llftal
Oritftefo
THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND - NOT A WHITE BACKGROUND

I
! 2510988

1
i
1
'

FORM V.3.

-ra.us

COMMONWEALTH OF KENTUCKY

^

DEPARTMENT OF HEALTH
DIVISIOK OF VITAL STATISTICS

Llfi

i

xx"<,

H^ffirtmflnn TlTntrtrt Nrt
^DECEASEO-WAMfi

1

1

RACE WHITE, HESIO.AMHICAN IHI1AH.

ASE—tAIT

trc. llfKlrVhite

^n£^'
5a. _ ^ '

4.

!
i
I

^"

'

$*£

^ female 3. APP^CKIMATELY MAY 1969

UHDH 1 YIA1

Krbb.

UHOEt 1 BAT

MT!

SHOUU
bt,

DATE OF BIRTH (MONTH, D*T, COUNTY OF DEATH

I16.
^ UNKNOWN

UIH>

7a

/a.

Harlan

7b

 yi»Kgyo«Noj ^ $###_ Little Shepherd Trail

Pine Mountain

8.

wo«,Nftwn.mHir«nroi
COUNTY

Hb.

i'l(:(./

UNKNOM

UNKNOWN

UIOOVB

^^fifl10*1101
it

MAILING ADDRESS

17b.

NONE
DEATH WAS CAUSED BY:

.'

\,-

W
f
1

LYINO CAUIE IAST

L

S r~J~ a

HUT

MIOUU

LUT

isr«n on I.F.O, No,, CITTOKIDWH, JTATI, zif)

UNKNOWN

l£NTEK OHLf OWE CAUSE PER L/NE FOR fo], fbj, AND fc;]

IMMEDIATE CAUSt

•' i .'

UnKNOWN

UNKNOWN

INFORMANT—W^M£

' / .' f .
A
CONBmOHJ, IF ANY,
WHICH OAV1 It!! TO

STREET AND NUMBER

U9,

Usi MOTHER-AW/DEN NAME

,7a.
IB.

UNKNOWN

insmtenY OMITS

UNKNOWN

lfe

UNKNOWN

["PART 1.

UNKNOWN

13b

CITY, TOWN, OR LOCATION

FIUST

Lis,

ISUiWlVINS SPOUSE (if wife, «m "AIDEH NAMU

WDOWiffife^ 11"clf11
15,
•
111.

USUAL OCCUPATION torn KINO OF woix com uutius MOH of KIND OF BUSINESS OR INDUSTRY

UNKNOV/N

RESIDENCE—STATE

UNKNOWN
.

9.

SOCIAL SECURITY NUMBEft

12-

HOSPITAL Oft OTHER INSTITUTION— NAME nf MOT IH UTHW, SIYI jnitr AHO HUUICO

ClflZEH OF WHAT COUNTRY MAFLK1ED. NEVER MARRIED,

UNKNOWrWECDUMTlT1

"^FATHER—NAM£
1 H VJi

DATE OF DEATH IMOHTH, DAT, TEAM

1 msio< an UHITI

^. UNKNOWN
•HJ 1 1

~-S

SEX

CITY. TOWN. OR LOCATION OF DEATH "^

STATE OF BIRTHllfHOTlNUJ^.,

U1UAL IUIDSHCS
Wlli DECEASED
LI¥!D. IF DEATH
OCCUmEO IN
INSTITUTION, 0 IV!
1ES D£NC! ItfOli
ADUIBIDN.

[AST

UNKNOWN

lp

-5 -xxy
s / /

Krlmnrp RprflatmtlAn Tmtt-Trt Nn.

HIDDLI

^^ l^Bol
.-> , r

-

*Vi ,^> ^^

fi«r

RU MO.

ifrw'tiH'oHjn i"'/" ATM

.

h

t/\J $ Cl-*-' *£"

DU1TO, O t A S A COHHOUEICt Ofl

l/l^-&-y{

r^-

faLtL-^4

/I'^L-f'iT^'

'

7

'
y ,.
C-i/v^- W-

.,.

v

,
\O

TH"

UNDIH-

1

DBS TO, O( AS A CO

(e)
FAIT II. OTHEH51SHIFICANTCONDmOHS!CONDIIIDMSCONT>l"UT!NSTa DEATHIUT NOT I£1AT[D TO CAUII GlYtH IN fA>T 1 (a)

