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HomeMy WebLinkAbout868776P' t i z4' 'l,103 G3M13J3 3 6661 ZZ aagtaanoN :sei!dx3 uo!sslwusoD nyv leas lepujo pue pupil ,&u1 ssau {+M 0002 'lagula:tdas jo hp ,72 uasua( uo' Z Hanna-1 Aq ew elo }aq paSpalMouve seNt auRwruisu! Su!oliaWo} ayl uloaur j o Munoj EutuaOAM }o awls OOOZ '.ragwaadas }o siq; pam •paaaai o .mart n s! a }enr)r}.,aa yjeap pres yalym ul,S,laoyare a!lgnd ay, Aq parjr,iai Alnp'ivapa do ipeop }o aweauiaaaa !etai}}a ay, }o Addy E ;lnepU }y S!y1 Jo tied pue oaalaq sayaele suer y pue ,adb:d leaa pies ay ur alma pue al2I3 ',saJa,u! lay grap 2SaltnA paap pauoguaua.ia }'e tilt u! 2uJ 44IM, paur a ,{and !ropey! ay} sl paseaaap says iaa Pup 5.Q' ,ue!»Y '(ZI L) •S'M suoislnoad ay, lank a uepaaoae ul uasua(uoa�7 IlaMO1 'c:asuaj 1Atags Juasua( uuy auaSaEyy u! Alalnlosge pa,san.4aOwd lea! paglapsap anocleaq, 02 al,RR au-M. yplgM le6661 zZ aaquianoN uo uasua( pAog 40 q ;pap to a.}ap at{) !pun 'paap ue.ueM pres ul pagj;asap se apueA0Auaa }o a2 p ples woJJ Alsntnul uou uray, ul paasaA o,aaay, aI2!4 pue swum :Nip! se AlAdoad lean aye Jo SJ UMO ay} auaeaaq uasua( pAoci pup Aalea j ua1 H 'uasua( uoaef 118Akoi 'uasua( ituays 'uasua( uuy euaglew 'aaueJtanu0a pies ay, to uoseaa /q 2eyl •a 78u!uulSaq }o,urod ayz oa spo.i ylnos aouayl :spa! 9 IsoM aauat[z :spa' 41.10N aauay, :spot 9 ,stilt aauaL;, 2utuuna pue SuiwoAm 'AlunoD uIOaull 'uow }o uMOI aq, a, 7,7 >pola }o aauaoa 4saMy1nos ay, WOa} y ,oN spoa Hsi gopuM lulod e SulauewwoD :,INI O 'X,.aadox{ pegrapsop Su!M011o} ay ;'diysaonlnans Jo i {$!.1 !in; y,ln‘ s,ueual se 'uasua( pAog put Aeleaj ualaH 'uasua( uoaeg Hamm 'uasua( lAa:4ys'uesuef uuy aua$. own paAanuoa 'sly abed uo lc,ti Moog ui GQOL '1 aagweldas uo >palp kuno) Moan f ayp jo tai }WO at.! u! papal poi pal;, AInp sPM paap yarynn 'a,ep Jo paap Alue.uem loll /.0 uasuaj sulxeW uo! ;Eaaplsuoa alquniun ao. sea 'L asnRny uo •Z uo palp uasua( pAog lay :Kegs pue esod8p 'yr° Sw uodn `nnel o, SulpJOXXE uaoMS /tlnp Is.,►} pue aye !Rime! Jo kulaq uasua( uolgi ilavci /.9 aDVd xd1'? xoog ,tDNVN 1 lNJOf ,l9 31d1S3 ONLIVNIMINg 1IAVGI33V F 1V'd a �1 (1:;1J3VIVIBM 1.17 �o 00 9 L L 9 8 r� �OJNl JO urNn0J 3H1 f oN1lNO.