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V I On) writ <br /> SAN JOAQUIN COUNTY <br /> r PUBLIC HEALTH SERVICES <br /> STOCKTON,CALIFORNIA <br /> CERTIFICATE OF DEATH <br /> _ .TAT[Ol CALIFORNIA <br /> *TAT(PIL[NUMBER Vf[eLAGX INX ONLrmO[M[Uf[f,WNIT[Oull OR ALTERATgN! - -- 10 - <br /> •I I r LOCAL RE61iTRATN NUMBER <br /> Da[y.Nl-FM.T IOiv[N) 3.M i.w - <br /> BONITA IRENE WALLER <br /> A.DATE OF/MTx 94 IA . " N-OO.1C A 7.1111 11 owiw <br /> 04/2491 ....... 01/03/2001"""""" 6UR <br /> 1225 <br /> DECEDENT DCCHDE«T 6.iTATE O[NR}H 10.sOCIAI s(cYRITY NO. 11.M,UTARY iCAVIG( 12.MARITAL lT-ul 19.CDUGAt1ON-Y[AA[GOMwI{l(D t..•+/ <br /> PERSONAL OH 554-24-7499 Yc! «D ❑UNq WIDOWED 8 <br /> DATA <br /> Iw.wAcl 16.HMPAMIG-!P[LIA li.Y[SELFUAL EMPLOY[R rw�{�'� <br /> CAUC �Y(, 0 NO -EMPLOYED { <br /> T.occulAnoN 16.Rao D.su[MilE li.YEARL IN Occuwnow r <br /> HOMEMAKER OWN HOME 67 ��J <br /> D-e[yoENCL-Iernc[,-AND Yuri[R ow LocwTr°NI - <br /> - _ USUAL 2 22865 HENRY RD •��' <br /> R[LIDCNC[ 21.cln i2.cDYNn 23.LIF COO[ 2f.Yws IM COUNTY 26.[TAtt OR Fow[ILN COUNT �••�•_ <br /> ESCALON SAN JOAQUIN 95320 SO CA <br /> Cu <br /> .WT3i. <br /> NAML.ML,TN>yiN .._ zT.MANIN! .I,. -.._ •-�- - - <br /> oa -•c N[onMA«T BRENDA HIX-DAUGHTER P.O. BOX'479 TUOLUMNE-CIC C95379'wYY.[w.G,...., ..A,f.LIPI <br /> zA.xAM[ RultnvlNc aroYN-vMST 2i.YIDDLL 20.wT IrA1P[w w.M[ <br /> �-�'1 : SPOUSE EI.wAML OI rATr[tL_'blRsr 52.IYDOL[ <br /> cxI : <br /> FE°.T HARRY JOHN HUGHES CANARA•[ <br /> INFORMATION <br /> ¢' 33,MM[01 rOYHLR�'IR{T 36 MIDOLi 37.-IMAIDLN) ]i.slwrR f«N <br /> FRANCES. LOUISE DICKMAN OK <br /> 3O.DATE Y M/b0 O..PMGE OF FINAL D1lFOSR10N --` <br /> 01/13/2001/ OOD MEMORIAL PARK HUGHSON CA 95236 <br /> 41.TrF�of Dwrosn1oH151 Aa.ncYATuwL of criwLN(q -- <br /> \ o EcTDR CR/BU.'. ► NOT EMBALMER <br /> AND ww4 PMLcMR {6.Y[{Nf[NO. A6.s16NwTVR( AL REs)sTRAR • AT.DATL MM/O°/L <br /> LOCAL Af.NAM[of Fuw[ C v Y <br /> REGIS <br /> 'IRA" WALLACE-MARTIN FUNERAL HOME FD-7 ► r�,{,,.,t'• l� •^w�f 01/09/2001 pH <br /> 1 OI.Plwc[OF 04TH F12'. <br /> 02.V HO6Y/TAL w[elA ON I W.IACLJTY oTll[R MwN NofMTMr IDA.LWI[TY <br /> PLACE WHISPERING HOPE CARE CTR torr. qAR. <br /> of _� ❑IP ❑ER/oP DOA[ ®How. [j A.'