Pinkerton, Cora REGISTRATIO
DISTRICT NO. �V �y NUMBERREGISTRAR'S awR .. C... PERMIT FOR REMOVAL AND BURIAL �'i8 al
IA. NAME OF DECEASED-FIRST NAME I Is.MIDDLE NAME I lC LAST NAME 2e. DATE OF DEATH-MONTH.DAY.YEAR 2e HOUR
C O RA ! EL I ZABETH I P i NKE RTON MAY AY 29, I S'� a:W M M.
3 SEX 4 COLOR OR RACE 5.o,VOn'cEbNEVER MARRIED.WIDOWED. 6 DATE OF BIRTH 7. AGE(LAST BIRTHDAY) IF UNDER I YEAR IF UNDER 24 HOURS
MONTHS DAYS HOURS MINUTES
DECEDENT, FEMALE WHITE ',.I DOWED MAY 3, 1879 73 YEARS
PERSONAL 8A.ETIIIED USUAL OCCUPATION WORKONE DOF 8e. KIND OF BUSINESS OR INDUSTRY 9. BIRTHPLACE couNfer"i FOREIGN 10. CITIZEN OF WHAT COUNTRY?
DATA MOST OF WORKING LIFE.EVEN IF
(TYPE OR HOUSEWI FE OWN HOME NEW YORK U. S. A.
PRINT NAME) 11. NAME AND BIRTHPLACE OF FATHER 12. MAIDEN NAME AND BIRTHPLACE OF MOTHER 13.NAME OF SPOUSE(IF MARRIED)
UNKNOWN L I V I NGSTC N, UNKNOWN L-% ?K: OW.J - UNKNOWN
14.WAS DECEASED EVER IN U. 'S. ARMED FORCES? 15. SOCIAL SECURITY NUMBER 16. INFORMANT
SPECIFY YES.NO.UNKNOWN IF YES.GIVE WAR OR DATES OF SERVICE
,rl 077-03-8507 GLADYS 12EST
17A. PLACE OF DEATH-CITY OR TOWN Rua`L i•R NAME OFANEAREST T wN)E 17e. LENGTH OF STAY(IN THIS PLACE) 17c COUNTY
POPE SAN D I EGO 3 MONTHS SAN D I EGO
DEATH 17o. FULL NAME AND ADDRESS OF HOSPITAL OR INSTITUTION-(IF NOT IN HOSPITAL OR INSTITUTIOM.GIVE STREET ADDRESS OR LOCATION)
3ALBOA HOSPITAL '.41 0 ELM STREET SAN{ D I EG O,CAL I F.
JSUAL RESIDENCE 18A. STREET ADDRESS(IF RURAL.GIVE LOCATION) 188.CITY OR TOWN RURALANDNAMEOFSCARE6TTOWN)E 18c. COUNTY 18D. STATE
,ERE DECEASED LIVED)
ICE BEFIOREADM SSIONI-27 4.-4 ADR I AN STREET SAN D I EGO SAN D I EGO C AL I F.
THIS DOES NOT J
MEAN THE MODE 19-I. DISEASE OR CONDITION PPROXIMATE
(nl
OF DYING SUCH DIRECTLY LEADING TO DEATH CONGESTIVE HEART FAILURE 8 YRS.,A
AS HEART FAILURE.
CAUSE ASTHENIA.ETC. ANTECEDENT CAUSES ` j INTERVAL
OF IT MEANS THE ARTERIOSCLEROTIC HEART DIZiEAEE 1
DEATH DISEASE.INJURY MORBID CONDITIONS.'IF ANY.GIVING DUE TO(e)
BETWEEN
(ENTER ONLY ONE OR COMPLICATIONS RISE TO THE ABOVE CAUSE(A)STATING
:AUSE PER LINE FOR WHICH CAUSED I ONSET AND
(A). (BI AND lC)) DEATH. THE UNDERLYING CAUSE LAST. DUE TO IC)
19.II. OTHER SIGNIFICANT CONDITIONS DEATH
CONDITIONS CONTRIBUTING TO THE DEATH BUT
NOT RELATED TO THE DISEASE OR CONDITION
CAUSING DEATH.
