Laserfiche WebLink
__.�.-f , a rsna ' __..-._., r� -r ,. ...�.. .� 6 . <br />STATE OF MARYLAPi1D ���H,�:� = - <br />_D e�ar#-menf of � n d M ental_ � _ e __ ���� -� �- <br />� �� � � r � � <br />° _ _ � -������`� �= = <br />.� _� � - -- -_ — - - -_ <br />_ _— - - - ---- - - <br />_ _ — :_ - _ — - � � -� --= - — - _- <br />= <br />=.=_- - - -_ - - __ - <br />- - � _- — -_ _ - - <br />'��e or Pe�in ��yn��� En�ur�1 Cv�e��tr�eg� , <br />F ,� � State of Maryland / Department of Health and MentahHyg�eri''" , � <br />-- �. <br />_= ---- � --R_e9�sa�er - �_ =_ `_ _== L'@lf/�Cc'lf@a -- -= p � . " t _ _ _ <br />Y�a_ ,sr - tt���--- � - _ , _ - <br />- ° - - _ -= ' -�, _ ��.F�� � - <br />�-� �r�� - <br />���� ��a:��iarc� �� � �-_ � <br />_ _ - ��� - - _ - � � = <br />_ _-- �'��� �� qb - - _ - __. _ = - ; <br />- _ - = ° - _ �+'n.�A�f D = - 4c: of D� c <br />lYational Institutes o� Health Bethesda . Mant�gvm�ry - <br />_ 5. 8oclal SeauritY Number 6. Se�c ' 7. Age (!n yrs. last blrthdey) I er 1 Year 8. D�te of Birth • i 8: Birthplace:(SYateor Feretgn : <br />t� M 2 O F Months Hours Mfn,� o <br />-=---- 505-52-6921 = 68 YB. �"u� �.��� - �e �xa. slc.�':_ �_ _ <br />�_ _ __ u�� - e�-: ° = — =- ° = - = _ -_ — _ _-- _ — _ <br />-,�� -- .,�� = n c = _ = ° _ = - = = � - <br />_ � _ - �To _ - - - - = <br />i <br />- = = j = - _ - _ ' _ _ = t&1 � �tiT(� : <br />- - - � ' <br />� = � -- Sll - ° �ZS1��� = - _ - - - �Y��__ <br />-- _- a' -- -- - - -- - - --- _ - -- _ <br />-� . `o` 1 ntber :— _ __- __ - - -- - _ <br />� - - - � = � p���e = _ - - - 10g. Citizen oi�Vhat Coun�l .^ . <br />�� � 139-28'Reutin Road 68801 , � United �tares - <br />� � 11 Marftal�tetus 12. Was [�ecedent Ever in U 3 13 W Decedent of His <br />� W _ _ _ or � M ic ON in7 (S ' es or No- � ce �lme rie8n Ind <br />-- _ .G - - � � �- =- Yes �$� lo - = es�.=➢�cl ��I �r.ffi� e:. � = - <br />� ° - � - _ - _ - _ ° �� = <br />'� _ 4 l��a'� l� D�at�� ' - �-� �LUo �• _ = � �f <br />�� m = - � �. L�eM��at _ _ _ - <br />� � - ` f+T�� _- - latedl -- _�ldrtd�e���ring mos! of t� __ l� ��uspy . <br />.� �en�ery �o-�� coneye ��-a � s+� oo nta'r�use rer�r� ' r � <br />� - _ _ - <br />� �� �_ � ��' �; . <br />� �� � Auto IKechanic ; Autamotfve <br />� o m a�- t7 �a�ners niame �rrsr n��da�e �sr� � <br />> � _ _ _ 1 B. Mother's Name (Flrst, Mf ddle: Ma/den S � <br />` _ __ - <br />��` - '_ ���Edw�i _-__ _ - _ - -__ -= �1�ert — � _ <br />�� � ' -�►�ae�t��� � - � - = = - - _ _ - = _- <br />� : _ = -- - = - - ^� �Nu��r�+�R�Cityor _ _ <br />9��1 _ <br />-�'� -. �.��e�n � _�e = Reu� —_�-, ��.=��d, 11T��s ��(� ; - <br />�$� fl - 20a.�eEhad o�Dispostdon - _ 20b. Place o Wspoakion (Name of ; p� •�, . City a TQw�, Sfate I <br />�, �� 0 1� Buriel 2 � Cr on 3 � RemovaF hom State �e�: aematrnY or otl�r p�) + I <br />__� � aL7ao��� sD�e��s;o�r�.� Westlawn Mem. Park ; 6/13/2011 Grand Island, NE-- '- � <br />.,� � <br />z7 s� t ot Funeral se L1ce�,aQe =: _ �,,� <br />� ° ' � , - __ = �� - ,IIItY � �_;� = _ � -€ <br />_ _ . __ - ` _ `= _ ��c� — �t �.