. ❑o.II[I. SAN JOAQUIN <br /> OEAT« IOl.iTw[CT AObRLss-ifT4[[AMD hUNs[q oq LOCAiIONI 1pi c1TY <br /> 5320.CARRINGTON CIR STOCKTON <br /> i lo%o° wAf DAufeD:r aN,ee oNLv aw(uuae aaw uN[FOR <br /> I.A.L.ANO O1 106.MwTN we.De,[p 1p cD wi- <br /> MM[uuTE CARDIOPULMONARY'ARREST DAYS <br /> cwuEE AI <br /> �� Iw.Rmnr F[nFoaLi{u <br /> DUE To laT CONGESTIVE HEART FAILURE DAYS ❑Yee NO <br /> CAUSE 110.AUTOMT PcwlnRMcO <br /> ~ D% DUE To la ARTERIOSCLEROTIC HEART DISEASE YEARS ❑Y[! _�_«P <br /> 111.Ys[tl D[, <br /> IN My O- ull <br /> [1- SUE TO IDI Y wr ,Gx <br /> 1 I la.OTNLR fXIN,FICANT--N ....GONTMOUTINO TO DEATH[UT IDT RELATED TO cAYsf o1Y[N IN IOT <br /> LUPUS OSTEOPOROSIS <br /> I L.MA•OFiwwilDN PERFORM[o FOR ANY CONDITION IN DRII Ill OR 11[1 F TEs,LIFT TY-Or OPaAi1oN AYD DAYS. <br /> I IA.I cER TNA,TO THE s[[T OI Mr RNOWy 116.NONATU D TITL[ 1 11E,LIG{N{E NO. 117. <br /> NY61- D[ATH OCCURRED AT THE HOIM.DATL <br /> "'ATCD A31079 01/08/2001 <br /> �ueca s.w`i!«nnl`Ir�Asr aECN.ur[ ► <br /> CERTIFICA• YM/OOILGrr / ws/DD/Cllr IIB.TYPE wnLNIRN6 FNTfKIwNa hA [r NAILINi ADOR[w P,LIF <br /> TION <br /> _11/25/2000 12/29/2000 DR MEHEROSH DAH 2800 N CALIFORNIA # 17 STOCKTON CA 95204 <br /> I TN•I-AT N T HOUR.a AE 20.JN/YRY AT WDR 1[1.UUUA1 OAT[M M I 12].NOVA IZE.FLACL O£INJURY <br /> )cAUACs sTAT[D. ❑Y[R O NON <br /> I IO.fMNN R of uT O „ <br /> 1tA.DLicq,w[HOW INJURY U-011.90I[vE1if MN:H RLsuLT(O IN <br /> NATURAL�wlcmE ❑N Icme 1NJuen <br /> CORON[R'f �` <br /> 4s[ aAlc)O[NT!^I TEA110N❑Oe"LD NOT aC <br /> _ Lam]INY[[ .«o T[ 'N[wT <br /> ' ONLY 126.l NUNs[R OR Loc ION AND GITr.LIP) <br /> Its.sliuruw[OI COROMu OA D[WTr cOgoN(w 127.OAT[N N/p O I G C Y r 126.TVP{D Mx[.TITLE OF COIfON[R ow OwYTY IOAPN[ <br /> I ► <br /> [TATE R C D E G FAA AUTH.e C[Nfui TRACT <br /> REDIfTRAR 46312 <br /> 243030 <br /> CERTIFIED COPY OF VITAL RECORDS <br /> STATE OF CALIFORNIA <br /> m+4 / COUNTY OF SAN JOAQUIN I SS <br /> b This is a true and exact re roducdon of the document officially registered and 4-1l�^ <br /> placed on Me with San Joaquin County Public Health Services. KAREN FURST,MD,MPH • ., <br /> to DATE ISSUED: 1 Z f �Q� LOCAL REGISTRAR <br /> • , This copy not valid unless prepared on engraved border displaying date and signature of Registrar, k'', <br />