Laserfiche WebLink
STATE OF ARIZONA <br /> 2 01005439 <br /> 200905400 <br /> STAtE pF AR120NA <br /> ORIGINAL <br />DEPARTMENT OF HEALTM SERVICES - OFFICE OF VITAL RECORDS HEATH NO. <br />Tt <br /> ,TE <br />r~v CERTIFICATE OF DEATH <br />^ <br />" <br />' <br /> ~ I i ~ J co <br />; ~. <br />; w'hy' <br />~ G:i~. <br />D-t D2 ~PI~.~ ~ <br /> .~.~. <br />A FIRS? E MIDDLE C. LAS? SE% DATi qF MgNtH UAL VEAF <br /> I~ DECEASEp <br />DOLORES JEANNINE SCHWEITZER FEMALE °~'T"DECEMBER 8, 2QQ7" <br /> i 2 <br /> <br />i RAf.E le.~., wtxle. bt9:• ~Inarar, {SMnry tnbeletc. <br />SPLC!FYy ~ WAE DECEG[M OF HISPANIC bRIGIN'. <br />fSPECIFV YES DR NO) IF YE5 INDICATE MkxICAN, SPANISH, PUERTO RICAN, <br />ETC <br />CU&W Wq5 U[CEA$ED EVER Ih' U.S. ARMEC FORCkS" <br />(SPECIFY VE$ pR Nq1 <br /> I, I, <br />~ Ite Na <br />4e3 . <br />. <br />4(: Na <br />5 <br /> <br />~ <br />J <br />i <br />qq <br />COUNTY <br />FLACE OF 5A <br /> <br />68. TOWN OR CITY <br /> <br />tiC. HOSPITµ OR llf RESIDENCE, 6F/E STREET ADO ~~ <br />. <br />RES51 <br /> ~~ . <br />°~A'" ~ <br />E <br />I ° <br />i <br />& P <br />lli <br />i <br />C <br />tNSTT`°I~'TA H <br /> Pinal Casa Grande (] <br />P <br />MER. <br />osp <br />ce <br />a <br />at <br />ve <br />are <br />~ <br /> 6. I <br />IN PATIENT <br /> ' pATE qF' MOMY DAY YEAR AGE (YEARS IF UNDER 1 YkAR IF UNDER I DAY MARRIED NEVER MAR ICP. 5URVIVMJG pF WIF6~ GIVE MAIDEN NAMEI <br /> <br />~ I <br />l <br />l BIRTH <br />1930 <br />April 29 )AST DAVI <br />~ MOS. PAYS MRS. MIN. WIDOWED, V RCEp ISpkGFY; <br />~arried SPOUSE <br />Lester Schweitzer <br /> ~ <br />. , ~, BS SC 5 ,o <br /> STATE AND pt rot v1 USA. name country) CRIZEN OF W?iAT SRpgIFY 50CIA16EC URIT' NU USUAL OCCUPATIO N (Give xIM1 of vgrk KIND bF BUSINESS OR INDUSTRY <br /> W `~TY'4~]t~~~aka Beaver Crossing D°uNTR1-~ U <br />S <br />A 505-32-4990 '~~~ i~amemaker~' Qwn Wome <br /> 11. . <br />. <br />. <br />12. 13. 14A. 148. <br /> 115Uµ 15A. STATE. <br /> <br />RESIpSNCE 155. CbUNTY 15C. TOWN OR CRY 15p. XIP CpUE H(?W LONG IN APoYONA? EDUCATION <br />HIGHESi'GR.4OE COMFLk~p <br /> AZ Pinal Arizona Cit <br />Y 85223 31 Years <br /> u ,5 <br />STREET ADDRESS OF R.F.G. INSIDE CITY UMIT S? ON RESERVATION 15 <br />R I US A ''"" "~~ <br />F R <br />IDENC ELEMENrARY SECONDARY <br />atx C04-kGE <br />n•aars+) <br /> 9438 W. Santa Cruz Blvd (SPECI 6s or No) <br />`y`es (SPECIFY or Na7 <br />~o q <br />ES <br />E <br />Nebraska ( <br />'12 <br /> 15E. 15F 15(i. 10. tfiA. 1BR. <br /> FATHER'S A FIRST B. MIP pI,E C. LAST Mg7HER5 MAIDEN A. FI T B. MIDpLE C. LAST <br /> NAME Jacob (7swald NAME Mataie Hobbs <br /> ,g. ~, <br /> L~~ INFgRMANPS SIGNATURE <br />~ RELATIONSHIPTO <br />DED AppRESS STFIEET NO CTIY ANp STATE ZIPGWE <br /> I I ' Lester Schweitzer usband 9438. W. 8ianta Cruz Arizona City, AZ 85223 <br /> L__L_~__ z,.- ~ <br />LJ <br /> 9URIAL CREMATION, DATE CEMETERY OR GRE M14TOiTt' - NAMEAOCA"RUN EM&ALME SK3NA7URL CERT. Nq. <br /> 1 ~._..I REMOVA q.HER,sP~~, <br />~emlBuriar WOOD RIVER -MENNONITE CEMETERY ~ f~,, <br />tt <br />8 ~ <br />, <br />~'( <br />(~ <br /> •+ ~ :< x5.12/11/2007 ~6. WQbD RIVER NEBRASI~ 'C: <br />, <br />xTA ~e <br />, <br /> FUNERAL NOME NAME STREET A:IGR gfTY ANp S"<.T~ (SIGNATURE) <br />FUN I E QR or peraun ailing as eu I CERT. NO <br /> I I <br />L_.1 Simes Mortuary -Casa Grande Chapel t 575E Florence 81vd Casa Gran6e, Arizona 85222. <br /> <br />zn ~ <br /> <br />xSA. ~T ~• ~ <br />. 