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<br />fEE N1aMBERi Q03a330962
<br />•, GIVEN';NAMES �[IT UI�G NIA
<br />k�st N�M� � BEy�RSUOR� '
<br />CouNrV 4� 9�nTHz g�N'�QN P��c� o� U��rH: NuRSTNG HOME / LQNG TERM CARE �ACiLITV
<br />O�TE'OF UEATH= �u l��! 24,2010 i�CYI.Itv OR AvvRESS: MANOR AT CANVON LAK�S-2842 UI. 357H AVE.
<br />NOuR'0� U�ATd: 6: A.M.` CirY, STATE� ZIP KENN�WTCK, WASHINGTON 99336
<br />5�R: F'EMALE
<br />AGE'S 93 VE11RS. RESIVENCE STREET! 9511 PEN9LETON RD.
<br />` SOC1i1L SECURITV, NlIMBER: 5Q1-�i0�b398" CITV. STATE, Z3P: BENTON CITV, WA$HINGTON 99320
<br />1NSTUE CTTY L1N1TS? NO
<br />H1,5PANIC ORIGIN N0,`N07 HISPANTC COUNTV: BENTON
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<br />I.E�14`?N 7 RESIUEN�E= 2 MON7MS
<br />8'IRTHUATE:,SEPTEMBER 29 FATHER= HARRY ]. VOSS
<br />"'.BiRTHVLACE: �RAN� 1Sl:AN'D, NE8RA3KA MOrHER: LENA HO�L7K�
<br />�IAitITA1 STATqS: W190WE� METHOU OF 91SPOSITION= CREMATION
<br />SPOqSE: PI.ACE OF 91SPOSITION= 9ESERT LAU1N CR�MATQRV ,
<br />CYrv, 5r�re: K�NNEWICK, WA
<br />> AccupATroN= CI:ERK Disrostr�oN v�r� Aucusr 03,2p10
<br />1NVt1'S�RVt CITy
<br />EvuCAT1oN: HIGH SCf1001.''GRA9UATE OR t3E9 COMPL�7EV FIINERAI. FACILTTYs COLIIMBIA M�MORIAI. CHAP�L
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<br />�l�FORMAHT: JONN A: �EY�RSUORf FuN�K�� 'U�RECroR: RONALU w HTEBERT
<br />RE4ArtUNSN.i�"e SON
<br />Ai1'DRESS: 95a 1 PENAL�70N RD„ BENTON CITy, WASHINGTON, 49320
<br />C�us.� oc U��rH:
<br />A. CARUTAC AR1t�57
<br />"1NTERVAC� TWO AN9 1/Y'HOUTtS
<br />B. HVP�RTENSIVE HEART 9ISEASE
<br />` TNTERvAI,s TWO AN�D '1/2 HOURS
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<br />OTMER CON�ITTONS �ONTRI6UTING Tp 'DEAJH�
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<br />� 0�1'E' IN]uKYs M�INNER QF 9EA7N: NATURAL
<br />N041t bF .TNJuRV: AIlTOP3Vt NO
<br />TNJqRV AT"WbRK?' AVATLABLE TO COMPLE7E 7NE CAIISE OF UEA7H? NOT AP�LI'CABL�
<br />` PLAG� Qf T?l]URVs �'�U T09ACC0 Il$E CONTRIBIITE TO 9EATH? NO
<br />PREGNANCV STATqS 1F fEMALE: NOT APPLICABLE
<br />�.DCATTQN OF IN7lfRY:
<br />CERTIFIER NANE: JESUS NORBERTO MARCELO MU
<br />Cirv, STATE; T1P Tir��: PHVSTCTAN
<br />-'CDIINTV: CEKTTFSER
<br />aESCRIB�` HOr+ '1NJURY BCC4RREV AvvRESS: 1b45 SPAUI.9ING AVENl1E
<br />CX7V,STAT'E,ZTP: RICHLANV UlA 99352
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