Death Certificate - Tichenor, Grace_6/27/1974, .. ' . % '• . STATE OF ARIZONA . . . . . , uD,l02�0. t .. z � � -'rE ' f ( , � ` ARIGIyAL -" . DEPARTMENT OF HEALTH-OIVISION OF XEALTH ftECOR�S AND $TATISTICS ` s ��� � ,: sTere cov,r, r,,; CERTIFICATE OF DEATH �..� F r_' -..tz _; • �' HwME OF �. �I�lT • C. [ <, �ssT SEn RACEO LOR D4TE OF MOw�qa O�v - vup ' ECEASED � � �. OEATH ...•. .. ��' ,� �,`G'ti ACE TIC}�YOR �_ fenale ,, cauc ' ` ,. ` June'; �6 `1 4 •'. � � =. iIACE OF�. f ♦ COV �t .'. 8. iOWN OP•C�T♦ . C. r�O5V1iAl OR 1�� PESIOENCC L E STPCEL O� CSS �' �M CIlT l L5. } � DEATX �. +�.: .: �rvsiiiviioH . ' . . . -. 9:P , .1 s. � I4arico ' � . , tdesa � •I s �liospital' � =' I � � : : O DI�T OF MONIN OY .1C�M 4GE1�[�v51lVnOEnIVE�RIfuNOCn ��� qq1T4L5TATU5 SURVIVIN Ulvl E Glv[MqO[n �.91 M ;. :�., 6AMp�'/) MOS. 0��5 MPS.. �MIN. ]�y�qPlCO ❑WIDOWEU aPQU$ Y u��: H�MCI `�eptenber> 21 .1904' `�i9� �rihur.' ;Ticlienor � '.� "' ? �. . .. J�. p. - C. B.�VCVERM/iP.Q01VOPCEO. y�' ..Fi"��'•� PLACE OF.'. �3T�TC On <OVxTM� t ITI2EN OF YIHAT 5✓EC�t�; SOCIAL SECUFI Y NO. USUnL OCCUP4TION �t qq5'OECEASED 4 VETER�N> BIRTM --' </,,'� I f� e� OUNTftYfi � fSJOR�tlO -C E,SUN�Cf O�r6 t ;: � Indiana � ik ,,. - U.S.A. ` �. Ui♦ - . . . . - RESIDENCES�p;� t�i - }'.•�. .� � .�a v ri �:+5?,j +�+. �o i��cooeq��: , �.::_ Ariiona,• r ?�_,.r� :.1•taric6` `�' ��,'`: .,;�'-.Fountain«Hills. ��;`F'.;'>�+�xt���t;8 268La'•; '} TRE T ADD ES O a�( �-� i crtrt�mli4?�MOW IONG IIVED IH <PROtu� � _.F PREV OW�ST42Ef'.YJ .Y�,• a R F.D � pi i � • ' ' fY ^- � '� ? �; , ' ♦r oncscnr �ooncss " �n si�r[ � � OFIREbOEHCE �.:' ` 16 E `Fa ette Dr � : � ' ' ' r ` ' � � , �.� �....E, o ��.. 1 �se - 1 ,a Indiana , : ? ATMER 5 �. F• .rusr ��, � e MI �lC 1. C. lApi OTHER 5 f NS ._. � •-MIODI[ - q G L/ST 7. ` � N�ME iL �i�. � ��p�� �y f:X !tf � y f - . r �iDEn - <S�� f1. _ ( J�� !1�1 ♦s I._ O�: T�.s1��.A"`U`�'Sl�..f�.� i.�i �'��6,. Schleter�: � eA„E _ 4''` E�ima�, r .r�:�`. Fj]�s! }�.;�% _.;- ��. ,r�Khdlaeyer INFORM4NT 7-$IGN�TUR �-�+ .. . wEl� IOwSnI> TO �'J'JFE55 ' `'SiiEfi NO � �ZIV COOE .tF'.. �i.f i .� ♦:; . ,. rs. ,�� �;i .�..1 occueco.:. , :e1 _ crt� oi.;�'t(`S �i _-`-' �,..� r. E_<Arthur Tichenor-: �x,c:�' I,>e.husband „�. `16 E: Fa ette�Dr? Fountai`h;Hills'�`�Az �( 0 MEDICAI STATEMENT� PART� . DEA WAS�C�USED BY: .� y�- � i([nTEI�ONLY OnE'C�VSE OY E1CM l� U. i li �T� LO Tlv[.GEiWLEn " OF CAUSE OF DE�TN � { � • . � .. 1 � c - - } - t ' ���'A.'JMMED��TECAUSEC%� �_ � '�-ON�ET�MDO[FiN' � < - �Lrf�lL:OUT.UNENII . , . . q� " ..i !.. C TEII IMMC011TE CYIS[ ON. i DUE TOOR AS f��• J�.