Document nNQeeOwod1kZ4QbmY0BZBrKQR

Identifying Information: Emolovee 11. K. Zigafoos Address Sex 111 Shaily Lane '! Ellenville, New York Aqe 92 Race W Date of Death January 29, 1963 1. Was patient hospitalized immediately prior to or within 12 months of date of death? Yes 4 2. Name of Hospital___ ______ No 3- Are you aware of a surgical pathology report or autopsy report? Surgical report ______ Autopsy ______ Neither Would you please indicate your own findings (specific diagnosis and organ[s] affected) for any liver disease and any cancer. Liver disease Date____________________________________________________________ Cancer_ Date ____________________ ________ QENC 20262 ORGANIZATION RESOURCES COUNSELORS, INC, 1625 I STREET. N W. WASHINGTON, D. C 20006