30 Tonsing, Paul G

STANDARD ERTIFICATE OF DEATH

STATE OF KANSAS State Board of H«alth—Division of Vital Statistics 1. PLACE OF DEATH: County

Registered No_.

Township city...-

(IMesta Mured in » hospital or inetitatkm, (tre He K AKE iartiaJ of Urn) a d

ULL »AJtt_zS^CJ^^2^^-Z2S (a) Residence, No

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(TJenal plan of abode) Lra*th of r—1i«—I In mttr or town » here dearth

Fa* d m w n l m r • member of the Army. Nary, or Karma Corps of the Catted State.? I f as. etate Orsaalaatfea

Kaah—

, ,

Ferlod of aajajaa.

MEDICAL CERTIFICATE OF DEATH

PERSONAL AND STATISTICAL PARTICULARS S. S E X

4.

3. Hlaa-le. K a r r l e d . W i d o w e d . o r D i r o r e e d ( w r i t e t h e word)

COLOR O S RACK

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D A T S O F rtTBTH ( m o n t h , d a y . r e a r )

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If laKflB t h » n 1 day, .-bra.

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8. Trade, profraakx), or particular SLS • _s , kind of work done, a* • p l n n « r , /.* , M M .yO % / a a w y t r , b o o k k ^ p e r . -tr. iTT^v9. Industry or burinras in which work w u doom, u afJk r a m , n w mill, b u t etc IS. Dmte deceased last worked at 11. Tote] time (yrere) thia oi!tyfa*ion/(mepeb an*» / aprat In thia yrar) f&j.-^LM..^U..^,j...Lr.....^^ occupation B I R T H P L A C E (city o r t o w n ) . (State or country) It.

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The prtarlpal eanae of death aad related ea . a e . of I af aaeet ware ae follows:

QAv- S ^ J J A A A -

Dabofontat

.'LA^VA-

*£Contrtbtjtary eaoaea o f haportaiieo r o t related t o pflaerpal

>*ame o f operation-?

^^\^AALlM^<4

W h a t t>«t confirmed

dlaraoalaT-t^-^g( War there aa fKdjajgjrcISgg

Date of *vf~T%/%

W n e r e did Injury

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OK SltMOTAL ~ <—

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. i!'"-5&. d e a t h la aald I laet naw h.'*^,**>aHTe on.. to h e r . w e a n e d oa the date etated abwre a t j ? _ * . _ m .

S3. I f d e a l h w a a d o e t o e r t e r n a l caaeea (rlolenne) All In alao t h e following: , ^^ A e e l d e a t . aalelde. o r homleJdef Date of lajory-

I U K T H FLACK ( c i t y or t o w n ; . o rVoUqI nI ItIrJy /) \(8tat»> l ' l » H ' "J*r V

INFORMANT (AddraaQ

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I H E R E B Y CKRTTFT. T h a t I a t t e n d e d deeeaeed

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DATE OF DEATH (month, dar. and roar)

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••.». I f m a r r i e d , w i d o w e d , or dlroreed" H C 8 B A N D o f /./^ / / (or> w i r e of fl*-*-£.-\

15. MAIDEN NAME

11.

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oeenrf_ (Spemfy d t y or town, county, and etate) HlMTtfy w h e t h e r Injury ocenrred In InduMry, In h o m e , o r In public plaeo. -^

Manner of Injury, l a t e r e o f Injury— 1 4 . W a a dlaeaae o r Injury In a n y w a y related t o o c c a p o t t o a o f d o If aa. aneelfy. (Signed). (Addreaa)

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NOV - 7 1996 fiOI VIALiD IF COPIED tMlEJSACOPV OF THE ORt«m»( C*T8 CERTIFIED 'HIS "«T( »' t(X EU K*N3*S^_ •nee *»T!STiCS —"

jrfeim. (tara u t o w u t I T OF HEftt *M AND EKK.T3raENT