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<br />' STATE OF ARIZONA
<br />2 0 i i(1019 9 ��T� o� ��20�� '
<br />D�F'ARTM�NT OF HEALTM SERViGES - QFFICE D� VITAL FiECORDS
<br />CERTIFiCATE UF [3EATH g� �ile hl0. �,02•2Q10-Q33166
<br />�. CtEC�dEN7'8 LEGAL MAME (FIR6T MI�IJLE, LA5'n 2. A1CA'5 Q� ANY� 9. DpT� dF C9EATN
<br />) EPl`EMBER 22,
<br />RENNA ELAINE KNOX 010
<br />�i. SEX 6. 8qClAJ,. 6ECUqITY NUM9ER: 6. �ATE dF HIRTH 7. AGE UNqEp t YEAR UHIIER 1 GAY
<br />8. ArtONTH9 9. �AYS � 7tl. FIOURB 1!. 11i11NUTE.S
<br />EMALE 10-12-1930 9
<br />72. PL.ACE AF pEAThI - HA$F�TAL: 73. PLACE OF QEATH - OTHER THAN HO&PEtAL: �
<br />❑ INPkT1ENT Q@.RJCIUTFAtIENT ❑ ISEAb ON ApFtIVAI.. Q CAp� ��� ������� Qf�E61FJENGE �HOSPICE FACiW'TY Q07HER
<br />� �4. FACGJTY NAf�E �i7A STREET A6flRE56 !F FIOY A fAC IL17Y): 15. dTY, TOWN 8➢P GO❑E Of# LOGA71Qh1 IJF DEATFi 78, GQl1NTY OP �EA7t1:
<br />EPPI'S HOUSE UCSON $5712 f�IMA ;
<br />17. �BIRTHPLACE IGTY ANp �aTATE qR F�I[�d �CriRdFFRY} 76. MARITAL STATl16 AT TIF� OF t9.. NAR[E OF 5URYIVIPIG BPOUS'�.(MAILVEtN NAME��:IF �4�VIFE,�'. � .
<br />PERTM:
<br />N5A5 CITY, MfSSfJURI MARRIED GERALD B. KNOX
<br />20. �ECELlENTB ff��l�pL REF11C1ENCE FiTiiEE7 A�OR�'35: 21. CIFY AN� CDUt�f�Y: 22. 67A7E 'd7.. ZJR CODE 2A.. EVER IM� Y� A1�tl� '� �
<br />� � , . FiJRCEB
<br />991 E LINDEN ST, UCSQN, PIMA RIZ�NA 5715 Nb
<br />Y6. WAS flEC.EDEPP� OF FffSPANIG OR�GIN9 xB. PE�C�p�FjTS RACE(S): 7�. IF AX�RX'.Al11pA71AN�R ALASKIF NNi1VE. .
<br />�� Nt7. MbT SPANfSH,, HISPANIG (aA UTIND QSI Wh1IfE � .�. D�OTH�R .. P eannrnaEwl�uEtivR[6E�
<br />0�'E5, MEMICAN, MEXICAN AMEFtICAN, CMICANQ 0 81"A'CK, AFRIGAN AMERIGAN � �
<br />� NATIVE MAMtAIIqN
<br />p YEB. PUEH70 pICAN p ASI.AN lIVQIA,�I [;J OTHEFi PACIFIC I5LANDER (SPE�,IFY� .
<br />CI YE6. CUBAN ❑ CHIt�SE � ,�odrriorv��aTYBE: .
<br />� � YES, OTHER (SPECIFYJ ('] �.lpp'ylt�°�'o ��� ,.
<br />- [] CxUpMAN1A�Y OR C'NAMOFiRl7 � OTHER [5PEGIFI7 AAfNTK)NAkTiqBE�.. .�
<br />KOFAEAN �� �
<br />G UNkNpWN p YIE . .. . ` -. �� �:.� `^,"„
<br />"�-�t7GCL1PAT14N= � O 5,4�MAAN :;�O�K�4�� At76C1"M7f14LTF�E: �� .
<br />HOM�MAK�R d AM�I9�CAP1 INOIAN DFi AYuA�AA NkT11/E y
<br />�9. FATHER'� MAME �FlH5T. M1t]QLE, LABT) ,,.,� .:.. „ ", �WER"5 NAME [FI y, ,,,:,,. , E PRIqR TO FlRST MAFYa�ACiE) ... . . .
