Death Certificate - Kohlmeier, Thelma Mae_9/13/1993' � CERTIFICATE OF DEATH � �I-��a�
STATE OF CALIFORNIA
$TATE FILE NUMBER USE BLACK INN ONLY WCU aECSiw�i�ON p5rn�ci um Cprts�C�iE mlYeEq
lA. NAME OF DEGEDEM-F�a3i � 1B. MioaE IC. Lwsi (Fwnv� y�, DATE OF DFATH-MO. Dwv. Yw�2B. HOw 3. SE%
THELMA �� � MAE KOHLMEIER June 4,1993 Fnd '2050 FE
4. RACE S Hisa��aiC-$aEC�sr e. DAiE OF BIRTH-MO. Dwv. Yv �. AGE IN ff�� 1 vEna ff �'ID[n 26 wouns
YEARS I �Otm�9 I o�vs uWpS I4�MrtF5
WHITE ,.E, X„o OLTOBER 07, 1919 73 ,
DECEOENT 8. SfATE OF O. CITZEN OF WMAT fOA. FULL N/�ME OF FATHER IOB. ST�T£ OF 11A. FULL MAIDEN NAME OF MOTHER I1B. SYniE Cc
PERSONAL I N� �USA Y FRED M. KOHLME I ER i I NpTM EFFI E COUSERT � I NTM
DATA
12. MILfTAPY SERVICE li SOC��� SEttmm No. 16. Mnqrtu SY�ros 15. NAME OF SURVMNG SPOUSE pF wsE wf¢w �wmv+ wYq
,a _ ro ,o_ r.o.,E NEVER MARRI ED NONE
I6A Uwiu OCCw�iqH 188. UwAL Kwp Of BuswFSq 16C. USULL EwvwvEn 16D. YE.�aS w 17. EWCATION-YFwws CO�RFrm
HOMEMAKER � HBM�"MA��NG � SELF-EMPLOYED � 50 ��� 14
�Bw. w¢sme..ce-sweer wrro r��usrn ow �oc�iwu tee. Cm tee. ziv Gooe
„s,,,,� 1620 VIRGINIA RD. ' lOS ANGELES ' 90019
RESIDENCE IBO. COtMiv 18E. NWBEP O� YE�RS IBF. STnTE OP FOnpGN GOVMRY 20. N�ME R6wTqH5qp, M/�R1NG ADpiE53
LOS ANGELES ' 4���ry ' CAL I FORN I A WD ZIP COCE OG WiOpYAM
� CARL A. KOHLMEIER-BROTHER
19A. GLAGE OF DEATH ,sa. �F �o,„,,,� s.EUr ,sc. �o�,.,n- 6�08 BEN FRANK41 N RD
PUGE Residence I ONE IP. ER/Oi. DOA i S R I NGF I ELD � VH 221 5d
-- Los Angeles
OF
190. $iREET ADDPES�4iPEFf n�A MlYBER OR LDCATpN 1 DE. CT' 22 W�4 DE/�TM RFPOf1iFD TO CARJ1611
OEATM � T�YE IMFAVLL FSE�� ���
!620 Virginia Rd. � Los Angeles °"";o�„°`n, x� „E, 93-05301 �„
21. OEATH WAS CAUSEO BY: �EMER ONLY ONE CAUSE PER IJNE FOR A B, AND G� � 23. W�.q BppSt pEpnpppum
G USE1A� �^� ARTERIOSCLEROTIC CARDIOVASCULAR UISEASE �i Unk ❑ r� Q H
CAUSE 26A WAS AViOVRY PFAFOaum
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WE TO IGI , I ❑ YE.a � N
25. OiM[n ScwFlCI.Hi COMCRWS WNlmmn�llc ip OEnT� BYT NOi REUiEO io CAV� GrvEn IH 21 28. WAS Oev�wiqw PEFiOrtyFp fOp Atrv COMOrtpN p ITEU 21 On 25.
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I CEFTFY TNAT TO TNE BFS! OP MY NNOVM1£OGE DE1T1 T/B. 9GN1NiE A!ID DEGfiEE Oq T1R6 pF GEIRIFlEA 2iC. CEpTIFlp1'B IICF]!9E NUYBq T1�. pATE $IGNm
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CERTIFICA- MONiN. OA�. YEww i MOMT�. �6v. YEwN i�E TYPE ATT£NDING PHYSICIAN'S NAME AND ADORE55
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36A D
NNERAL
DIRECTOR CR/T
AND
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(� REGISTRAR O I ��
STATE �
FEGISTAAR
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� i SOMMERV�ILLE, �I�NC
@ROT�HERS�CUN�NINGHAM &
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B. C.
� f� � IN� T�WE CERTIFIED CONY OF T�HE qE�CpRJ
! �E �OUNTV OF L0.S AN(',E�ES DEPAqTMENT
��F HEAITH SERVICES IF IT BE4RS 7HIS SEAL IN
� NURPIF tM(.
; �uN 10 1993
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