`; -� � ��� � i. 1., � .j " I�.Oft[ASCO.M4! �OULT �� UNC • OTM[I1 V�ECIGITITIN4 �.� B: CONSEGVENCE OF: 41 t � .� �{ ♦ 1 `. `'9f'' .I[w��E N�3.SME YNCL� .UU9b lNOVl0..0F. CrvEN OM: `J•� - �t/ ` f .'.} • - . �.O.l . N�t4i LT:GC�in .ON Iw♦ - - • • . • TIw�E 1 V lTYU�i �ES.' .tu[s• oc.�csaccnvc�r. ' DUE�TOOR�S'♦ �� �:. ' . ' ..• ( ' .f � 'xo.uxseoww ' � _ `USTUIDEPLYINGC�USLI�ST. i ♦ 1� - r� . � - . t.r �..' l ' -.0 CONSEOUENCE Oi:'/.f1 • r .: '�+.a . ''W __"..,� }._ i'`} 1 .� 2R svKtr - �� mK�t PaRUKCONCMVwan• PARTl��� OTHER-SIGNIFKANTCONDITIONSPND/ORENV6iONMENT4LFa�70R5 PUTOPSYi �i�ce b[n[I� o� cems- � � Mp�EjM l� CTMSCOMR�VlYF TO. ' y rI. � ( ��1 � r. (j . CS p ]�DEI�CO.IH D[TE• 1 1�: TOIMM[�iTT DWERL�N[4Tm'..,a� -/.!`��.-'y n�2P'�•` NO.�kI22B�1VCC0:ITM�YElON.i p i - PXYSICIANa��OR D Fx/�MINER . (.' + , o¢�re occaneco , c. � o< . .. » � �, I ! '�= ` . f. �T.� . B@i lµY�MO CCOGE'.I.FlDVNOICSSIONAIJUOL�FJ�TW[�i<� j v'1 (�TTCMG[Ol l� t� MO -. xO1i . VC1q �MO. 04Y, YC fl' . �. . ' TrIE JSES ED !'� i� f TITtC . � . . Tx[ OL<[�3[C {1� . a TO . •� < ': ' M• / ///y, �� * p�Y� O � f e �. tt ��i.i}�= ,"��SY.? 10�s410� 7G,'li` 6 6'it� 74.?1y.51Grv<TURED. . GuAJ _`.i =��_ ia4. 23�:. .. • -i:36 Ii GE N♦. E ME EI • . "•• v . Y�IYO(SI1W MO /�1T .1C�1� � NOVP 1 IOID� (UIO OTI .. •• T�AICMON�v��� 2.r . �VICWOOOY�F �9•M IL�ODRESy� �:. - .`.�. I i1 -'OATClIG (D' i,j' (�� � 'r.�` .. ot�rw. '�4 �= ' e /"'.� �ri _! . re :3�. „',._..: .•6••. 6'•7� S.'15 a�.l z.334 W. r10th:P1; A1esa, iAz:w.: . ,_:2��=7-74 MANNER O { MO �-O iF. . Mpu ♦ixOP C OW O D.Inlyq ). Y Ir i LCIX V T <�.' .i�Z}ZIJSF�.\ R'� INJU0.Y j MJUREG_ C! NO�UN OCCVPZ� �.!1- f�� 1 .� ❑�ccio[nt ON�TYFALii 2i�."i +'.�'; I,:'fl I2ia•'l� :;i' I - ' Y � ' :'2� )i�ea�t . �'l C�vSE3 � ..26 � " f ! _ 39 S � • . . - I v ♦`] �11�1� TER 'PIACpE'OG, �IMWE,StOPF.i�CtON SPEE?`.E�CJ NMERELOGATE 5 EEi��ORlO � CII .N1D6TATE �MOMICIOC'I�J INE�i :� �. � f .�'�' _. � i. � , .� ( } �. �� ] 2i - } ' ze. nc sacur.: � ' ':.i'_� '. � .4-, 't .y-x,yt � � CORONER .� . _ • . �.'.., �. . ; - r. : . � . t.._ . sicHnruae •' p `. � 1< I � r.�ru.cwc.uxu: arc•' : )t - e . . .. `�� .in p . � ..�' � y1 � -�A IPOM C♦ INITION OITM�'l00� 410/011M� IXVESTIG11T1011. �N MY O�INION �( �:.i.y 1 j {Z 3. OEAiN OCCJPPEO�IM TMC M1M CP� D VMD[PTME CINCYM]T410E3 $T TCO. � D ' , � � DECCbED W�] �t G- t. U Y E R I. MOUP��.,� � 1(010! (UIO O 1 32 li [ 4ME CNtCI . S�> �rynl �'tt {5 � .' �� � , V0.0NOOM[EO ���' � � VIE -0ODY.�RCP " - �O[�0 ON � t i j- DC �� �OO E55 DA C SIG ED � Y" o. `,j 1 . :�'L i r ir , ft r OI f� .Y'�f� 1 �!'Sr� � 3<..:•• . � 9 �:���Fi .ae� SVG]IEMEnT1PY ENTI11C5• �•y�• . � � .y. .