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Elizebeth Short ‘FULL NAME Tr c) NAWE OF HOSPITAL OR INSTITUTIO! hetween i: Cc: ¢ » CITY on TOM! ROT 16 MOSPITAL O8 is Cod Gidorsine ery On TowN LIMITS, (€D) LENGTH OF STAY: (Sreciry WHETHER YEARS, MOM: . < tm Hosprrat on ixstiTuTI0 Locos Sracer Wo. RK OWN In THIS CONMUNT : unkno ‘CALIFORNIA 0. DATE OF DEATH: Monts + ex) Te roneicn son, WOW LONG IM THE U. S_ Ate ‘3. ce) IF VETERAN, NAME OF WAR JS. cr» Sociat Security Nol] 21, MEDICAL CERTIFICATE . - § 22, CORONER'S CERTIFICATE no unknown ad MenERE Cearift, Tuar ¥ atrEnpeo| nest’ CERTIFY, THAT YHELD Ax THe DECEASE : \ 4. SEK 5. COLOR OR RACE 6. (aD ess. ‘MaRRieD, WiD0! female | cauc t single fog tn ane ENE OE Bes 6. cay NAME OF HUSBAND OR WIFE |6.ce) AGE OF HUSBAND * = — — i __veans || ox —_—___———-19___} ee AND THAT DEATH OCCURR ~-HAanD HOUR STATED ABOVE. i iM ‘DURATION BIRTHDATE OF DECEASED. vox haa aT IMMEDIATE CAUSE OF DEAT! 8. Ae 22 nse 5 wo 15 whe | ‘9. BIRTHPLAC! ie Park CASS. fo, Usuai Occuration__Wwei tress 11, Inoustay or Business Te S taupent_. : Gleo Alvin Short ae oer rrinia = : Phoebe M Sawyer acon ADE. awyer. - - Medford Mas ; ‘ . 10.62 Be iD ma Berkeley (Cal St onvomtene . a Euaauens) Zt 7 7“ Ticen: Ge) Were Dio Euonuens/ Zee 7 @7LL E/E ZO | Tien oceunds ! H . ¢o) pio mauny dccon im ONASOUT HOME, ON FARK, IN INDUSTRIAL PLACE, OR IN » PUBLIC PLACE! WHILE AT . see oa 1) MEANS OF 1NJUNT_A mTORN ¢) FUNERAL Director 24, CORONER'S of, f > Rabrsictae SIGNATURI OPEC, HID Kooress hee coe ear CERTIFICATE OF DEATH This eto cart that this document I a true copy of ho offical record fled with the Reglétrar-Recorder/County Clark, Sas CHARLES WEISSBURD. : : Recistrar-Recorder/County Clark . » 19-0998245 This copy not valid unk ‘ iisplayi : , This copy not valid unless prepared on engraved border displaying the Seal and Signature of the, AHHH,