Document LJyoq5QnKrpoXXy8gZGor1Ee3

FILE NAME: WR Grace (WRG) DATE: October 31, 1968 DOC#: WRG034 DOCUMENT DESCRIPTION: 1968 Death Certificate for Florence Hermsen . . re.< u NI 41 lN< . vi?.'* *r AVUotnMI *-4*0( pi(;i?m*o 0lo<t(llVlw'MltIp,((VI iICM-.lNt.O-CMI .1*0 -, : ryW^J IJUMLWPMP*?: UUiVMfH oumi<*i ci ci (M roto j I.4MI .in ^..l uti<uif :1 `ss**'. "f.- ___ __ ftrrJ.^ t *Cf *CIV, ('mino, 3T?"iSfpttt ot # u n ite ________ O l 7 f<*| 1 ___ ___j_______|,. 1x 0^--2^2--1199<0 0 ,,Li n eoin ctrio^v 6r.c4iiirrouTH' " J4'M*41(ll|<*|M| o.--lh(O' OSPITAI 6* 01*1* irl}tUUl.ON--"**< NOI ---*, c4 4>(l|l i>4 -W-9I* ' L ibt>y ________ J.___y e s ___.>t.Johns Lutheran Hosp__ S*Alt O*t>CfH44NOIIM|#.4*., MM| omiN o> wMAi couioit MAItllQ, M(VlMAftllO, UJC VIVONO SfOUSC l II -1*1. 6l m* In n i. I ... (O^iri WIDOWIO, OivotCC0*t*c*** i Minnesota USA married F lo ren ce E Spcncer_ oca iicuTlit NUMict UOSUUAnI<OCIMCIU. (fAllalONCn4i<lrl IH*0O-OHU-6t>w.-0-OHO* inooTsusiniss oa inoushy L aborer________________ ' c n r V i o w H . o *"*i o c * h o n 1?_____ f o n o lit e .Mine_ JMl'i* I09 n o <* 4mn.( * S i t i t i ANO N U M ld . Montana L in co ln " -Ljb-by. 14R .1 nnnV C E S3H inK)Smanl--nam( ,, Florence Hennsen r PA! I rr ' ocayhwascausio sr, MNlOwll C*VM MAIIINOAOOCtSS 41111*O*o. O., (Iti o>0>4, (UH, II# WS 207 Mevada,L ib b y,Mont 59923 l l N I f f O n i t O N ( C A U S I p i * Hn | i o * ,*o ). fb). a n o f</| . (.1 Acute rayocardiai in fa r c tio n rio.'t1*~~4'(ONiivir*5r " * * "" I l ' - I I M 0 * 41 4 H> ( I . 20 min * ( 0*v| li(| io C OmMi hO IIO * l . I l I N I , i ( i * Il ( * u M io , 111*6 ( I I i n (GUi mHi (WAlMl O lf (bl MI IO, Ol >$ * (0M0VIKI e*: f A lt II. (<) C i m i SlCNUlCANf COHO IIIO NS: C0**4M10--4 to O lt i* Md n o i | | * i i io C*v 4I G|m - **#l t aI1u(t4oOp*syNOI IEtrs <*hi ***o<i4t ; i ( O N I -- IH I I - I M I M C . o 4 U IN Qb.ro.ni? h e a r t d i s e a s e . . . d i a..b. e...t.i. s _... a C O D En.I. Si U> ICIiiD-<Ec , hO m iCiOI nDAl tTEi nOt lINu Ji Ui i Rf vY - - 4M. C.A, I 4 uh nOiUi R MOWinjuSY OCCU**tO 1,M><9**1iuAOf imjwmiNffttl 109**1. tt|- 49 Iteo a U N O E K R m jm EO kMCiivi 70S 30 M 7 INJURY A l W O K PI ACC O f INJURY - - o - l , ( * - . H i m . it r t c t v , I O C a H O N t 41*111 O * . I O . MO . 1 . 1 O * I O - M , U t i l I t K H .II ** O l MOI 0K6 I4 0 C ..H C . IM C H II ___________________________ 7* * CUllftCAltON-- PM*StCtAnMi}NOii 71 010*410 NO* --0 * 4 It* OA* 1f * t to . A0 O H \A W M l* /M || 4 | ) 1 | OM *O N W CAT t| | 1 6 ta / (M 9 1*01 1 IM ! t o o * *1119 |*IM . IO-OIAVIM9IO C C U 9 K 0 *i ! run. c- -i 0 * 11. 4 N 9 , I d 1 U \ 111 !.u )l9 MO f to 6 * I* 9W (m u IIK ! si i ' . i; C ERTIFIC A TIO N -- C O R O N I Rr Off Tm i oasis O f th* I i m m a UOM Of M i o t i *** 0 /0 tua M V U l(6 * liO M , m * O* CTEhR1UIER--NAM<imi o*rMn 0a im o c c u m iio m m o*ta **o m m o s < *w m ii i u i i i . 