AUTOPSY
[nsoiKol

IF YES WEtt FINDIHGI COKimuEi IN DEiawiNine c*u»
OF DEATH

ACCIDENT, SUIC1B6, HOMICIDE,
DATE OF JHJURT (HONrM, CAT, TEA*) HOUR /
HOW INJURY OCCURRED (EMTEt WATU1E Of INJUIY IN fAlT 1 01 fAlT II. ITEU H]
OFL IJHDEI£!tW1HEP llfp^fT)
L
f /
/?
,^y^7n'>~vl/V?
/V^
X
20a,
f ^/ X / /1'^9^/^f 'fflii.
[ ^/^?^7 /^v"?^. t^/'?'') SOc, '/ C_
Mi 20tJ.
t^**ys fi*~^*''} -^~i /^J^*2
INJURT AT M/OKf; "/
f L*.C£ QFjlUJURY AllHoUE; rWu, ifiEET, FACTOR, LOCATIOM
Isrutl Oi H.J,D. NO.,"aTY OH'TOWH. tiATt]
(irKtFf YEISI'ND)
own ILOO., ETC. jjrEcyr)
y^1
, __
X/
/>•
.
, ^s~i

i

''CERT4FICMTON— " ""

ttortTH

DAT

YEAH '

PHYSICIAN;
I ATTIWBSD THI

 

HaNTri"

DAV"

TUI AND LAIT JAW HIK/HU ALIYI oif i DID/DIC NOT vitfr THE DEATH OCCUHEO AT iHt FLACE, DN THE

Jn
If-*

MOHTH

Ha. DiCEAjfD FioiJ
 21b.
CERTIFICATION— MEDICAL EXAMINER OR CORONER; ON TUB JASII of THI

31=.
Haiti o? HEATH

DAT

HOHTH

DtATM OCCUIIED ON IHf DATE MO DUETO Wf CAUSillj STAlID.

CERTIFIER-fMMtiTTfi OJLJJIWTI

P

MAILING AODRESS-CffiTlf/fS/

''BURIAL, CREMATION, REMOVAL
MT^nvn al

fS

•H i" T *•" F<1 K30K
ft1^

DATE

IMONTH. DAT, fit.ti

^d.June 6, 1969
J£M£^eM6£ffian

1,

[SIGNATURE) / t%^*..fs^ t_~

y

"1

'

'°DT AFTEI DtATHi

31d.
IHI DECJDSNT WAS FIOHDUHCED DIAD

EXAMINATION Of IDE 100Y AND/O1 THE IKYEJJieATION, IN UY OFlNlOll,

1
i?

VtAl

STIEET o< W.D. NW

aTr

CEMETERY OR CREMATORY-WAME
nb. Harlan Gas Ceneterv
FUNERAL DIREaOR—SIGNATURE

'

£«lTovL

IMfUJH]

DAT
,

DATE, AND. TO THt 1EST
OF MT KNOWIIDSE, DUI

»•.

s~J^

M.TO ™» eAusitil ITATB.

JtAf
I

"S«i_ol inu
^

HQlil

h /. C-\

DATE SIGNED IMDNIH, DAT, m<i
DAH

LOCATION
cm o. iown
we. Fairview Hollow

L

'

iu

'

'

JTAT*
Kentucky

ADDRESS (ZIP CODE]

1

Ka. ih^f '-t-rT.rt'hst^-,
Colonial Chapel. Haf-l^n, Kp.nt.nn^y Lflft'W
^
{lf?%tf
S^^x^f^^^^-^^X^^T/T^^

5^

THE BACK OF THIS DOCUMENT CONTAINS AN ARTIFICIAL W A T E R M A R K - HOLD AT AN ANGLE TO VIEW
I, -Paul F.Royce, Registrar of Vital Statistics, hereby certify this to be a true and correct copy of the certificate of birth, death, marriage or divorce of the person
therein named, and that the original certificate is registered under the file number shown. In testimony thereof I have hereuntp subscribed my name and caused the
official seal of the Office of Vital Statistics to be affixed at Frankfort, Kentucky this _
2d±Q
day of__kAU\ ?n

Ct^to Dnr-Vt..

