Document 39zZ5gJ4445Na5xKyo0NQ1E

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Ct'-'l'L' /yfv^&-OWiow-Y' /Xoi^onG- ) j ;f ~%t``iTi/ohl *, .u ah I \ k| nJ ' Am mm ! *& /3 73.2. A'MSSOTmj&fi-' . (s)/*7.. ~'rr?,'j \i . is rcvrnce wjot oiy m CSQ NOB /V M A lu 7*1 ' ' CA .Ci C* Dt ATfl Ortiy on* c#w* p*r In* for ?AT |. DtATH WAS CAUSED BY: immecaate cause -Respiratory- Insufficiency /-e Cn*c^*n3m f r*. -n< * Q* r<v* to 9rM cm* *41 *v*q wi4 %' DUE TO (b) _ I^alignant v^gnt.hai-inTSA vith Metastasis--' DUE IO |e) . . . yJfomOOG. Past" l. OTHER SIGNIFICANT CONoil IONS CONTRIBUTING TO DEaTh BUT NOT RELATEO TOTW-TlBUlNAi UlU.AU. LOHOUlON GIVEN IN PART *a| UtDICAl C IKTlflf AllON a. OrUfawlafc - &3 Iff4 h^TS* */. - ^ jrt=. C i * a. puti sci7vptaisn tmm wm*f tmtmm fm * >a/* f*i mmd(ft .--<--JfrA'cJto&V//' v -lz" <v--. /?&**/, ft^c/5/0^/. C-. tyutf/AQ 4V/ /&r6zA&f l*`".*J__ I X>itr ctxxti pofiKTcaaiw -- *l:[mi(l/'/y5i>kr>U WO. c c: a f* iW fc*w ^ w ht ' ^ffc ~ JroHilo^ohl ' *< **-? Bk I pa. ' Itav w W !> a* <*W (K 3l Injury Work Y. C No 3W. PUcj of Injury O Horn* O P*rm O S('e*C O Factory G OM'C* Su'Wm? O QtK*f 3tf. location (No. and Si) 3Jflt City or Town 31N.S Warn in