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Death Certificate - Minnis, Gervis Claude Jr_9/9/1971�d':>:Yir'.; . � . _ COPY OF A RECORD OF DEATH .� i STAiE FILF NO. � .: ' f ' STATE OF MAINE DFiARTMFNT Of NEAIiH AND WELFANE ' 1. �IAQ O/ DFA1N � 2. USUAI lEStDENCE wn.,. d�.o�.d u..a. i, �,,.�����m�: ,..;a..., w�e,. ,aT�..,o� a courm York ' ,. sr�re NeW Hempshir�. couHrr '� � b. CIiV, TONTI, Oi IOCATION c. LENGTM Of STAY IN 16 c CITV, TOWN, Oi LOCATfON Kitter4 � � 1{9 Min. Portamouth I�� �� �� �•v��o�. s�•• ��•..� add....� d. STpEET ADDRESS. � I�. IS MESIDENCE ON A�FARMt II.�.Naval Hoepital 22 Sewell Street �ES,� ,,,00 fint Nam�� Jb. Middb Nam� � 3c. lo�t Nam� '' a. � DATE Mon�h Dor t� r �".Gerv,ie' ' --; Claude ; ?�1? nnia, Jr. oE�rH June 6, 19�y S. fEA 6.—COlOR-C&-0.FCE' '%. -MO,,;bz: H.,., Mo.,;.d := I��B-DA1E OF 61RTH� I9.AGE �In y�an � �m.� t y.e� u �nd�� v n,. Male • Caucsaian w'�da�ec :- D.wud' � 192� �a�rhinhdaYl oa�� H,�. M;., I'6D• 3� u� IOO.� USUAI OCCUPATIONIGi:. ;,,;d or 106. KIND OF DUSWE55 OR ��YI: � eIFTMPtACF(S�a�� o�'fordpn mvntry) i). �ITIZEN OF WMAT �os'i�'eY����or�sman'.U.S.Navp'"OOSiR�� Oakland Cit Indian U,S.A,�our+ur. 1]. iATNEi'S NAME' Il. 'MOTNER'S MAIDEN NAME - 15. NAME�Oi SPOUSE (If Morri�d) Gervis.Claude Minnis Nora Hobb Vir�yinia ib. w�5 DFCF�S[D EvF1 ir� p 5. �RwED �04tSi� 17_Sa.SECUGII _NO. jQ. INfORMI.NT � ddr Ir � .. �Ca�_"., ��� T�#Ci2'=3'$Gt3�,. "� Unknowri . �or�sm5�}". d�;�ti'�cr. � MI`s_ �J;r, iniw d nn n 19. CAUf� Of DIATM (Ente(only �ne mv.� pv Gne for ia). Ibl. and Icl.) ' wnrv.i� u*we[� Owyl �vD Ol�in �AR1 I. DE�iN WAS CAUStD ET: M ocar d iai nf ar ct lon � hours � ! IMMEDIATE CAUSE (o) — a. `°'""'°". "°"'', DUE TO (6) Arterio�clerotic cardio�•ascular ".�::°�e�:",o aeeae eci�q iH'.M�.- y��q ov.. b.r. OUE 70 (d 1RT 1!. orne� vennie.nr eorvorioe�s .�-�,.���:�o �o n.o�n e.:. ,o ..ie�.e ro�n. r..m.,,ai e�,.ew v�d.�:o, a:. ..� ro.� uo� ❑ ni,�[ a a�wtr SUKIDE MOMICIDE 716. Navr ❑ MenM. DayOi�..� p.m. DESCNIBE MOw INJURV OCCURRED. ¢,�., �om.. o� ���„y �� �a.� � e, r.,., u,i ;,,m �v.� •�4 ��lur� tJllu�K[u Iu. YLA:C UY INJUNY pp.,;�o.�Eonno�.�.�jli. �ITY, TOWN, ON LOCATION COUNTY STATF � WItRE AT 1tOT WMIIE❑ re.m. �en.,,r. ,�,..�. om.. eido...•� r.� - . .. . . . M/ORK� ❑ 'Ai�M�ONK . .. , - _ _ t]o. Ri�tCAl�[fUAUN@: i n:,.c� <��ry �na� hea «. ..a o� .n. r�... 7]b. VMT5ICU.N: i M...e, '' � '� - .�W lrem nr.w� .imN abe-e o�d ��a� 1 M�a o . ,rpy'lne� 1 o ecd.e rA. e.om.d�l,em. , � 6� .�.00� e�l Iw�oo.rl o..d ie. .. o.o w� M nrnrm d r � a�awvd c �.�� r � . . _' _ _ _ - '�pr _ -aba. _ ��_ _ l70. ftpXAlU+Zt ^--a '�n.�,« e, �,d.i ' 176. •DDRE55 f�mi L�tfiY�F—.,`—M8{''o�Jc•oDA1E SIGNED W J�Betielis CDR.�'-.MC ,USN: ------=U•.�:N val•F'io's ital '°'June'b;ly6i} i�a. WueV cREnv,riOn. 7�6. '0.:. ,`. 2�c. NAME Of CEMETF0.Y OR CBEMATORY 2�d. 1OU710N (C�ry, �o..n,�or coanyj (Ao��) B�Al SpKIIY) a� 6-9-6!.� H�rmot�y G^ove Pc.�rt.:eouth, h. H, f3. /UNE9Al DIRKTOR ADDYESS ]6. D�TE RECO. er ic.c.i rtc. 17. REGISTR^N'S SIGNATURE � GeorQe B. Ward,Ports.,N.H�June 8,196U burn�].1 �. Fri sbeo , ' ., ' • } , � { �_� _