r'IAmNn JAwEsw
WWII

comm KING
DATE a: Dem MAY 112ml
HOUR or Dam 12.01 AM
SEX NIALE 
socIAL SECWIW NDMDER

AGE 92 YEARS

HISPANIC No. Mar SPMISHIHISPANICILAVINCI
RACE WHITE

aIRm DAIE _1925

HIRTHPUCE CUBA, IL

MARIIAL sums 
SPOUSE 

OCCUPAIIDN- CHEF OF mE 
INDusrAv I1 5 NAVY
EMATION. HIGH SCHOOL DR GED COMPLEIED
some: YES

--

REMVIDNSNIP
ADDRESS w, FORT ORCHARD. WA sum

cwsE or nEAm
A AND SUBARACHNDID 
erAvAI DAYS
a DLum FORCE INJURIES DF HEAD
INTERVAI DAYS



INIERVAL

omER DEAIH

DAIE DF Imunv' 12, 21m
Mom: or INJURY 1251: AM

mum AT WORK No

PLACE or 1mm CASCADE BEHAVIORAL IEALTH

woman or NJURY 12m RD 
mrEzIF; WASHINGICN um

00on KING
DESCRIBE NW INJURY occuRRED LEVEL FALL

IFIRAuwoeroN NM APPLICAELE

CERTIFICATE OF DEATH 

 
    
 
  
   
   
  
 
    
  
 
 
 
   
  
 
 
 
  
 
  
 
 
 
   
     
       
     
       
         
       
     
   
     
     

 

PLACE OF Dam 
rAmurv OR NICNLINE MEDICAL CENTER
ZIP "166 

srREEr -- 
CITY STATE ZIP PORT ORCHARD. WADDJH

usmE :Irv um: no 1:011er ms>>
TRISH. RESERVATION MDT APPLICAELE

LENGIH anE AT 44 YEARS

 

FAVHEWPARENI LINCEL moms MACON
MOYHERIPARENY Am FLORENCE DAVIES


0; mm"

PM ORCHARD. WASHINGTON
DISVOSITION DAVE MAV 221 

 

FUNERAL FUNERAL HOME, 

1151 
rm ZIP PORT ORCHARD. 98366
MARKRIL

 

 

 

IMMNER or DEATH ACCIDENT

AUYOPSY No

FINDINGS AVAILABLE YOWMPLEYE
mm or Dam 1101' APPLICADLE

DID women usE CDNIAIDIHE No -
PREGNANCY sums FBMLE No RESPONSE

CERTFIER NAME NICOLE YARID, MD

1m: 

ADDRESS 91H AVEWE "59792 MEICAI. EXAMNER
cm smE 2p WA sum

DAVE SIGNED MAY 15 21)"

CASE REFERRED WEDNER No
FILE NUMBER
mam" Nm APPLICABLE

DEPUTY DEGISIRAR DIANE HOGAN
DAVE RECENED MAY 22, m: