Loading...
HomeMy WebLinkAbout872676(leas ieuolou 1emo wo ro3 earn siiZ) R M0Vd 21d r;gxoou3 DN{tt'QA 't *i:J 113N'tiV4 i�4 .3NNV y 1 01 :6 1,1I 91 10 A13 kl.NflOO NM3Nfl aalsn.is N1Q'IO9 SMJIlI V2I I1Q 7 T71/ x/ S S'S ��zsnxi �o HiVaU ZIAVQIIIV 3Sf1 S.213Q21003212IOd 3N11 SIf,L 3AOHV 30VdS 9 L 9 Z C 8 xov Hsoaxnd -aav vilsxoarw a2HD LJ V Has spawelyJo,ilunoj eiu.io31P3JO a3s1S TOOZ OT 'II23dV •pa ;ea '00'000`cL9$<to wns aqi poOoxa Ion p!p `paglaasap Al'podoad ow do amen 11n1 ayl 8wpnnoul 'ylsap }o alsp le luapaaap prey .1q promo "Claado.rad 1 euosrad put, Mal 11n jo anlsn ayl lsl1.L •uaploo sxalg sagaa sl aalsnal 2ulnlnans ays, 688958 luawnooU paprooag bti£ ailed 9Zb'1oog u1 papaoaazi I 'ON ,LINfl `SL,LV.LS1 NOANV0 2I31,V21d dO (0S) A,LdIA QNV (6r) aNIw L2IOd S,LO'I :N103N1I1 d0 A1Nf100 `9I■1II110AM d0 MINIS aH,I All :,Claadoad !gal paglaosap 2uiMollo3 atp uraanoo `8ulwo,CM Jo als ;S uloaul'J to sprooaa lslom) alp u1 papaooar lsrui s)lolg •S ssaJ ay1, Jo aa;snal, 'slam •S alssa,L se isrui s)10! 1 •S ssai of aolue.iri ss sal'! 1 •S alssal, iq palnoaxa `6661 11 ,Cienaga,d palep lsnij, mom .S ssaj ulslaaa leg; u1 saii nd ay13o auo ss pawsu slang •S alssai se uosiad awes ayl s1 `yleaQ Jo alsogn1aa33o ,Cdoo page lao palmy alp u! pawpaw luapaoap alp s31arg .S ssa j ayl Jo aalsni j `slang .S anssaJ lays :s,Css pus sasodap 'uaoms'Cnnp lull 8uiaq `ads 1e;1a1 jo'uaplo0 sNolg sagaQ `l Va31nIV1V 10 AINf1O0 VIN2IO3I1V0 3O 3.LVIS 6rSb6 V;) `luowaa,l AVM ONI W SZ801' NaQ'IOD S3I3I2I VUgdU 01 QaU2I0032I NdHM QNV Ag Qa,LS11103219N1101I0032I a nnuu2! S .aN JapJO dry RIalppv palls au^N STiTE of cAi ILL OItrurA. DECEDENT PERSONAL DATA 1 3. AGE YRS. UNDER I v 69 i .DNTHE I D.YR .AT 111 P 0 11 M /200 4.'DATE. Or OIOTH MM.,00 /GCYY 07 10/1931 114. 8001AL SECURITY NO. 728 -01 -7356 24,. .NAME OF SURVIVING SPOU6E FIRST 3S..: NAME 0 tyd 114. RTIFY THAT TO THE 8E8TIOP,nY KNOWL EDGE. DEATH OCCURRED AT THE_H�UR DATE AND PLACE STATED FROM. THE CA MIS STATED DECEDENT ATTENDED SINCE I DECEDENT LAST SEEN -ALIVE NR /4 MM /DD /CCYY y ZRTIFY THAT. IN NY OPINION ':DEATH C4q AT THE HOUR, DATE'4Nq PLACE SVATE0 FRDM THE 4A 4 8E8 STATED. 119. MANNER OF DEATH !NATURAL L 541010E HOMICIDE PENDING COULD NOT E B 41)4*) 8 7 INVESTIGATION OETERMIRE• '135: 11ANATURE C ■RON0R of DEPUTY CORONER 2. MIDDLE Schiere 11. MILITARY SERVICE I8. KIND OF BUSINESS Education 09. qwT. 1 D D/ 0 v v 6 7.14 0 2 IQ *AML F ;URI i RAL 0{ 1 er4oet C e!k 1 dr See F OF DEA Reside 1 D0071418(,A8 6AUE 1t�1 ECNTE8I ONLT ONE CAUSE' PE8 LINE FOR A, R, C. ANO'01 11,1144II1 rTAfl IAN4EDIATE OA(* E MJ M C,lE T�II (B) DUE YO LK) DUE TQ dial Inf arctxi •IOPST. PERFORMED 18 NO 102. IF HOSPITAL,., 4P8CIPY on IP ER /OP 0 DOA 120. INJURY AT WORK YES NO HOURS MINUTE. 127.0ATEMMY130 /CCYY 1 3 INJURY DATE M M/ O D/ C C YY 24. YRS IN COUNTY ID.% BT 3 000RE8R J 07 AND NURSER OR LOCATION) g. 0 Huntins on Circle 422. HOUR B, HOUR 2100 112. OTHE BI,:; IC1, TC•DIT1 °NE coNTR1 TIN .t Inflammat "o Bowel .Disease 113. WAR OPERATION RFORMED CONDITION IN ITEM 107 OR 1121 IF YES, L137 TOE None 110. LICEN8E NO. 117. °ATE M M) 0 0/ 0 C Y Y A30923 07/13/2000 1te. TYPE ATTENDING PN7101AM78 RASE, MAILING ADDRESS, ZIP Anmo1 S. Mahal M.D. 2299 Mowry Ave., Ste. 2-A Fremont, CA 94538 123. PLACE OF INJURY 124. DESCRIBE HOW INJURY OCCURRED (EVENTS WHICH RESULTED IN INJURY) I' {l. ".;13979 INFORMANT FUNERAL OIRECTO4 AND LOCAL REGISTRAR PLACE OF EIEATM CAUSE OF DEATH I II PHYS1. 