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'�li Ili LPcAUI F ILE tA�MBER
d. DECEDENT -NAME FlRSF I I lidI
u
Arl q
lipou
Roy
A. SOCIAL SECURITY NUTABER 64. AGE -Lad Birthday
(riasl
520 34=9215 fii: 64
74 PLACE OF DEATH lc... f:Edy
FACILITY NAME IN n6I
South Lincol ,s
6 STATE Of BNTN,/h net In 1A
IO NgT
1 11 DEC EVER1NUt
141166
MMWEST DANK NOTE COMPANY,..
DUE TO (OR AS A CONIEOUENCE OF):
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
Wainwright
66. UNDER 1 Y AR
;RACE American In61tn,
c l ITIGr4
(F r. iiF if r,
26o. REOI
s 26:. NAME OF
2A. 140M6 A6 ADDRESS OF CE
Kemmerer
Ste wart
KIND BUSINESS OR INDUSTRY
Education
7 1 mer 1d
541,.LOCATBON
2 DATE OF DEATH (Mv. Sas w.)
September 14, 2000
DATE �IRT MU, D.F;i' M)
May 31, 1936
27. AUTOPSY (SpaMy
yet dIRO
;(0-12)
cow (1 -4o 50
6
This is a true and exact production of the document on file in the office of Vital
Records Services, Chey nne, Wyoming.
DATE ISSUED. r u
Lucinda McCaffd�y
Deputy State Reglstrar
This copy is not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar.
20a. OR MEP
W omi
Name Sehmen
Own And Death
PATE Il pt
Se a tembV r 18; 2000
1,