�. ; 36.� "'t'•i•�' `Yt.r. � S. `r ' R.' ' ..� ! . . �%' -f`l w .-Yi..i. �S / , % l ( OISV. O! Y�OY bVF O�i[ O/OISPOy1T10M CEM[�E4♦ p� l • y ` Emtl ' ME 5/!i CPCl0.TION ON i1FN0 �L � � k` CIIEn��i 9�1'l6Pe� HZl� CP.IQB4P���/ � t y � 9Ji. !� •. )�ltemov � ,,,.�6�-9=7.4 • ,,.Pr�nceton':�Indiana. 3�..D � •' � �� ��' , 'IVMLN�L O [ • �'.N�MC .. ti . .� yTPCCt �ODPE55 - � � .f �. �i�ic '' ' ' fUxEX• CCL IGN�T flE' �:f.: � CCPt. NO. ' o J.: Melcher-Moi-tuar 4 S:.'Sta�le .�Dr:-riesa Arizon �. .-�C �i ' i' � .� � h� O1TC NCG15T[NCD� .� RE4. lllE NO. - PFGI3TPIP 9 914N�TU F � 9CG !O STFI< 2 O E N D 3 Of `IC� I G` � �I� i/ � �� /f � . A0 } � > f'�' . \. �� �3.tl�.0-%Y/•`^aa./ �� ae:�. �Srv��.i/✓�1.�1 '�1�: ..rde.6� .'.�J Sr >�'^.e �r - va¢ ecv: 10.➢2, . _ . .,� � � - . � n J�-/ . x �] 1. •� t' . G4 : �,F - - y , .4 � � r ��1° l . A . . .. �_v' _ ..L .. . �'_ ,� �,�= r3� , ' CERT=1'FIED COPY OF VITAL RECORD '._ `�x r' 1`>�` t -.�..+ �ry .' S�t �;_x f� ., ss.��*, il� . ��- �' _ 4 ' r . '. � .-- r � .:i+: . - 31` f ,-%�� ' ? . r � _ `. State of Ari'zona) • ' `_ �`• , ° ` '- � ` - - � � = ss ' � t't",' r Date�issued June�13, 1974 � t :4County.,,of Maricopa) � , . ;.t � +.� , . 6# .:"i� ry�?� . - .� c � - :;Z, � , i" � �� ,[� .This copy',is a`true�and exact �e�production of'the document of{icially;regisfeced.and�; ; :to be inco�porated';in the off.iciat records of certif.icates' in the Bureau=of;Vital;,Statistics; Ar i zona $fate Department `of, Hea I th; - Phoen i x, Ar i zona. -:. { ��� '{ ti�;` � � �` � ? ;;•„ ' ': '. ,_ - � , t �. , _ f : , r � ,� Issued�under the authori�ty of ARS 36-34i and by direction of ; `.� ,� �•� � :'_` • �. . �.! .f �, ' . ' �- .����4�}r� Srl �,- _; • � � ,S -:t � . t� / : 3 4 '� `< ., � � f t � . �` . . `' � P { t l '.� . t ` � ' � � • � • : ��� i . t E � ' / . ). . �ti4_ �{1 � � ) � ' .' . �. ' . 'il �SiT �. � : i � r' .. S. F. Farnsworth;' M:D �, M P..H + - ' +F �", �� � z_ - ' ,. 7 f'� t 'i-<' * ' �� County Reg(strar and'Director , '� �' 'a� �� �� - ��:.5 - a . : ' � ... S. , , r , ', , - '. r„�. . �; . _, ,.�. ., Mar i copa County Department .of,'Hea l th'•.Serv ices 4' . , ' , :_ -' .• :- � ., + - `,� ' , i : � � .. '' , ��'� � s�'•t` Si� '�� AfARICOPANC0UC0YYSEALr,�IN CGIOR ANDEI�RESSc0EH1TH RAISED SALRJF'ISSUIN6GAGENCY:X� +��� ' i � .?s � ,S , '{t �'�'�l....L . ii�.� .l . . ^ T � . 1.`:'� - � . .._ - - - _ _ _ -.. ..�. .:, ' r � -.�� . e.. ..�"�-... -. :._ : .. Ifs�. .:L ....C'..� �L�. � SILr...u_M:._ � ' ..:.. . . . . . .. . . ._ . ., .._'. .. . . ,� . .,. .... t