0, IAN'S OERTIP1OA- 71 09 E. RELATIONSHIP Deb i^ Golden -Dal COUNTY HEALTH CARE SERVI PUBLIC HEALTH DEPARTMENT II RE8IDENC 187'.E 'NUMBER OR LOCATION) V7 0 HYlntin ton Circa.e CERTIFICATE OF DEATH; STATE OF CALIFORNIA Use SLACK INK 0001 /90 ERASURES. WHITEOUTS OR ALTEBATION• VS•11 (X117. 1/00) 29.'MIDDLF. ter';}!, 3. 1-401 (FAMILY) 23. ZIP CODE 22. STATE OR FOREIGN COUNTRY 9 32 California 27. MAILING AMOUR 19TREET ARO N MSEw 1OR w ROUTE NUMBER, CITY OR TOWN STATE, ZIP, 40825 Mino Way Fremont, CA 94539 30. LAST (MAIDEN NAME) CERTIFIED COPY OF VITAL RECORDS 1. STATE OF CALIFORNIA 11 ss COUNTY OF ALAIMIEDA This is a true and exact reproduction of the document officially registered and filed with the Alameda County Health Care Services Agency. DATE ISSUED: `711 00 VOIDS THIS CERTIFICATE 7* s 3 444, a v /z1� ANY ALTERATION OR LOCAL REGISTRATION NUMBER 06, UAL EMPLOYER 9. itas Uni fed Sch 18. IN OCCUPATION A�11L ela This This copy not valid unless prepared on engraved border displaying date ands a of Registr I. EDUCATIO CORN. "ED 18 +p7 1 2 HEALTH OFFICER AND LOCAL REL ALAMEDA OUNTY, CALIFORr�'IA 34. EIRTN STAT Utah 38. 81810 sVATE $E „ones Br V II I IIIIIIIiJ' ARUM 491L VO 'Ted e 49IL x 'O'd ''any iewwou 9E29 NOLLVIOOSSV MIVION 1VNOIlVN E661© /I/J r l!! J l/!f J!!! J.G l!!. I lJ S i 1 ti 0 tl tl 0 `1 `1 0 Q 0 t1 t1 tl Q Q Q 1 ti 0 Q 41 Q 0 Q ti h Naaun �n 3wyry ,e.� aye y01yM to lle t I LZLZBZI# w wO �lON j 0 a yl /aay /sy �tq �ey� pue (sa1)��loe 1 1,1 41 Q tl 0 1 0 Q 0 0 1 �Jl_/ 1 1 �t! l l I l l �l././ f././ I. 1 ll./ l!./ 1. 11!! ./.11J-llffl./✓�^1✓./f.,/./!!. J� 3n08V O3WVN NVH1 H3H10 (S)a3NOIs 11\00111000 dO 31V0 S30Vd dO H38WfN TOOZ `OT aiadV 'N90111000 f1000 dO 3dAl HO 31111 OMs SSSSn2is 30 HSKSQ SIAVCII33'd 1N3Wl1300 (MINIM 3O NOIldIH3S30 •wiol s143 to luawgoelleal luejnpneil lueneid moo pue luewnoop a41 uo 6ul/�lei suosied of algenlen enoJd �(ew 11 'noel �(q peilnbei lou s1 nnolaq slap ein 46no41 MN A O d0 3in1VNDIS .0113nd Ak1V1ON '300 3NVf.''D'3 8 301330 30 31111'3 1VN 1YNOIldO "lees Ie!ol flo pue puny �(w SS3 NlIM wag gwnq to dol H3NDIS 30 1NIad0 11H11HDIH t aaIoo x '�i 1ggd :6ul�uesaideld sl Jeu61S Jolemesuoo JO uelpaen0 aelsnal io �tI ed ul ewoilV leiaua0 pallwl1 JeulJed :(s)a111 Jeoll}0 a eiodao9 lenpinlpul T] :eweN s,.eu613 i N3QrIOO 2i v aCI H3NDIS AS O]WIV13 All3VdV0 �ININNIINIIIINIINNIIII11111iIIlIli1 {luiNNillliilllili; illlI Ii1 luewnalsui a y pe noexe page (s)uosaad POO 'ez'n0N dx3•wwo0(yr y a uodn q 1.1 ua a ao yl `(s)uosied ay; luewnalsul eq uo (s)einleu6ls HIWYMOH'ciNV l ldeo IIIINNINIIIIIIIItl IIIIgiII11111111111111PI1111111111NI1gIt11q11111111111111111N1 pazpoq ne J!eq /aay /sly ul ewes ay} parnoexe Aeq /eqs /ay ley} aw o} pa6paIM0um -oe pue juewnalsul ulgl!M eq pegposgns aae /sl (s)eweu esoq (s)uosaad ay; eq of eouepine kopelsijes to slseq eqj uo ew of penoad ap ew of UMOUM illeuosaad (S)k13NDIS d0 (S)31VVN paaeedde Alleuosaad 31V0 `ew aaoleq IIJ1 VMOH •CI NVSI1S TOOZ `OT TT1dV UD Ppeuie lO A4UnO3 QTR 3 T O l aiels LOOS oN 1N3INOA3 3SOdHfld•1 11/ VINUOIIIVO