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SUBSCRIBED AND SWORN to before me this I 5 1, day of June, 2000,
A.D. by Lawrence L. Ward.
WITNESS MY HAND AND OFFICIAL SEAL. e y.,
4g O T4 4.1. 7
Nothry Public y cam ?n
My Commission expires:'�TF� Ici ac'1 '���i,,ru
2
CERTIFICATION OF VITAL RECORD
Je D. a
520-7k-8081
7. PLACE OF 0ATHiChm4(
ti14115 In*Dont Elea 'InatIont o DOA
70 FACIUTY NAME Inji*!In stivot old
235 Post t e
irgiN IfIRTN PierVf
WI. Us token, mow on•rittrliiii."
-Severe Asthma
.DPE10.0R'■43 A CONSEQUENCE OFt
41.
A CONSEQUENCE OFt:
S7Cobillteneoineibuible to down but not .lord so cow Own In PART L
iji II 4.)
omp DEATH 4,,
114 4LB ovouuRy
•Synd e xth.ouuraTm
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ANY ALTERATIONORE
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This is a true and exactproduction ;O the document on file in the office of Vital
Records Services, Che enne, Wyoming
LAST
Walton
56 UNDER 1 YEAS
STATE OF WYOMING
DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH
'41
Vorikt.,,r t
74:
DATE ISSUED:: l' :i Lucinda McCatO y
1111; Deputy State Ncikstrar
11
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This copy is not valid unieSs ptepared on paper With an engraved border displaying the date, seal and signature of the Of Duty so a Registrar. 1.--
IDS TIIS CERTIFIC ATE
A 0
To. i„ OF DEATH
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BUSINESS OR INDUSTRY
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