HomeMy WebLinkAboutProof of signing authorityCOUNTY OF DEATH: KING
DATE OF DEATH : NOVEMBER 10, 2018
HOUR OF DEATH : 10:20 AM
SEX: FEMALE AGE: 73 YEARS
SOCIAL SECURITY NUMBER: 534-42-3251
HISPANIC ORIGIN: NO, NOT SPANISH/HISPANIC/LATINO
RACE : WHITE
BIRTH DATE: DECEMBER 31, 1944
BIRTHPLACE: RENTON, WA
MARITAL STATUS: DIVORCED
SPOUSE: NOT APPLICABLE
OCCUPATION: ADMINISTRATION
INDUSTRY: EDUCATION
. EDUCATION: HIGH SCHOOL GRADUATE OR GED COMPLETED
US ARMED FORCES: NO
INFORMANT: DAVID NIELSEN
RELATIONSHIP: SON
ADDRESS : 1740 NE 16TH ST, RENTON, WA 98056
CAUSE OF DEATH :
A: LATE EFFECTS OF CEREBROVASCULAR ACCIDENT
INTERVAL: YEARS
B:
INTERVAL:
C:
INTERVAL:
D:
INTERVAL:
OTHER CONDITIONS CONTRIBUTING TO DEATH:
DATE OF INJURY :
HOUR OF INJURY:
INJURY AT WORK:
PLACE OF INJURY:
LOCATION OF INJURY:
CITY, STATE, ZIP :
COUNTY:
•,
I
DESCRIBE HOW INJURY OCCURRED;
Pl.ACE Of DEA TH:. ~ONIE
' : FACtLITY OR .ADDRESS :· 1740 NE 16TH ST
· CITY , STA~,ZIP; RENJ'ON, WASHINGTON 98056-2650
RESIDENCE STREET: 1740 NE 16TH ST
chv, STATE, ZIP:"' RENTON, WA 98056-2650
INSIDE CITY LIMITS : YES COUNTY: KING
TRIBAl:'RESERVATION:· NOT APPLICABLE
LENGTH 9F TIME AT RESIDENCE: 50 YEARS
FATHER/PARENT: RONALD WIEHOFF
MOTHER/PARENT: ALVERNA PETERSON
METHOD OF OISP.OSITION: BURIAL
PLACE OF DISPOSITION: GREENWOOD MEMORIAL PARK
CITY. S1ME: t{l::N H)N, WASHINGTON
DISFOSJI iO!s ;:,ATE :. NOVE MBER 19, 2018
FUNERAL FACIUlY: GREENWOOD MEMORIAL PARK & FUNERAL HOME
ADDRE SS: 350 MONROE AVE NE
CITY ,'STATE • ZIP: ~ENT ON, WASHINGTON 98056
FUNERAL DIRECTOR: KENDRA C. BAUGHN
MANNER OF'DEATH: NATURAL
AUTbPS'(: UNKNOWN
WERE AUTO~SY FINDINGS~ VAILABLE TO COMPLETE
CAUSE OF DEATH: NQT APPLICABLE
DID TOBACCO'USE CONTRIBUTE TO DEA TH: UNKNOWN
PRE~ANGY .STATU~ IF FEMALE: NO RESPONSE
CERTIFIER NAME: ARUN VIJAY, MD
TITLE: PHYSIC~
CERTIFIER ADDR~S: 425 PONTIUS AVE NORTH
CITY , STATE, ZIP; SEATTLE, WA 98106
DATE.SIGNED: NOVEMBER 12, 2018
CASE REFERRED TO ME/CORONER: NO
, -., ' . f.!LE t-!l)Mt3ER: NQr APPLICABLE
,, ' .. ATTENDING.PKYSIGIAN: NOT APPLICABLE
IF TRANSPORTATION INJURY' SPECIFY: NOT APPLICABLE ~ ~ \ '. . . :, :,$ idci ofu~~ REGi~R: '. ~IANE BOGAN .. · -·,~ \•,,, · t be1TE J~ECEl'{,EO:''NOVEMBER,.1 5,2018
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2020 0EC-4 AMtt:22
Kff1G CuViT Y
SU?eRIOr{ COl!iH CLER~
KEIIT. WA
IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON
FOR THE COUNTY OF KING
IN RE THE ESTATE OF:
SANDRA LEE NIELSEN
NO : 20-4-06122-8 KNT
LETTERS OF ADMINISTRATION
DECEASED (L TRAD)
The above named decedent died intestate leaving property in Washington State subject to
administration. DOUGLAS A. NIELSEN is/are appointed by the Court as Administrator(s) and
authorized to administer the estate according to law .
BARBARA MINER
::g ~ Court :~::cy Cle~
Catt
• NOT OFFICIAL WITHOUT SEAL •
11· ' •
I, BARBARA MINER, Clerk of the Superi?r Court of the State of Washington:
for K ing Counly. do hereby certify that this copy Is a true and perfect transcflpt
o f said a·,g,na• as ,t appears on file and of record In my office and of the whole
ther eof :t.. ·r STIMONY WHEREO_F. I have affixed niECa~t ., •
co11 r: at ~Y : ,1 ,c e . at S eattle on this date __ __._...._ ____ ...::s._..,.,,v..
BARBARA MINER, Superior Court Cl erk
By a,~
Deputy Clerk A. SON
RCW 11.28. I 4 0; 11.28.280 revised : 04/20 17