Death Certificate - Pugh, Marcia S_5/5/2011CERTIFICATE OF DEATH
eoR No 000000180693
534396
o�rz�izo� i
Facni 10. If OeaY� Ocar.ei Li A Fins;.tat t0a. If �ean OrcrtrJ Somexnere 01ic inai q I�mpeal
❑ Hospice FaoY.y ❑ OeceOeMS Hane ❑ Nursi�g HonrAagRmm Care Faafiy
❑ res � No ❑ u�w,wrti � ��osen� O er..cycqoewm:remam�'+�n � oeeaw,amal p omclso«'fi�l
1217 WASHINGTON AVENUE
19. OecNdfYS Etlurabn 20. DeceOmt Of Hupar
HIGH SCHOOL GRADUATE OR GED
COMPLETED NOT HISPANIC
❑ ewal � cremr.;on O ooweon O E�tomanem
❑ Renwal Fmn Stax
� Ye5 � NO
� n�amea0 r.Umee.a,tsePara.ea ❑ a.«om
❑ WkoweO ❑ Ne�erMa�nW ❑ Un4no«n
47670
2fi. Pan I. Enter Rre Cluin IX Even6 - Diseases. Iry�nes.Or Gomp4wUpa � Tl�at Direqty CauseE TTa Deam. Do Not Enter TemJnal Evenb
Suai As CarEiac Mesl Recpve:ary Mest �� ����ar FbriAa�m WNan S�rnmg Tha Etidogy. Do Na ADGevu:e En:er ONy One Causa On
A Line. ME AEGtinal Lines H Necessary.
Immeaa:e Cause (Fnal Oiseaze Or ConCiuon ResW�m, In Dea;�) A. CAft01AC ARREST '
e1PY�
SeQUenGalry List Conaltims, It nny, Leaaing To itie Cause Listetl On B. ACIJiE MVOCARDIAL INFARCTION
LineA. En:erilieUntletlyingCause(USeaseOrinjuryTtia�Iniva;eE �ej64�
TTe Evenu Resulmig In Dealli) lest C. TUNNELING OF ANTERqR DESCENDING BRANCM OF THE LEFT CORONARV ARTERY
ei ..
D.
❑ Ya ❑ PeaEa0ly � No � Unimwm
520
E131•.13
Yrs ❑ No
� Yes ❑ NO
ACFtmuma:e
In:enal: prtsel
To DeaN
�..�v�.we.�r...� ❑ n.e�..un»av�.� ❑ n.�+.ms�.=+v�—�w�.,.zsnaa.a� I� Naynl O tb.riafe ❑ Acdxm ❑ Paw+gimatqmm
flwi�.o�.aa.A.o,..00...:.i.rw.�.c+ I-lu.�.n.a�.+.r..n.=..r... ❑SmdaeOCaeaNaeeDexrminea
❑ Yes ❑ No
IQl..�m..v�0ns�av�u�.au�n. Qa�.lswhl
CeM1SC (C�%kQYyOnl)
CeruMm PMSican 6d Camx .❑ Hea� 05cer
FEB 02 2011
3395 q77EMqN ESTATE: The Sotial Sewr.ry a¢ be�g reWes:ea Dy V+s sta:e a9ency in wtler ;o pursue respmsiosry. Ustlnsure is uduntary ane mere wi� ee no penalry fa rehsal.
NRA-20
(7/OS)
1 1 . . 1 1 : � . 1 � 1 . I � � 1 : . . L 1 . � 111 