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GOVERNMENT OF GUAM -> \*l
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GO\'ERNMENT OF GUAM
IYre/PAINf U.S. STANOARD

EAMAN€ilT
IN
CERTIFICATE OF DEATH
8UC( tNX 1 DECEDENI S UAME !Ftst.Mtddte.Lbst) 3 OdIE Or OEAIB lMonrh D.\ )

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FRANCIS DOANE TI lGUEL June 16, 2008
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's:t otxil srot 5a AGE-Lasr B,rrhday 6. OAIE OF Blqll tMonth. ;;Wtr,m rc;;M
axD 8Ai0800x

A, WAS DECIO€NT
7 2-6136
EVEF IN U S
45
9.
i.'2'1
PLACE OF OEAIA lcheck only one: see ost.octrcns
, lgoz
on othet sldet
FA?gq Caqntyl .
rn1_Ll-D D 1ne s
ARMEO FOBCES) oTHEF
lI .r"'"", ll enro,'o"r,"n, L-l ooa - tN"r,ns {oF" J Fe-.o, r. ffi o,r",,so-r,[J1. gent Caf e
9c C TY IOWN OB LOCAI ON Or OEArH 9d. COUNTY OF OEATH
548 South Marlne Corps Dri,ve-TakeCare Tamuning Guam
12a DECEDENT'S USUAL OCCUPATTON 12b I NO OF BUSINESYINOUSTFY
lciee \ihd ol work dahe dding nast ol life
z Oo not ose tetned.) '9oaing
e.
FO 56'1 es Supervi sor tv Free Business
36 13c. CITY, TOWN. OA LOCAIION 13d, STBEEI ANO NUMEEF
Dededo Kayon Mason #88 Las Palmas i
Hz 1 3r ZrP COOE !4 WAS OECEOENT OF HISPANIC OR GIN] 16. OECEDENT'S EOUCAIrcN
{Spe.ily No or Yes - li y€s, soec ly Cuban lSpecily anlf highesr gtade completed)
Metlcan. Puedo Brcan. erc )XXNo U yes
96929
17 FAItsEA'S NAMt lFnst,Mtddte,Last) r8. MOTHER'S NAME lFnst,Mtddle,Maideh Sril)ame)
Adolfo lt4iguel
19a TNFOBMANT'S NAME lrype/Pant) 13b. MAILING AOOAESS /Sreet a,d ryumbe. b. Rutal Route Numbet. Ctty or fob.n. Stare, Zip Cadej
Marilou Liao Miguel POB 25855, GMF, Guam 96921
?oa METHoo OF DlSPOSlrroN 6-24-08 20b. PLACE OF DTSPOSITION lName ol ceheterr, crchato.y, or 20c LOCAITON-C rv or lown. Slare

?l}e,."r ! cre-n,m n Bemovar r/oij, siare our't?idir'%t Peace Memori al Gardens

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OIle ,speL,J, lvlemorial l^lalk Garden Blk. 433 Lot 10 biindward Hi 1 1 s,Yona,Guarn
21s SlGNATUBE OF FUNEBAL 21b. LICENSE NUMBIS 22 NAMI a\O aODqFSS O. r4(.1 r-\
,9 P€RSON ACI NG AS SU lal Lrcensee) Our Lady of Peace lYemorjal P1an, Inc.
,a s€E oEfrilffroN
ON OTH€R SIDE Barrigada, Guam

6 23a To $s brr ol my knowldo6, &oth €cuiled ar th6 rim5, d.ro, and plac6 shtd 23c DATE SIGNED
I - lManth.Day,Yeail

6 Sishature and fite >

ITEMS 24 26 MUST
9 AE COMNffED 8Y DA E PqO\OU\CrO DEAD tMoolh.Da\ vea,l 26 WAS CASE NEFERBEO IO MEO CAL EXAMINEF,'COFONEF)

o moNou{cEs oa
27 PABT I Enler rhe dLseases, injures, or compiicalons thal caused th€ dearh Do nor enrer rhe mode of dting, such as cardlac o. respi,ato,y
9
zilest. shock o. hean lailure Lsr only one cause on each lioe
."a o*'n
G
IMMEDIATE CAUSE lFrnal lo*"'
o d,sease or cond,r,on , End Stase Brain Cancer I
-+ OUE TO IOF AS A CONSEOUENCE OF)
f,sTiuc
d
THEF SIOE
Sequenl a y rsr .ond I'ofls,
Seizure Disorder
I I any read,.9 ro Emedale DUE TO {OR AS A CONSEOUENCE OF)

a ca!se Eiter UNDEBLYING

CAUSE {D,se.se o, trrrriy
,9
rhar rn r aied events
n res!lrng . dearhl LAST
ld
slgn i canr condnlons co.tiblll^O ro death bur nol resulrng in ihe undeily ng cause Blve^ in Pad l 28b WEBI AUTOPSY FIND NGS
AVAILABLE PRIOF ] O
o COMPLTT ON OF CAISE
OF DtATts) /Yes o, rol

29 MANNEB OF DEAIH 3Od, OESCAIEE HOW INJIJBY OCCUNF€O

! Naro,ar E Pe"ons
lnvesr'qalion

s",",4" n courd noi be 36. LOCATION lSlreer and N!mbe, or Fura Boule Numbe,. Cdv o, Tow.. Slar€)
!
Deierm ned

31. C^E.BT FrE8, crnrrryrc BystctaN /phystt, ceditltns cause ot death when anather phystctan has pronounced death and campteted tten 23)
tchetd @ry ffi
SEE DEFIiltr'ON ': il;;;;";y tnowue., &.rh ecu,.d &6 ro 6. d!..t!) snd mann6, s n!rd.
ox oTa€8 sroE

I pnoloulCllC ANO 9E]IIJ]!.9 E!ISI!14.U lPhysiciah both p.onooncins death and ce.tifvins to caose ot death)
To ih. b.i of dy ho*Ho.. &.lh dcurd d 6. dm.. &t6. and d.... en4 du. to rh. dut.{.) and mmo.r a. ttarod

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On th. blli. d .rlmlEilM in my qlnion, &ath @cured al lho tim., &16, and pl.ce, .nd duo lo lh. €ulelt) and mannet as sraloJ

31b SIGNAIUR€ ANO

32, NAM€ ANO AOOFE wHo coMPdETEb causE oF oEATH ltrEu 211 (Tvpe/Pnnt)

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This is a true and exact reproduction o{ the document olficially registered and placed on lile
GOVERNMENT OF GUAM
Co^+ R. b^,e*
AL sE RV cES -'"" CAROLYN R. GARRIDO

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REGISTRAR

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This copy is not valid unless prepared on an engraved border, displaying the date, signature and seal of the Registrar
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