20A DATE OF OPERATION 20B. MAJOR FINDINGS OF OPERATION 21. AUTOPSY
DPERATIONS
D YES g NO
22A. ACCIDENT (SPECIFY) 22e PLACE OF INJURY ABOUT MOM., 22C LOCATION CITY OR TOWN COUNTY _STATE
FAR SUICIDE M.FACTORY.STREET.OFFICE BUILDING.
DEATH DUE TO HOMICIDE
EXTERNAL 22o. TIME MONTH DAY YEAR HOUR 22E. INJURY OCCURRED 22F. HOW DID INJURY OCCUR?
VIOLENCE OF INJURY El WHILE ❑ NOT WHILE
M AT WORK AT WORK {,/^�
23A CORONER'S:I HEREBY CERTIFY THAT I HAVE HELD AN❑AUTOPSY.❑INQUEST.OR 23e PHYSICIrA-N'S:I HEREBY CERTIFY THAT I ATTENDED THE DECEASED FROM IS TO
illINVESTIGATION ON THE REMAINS OF THE DECEASED AND FIND THAT THE DECEASED '-2O IB THAT I LAST SAW THE DECEASED ALIVE ON 5 '2 /Q-52 19
'HYSICIAN'S
CAME TO DEATH AT THE HOUR AND HATE STATED ABOVE. AND THAT DEATH OCCURRED FROM THE CAUSES AND AT THE HOUR AND DATE STATED ABOVE.
R CORONER'S
ERTIFICATION 23c. SIGNATURE DEGREE OR TITLE 23n. ADDRESS 23E. DATE SIGNED
► ROY F. 3ERRETT, Li. D. 3462 MIDWAY DR. SAN DI EGO 10 5-29-52
24A.U BURIAL 24e DATE 24C.CEMETERY OR CREMATORY 25.SIGNATURE OF EMBALMER LICENSE NUMBER
FUNERAL CREMATION P I NE I EW DE ET- •Y
DIRECTOR REMOVAL 5-31-52 (;1 FN AL1 c JOHN D. MILLER 3562
AND 27.DATE RECEIVED BY LOCAL REGISTRAR 28. SIGNATURE'OF L AL REGISTRAR 26. FUNERAL DIRECTOR
REGISTRAR M A�� 2 9 ► ."' ,, BONHAM BROTHERS MORTUARY
This permit shall be issued ONLY upon the receipt of a complete and correct CERTIFICATE OF DEATH by the Local Registrar of Vital Statistics
LOCAL Permission is hereby granted to the above named funeral director for the removal and burial of the body of the deceased person identified above. In
the case of death from a dangerous or communicable disease, the removal and burial must be conducted accordi to the rules of the State and Local Boards
;EGISTRAR'S of Health.
DATE PERMIT ISSUED SIGNATURE OF LOCAL REGISTRAR OF VITAL STATISTICS I BY:
PERMIT ►
ENTI FICATION I HEREBY CERTIFY THAT THE BODY OF THE DECEASED PERSON, IDENTIFIED ABOVE, WAS INTERRED OR CREMATED THIS DA E,ON PRESENTATION OF THIS PERMIT.
)F SEXTON OR _
2SON IN CHARGE N E OF CEMETERY, C M, E C. ""'� DATE INTERRED OR SIGNAT E OF PERSON IN CHAR
OF CEMETERY BURIAL �/r / ���/1,1,� �v/�
CREMATORIUM CREMATION ry ,�•�y,�r � D /91 ►\1�/"[.�4.-,,,a4 �. 1 ,
•
1. The original accompanies the body to its de6ination.
2. If the final disposition takes place in California, this permit must be delivered to the person in charge of the cemetery or crematory before the body is
interred or cremated.
ISTRUCTIONS 3. The person in charge of the cemetery or crematory must return it, properly completed, to the Local Registrar of Vital Statistics of the District in
which the cemetery is located, within ten (10) days of the date of disposition.
4. If no person is in charge, the funeral director must sign the above statement and indicate on this permit "No person in charge". He must then file
the permit with the Local Registrar of Vital Statistics of the District in which the cemetery or crematory is located.
5. The duplicate is retained, on file, by the Local Registrar of Vital Statistics who issued the permit.