TEXAS DEPARTMENT OF HEALTH' ... B.UREAU OFVITAL STATISTICS

~~~t~, ~j~~/~~~r~,,~~,~,+t_a_rr_'_1_n~g~~_o_n__ ~A=1=b=a~~~~~~~~~ ---L.~<?_~~1 ~,~r~ M1.PLACE OF DEATH • TEXAS DEPAfHtv'ENT OF IiEALTHSTATE OF TEXAS BUREAU OF VITAL-STATISTICS

STANDARD CERTIFICATE OF DEATH

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DURATION

COUNTY OF. HAJ'ua•••••i..•n•.•••SL- '-CITYOR "'mo T .4.2PRECINCTNO. -=~~~~~~.~~e~x~a~8~.L-------- ra~ ~ 1

GIVE STREET AND NUMBER OR NAME OF INSTITUTION

~'/g~~~:s~~Isabella Horney

82049

LENGTH OF RESIDENCE <.>0 (SOCIALWHERE DEATIi OCCURRJi:D~YEARS __,---MONTH~DAYS, SECURITY NO. RainaRESIDENCE OF l STREET -M-2 ''''mo v .•••••ll'1I••"r~lI:- Te-.' ,

~ ~TQH~E~D~E~C~E~A§S~E~D~r~A~N~D~N~O~,§:~~gT~~~~~~~~C~ITY~~~~~~~r~OJC~============~C~O~U~N~TY~~~AY'~~~·~~~.~~~6T~AQT~E~_~~~~~=IPERSONAL AND STATISTICAL PARTICULARS MEDICAL PARTICULARS

iii 3,SEX I.'COLOR 17, DATE OFUI lilema.1e OR RACE DEATHml~~~~R~~~~~--~----~W~h~.~,~,L-~--~-----II-~~~~~~~--~Mua~r~@ __ ~2~2~--------~·~19~a:: s. SINGLE.MARRIED. WID. IS.I' HEREBY 'CERTIFYTHAT IATTENDEDTHE DECEASEDFROMW OWED OR DIVORCED Wid d - ..., _~> (WRITETHEWORD) owe - -- .194_. TO ~ - ~ . 194__W IS, DATE OF ~_ _ t:> <7"'"a:: BIRTH Jll17 20 186' ILASTSAW H------ALIVEON ~- -- - ~.20 'A'94--W I------------,---------~.....::..------___;_------_:::_----:_---IITHE QEATH occuRRED "N THE DATE STATEDAeOVE AT' • • M.~: 7. AGE 8'0 YEARS' MONTHe, ~AYS' IFLESSTHAN I DAYZ 1-~~~~~~~--~8~·----~--~2w----,--~~~=,~~H~O~U~R~S~~~~.=~M~IN~IIQ '" SA.TRADE. PRO·~ FESSION OR KINDa:: •• OF WORK DONEo g SB.INDUSTRY OR~oICU~B~U~S~IN~E~S~S~IN~~~----------------------------------~-lli~~~~~==~~=:~~~~~~==~~==~ __.I-----------II? WHICH ENGAGED

9. BIRTHPLACE~ (STATEOR 'Wran.e CONTRIBUTORY~ I~C~O~U~N~T~R~V~)------------~~~--~~--------------------------IICAUSESWERE~ -I------------I<I: 1'1 10 NAMEU ~ E. Fia.herz ~I-I-I-.-B~I~R~T~H~P-L~A~C~E~~--~~~~~~-----------------------IIO. '" (STATEOR Unknown~·I~~C~O~U~N~T~R~V~)__--------------------------------~--~~---:II----------------- .1-----------1<1:. eI 12. MAIDEN~: iii NAME Unknown~. ~1~13~.~B~I~R~T~H~P~LA~C~E~------~====~===---------~-----------II·~~~~~~~~~~~~~~~~~~~~~~-----------ILLZ§ (STATEOR

COUNTRY) unknown•• 14 SIGNATURE~ E. .I~---B~~lV~t-~~~-----llol-:-=-::-::==,----"'M=r--"s~.--'J!j""-"mma==--H"'a~mm"""'L--.,....:.-~----_;_-11DATE OF OCCU~R_Ef'lCADDRESS~ ::tl:2 Emo""'"I~~~~~~=========T==============·~.~J=============T=E=X=A=S=IIPLACEOF OCCURRENCL-~ __;.-£~~~~~_U~~~~J_-----'"I!S.PLACE OF~ BURIAL OR b f'\~ REMOVA~~~ u__uua a__r v_e__Dl__• ~~T~EX~A~S~III~M~A~N~N~E~R~O~R~M~E~A~N~S~~·~~----~~~~~~UR~~~------g, ~. ~ IFRELATED TO OC ..• 23 PATION OF DEC ED.E Jli.ar. 19. SPECIFYh~~1~6~S~'G~N~A~T~U~R~E~----~==~---=~----------------~~~ SIGNATURE

~ Tapp Fllneral Home (!om Inglis)~ ADDRESS ~g Slllphur Springa ~ . . TEXAS

ADDRESSTEXAS

.TEXAS

E541973This is to certify that this is a true and correct reproduction of the original record as recorded in thisoffice. Issued under authority of Section 191.051, Chapter 678, Health & Safety Code, 1989.,~~~~

STATE REGISTRAR

ISSUED UL 8 19WARNING: IT IS ILLEGALTO DUPLICATETt:lISCOPY.