th de Boulder
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<br /> Nr3EGAN . cpfloN R - cN rH e
<br />w.6EST Of Mr FaeprLEOGE nEarw En A: 2Sj.lT?
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<br />AND OVE TO TREC EKr STATfn ~QN THE Oaif .Rn nL w WETn aVfE,Sl STATE
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<br /> DATE
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<br />1 DATE SIGN _. waver
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<br />78
<br /> NAME ANO ADDRESS OF CERTIFIER tPHt$iCiAN OR CORVN£gr~*.v. ~.. +~.,•~
<br />z „ Ro Laxt M. D. .. _1055 Clermont St., DemTer~Ca 80220
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<br /> ACCIBENT, 9FitC10E. NDYICIOE. 'OA1~AN01R)UR Of ,N.4)RY iDE$CRIRE HDYY :NPJRVf 'C;aRAED
<br /> UND[tFifMWED. K1iDIN61NVESTeGATR3M.; "M^ •~,
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<br />IN.RiRY AT 81pR% ,rn o PLACE OF tr'~0.+°'RV _ nr+,wn. r~ L(X,AiIDN s wEf rn n c w ' 'w r~ D.~e y: wrF~I
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<br />SYA~ EiF COYa0AAD0 w v{"__._..-- .-
<br />United States of America
<br />~. Of (JCEUS
<br />I hereby certify this document is a true and correct copy of the original
<br />reeor~„ ~i4 ~jy,`vcvstody., Issued in Denver this 29th day of March A.D. 1978.
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<br />ra3Li3~: staff of-tea ; ~`' _ Donald navida
<br />Coloe:]S.s~ft,~~A,f-S,e41~ = State Aegiat r of Vital 5tatiatica
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<br />F;~,~r ifi~'_~ny; Person salters, vase. attes~sta to use, or furaishea
<br />to aMf't~1f1 Q9{4IAe~/Eetive use any vital statiseics certificate.
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