Death Certificate - Lockwood, Russell_11/4/200911/10/2009 10:53 FAX 8308955166
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THE UPS STORE -PTP
CERTIFICATION OF DEATH
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oeCeoeNr N.nFnE: RUSSSLL ERIC LOCKWOOD S�' Mp1,E
DATE OF COUNTY
�E'°'TM' JULY 9, 2009 OFDEATH: JACKSON
DATE OF MARITAL EVEF IN
BIRTH: p/�CH 2O, 1937 STA7U5� NEVER �RI�DARMEDFORCES:
SOCIAL RESIDENCE
SECURf7YNUMBER ADDRESS:
SURVIVING SPOUSE�
(IF WIFE, MqIDEN NAME):
UNDEALYING CAUSE (ICD GODE): ( IZ SO �
ATHEROSCLEROTIC CARDIOVASCIILAR DzSEASE
YES
iM1313 ARIUE CEPiIFlGATION pF ryqp1E PND OEATI FALTS AS R2CAqOEp 9Y iHE gUPEAU OF VfTAL FECONDS, JEFF(p90N CRl'. MISSOUpL
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DA7E iSSUED: SEPTEMBER 16 , 2 009 �vra d. Cross ��
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