71_______________ MAAtNO ADDRESS--Clini if 111 O -3*lM l llO lM l M l M O m O 0*9 w n( I 0 (.1 4 0 SfNAtuif" 7JS_____ J a n e g F . Graham '"iVt) |19l 091.0. MO, L ib b y ,H B fita fta At ?3C. DAKSKSNfOiOmm, a*Ti~ 3,1-13-68 ^ IURIA4. cremation. REMOVAL CCMtURT OR CREMATORY--name IOCAI.ON cm o. lOww 1IW 93a. b u r i a l OAK ImOMM. 0*9, *9*91 ^ L ib b y C em etery Juibby,M ont. MORTUARY --NAAtf ANOAOOMSS <4<*MI 09 9.9. NO., CUV09tOt#41**9. tifi 40 1 1 - .-6 8 __________ TM ^ c,At "." ^ T a F o I S ^ C o in p r ^ 1"" f*Mnnr 5Nhv4?*^1 W/nno TtV>Vi^r j ^ ' lclJAirin"-Kl? ls h n e r " 0*19 '**** "gg UOlSttAO STATE OP MONTANA v > C ounty o f L in c o ln ) I , ELEANOR L . VAUGHN, C l e r k a n d R e c o r d e r , i n a n d f o r L i n c o ln C ounty, M ontana, h e re b y c e r t i f y t h a t t h i s i s a tr u e copy o f a c e r ta in DEATH CERTIFICATE fo r kZL A0071258 .. . . . v ^ th e r e o o r d ir T^ ' n y No T4, f my.'J ia n d ,.a n d t h a ^ s e a L o f. a i d . . C o u n t y d a y . ..; ELEANOR L . VAUGHN, C l e rrkk affd 1R e c o r d e r ')/ L in c q lm C o u n ty , M ontana D eputy ( OI* E O * PRINT tN : , 1* , * M` ^ ' U t U U t O O l I.M Attain 104* IV04NCI mu i out*ao ITT# K ClAlW a r g i n o iM OwiVO. 0>W tin o iu d llOM f" - --N --- --1 , v., IH I WWW * CKRTIFICATKOF OCATH M t * lK * f l I M ( t i l l 1 I K U M I =mi m ,, N M l ............. SM 0 A lf U t Ut AIM **, M l. MA#. , Homan Iterasen i malo 10-11-68 U C I M il. M ia M , M W M M*, K vFCTt A G E -- Ait W M 1 (At kratM *tAM " i F B * n VOMI * M l DATE O# M t M Kl I COUNTY O tA lH cuy. to."' white & I 1' 0"-2r2O-1900 ,,Lin co ln O*uXaiionoam w t ctfT VIRATI HOSPITALO*OlHtl INMIIUK>N--MaW7mm5uI IM |IM4#, G*( |<Mt 4M NWald M d ' i o mo i n Libby , yes STATEO#fttSlH11M*)f mw.t a.. # naw CITIZEN 0 1 WHAT COUNTRY , m a rr ieo . N ivea m a r m o . :SU tV iV iN O SPOUSE UMt >U|N M*M , M innesota0"""'' USA Qarriod jirlprcnco li Spencer. .. SO CM SECURITY NUM UR w iO O w tD . DIVORCE 0 i M ( m * U SU A I OCCUPATION lOiot IMO 0 M l N M MINO O kl OF r * i N o o b u s i n e s s o a i n o l i s i * w q iiin o u n , iv#M ir H ta lo i L72=18-0391 RESIDENCE -- STATI C O U N fY Laborer CITY. TOW N. O I LOCATION m Z a n o lit e Mine. iuud ir uMtri S t U l t ANO N U M tii I MCf ?| Ot NO ' .n e i ........ . " ' v j a n a - , - -- nat ' RAIOOU UH m o t h e r -- M UO tH Na m e > , - ami Herman INFORM ANT -- NAME ___ Herrasen_______ MAILING A O O lfSS ta n t t a r o n o .. C*tr oa 'o -*-. i * i i . u f i IN Florence Herrasen ,n 2 0 7 Nevada,Libby,Mont 5^923 ^RARt 1 DEATH W AS CA USED Y ENTER O N U ONE Ca u s e h i UNE f O * ,0 j. ,*J. ANO ,cm I ,*.' ,*,' c V m . i - i ' i i - io, Acute myocardial, in fa rctio n Oui 0, O# 4 A wOn MOw nvI o * ----- 120 min j ib| CONOMiOMt, U ANT. w h ic h C a v i m i to HM lOlAll CAULI .01, ItA tlN O IMI UN01I- Ov 0. 