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Death Certificate - Muehlbauer, Walter Henry_5/30/2001PHVSiG.w pi �/.ED IUIEMYWEflE%� ENiY1G CEROfKAIC N�I COW�ICIf MN SKN MEdC/1 CEN�Fl u�ror+�numne NIXA15. �v�.w: +OxO1��XSU{ �►_"�_ � _ ; _ . , � UV�ON COUNTY HEALTH DE�TMENT - � . .. . �.: - �ueo erv�oFOnn wcKS omve � . � _ ' LIVINGSI'ON, TENNESE[ 90570�2701 � . TENNESSEE DEPARTMENTOF HEALTH � CERTIFICATE OF DEATH STATEFILENIIMBER 150CIAL SECURITY ( �y 1•r_ wi�wrnea�� yo.• '�fi�u �wo.n�lb.�` ' US /JiIaEUFORCES� 1 ' : Yes 2 �%Xi ��0 1 E.FACIIITYNMIE P/ndnsflu0 I.ivineslun Hccianal Iluspi�:d Il. SURVNING SPOUSE (1/ mte. P�� ^�^+an nertro) I.ucillc 4:. �'Nuurc Nevn MarrrcE. Wpow�. DiwudlSG��Y) Afarricd Ila RE51[JENCE-STATE I ��cnnrsscr 1k.IN510E GtY 1DI.21P L hUTS� � �__ I Yes z a 7 No I 3xsr,x IL FAT11EIt5 NM1E (FV9. Willi:m� Afuchib:�un 18a WiOfiMANPSNAME(i I,ucillc 111uchlLuurr 20a. MEI MOU OF DISPO5III 1 IL� Bmial 2 L_ � ri OanaGm 5 � e.u�.i¢arewrnn..�u�,r..i 7. dw z�, i�» L � Yll1 [IUOuiwiw+e .1 �.. -� UOA I � Uvertun � � Ililhum COOE �1� WASDECEUENTOFMISP, I (Specity Yes w No-lt yes, sp , Meairan, Pueha Rrcan, elc.� rc n,.� �.,.........w.......n 5� I Rcsi�ence 8 1.. � ONa Ovcrtnn (Gl.e ti,e a»c.w mw e1mrs mov a wrknp Ya. 0o nd use ieHed.) lirick Mnsnn Canstruc�inn DECEASEO \1'ifc Yes 0 i� No I (SpetdyJ �Vhl[C otf�er{Yece) Ganalion ] � Removal irom SIa1e ouK. rs�w�i Aarons Cha .► ii �i ,titl�r. c.�.c`��. 15a �HY51 INN - lo IM Ecsl d my knowle�lqe, Oeal� oro<re0 al Vie Ime, tlale, antl plxs, 1 �� I SIGNATURE AND TITLE OF PIIYSICIAN ► �,.�,d d -6-, i6a MEDICAL E1lAMINER - On NB Gisis d eunwu4on iMld vrvaslgalq2 vi my apirvon, z I � SIGNA7URE M1D 11IL[ OF MEDICAL ExA611NER Vinccnt I.. I�rumkr p1.D., Sp! W. INain, l.ivin{�slun,'1'N 38570 1221 Old Union 12oaJ �iun Inaw, 18. �te. em f5ma (t� a ) MaJiline Munslcrm•rn 1BChWLWGADORE55 (SheelWNUmberwRurdRMeNVmDer.GraTam. Seh. ZV Cotic) 1221 OIJ Union Ituad llilhnm,'1'cnncssec 3ASG8 DS1710N (Neme d mmercry, c�emerory, p I i0c. LOCAI ION{My a Town, Slate lo Ne �use(s�ariG mame� a9 alaltt I25b. LIGENSE NUMOER , o�o-�.z� 26b. UCENSE NUMBER 0 25c. UAIE SIGNED(Abnlfu Oey. Yeu) ~ I � � i � 1 nNs) rd marcia aa pa�eA. 28c. DATE SIGNEU(Almtn, Lb/, Yeu) . _ . .. . _ ... .._ . _ .. ... .. _.. ___ .. . .._ ....._.. LB PART I. Lttlm llic OifN5C5, vyllie5 p uny'LCalms Ou1 eiuseE Ilq Eealh. OO MIlNIX Y! mW0 d tlj�y, sutl� i3 CdIGiC V fOSpvilPy ApPO�YMO aies�. slof}. alna� ladae. Lisi aYy ane rnuu m caU' I✓�c. ' I wmal Beh.een � O(ISl� :a1C OItTI�I IMMEDIA7E fdUSE �flnd H C N i` ,�S . ��^ n� o � C �+� discnseo(undilinn •. - ____ �uul�ivq in dceWl �� OUE 10 jOR AS A GONSWUENCE OFj�. � � _ 0. /� rI '�Hti � I Saquc�Gdly Ilc� i uJitlm�s. DUE TO (OR �5 A GONSE UENCE OF�: � ' -- ----r tl ury.IC�Ein9 �e �mmcYlpe . c.mc PoicrUNl]FNYING I GUSE IOlvu:e ar In�ury �� UUE TO jOR AS A CONSEOUENCE OF�: --� N�1 iniC�ICO wcMt �oWing in 0[�NI �T I a � PN2T II ONtt sprvl�v raM�tions fcn4iMUq to OeaN Cul nol res�l�vip in Ne vqclyinq rausa pivm in Pari 1. 7Da. WIS AN AUTOPSY—�-28b. WEftE AUTpPSr F WDWGS PERFORMED? AVNlA6LE PRIOR TO C V H_ i 4^�^.� L � � m� —• l,i f��...' 1 M w J� I COMPLETIOH OF CAlISE � — _ — � ! Oi DEATM7 �: � �k,,,��.,.._ t;..,� , , n r, o __ _� ,. Ycs 2 �NO 1 Yn' 2 1_"'.� No 3p. ALVlNEN OF DEATM� � � J1a.:Jl�TE CF INNRY -T]ID. TRIE UF 71c INNRY AT WORK7 �310. DESCRIOE HOW INJURY OCGUltRED _ lATOnN DaY Yaerl I INJURY f ' 1 L�alval S Lj PcrNVq 1 u Yes - h.euq�ron 7 � J MciCeN __ M I 7�i> No 71e. PIALE OF INJURY - At rorne,larm sueel, bctay, o11m 311. LOCwTIOH(SVee� aM NumEei u Rual Rane N:iMer, Cuy w Town, Siate� 7 I_�S�rioe 8!___iCMd�Wx I oviMVg.e¢ (Spm/Yl T DeinnvneC I � r j HarttioOe � Tlds is to cortify that the above io a true and correct copy of the record . fl.led xith ttie M�ision oP Vital Recorcl�� Tennesseo Ikpartment oT Public. Flealth,by the local'flealth Depnrtment. This is valid only When tha embossed ��..�seal.of;the iasuin� local Y.ealth Department io affixed: � _ .. _'e.:�:� � .. ' • .. . . .. . . . ) . .. . , . _ . "'+`.,.. �' . . � " � � _._.. .� . . . . . ..,:.�.. � qn..� . . . . -' � , .. o: .� .. . . . .�r.• 'a:•�� :'.: . . � :;J+� � ' ' ii: _:.�ti`..".r ,;'}�:� .. . . •.�(, . . �.� ':... . ,: . �'� ': :: � ,v �1'�31. . . ". . '-:r::' � . . . • � . F:�r i . i -i. . _: , �, t':. .. .� . .