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OUNTY OF LOS ANGELE REGISTRAR-RECORDER/COUNTY CLERK xara FOREST TAWN MENORIAL PARK 300 FOREST LAWN DRIVE LOS ANGELES, CA 80068, [meee |eesezer ace er CALOSANGOR JUN 2 4 2018 ng a atau eat ass are i eet eel COUNTY OF LOS ANGELES REGISTRAR-RECORDER/COUNTY CLERK PHYSICIAN/CORONER'S AMENDMENT sz00g08st14 NOERABURES WHTEOUTS,PHOTOCOIES. 3200919027107, ty 1 sieTH DEATH Ol FETALDEATH __1VPE On PRINT CLEARLY IN BLACK INK ONLY ~THIS AMENOMENT BECOMES AN ACTUAL PART OF THE OFFICIAL RECORD —_TEEOR PRINT CLEARLY INBLACK NKONLY —THE MEET ECO —————e—e—v—ev—ecm—r— PART! _ INFORMATION TO LOGATE RECORD somes | tncract _inskson e ‘ SAREE [saa wor a ara oma | eras 10s ANGELES PARTI STATEMENT OF CORRECTIONS Win] DERERRED TREOTEPROPOFOT 91.3 | _|wroxcation GRA SENZOOAZEDWE EFFECT TT HOMICIDE 95/2520, 'UNK RESIDENCE INTRAVENOUS INJEGTION BY ANOTHER 700 NORTH CAROLWOOD DRIVE, LOS ANGELES, CA UNPOLRMA TIONAL, NOT A VALID DOCUME INT (O ESTABLISH IDENTITY =a ae rere ‘0431/2009 LOS ANGELES ca ‘30033 (apres This to ce nat tig cert tue copy othe ofl ‘eceedtad ah the Repatar RecoroerCounty Crk Reaches JUN 2 4 2019 waco OE SiS sg) 1000003063662 CALOSANGD2 bomen URC PENA UOT) Pek Sere COUNTY OF LOS ANGELES REGISTRAR-RECORDER/COUNTY CLERK seomat __MERELIOAMEADAREEDR mre eu Deir beATH © FeTALoEATH {TE On PniNT CLEARLY IN BLACK INK ONLY THiS AMENOMENT BECOMES ALLACTUAL PART OF THE OFFICIAL RECORD PART! __ INFORMATION TO LOCATE RECORD 3 of 3 { ICHAEL JOSEPH BOM 9612572009, Los ANG JOSEPH WALTER JACKSON KATHERINE ESTHER SCRUSE PARTI | STATEMENT OF CORRECTIONS TO BIRTH, DEATH, OR FETAL DEATH RECORD. TTR nee reper ronan mer | Arena Gnu DEAT 30 oo oeOTEDOR. a0 FOREST LAWN MEMORIAL FOREST LAWN MEMORIAL PARK, 6200 FOREST LAWN, PARK, 17128, GLENDALE RIVE, LOS ANGELES, CA JAVE, GLENDALE, CA91205 i | MORTUARYS TENP- ]suRA—— |ENVAULTMENT. ate ne NO) A VALID DOCUMEN ESTABENS| We: the unaoraignd, he dor penal of pean tat we ‘ing iene, ery rte nay of aria ive personal nowidge ow sav fas ond A osc | #300 FOREST LAWN DRIVE, LOS ANGELES, CA 90068 [1032009 JANICE YOUNG. | MORTUARY REPRESENTATIVE The ocenty at bad “i isdocument is ate copy ofthe fil 00rd fhe th the Regier Renan Coun ak Sue Oy JUN 2 4 2018 ‘DEAN. LOGAN. ee HIN A 1 cos ed ne pad on a a 1000003063661 sed suerte Ree CALOSANGO2

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