<br />, M � l LA6T NA 1f
<br />) HARRY E. HUTCHI50N 1lN�NUN;Ia,AJA. •� ,
<br />$7.MIF[7RMANTBNIAME � "{'�(kpr ,,;,,, .., I N A pE. ,: . . .�
<br />GERALD B. KMOX ° "' SPOU$E 8�5� E LINp�I Sl" , TL�CS�N, Af•21ZONA 85715
<br />99. NAME AN� ADORE55 �F FUNEFIAL FACILITY: � ,� 35.�FUNERAL OIR�CXOFt: � 9S. LFLENSE
<br />NLJMSER_
<br />) HUDGEL'S SWAN FUNERAL HOM� PO B�X 128�2 TUCSUAI, A� ; BFtIAI�.P �i9p I� , FU�V�RAL DIRECTOR F0547
<br />97. MEfHOO(S� OF DISPOSi770N: 38. ti�.ME ANL1 LQCATI � N� ivt DiSPp ' IACILCCY � �$ .. �MIF �C�U LOC TION �F pnd D16A081TION FACIIJTY_
<br />GREM)�71QM SWAN CREMATOf�'(, TUCSON, ARJZONI� NC7' �-''
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<br />� csu� ro ow as n aa. e „ 4�.. ,wpaoxiatar� rwr�t�vat�:
<br />, co�us�csu�HC� o�: CELIAC ARTERY QCGLUSIQN f IJNKN�WN
<br />qIJE T4 QR AS A �46. G :.'..� ............. !.; 45. AF�PRO%IMATE IN7ERVAL:
<br />CQN^�OUE'.NCE t�F:. �.
<br />ARTERIOSCL�ROSIS ' UNKNOWN
<br />�UE TO OR AS A d6. o � �.� . . .. ..... ........ 47. /1PPRi7%IMA7'E !N'fERVAk.: �
<br />CONBEflIJEfVCE OF:
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<br />4&. O7'F�1� SIC�II�tCAN( CCY1W)1'YIt'�N9 CON7A�16UTINp Tp pEpTH BUT MdT FESl�77NCx 48. IIK1l3FiY� 50. Ih1JURT�AT WORK7� MAWNER qF�qiTH 6'�� T[M CIF l7�AT�F1 �
<br />NN Tt� UM�EHL'vlNtl CAU8E8 Ci1VEN ABf]YE_
<br />NO NO NATURAL L7Ell'TH d17fi ,
<br />' � � � 59..WASAMAU7QPSYPERFOWdEn7 54.NPEAEAU'!@PSYPiN INt3&AV Tf7 �
<br />' coualErE TtrE cwt� OF oEam? &
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<br />- � CCRilyEnp P11yB6det71Nuroe PreCENIanMIPhYm1CrM1i ASAM�m�[- Tqtlie hes! d my 55. NAME QF PERSON COMPLETINC3 CAU9E OF �EATH:�..� " 5fi_ QA7E CER71F[ED:
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<br />knowladp4, do�h oFained due tothe ceuse(sj and m9nner Stated. ��C •M p!>° � A�'
<br />� Medicat Exarriner/frbal Law EMarcemerN A�fhGrfty- l?111tF! m�i6 pf 4xArt�iR1d14�. �„ � � y�y 1 1 1 t p� A r p . � y .. . f
<br />nndiw x�vos�mian. in roy npar�an. daedn nccurrae et tt�e t�me, eate, ana ptece, ena NA.D ti� � 1 . - t! i�; f� ;'' ��� 09-22-201 D
<br />au4 �� rna �„�m� �a ��� �a_ LAWRENCE LINCOLN, �
<br />57. CfiHtIF1Eq'S AD�7E5S: 58. NA:M£ PF REq18TF�AR:�^ ' y .,+.�., • .��.� 59.DATE FlEA16TEREl7
<br />�� Issued 09-23-2010 1 �1DREY ROGERS " ":. `• ' n . � q ��a r 09-22-2010 "� p
<br />� 5679 �.
<br />_ .: �. �»�;�
<br />. .. ' ��������-' s:
<br />7his is a true certification of the facts vn file with the OFFICE OF VITAL RECpRDS, ;, �'�' T • .��, �. R A�=����� A �i�r � �
<br />ARIZONA DEPARTMENTOF WEALTW SERVICES, PHOENIX, ARIZONA issued under^ • pSSIS7AN1'�5TA7E41 (i13'�IAR � f '�'
<br />� �, � � � � � �;� ,��, the au[hority of A.f2.5. 36-34�, and by directinn of: ,�... , � w �1 `. ^'"�
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<br />. 7his copy nnt valid unless prePared on a form displaying the State Seal and impres5eclwj�h; he7?I�e�5e�l Qf�Ff¢�,js5;p� agencX
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