� � =°_ <br />= -� = — - — �� = a�o � � mQ��y�,cn �� - = � _ — _ <br />_- ; _- t�Wre us�� c�n e�t�tn� - - _ - � = - _ '°`P�'e� = = <br />_ � - - ° - = ° _ _ - - � and � ° <br />- siis�or�� = a = = u `a : ° - _ _ � - = -" _- - <br />-_ res�lUt�9 in death} Due-ta ( a con <br />- - �. seGuence ot}: ! <br />�- _ � _Sequent�Jlstcosditior�s. _- �_ � _ � _ _ � tyv - <br />_� 'C =� . � _ ta7e�e ,° �u ° _ _ _ _ - _ <br />� �e. -, - _- _ = - _ : - _ _ _ - <br />��? - �a �linj� ' ,, _ ;, - _ _ _ _ _ _ _ �p - <br />- _ ° _ - - - � �_ _. <br />T� - � r��� � las�- �p (oi a�� � _ - _ - _ � - - <br />�, ... ,/ .d.: , \ .. . - ? ''� � � <br />3 °f `� G IF FEMALE: <br />��. C. 23b�las decedent pregnant � es. outcortre of nancy . ; <br />� > : �e ��thS? -- � �S�th � et�°� � ` 3 � Ec�Is p reeeme�v- - ° �Dat��I�Bt� <br />�= - � ��� - __ at�Df��� Ot = _ _ - � oo� � Y� -_ <br />-- � ��lnk� ' <br />a- �- � _ _ b���b � - underiyF gi��a �� - � <br />_ _ � ��^ bacco use �te f af d� _° - <br />rn�_- = - -- - _ �_ _ = =,- - - - --- - _ - _.__ ° , <br />c�' � � --- . 7 0 Yes 2 � IVo 3 C _robablq- .�t � Unkrmwn . <br />� �� O. \ 24a. Was an 24b. Ware 8utopay fpdings ava(lable ", <br />�_ _ _ �PgY P� to compleHon nf csuse of <br />�� - — - _— — ° =-= - _ �� _ <br />�� = 1�a��e�medic� - - -- = '= = - -- - _` - ° _ <br />: �ormed � d� . <br />� �. N _ 1 <br />_ - <br />_ ��f <br />� `; �l� __ � er -�-�� rrt 3 - _��°. 6 � - _ _ _ <br />_ � <br />. 7. � � _ <br />� � A t Naturel � 5 � Pending (��Rth. �Y � injury� wI��Y - : �e how injury occur� - - ` _ <br />� r « V EcccideM Investigatlon M 1 � Yes 2 0 No � <br />� � � 3 0 Sulaide 6.� Couid [wt tKS - _ _ _ - _ _ - _ <br />.c ,4[fHamlgide detertnined ��' fmm sYreet factory oif'�ce_ \" - 28f._Lacation. _beetandNumber _ _ <br />_- - - _ _, — - _- - ° _- = = -_ _ - - - °- <br />_ teJ <br />�c _ i� � � _ '��to� �eatF����tt� t�dP�a��lG�m - �ta� = � <br />� ❑__ s of � inve�tio���y occu e� an� - 1 and �»,�_f <br />� g ---���e1 -._ -- _ Ta the ��Y' - ,� date and = � <br />3� � � �b. certlfier = '-_ - : _ �. Ltcense number P � d =- - $, - --- ' - <br />-_ _ _ _ <br />2�. Uete signed (MOMii. Day; Peer) : <br />I <br />} -' MA-233990 p b: _ d'} z.a t 1 <br />� = so. nlame -_ _ __ _- rs"se -?� Y� , Prin�� � _ ° _ == - = =- ° - <br />=- -- - _ - - - = - - - - - _ _ - -_ _ ' _ _ -- _ <br />_ - _ . ;- _�Z'a3� ° - - =' `- - - - _ - - <br />' - — �3et - _ � _ � <br />- _.. �r�1 = ° � _- _ __ - __ = - _ - � <br />-_ � �i1-- - 11 - _ _ = � _ _ = . _ � - -� <br />;, ����'�7 � 2 = - -- - - _- - � - _ _ - . -- <br />ORIGINAL I HEREBY CERTIFY THAT THIS 40CUMENT IS A� �` <br />_ _ _ _ _ _ � Rl l� �OPY �F�REC�D � I�,�I T �_=_ _ . _ <br />� �= = = = - _ � - _ _ = = = - - ��- <br />� VIl`�C� <br />- - _ -- - - - - _ _ - <br />_ - - _ - - -- - - - <br />- - -- - <br />- - _` ° _ <br />.���� - - _ � -- <br />_ _ _ � .. <br />` = � ����= _ ���. <br />�" _--'UT1���O 1 � - - ST,4TE REGISTH/tH �' ---�°,°�'___-,°-_,- <br />_ = _ �DO NOTACCEPT UNLESS OPl SECURITY PAPER W#TH SEAL - <br />.�.,.. �.�� °-- -_ , � _ 1�9F - C - - - - - � _ _ _ <br />V(IAL RECORDS LEARCY EM80SSED. <br />�1 � - �� � � - . -- ..— :: _ -��= = _ = -= = ° - V�!/srmr <br />_ _ ��L`ti�__� ._. <br />� _ <br />_ <br />- "'- ..:::� - . . . a � o • • �m� �. <br />�� <br />__..._, ..... ..�___ .e.. ,.,,..,.,....._ _�__e.- �__,....,.,.. . . . � o • _ . . . . . _ ... . _. . , . _ <br />..'-- °°--' - - � . > . .. ,. .. ti/� � <br />