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TATE OF COLORADO
<br />MR,
<br />STATE OF COLORADO t La ;
<br />CERTIFICATE OF DEATH ST"TEfi"u""BER
<br />ppI v ?
<br />I I. DECEOENiB NAME IFrrK M 'T°"°-•+
<br />' I .tltla, L.nl -,,. I
<br />Ina E. aEX i C. DATE Of DEATH Womn OaK .. I
<br />POPE F
<br />A - L..t July 4, 1997`' r
<br />• a !b. UNDER t YEAR 1F
<br />NIMM?ER URI aMhdeT IY,M) ao• UNDER 1 DAY It DATE OF BIRTH
<br />4_ 4_ 4 89 » His Marts IM°MA.Dq.w,n b.ntl nna
<br />w PLACE *CA N,cA.c. ' December 15 1907 Wales En land.3LTT_
<br />A N V 1 pIFO,N
<br />u.s AAMEO FoRCeaT
<br />+ a YON *N• "WIT L! r OTHER '
<br />OingOam ole"Outw,anl 0PDA .Nun Hem. a R,nwne. E[paNr/s~i SOn's Residence
<br />M. iACILtTV NAME PI nei m,hruhpl, p.r, sn,ar,ntl nYIM,(I
<br />110. 1r, TOWN.OR tOCATgN OF DEATH E°. COUNTY OF DEATH
<br />I9727 Highway 165 R e lam. NT
<br />wOrSUI5UAL000UPAT/ON 10b. KIND SUSIN SSMIDU AT I Pueblo
<br />tE.r, Amtler OOMWnn•men et.en.ryha. I. NA I AL TA U •Manyq 12.8 SE 411NN, OA, AI.Ien A.al,) 1
<br />D ^?!IN, mnr,tlt N,nr Got
<br />WGOmraq
<br />Dtra,aSgeY,1
<br />Cattlewoman Ranchin Widowed 1
<br />10.. REST ENC •STATE 130. NiY I CITY, TOWN. RI TON Dan L. Pope-
<br />Colorado . tR ET ANO NUM
<br />Pueblo Pueblo 1947 Siloam Road t
<br />IS,' I N5 10 130. ZIP CODE 14 WAS CEDENT NISPAN South
<br />defy
<br />Ni t5. RACE: Am,rk.n lnOlan, 1E. DECEDENTS EDUCATION (Sa,AVry aNYApANt j
<br />ydd, tNAITat rrlt'tP°w°frlOYde • I'»4 ,pagy CYO.A, &,I•lt, Whoa, am (SP,C HA vna. 511 6 l Eam.n - _
<br />`Y oy" RN° Clyde ?+n °C) PMre oA ttl
<br />81005 Caawnsl"'Eh..i"sae.'lYia) ",
<br />r ?!
<br />t N 'NA 1 uN. AAtltA,. White 10
<br />L,nl Is. MO -1, r"st. set .NNn N„MR MT-NAME I
<br />tl.w.a.a
<br />Walter Price Me
<br />TDa. METHOD OF DI T Annie. Evens - Walter Pope Son
<br />»a PLACE OF DISPOSITION uwrn. a G/Maryt a.T.nn. a toc IOCATg11 • ,
<br />• 7CS°nal ? Gamatwn q Rde+,wl Iron Step ON,rPYaI CNr a To.rL agte
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<br />21a SIGNATURE Union Hi hl and Cemeter Florence, Colorado
<br />Oi FUNERAL DIRECTOR OR PERSON ACTING AS SUCH t
<br />E10. NAME AND ADORE86 OF, iAC41TY:
<br />Florence Mortuary
<br />REGISTRM'g SIGMA E 120 N. Pikes Peak Florence, CO aP: 81226
<br />3. • ` '
<br />ZZG OATEi1lED (MOnM, p.KJUL m 9 1997
<br />ZJ. 1 OF EA N .. A -
<br />t E " N CAD
<br />M Yonln Oq 25. WAS RONERNOTIFIEOT
<br />- 4 YNr NOw ul (Ves er Not
<br />4 .1340
<br />- TOa[COMPLETED ONLY EY CERT1rY1N0 PHYSICIAN 1997 Yes
<br />a6. IO ter, o,tr Olw - - - TO EE COYIrLETEp EY CORONlR
<br />r;--.0094.
