Death Certificate - Witherspoon, Ronald Lee_8/18/2017 r n`_,. ;W W5 - ." S:i' ` ...^: 4 CERTIFICATE OF DEATH `".. � ^`717) : a..C ;�� v v,A
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I Decedents Legal Name(FirsL.Mddle:Last)i � ,1 1a Maiden Name(if lama\I�e)� 2 Sex 3.Time of Death'- 4 Da a bf Deafi(Month/D ytYear)l'
■I) L 1 RONALD L'EE WITHERSPOON f .�"s ` }`. l �Z t'° E 1 �{C c f`o '` t rrli�'
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p9 Evet ul US Nmed Faces, 11011 Death Om.ned In A Hospital. 7 t /I0a I,Dea,h Occared Somewhere OMerThan'A'Hospital '1� RD _/ j(
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y-la DEACONESS;HOPITAL/i1V A 111Th i11 r1 W111111�J.f'!;KAq�}Alh--Tt�G/-� �u,�151 1111la\-- I It
Fes( ?12 City Or Town'Slate And Lp Code *. 1 'U Cr A a 13 County o Deh J 4 Mriuu;us'A
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X15 Strvmng Spouses Name /rsr,, csUue.Sele,15a(If Wde)GNe Maiden Last Name:rt's 016 Decedent's Usual.DozioationlE1 eer ffyttur-LIL - 6117:Kik of eustlessNkusiryaf..7a
L1?„9 Residence state' i%�1, i//i�1�1 i) 710a cd�(y�+ ,' 1 U tebcityya mown/ 1•1'
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€C Decedents Eiucaoroit WE } - } (try 20 Decedent a Hispanic On9in� ;P,✓;S tyo 021:DVece�enl's Race w Cr. 1 �e� ltvsar y
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C 22 Parents Name(FUs.Middle.Lastld'>AVYt c S..'>�a1AA�2AYf+y-111023 Parents Name(FEsLMiddle.Last110A 0At1tA<Yl”23a Parents Last Name Before First Maumee
l 24,hmnants Named///_all D -enulnSl/L o 24a Retatiautio To DecedentIULTINS G24b Ma-.- •Address Steel And Number Ci .State.Zip Code). eeNWc.aurs rci3Un4 a
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.25a Method of Disposium lI i 25b Place of Dispos t on(Name Of Cemetery CrematorycOther Place) 41 25c Locauan Ciry Town Ark State,-...._ - U
CC�`�,SY�� tie I I1OOF,F,RANCISCOIN� d��1 �. ' I �C�`� w�,11C��\ ..4,s\i„
4NWas Coroner Contacted?T 27,Name AM Complete Address'Of FuneralFFadlity a -..+T 27a Funeral Home License Number :"
a 11 r '1 iii �' 611 -CC1L ii FUNERALHOME,eRIN ETONINN}n (I� I p [w {�
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W �27yb_Signature 01 Ina ana Funeral Service ``\\ e Li -227c License Number(Of Licensee))U l! I {y i
/,ktll(� '111t ', C411 / 111{,2���/�,1Is �ilCause of oeamlSee eCn ructions And Examples)k �'���( l Z7'� lioitZ' 171
W c-e Part i Enter The Chain 0f E eras'Diseases 4pmes OrCompgwtidns That Drecdy Caused Tbe mitt Do Not En er Terminal■Event t �l k3 - A serval hate t 1
)SuC.•AS Cardiac Arteet Respiratory Arrest Or VentrmAar F bnllat aiW than Showug I-ke IIogy Do Natilbdre.?ate Enter:OiJ 41.1ne'Cause O (17, ./!<� tr.terval Onset
S �} S 1 r\v'ylil �'�t.'jty.2�'���tllS\1� iM1 �L.��[�L ��ttl[�i���Qt]�iC�1\dt��w�n _etti.t\� ►'.. f �To Death✓
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W [�Irmeaute Cause(Einal Disease Or Condition ResWUrg In Death '� A „ NONSMALL CELL=CARgNOMA OFTHE LUNG Ri `�' :L-JESJl14IIR\n�1tiL7t>\>2/L
1✓i.) 11 ��fl,iill 4� 1� 11 1 Due To(Cy ASA Cmsequence Op �rl l
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SesGUenoalty USt C«k I1�My Lead Ng TO The CauseLlsted_On\\��' � S �� �� I`✓'` `:A(11"/�Ls
JW �Lvre, Enter Tire,fk,-, gCaue(OlseaseaInpiyT .„)W.-e' : ti Due. (Or As„ Consequence Ot),,r., v/"�1�. - I
/The EveSms Resulting th DepL).Last 1, .... 2 i 1 Ij / v f ,. y ��' //Ju1Ui Y l `
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�.���ii45% �}C ct iin ll, o Ili 4,r Due.To(OrAsAConsequence OW-A' � ,
Part II-Enter Other Sign errant Conditions Cmmbuting To Death But Not Resulting In The Underlying Cause Given In Part I c.:.__29 Was An Autopsy Performed?�
L7 fi 1 /� it �� h Lam/ v ` �4t1 OVi 11tl4iC Mira L'/�t1,(} 1111 NO�
7 {t /1 f` 11 /.y 1�I iii ly r �{ �iie �ttil() /���t[1'`��/{�11t`t�/,1 Were Ali sy Fkidg AV ICEie TOCOmple.e The`Cause offDDeath? n- ••
41 4 ::-.1:;-..t4. 1]I/�n tat , ✓a 1 l //a ( -��� U��i`I uu� u _ L,��s.,o_m.�
I+ 3�1 Did Tobacm Use Contnbu a To Deeaa,h\ 32 11 Female' 33 Maurer of Deat [ � �t U r v�.
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I 34 Date of Iryury(MTithpayrrear) 1ll 35Time of Injury,v 36 Place of Injury(EG.'Decedenrs Horne,Constnudion Site lResuuranl urooded Wea)% 737.I$ at Work?
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Signature Ol Person Cen.tplg Cause T�\\�G1\u�Ar tt �j�u���^�(�.. ` 2 Cenitier_(Check wore)` ." \, '
lcCd;VW LL•IAMM•HOUSER MD:'6yelecltr`niccsiginaturra n—.-- IA.-44;N .�n1v SCORONER Ifi ae U
all 743 Name Address And Zip Code Of Person Certifying Cause Of Death C/ U�= If f/` 44:License Number 2'45 Da a Curbed
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146 Signature Of Loral Healti Officer > tli{ 3 l/ 1 ! i 49 For Reg strarONy`Data Fled(MondYDaytYear) U { 1� 5
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