188 <br /> <br />25u <br /> TO THE BEST DF MY KNOWLEDGE. DEATH OCCURRkOAT i riE TIME. DATE AND PLACE A pN I6 tpF EXAApNATION ANDIOR IdVESTIGATICN, IN MY OPINION DE ATH OCCURREp <br /> ~, DUE TO THE CAUSE{51 STATED. ~ <br />~ <br />~ <br />S A7Td(E „ ME. PATE ANP PLACE DIJE TO THE CAUSE(51 AND MANNER S7ATE V. <br /> <br />1 E ~ ~ <br />i , ~~ ~~~ ///~~ l' <br />ANO TTITLE <br />° r!/(rF.f..°7" ~~ a .< SIGNATURE <br />AND TITLE I- <br /> i <br />~ ~ <br />u <br />' <br /> v ~ ~ OAT[ SIGNED I"}n., Gay. Yaerl MUVR1 aC` _ AM ~ ~ ~ r y <br />(j <br />I <br />- ,IR pF DEATH <br />DnTE IE$NEU (M Ury. Year{ Mq <br /> 2 u C ~ l Z ~ Q ''~f ~ J <br />~ 4 ~ <br />a2. ,.. <br />! 3 ~ __ I3c. <br /> I , r °' NAME DF ATTENpING RHYSICIAN DFOTHER THAN CERTIFIER (Type °r pr 111 '" b' 'I' I FRONOVNCEp L1EAD (MO. Day. Veui i PRUNOUNC[U DEAR (Ha:r; <br />_ I <br /> <br /> NAAAE AND ADDR ESS OF CERTIFIED PHYSICIAN MSpIC:AL''.~c~N~R ~ <br />x~le~'d~~EN~L i~il~~~ 2 7 7 <br />O~ AUTHbRI$ED FUR CREMATION MEDICAL EXAMINER'S SIGNATURE <br /> ~~ . <br />T Pn • <br />3rannklin H B roi 2 F1 e 4pPECIFY7 "Yes Nd nt. •,~ <br /> DAT ° G15" <br />/~¢ <br />~RE ~ <br />~ REG. FILE NU. REGI RA " 51GNAT URE REG. DISTRICT <br />~ ~ DATA REC'p IN STATk gPFICE <br /> { <br />~ <br />42. ~' \ ~ <br />~ d3 ~ ''AA. ~ '' 65. d5. <br />S <br />7 47A. IMMEDIATE CAUSE (FINAL ;'11 EA E OR CONUI RE5Ui.TING IN ' EATH)'IE ~ N E CA EON UNE) ' <br />\\\ <br />y ~• <br />W <br />' <br /> S <br />r <br />/ <br />z <br />~ <br />G/-YT <br />j $ ~ ~ k ~ ~' S1 /~"4~~-,~ <br />w~7' <br />APPROXIM4TE <br /> u _ <br />,. <br />~__~____.. ...Y <br />GGii • <br />~ ~ ~ ~ ~ ~ ~ q78. DUE TO DR AS A CbNSEUUENCE OF. <br />BETWEEN <br /> C S ~ ~ ~ <br />~" ONSET <br /> <br />W ~ F= <br />L~ <br />y ~ ~ ~ ~ ~ 47C DuE TO OR AS A L"DNSEOUENCE D~ ANp <br />pEATH <br /> PART II. Omer dnnifirartt cor_C4Aemuling io tleatn but not resut['mg In cnu unaMryirlg cnucr~. p~ven In pen I ~~ AUTOPSY WAS C ASE REFERRED TO'MEpfgA4 EMMINEF ' <br /> B gBPac~ y4e'e o~ No) <br />~J ~pacAy: Manor No) <br />'v <br /> ~ 49 <br /> MANNER OF 6EATH DATE OF MD DAY YR HOUR IIyJURY AT WARM? DESCRIBE HOW INJURY OCCURREp <br /> NGTLR°L <br />C~S ^ HCMOLE <br />~ CN INIURY {5pedN' Y®s of NP) <br /> B ' . <br />~~ ^ $2. 53. M 5<. 95. <br />~ STREET' AopRESS CITY OR TOWN STATE <br /> IMdaIIGATICh PUCE DF INJURY {µ Home. tam1. St.onl. tettory, odlce bV~ibing, OtC.I <br />$P~(:IFY WHERE LOCATEp <br /> . s1. s5 sr <br />_ ~ <br />_ _ .... _ 5UPPLEMENTARi ENTRIkS <br /> TRIBAL LAW <br />RGEMENi <br />OmTY <br /> <br />5 <br /> <br />_ <br /> {Rev t-eB) ; ~, ~'i/p~. <br /> <br /> <br /> <br /> <br /> i V Ar <br />y.w ~r <br />M.d~~ <br /> This is a true certification of the farts nn file with the OFFICE OF VITAL RECORDS V.-~ <br />PATFIIBI%~'~4Ul-A <br />~ <br />~ <br /> ~y ~ ^ ~ ~ w ~ ARIZONA DEPARTMENT OF HEALTH SERVICES, PHOENIX, ARIZONA issued under <br />r <br />1 <br />s <br />! <br />i\ <br />a <br />f A <br />h <br />h <br />d b <br />d <br />f ' <br />A~^ISTANl`BTATEfi~AAR <br />^ <br />^' <br /> V <br />4 <br />. J <br />t <br />' <br />.R.S. 36-3 <br />1, an <br />t <br />e aut <br />ority o <br />y <br />irection o <br />~ _~ <br />a ; ~ <br />: y_ ~ <br />'a~'agency. <br />This copy not valid unless prepared nn a form displaying tho State Seal and impressetl~{y'Ix~~ c raisedsP.~l tgf thc~5s'ul <br /> Y <br />