<br />."I" vcaun,e.l Me bin,, pate anepowl, rp it- to j IM G,.mq an ..sated tT. On the GP. IK,ummabonaM/aln+aM .
<br />In mreplr.ella?m OOCYr1,0.I Na
<br />hnl.. Gla,ntlp nd•Ou tetM 1. 1110I1
<br />agn.tun. I n ? OPII,Mq,nO m.m.r y Wlq
<br />? R¦'
<br />1 1 2E. DATE SIGNEDIMOmn O,A r,.q - - SP urn A I.A A.
<br />"Ji DATE SIGNED IMO K n,rl
<br />t ,
<br />Z ' U^ - Q
<br />JO. N E. 1 U AND MAIUNG ADDR SS OF CERTIFIERfC N RI YwrPnnll c `1Z
<br />3
<br />31. NAME OFA TE"OING PIi 111 T.E. THA
<br />CERTIFH:A /TypUprmq
<br />4 3. MANNER OF DEATH
<br />SSA DAtEOF INJURY 730. TIME OF SSO. INJURY AT 35u OESCMeENOWIN,WRY
<br />S?NMr4 O Ana IMQn III Dar. YNh INJURY Y,pRKi
<br />a OCCVRREO
<br />S C1 A lints ?lfpn
<br />/lciie.nt M aYN ONO
<br />a SYflfO, a UnO,lampMtl
<br />Wander SSa. PLACE OF INJURYvY hOma.NN itiraK lanary.aR/pa 35L LOCATION
<br />a IIOr.IC10a OIMIOInO, N0. ISa,d/A O"" YtO Humtw der Rural Rplte NIKII•ar, CKY. COOnb. attAp
<br />-
<br />P' S..IMMEDtATE CA USE [ENTER ONLYONE CAUSE PER UNJE\r/t E FOZ AND(yl DO"-N, mp0,y
<br />11T (/M hMw (a•y uroae or AaaOMYy wr«e)Mmla Mtenu wlw°.n
<br />• 1.1 .nO Wa h
<br />CONDITIONS DU O RA A N
<br />IF Ar:Y WHICH
<br />_ GAVE RISE TO MImM bet" n Onaat
<br />IMMEDIATE CAUSE 161 Mretldeis
<br />STATING THE OUE TOOR AS A COHSE E
<br />UNDERLYINGCAUSE YMar»I Wlrraan tMlaat
<br />LAST kl to - aM WaM
<br />?ARi OTHER SIGNIFICANT CQNOIiIONS-COnOMry
<br />Ite OOntIft"'plpeann 0yl nol mated to U."
<br />II PART .•..iCOhOt deYN.OW.rtr, amoaarl 30. •IITOtagY O ?Yr.E,S ?w?n ?fYIOYI•.Oerl,l•mW
<br />(YM •r Atq MWtalO1111Ola GYMaMIOH
<br />No
<br />THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF THE OFFICIAL RECORD WHICH IS IN MY CUSTODY.
<br />J U L - 91997 :-t. ark DATE ISSUED
<br />yi JOSEPH D. CARNEY
<br />? ? / ?? ? STATE REGISTRAR
<br />Do not accept unless prepared on security paper with engraved border displaying the Colorado state 3 i
<br />_ y seal and signature of the Registrar. PENALTY BY LAW, Section 25-2-118, Colorado Revised 5 H
<br />Statutes, 1982, if any person alters, uses, attempts to use or furnishes to another for deceptive use an
<br />` _' vital statistics record. NOT VALID IF PHOTOCOPIED, y
<br />87 "
<br />__ ??? .. • • .. Jas ?a>?>?P?.,t,....intl;:: ._...
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