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<br /> J CERTIFICATE'& ;:DEATH STATE FILE NUMBER-1052019001922
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<br /> DECEDENT'S LEGAL NAME ,5,.;
<br /> ALVW JOE MOSCH JANUARY 14,2019
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<br /> - Is" SOCIAL SECURTTY NUMBER AGE18s1 grthday(Years) ' UNCE,!i Y��R, t7.NDER,1 DAY_ !)ATE OF BIRTrt(MafOayNr) BkRTNPtACl:(Slate or Foreign Country)
<br /> MALE 521 34.6172 8B a 3UNE 10 1930' COLORADO
<br /> 1F DEATH OCCURRED IN HOSPITAL IF DEATH OCCURRED SOMEVOIEll OTHER THAN A HOUP'l f:'
<br /> DECEDENI'S HOME
<br /> - Fadllry Name(0 not insibAon,9N4 Street!.nuInDrr) CITY.tOWl1-CR LOCATION OF DEATH COUNTY OFWATH -
<br /> 1520 WALL STREET CLEAR&REEK .:
<br /> RESIDENCE-STREET ANQNUMBi?R - - APT.NQ { ZIPCCDIs t'mozorryull
<br /> 1520 WALL STREET all YES �
<br /> RESIDENCESTATE ' CQUNT`! !•'�:' - � 011YORTONtI r: ..•_�
<br /> COLORADO .:is u: CLEAR CREEK :, Pill SPRINGS
<br /> DECEDENT'$USUAL,OCCUPATION(taMve Pled of work donf aYtVp most otwerking life.qa not tpe Rthedj lttNO OF BUSINFS5lINQUSTRY D1:CHlSt:NTB EDUCATION PROSPECTOR A MINING SSOCAAT£DEGREE. E D2
<br /> DECEOWTOF HISPANIC ORVGiN }; t':t� ''(F;;: D2=!-?,r'SRACE
<br /> No VJhfa �Om
<br /> EVER IN US ARMED FORGES MARITAL STATUS AT TIME OF DSAYH $POt1SFJPARTNER NAME II wife ne name nor to nrslmar a am
<br /> ( B ?• aS) i irr•
<br /> YES WtOOWfiQ .. PATRICIA CO.LLENE HAROLD. ^ rfl
<br /> FATHERS NAME ,.:�t- -",,;s - MOYMR4f'S EiAM6-!!RIO�i•FD�F1FS=MARRfAGF :
<br /> HANS Ill ELIZASfll LAiINER7:
<br /> INFORMANT$NAME .. INFORMANTS,RELATfO1JSFpPTODI�CEA&ED mW
<br /> DAVID MOS¢H
<br /> ww OF Full Home "se = E
<br /> isr it T3 .-gSYANDSTATEiFUNFRALHOME VWISCARi`.AFHiNC1TIF1ED:1_ ,.gam
<br /> KIBBEY FISHBURN FUNERAL HOME ("^ : '`--. "LOVELAND COLORADO YES'
<br /> METHW OF DiBPMTWN .PIACfi;OF ION - '4SPOSM -:o- '...,T -I�cAT10N-Cl COUNTY,STATE MCA"
<br /> �ID
<br /> BllRIAI-CEMETERY LA!( S(0 AHETERY-LOVPLAND :.F; a: rL1DV 10 IwRIMRR COLORADO °.:a0"r'i
<br /> INJURY AT�VORIc IR TRAN3PORTAjIOji FiELATEO.SPeCIFY DATW OFCI W VFtY, "v :'" TtM6 OF INJ(iRY I r N
<br /> PLACEOF49URY'
<br /> LOCATION OF INJURY(Skag Will All Ill Clry ar Tgwn,CuuMY.,.P_"t ZIPCabej,,'.•
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<br /> DESCRIBE kONCINJURY OCCURRED - '••`t.`:'r'}+'y, '.,r r'- :)' -.:, - -4
<br /> WAS 0ECF0DJT UNDER HOSPICE CARE - -"4�Xft[ L OR PREsumsD.rma-oF.DEAT'ri DATE:PACNOUNC6D D"O0&O"YNR) TIME PRO1401JNCED DEAD ,_�•�
<br /> `YES O5-83 A04 JANUARY-14,2019 05:56AM
<br /> MANNER OF DEATH YdAS:JIiN`d5Y PERFORMED -NMRE AUTOPSY FiNQIN05 CONSlDEREQ IN DETERMINING
<br /> NATURAL. THECAUSEOFDEATH7 -
<br /> _ ' 'it,f3G: �.NOi-7`.:'•-..:Viv
<br /> CAUSE=OE DEATH t
<br /> PART k _ _ sec the_'yam al events•d3seases,_Ir.}uries,ormp?t at dlreesEY causes fAa deaN. Appro)dmate inwm1:
<br /> -(.'•ii c On".t to death
<br /> IWAEOLAi E CAUSE(Flaw dlsaasoW_. ?. CONGESTIVE HEART FAILURE _
<br /> cand:tim realAting in dW1I1t '•.�,�•�_ g''�_ + �M4- < - - 8 YFJI.RS
<br /> lea�ctartbekpllsfc�dtvns,;iany,
<br /> rg Ilsted on Bna a. („+ �:;; s:,a-
<br /> - ErAor Ina UNDERLYING CAUSE - •fit'^ •-L^"
<br /> ldbease or injury that hittated Ole ".6;
<br /> - events resaftirtg in deathI d - -
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<br /> i PART ki Eniv.then death ta44ot T-46np in ft urvailyho cause gWe4In PART
<br /> CHRONlCA-F16 • - vr.:
<br /> Yrt1E,NAME,ADDRESS,ZIP CODE AND COUNTYOP IAN •' - DATE SIGNED
<br /> TODD WSSER MD 30940 STAGE COACH BO , ARO EVERGREEN CO OD438 JANUARY ill 2010
<br /> TITLE,NAM'e,ADDRESS,23P CODE AND COUNTY OF CORONER :, _ _ DATE SIGNED ,
<br /> RI S IL'TON CHIEF DEPUTY CORONER PO BOX 20 ; R K JAiJUARY 22 z(it -
<br /> -CATE FILED I3YREGISTRAR
<br /> JANUARY n 2019DATE ISSUED:
<br /> n„ ;lAh1UARY 24,2019 t rswu
<br /> THIS L5 A TRUE AS A.ALEX ouINRANA
<br /> RECORDED IN TEAS 0FTrTCE To naYseoept tMless P�ee�arai txr STATE REGISTRAR
<br /> security paper with high resoluttdn"66rder duplaytngfhe Colorado sate _ -
<br /> 0 sir(and signanue of the liesst3ar.PWA=B Y I.AW,Section 25-2-119, I
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<br /> Colorado Revisep SUtute<s,1992,if a person alters,uses,sttempt;t I
<br /> * use or fumishes to anothei fOr deceptive use$ny viW statistics record.
<br /> f NOT VALID IF Pxor000PIED. 009133463
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