&M JO J1N1S 3N1 Ih CERTIFICATION OF VITAL RECORD 87 6 DEPARTMENT OF HEALTH STATE OF WYOMING DEPARTMENT OF HEALTH CERTIFICATE OF DEATH INI ur1ion PAU01- DIS,POSI 11011 CL •1 VR 2 -89 8/97 15M LOCAL FILE NUMBER 0 1. DECEDENT -NE FIRST SADDLE AM BOYD SOCIAL SECURITY NUMBER 520 -52 -8074 7.. PLACE OF DEATH (Check'0Wy :or.) CI Noonan Noon 0 ER Outpatient O DOA 7b. FACILITY NAME (M not i.tlad)on, 8h. elta .04 ram 86304 NORTH WASHINGTON 11. WAS DECEDENT EVER IN US ARM EDFO(fOEST 17. FATHER'S NAME lHI.Y f' Mdcle 1204 INFORMANT.NAME (T1W or. hint) SANDIE LEE JENSEN 22d. NAME STATE OF WYOMING N*0* Hpn. *3 R.rtl«to. 0 oCar 20b. DATE Ala, Dsy, ,w NOVEMBER :26, 5s3© A 1 1*% *(CERTIAER emu LMT JENSEN bb. UNDER 1 YEAR 1.43001. Dry. Pomp AcErla Nulaq.r 210' MAZE OF X71 Y S SWAB MORTUARY 24 NAME AND ADDRESS Or cOPmFER (P+tYOIGlw OR CDRPNER)(fjian« 1) ALLEN D. CARTER MD. 110 HOSPITAL LA 5 8.6.04149 114 ooM bons, DUE TO (OR AS A CONSEQUENCE OFI: .by, 1.d12 1 MILd1.1 wow Enter UNDERLYING DINE (Disssw or WA7 DUE TO (OR AS A CONSEQUENCE OFI: Mal INtl psd wants monks] Fdgwl LAST TART 8. OTHER SIGNIRCANT CONDITIONS- Conallons aon*Wl9p 1 .4.ab bat not MOW 1 ea.. (Won In PART t 28. MANNER OF DEATH This is a true and exact reproduction of the document on file in the office of Vital Records Services, Cheyenne, Wyoming. Mr' 1 DATE ISSUED: 2. sex MALE 60,5114039 1 OAY 72 CITY, TOWN, OR LOCATION OF DEATH AFTON 9 MARRIED NEVER MARRIED 10.8UNVMNO SPOUSE (N aile.'EM maiden IM wn.) O 0 ED OW0 C (Spy) 304 DATE OF INJURY (A1Mh, Dry. Mt«) PTY A'FT WYOMING This copy is not valid unless prepared on paper with an engraved border displaying the date, seal and signature of the Deputy State Registrar SURE FILE NUMBER 3. DATE OF DEATH (A4. Dry. I) NOVEMBER 22,.1999 0. DATE OF BIRM MM., My,' I MARCH 10, 1950 SANDIE LEE` 72.. USUAL OCCUPATION pensi 6404 a aba "abM; 'Most 12b. KIND OF BUSINESS OR INDUSTRY EQUIPMENT O�' 1 o CONSTRUCTION l3n.:ORY. MOWN OR LOCATION AFTON 134 MEET, NUI!U4ER 86304" NOR WASHINGTON 289 REGISTRAR (0146.55 !l'" 77 1// PART L EoM Ma 811UU, Mu�.e,« mood esacs1Mn. Sat ead 4Mh. Do no1.M« 101 a m0M MM*VC Web 114 001010 2 or mpraary .nwt..hock, or Mort MumMumLIM only en. ce 0. on sash Wm. dime or condllion DAMEN=CAUSE(F4W /I .a AA /2 i Of Ir/ J/,,V /�.(N_A a.uabl 1 dw19) GIN c•- r r Af.. v el le ll• Vf Gib•" Cl TON WYOMING 83110 2519. DATE RECEIVED 8V REGISTRAR (A4, pry, Yr.) M.M.. 6,.mm. DANA god LoC MSON T OIL OR TOWN STATE AFTON WYOMING Nomb. 21e ADDR Y 45 44 EAST FOURTH AVE., AFTON a on W Mob ito Ow M 450 e.,dref In my p Non dMM ooa.r.d "'MAW i of Yd tAxr+ dub a: 4) Md y (sat+:+ «rd MOW fwalyt�.ry ii+as 23b. DATE BONED OW, Dsp. 14 239 Ibt1R.6F DEATH 7 -'/5' 4 YES 30d. DESCRIBE 11004 INJURY OCCURRED mil/ Lucinda McCaffrey y Deputy State Registrar w uhNOtell omit IC i:1i ANY ALTERATION OR VOIDS THIS CERTIFICATE