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Death Certificate - McDaniel, Oles_5/14/1974� _ - - . _ CERTIFICATE OF DEATH --- --: O%Vt/' ----,�SiZ�-==°---` �� '�--* SiATE OF CALIFORNIA-OEPARTMENT OF PUBLIC HEAIT LOCA4REGI5iRaiIO� D�5iA1ci AND CFl1nf�UTE:nUMO[x -- • Ie. NAME OF DECEASE�r�RSrn YIOOLE NAME � ic LAST NA�E 2�. DATE OF DEATH-vo�re. on. rue �2e. xoue' _ _ OLES i NP7N i B1cDRNIEL Rugust 25, .3973 ; 12:20 P �. �"-' --- � 3. SEX---� �. COLOR-0R�RACE 5. BIRTHPLACE ��mm�"1O"O°" - 6. DATE OF�BIRTH . - 7. AGE'�unun.v..r- 'ir�unocn�rux-= .irusaenuxam' - femal white h7orenoo Indiana Au uet 7, 1900 73= ,E�� .- � -DECEDENT� e.-NAY.E AND BIRTHPLACE OF�FATHER ' ' � � ' 9.-NAIDEN NAME AND BIRTHPIACE OF MOTHER - _ - -._ _'- � --�-'_,_- . - _ _ , __PERSONAI Nathan Jenkins-Indiarsa Lucille Jones-Indiarra - — _ - ��_; �- �_�_DAiA--_ �O..Cf71ZENAf:WHATtCOUNTRY--' II.'SOCIAC SECUR(TY.NUMBER 12..++vnreo. x[v[x��uxaim. wioowta 13.:NAME'OF'SURVIVIN6'SP.OUSE:�n nsccxrte ��ion ���n=' ' . ' oiwxcco�seccirxi _ . i .S R: = . ' widowed_ = ' ' ' _ -.=d = _ ' 1<. U5T OCCUPATION 15. „ �..,p. I6.yN�ME o.iv mn.re;�ROYirvG COMPANx OR FlNM �� 17.•KIND OF INDUSiRY-OR BUSINE55��- -- -�� housekeeper 30s�m Unknown - private home -. � °-_�- .-°•• lBl PUCE'OF�DEATH-NALE OF XOSPITAL'ON-OTMEF�W-P�TEM'FACRITT ��IBl. $iREET�A00flE55-f5in¢TI.MD W�OF6'O�LO[e110m° °:_ .-= IBCieLOEtm�mrzqiurep�l�]•• �"'�PLACE ' ~_..I�sr[nnresonxo� . Brookside HospitaP � 2�00 Vale Road ��� Lyes°--- � ^ DEATH ^ IBO. Cftt OR TOWN - - - _ . _ �18c COUNTY �18r. u�=n>nnnocmvw.r. '�18a �.�:�>n. .uu �_ - -= - --San Pablo..;-. -.- - - .. � Contra Costa �..-12 - _ ; -rE��:!:. �12�� �y�� -"�'USUAL" � �9�.USUALRESIDENCE-'sirtEeiADORE55�xncrreeow�euonia�nox�--�19e.-I.�SIOECITY�COAPaPAiE�uMlis =20..NAME-AND-MAILMBADDAESSOF-INFORNANS.:.,�•r•:.:= � ISPFCIf} YF} OR M01 1 , RESIDENCE � mcDanieT I, mouTMOCCVaenix 1531 -�ayo� �Vista .,�.. _ _ , yes_ Relph V• _ __ _ _ wmrvrox. urta t9a CRY OR TOWN � �790. COUNTY iisE srere �7531" �Bayo Visia �oucc evoaE -'- °- .��.� -:'San Pahlo ; Contra Costa ; California Sa ablo, California ?�-z�vti�..t. � . ' 21�. CORONER: � •c.n� a.:�n .,.r 121e. PNYSICIAN: cu :. o«a..n v . � 0 0 � �t� �itn6!TSiSi' -�''� .. � .