 SEP-11-2003

11:.32

3124'4035'38'

ADA American
Dental
Association'

211 East Chicago Avenue
Chicago, HKnots 60611

"P700T

T 312.440.2500
[=312.440,7494
wvm.Kia.org

FAX Cover Sheet
From

To

Recipient

Philip Bianchi

Sender:

Karen London

Organization:

Hartan County Coroner

Date;

September 11,2009

Fax #;

606-573-3737

Fax #:

312-440-3538

606-573-3030

Phone #:

312-440-2787

Phone

ft:

FAX Length (including This Cover sheet);

Z page(s)

C] For Your Review/Comment

Q P&r Your Request

PI Please Reply

O For Your Information

Notes/Comments:

Mr. Bianchi:
Here is the photocopy you requested of the Letter to the Editor that was published in
JADA in August 1969. If you need anything further, please let me know.
Karen London
Permissions Editor

 SEP-11-2003

11:32

or mobile11 clinic on-the island, IK
ckairmari is Tom Nicholson, Puerto
Rico,
Two oral surgeons—Morton Brod
0{ Westport, Conn^ und Everett
Claus of Littleton, Colo—and their
y^veS have contributed tours, of service aimed at establishing a continuing, preventive dental program.
Any dentist wishing to contribute
dental service, equipment, or instrunients to this program may contact
Doctor Nicholson, Box'97, Aibonito,
Puerto Rico OO609, or the Christian
Deatal Society, 1600 Bast Speediyay,
TMcson,ATiz857l9.

AsK.dentiststoheip
in.identifyirig dead woman
ffarlart, Ky; Authorities at Harlan,
Ky, arc asking dentists to help in
identifying the remains 'of a young
woman, found in a remote section
of Harlan County. An autop&y re-.
vcalcd the death to b* the result of
numerous stab wounds.
Time of death has been cstunutcd
at three to_four weeks, prior to discovery of the body June 2, 1969.
The victim is described as approximately 20 years .Of age, 110 to 115
pounds, about 5 foot, 3 inches,

Donald J. Walden of Denver
(letl), executive director,
Colorado Dental Service, reives the Rocky Mountain
Achievement; Award from O.
S. RnesiiVer, president of the
Alpha Prncsa dontai fraternity. The award—given to but^»ndlng members of the denprofession—recognized
's dedicated
a dental practitionand his efforts in promotand dental eduthe Rocky Mountain

3124403538

P. 002

Kenneth J, Ryan (lottl of Flirty Micht retiring president of the National Associattgn of
Dental Service Plans, hands the gavel of office to his successor, F. Gone Dixon, San Francisco, at trie close of the recent NADSP annual membership rfteeting in Chiqago. Doctor
pixon, a member and former chairman of tho ADA Council on Dental" Care Programs, is
vice-president and managing director of California Dental son/ice, tho nation's largest
dental service plan. The NADSP membership approved tn.e adoption of Delta Dental Plans
Association as the new corporate name of the national coordinating agency.

brown hair but tinted auburn some
time ago. The upper three front teeth
appeared to have been removed by
a dentist withjn the past six months.
The dental chart shows th.a.1 no, 4,
5} and 6 teeth, upper right, have been
missing for a long time, HS has no. 6,
lower left.
Any information about the victim's
identity should be directed to Sgt
J. E, Cromer, Kentucky State Police,
Post 10, Harlan, Ky,

Project HOPE plans
ten-month Tunisian stay
n, DC; The S^ HOPE /
will sail for Tunisia late in August'V
for a ten-month stay, marking.;.thq'
* •»'/'>'
hospital ship's first return to'' the
. African continent since its voyage
to Guinea in L964.
Selection of Tunisia as the next
port of can for the SS HOPE was
made on the basis of advance racdi- ,
caj survey team, reports and' the
"warm invitation" of the Tunisian
government, according to William
B, Walsh, MD, Project HOPE
founder and president.
"We arc very much looking forward to the HOPE'S stay in Tunisia,"
Doctor Walsh said. "Not only did .
"the Tunisian government issue a
most warm invitation to Project
HOPE, but our first advance medical survey'team was moat impressed
witH. the .cordial reception extended
by Tunisian government officials and
the country's medical profession."
Project HOPE will celebrate its
tenth anniversary in Tunisia,
The medical survey team—-the
first of three such teams—arrived in
Tunis last March 31 and spent 10
days touring existing medical facilNEWS QFQENTfSTRY i'295

TOTAL P . 0 0 2