0 I A COmMQwI nCI O# ATINO CawJ I U l > OTHER SIGNIFICANT CONDITIONS CONDITION COm#iu1imC to OlAtH Ut MOI a lu n o to CAUM OlvlM IN AAit lot Chroni c heart d i s e a s e , d ia b e t i ACClOENT SUiClOi. HOMICIDE, o70a 701 UNOCTEIAUNEO j f ic im D A T E L E NJRY MONtH. OAt, *1 A l l HOUR 7* i HOW I M i 10 IN JU R Y OCCURRED ATUtTiOoP#SYnoi !'Ha e IP Y E S 1*1 tNOiNo* c o n - m10( 1 ( 0 IN or oi*iH vtH U TH TM O .iw ll 1* n aw YI c in j u i ( a >oa fa i < >iw >a IN JU RY AT W O RK 4iMCi'Y t i oa n o i Pl a CE O f INJURY At h o m i, a , vt4i , A C T o a r, {o t t ic i L o o .t t c . < ecitTi LOCATION i tatti oa a .i 9. n o ., o h oa iq w n , m u 2 U!?0r1 CERTIFICATION-- moni 04 mOn IM OA* FM ICAM : AniNOlO tut TO '?1k j ia _o ia A to _M C -______________________________________________________ MAI I ANO U t U<H H IM / H tl 41. . O N I , O lO -'O O NO t Y .( # M l jo iA t H G C C U U t O ! M O M tN CAT y* a ! IC O A t ilt o t * : j.N ^ g ,* At tM( y t C a i a m ? ' ) Ijli 1 ?!# M to iH| CA-s*-; 1 s: CERTIFICATION-- CORON* ON th{ qavs c f t h i (lA M tH A tlO N O f IH ( O O t i U } / f , l tM( IM V|tlO A tTO N I*. m l 0 IN tO N , M l O tC IC tN i R i O mO wn C IO C I a O mO n IM 0 *R oiatm occutaio on n( dati amo out <o i* i ' Atro. H i__________________________________________________________ _ _ _ _ _ _ CERTIFIER -- NAME itrri oa (.mti ?Ja____________________________________________________________________________ i SlONAluRE , .... James F. Graham M D DATE SIGNED - v - 1 1 - 1 3 - 3 MAILING ADDRESS -- CERW.'fR ; 4 tain oa t.r 9 no L ib b y ,flrftia BURIAL. CREm a UOn , SEmO v a i "Mc"" b u ria l 25* D a IE m O m I m . Oa . M a # i CtM fcitfiv OR C M m a TORY -- NAME I ,s Libby Cemetery V h To a y -- n a m e a n O ADDRESS .IO C a I iO n !Jibby,Mont. v a n i oa * o. no . o n oa to*w C'< C l I Q m m i. i ___________________ " r iir o ld ' Gombf r v - m r if F u n n r - n i K -- o T - '-^ h - ''^ r - L L' 1* 5 ra "Jdnr. ' Kershr.er ll- 1 3 -b d Oa U ' e^ v A ( .jtath: o f fomt/tja ) County o f in co ia ) I , :Ll.l0:< L. V\IX?HN, C le r k an d C o u n ty , lo n ta n a , 'nu roi-y c e r t i f y t h a t IC.Vfn CCRTIFICATC i n t t y r i f o r , '' ' / / / ... J / ^ >-u y R ecorder, in and ion Lincoln t h i s in a e m o :j:r/ of a ecu' _______ '.a i t a.;:-`a r s on th e r e c o r d s In my o f f i c e , f L i - .'/flT.M.iJ !,;/ h i : : sn.d tle s e a l o f -.L i o tc * i k u ji ^ y 1963. ' < * " / * <* L. * t:!.l \ i * , M X .......- b ;L h /C J. -, h . v n - * ! ; 1r,ro i i ' I Ts *. ' , 1-Vvii i* 1 i 1 >l . U ^C071257