-.e. � n.m nr. nn eu �.• . _ ,.__._ _.__ ' �en�.xa.rca.rr.�� _ . :.e,m..e.r�.�..e.uns..rzv.or�j-Ia �r�/ '"� �. �E�°�� �}��c'$11E'Y'L'.11 l• �--PHYSICIAN'S c.a'u-:°n��� e":'o:::;.e.E��..,,i..o. �.��.,..� ,.. ... ..tt�E.K�: °.Y� o__ _ . ;O&C-0ROPIER'S�aeu..�,:a.«ci.u>ugw�:�": .i.. :,;no". .. .,..,rtCbrt •NJ ��•. I ' _ �� ..a....�.. �d- ..��o-4f:f:d:��i'��• ' "'CERTIFICATION i , -u "I' ."� . .__ ' ' o; ��• �„� 21c ADQRE55 ' -� _ ' _. __�._ _.�2Ir.:,,�;R.,.s. - - nvesti=�a�ion � � - , - ----- ,,,:a,R,�%.�,�,,, ;-- - P.O:Box 391.t artinez � -�------ - � --�-- '�- 22w. zrrdn-wwu..exro�a�exr-�22e. DRTE , � 23. NAME OF_CEMCTERY OR CREMATORY__ __ 2. . BALM _ i PMtE:ur.rom [�ent o)_�¢ NSE�rvUMeER' �.FUNERAL � ov cnc�.noe � I " -� --�DiaeCrort — cremation' � 8/29/73 fairmont Ftemorial ark --- - --- ----- - 2362----- _-'"c`AND- : 2i E ox rcrtsox ernrc.s sucx� 26.''^,'�°oep:e�A.=.i` o'�cro. � 27. l REGI R-Si vJrt'X -'-.+' t'_ 28:: s•c Fr..o q.cus..:o_. --°-�an� 5'�!r�IF}F"��€9tEF1 , .,R_,:.._—_- RE615TRAR � ° ��' � ► ��4::(��✓J"l%�G� 73 73 Richmond Fu�=_ra1 Home ve=_ > 7- y'%' ' 29. PAFR I. OE,1TH WAS UUSED BY: ENTEA ONLY OVE UUSE PEfV LINE FOR 6 B. AND C - ..- - _ � -_- --------�—"YED1""`"°5E CORONARY OCCLUSION.i•iITH hII'OCARDIAL IPIFARCT ON� _=,��ox� _ . - - - u> -.�, .-.�—__—__ -�uiE- �-_-• UUE T0. OR RS � CONSEOOENCE OF � . INiEXV0. -�Q - . - COHOITIONSIi�NT. WHICN � ' � ' ' OETWEEM r CAUSE i Q . ' G�VE FBE i0 THEIYYEDL <B) '� ' ONSEf �� . OF_-:-' ^9iE�UVSF'1US'3T�TING' DUE TO. OP AS A CONSi00ENCE Oi � � _ �-'-DEATrI_ TNE UNOENLYING C�USE -- -_. _ . . . - - - � .. � -_ _ �. 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D: -_ . _ E, F_ _ —._ . _ _ REGISTRAR � �ERTIRCATION This�iz�to certify that the abore is a frue and correct copy of �kds.recorded-on-lhe STATEMENT os registered�in this omce. 6NANRE OF CEBTIFTIN6 OFFICIAL �/�/7 / �� '/ ' �_ /1 OFF{CIGI ,�ya �� . accaFCCnnv�c�non . �ontra Losta_c:ounLX neaic Martinez, California S11iE�OF UUFORNIA. DEP�f[TYE17r OF PUBUC HEALTN. WREAU OF vRAI SiA775TiC5 -de Loca1 Registrar _ � CATION . -- -- •' -sEP .__a "i9i3" - ` .�..v...� r. �q�� t �