Lewis v. Commissioner
Filing
200
DISCOVERY ORDER (see attached) and corresponding Exhibits. Signed by Judge Charles S. Haight, Jr. on May 3, 2013. (Dorais, L.)
Case 3:03-cv-00196-CSH Document 198-3 Filed 05/02/13 Page 1 of 1
VS04 REV. 11/88
STATE OF CONNECTICUT
DEPT. OF HEALTH SERVices
CERTIFICATE OF DEATH
STATE FILE NUMBER
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YES
FATHER· NAME
MIODLE
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25
INSRMANT' NAME
27
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MAIDEN
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MAILING ADDRESS
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PART 1. OEATH WAS CAUSEO BY (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b) AND (e»)
IMMEDIATE CAUSE
30
10
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coNomONs. IF ANY
WHICH GAVE RISE TO
IMMEDIATE CAUSE(aI
STATlNGTHE
UNDERLYING CAUSe
da. s
LAST.
31
NURSE PRONOUNCEMENT
TYPE OR PRINT NAME
34
CERTIFICATION· PHYSICIAN Mel.
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Day
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:N COMPLETED, this form attended tile deceued '"""
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be sent to the registrar of r.W:-:AS::-::CAS=E=-=RE=FE=R=RE=D=-=TO::-T":!!U~RG=ER=Y~R::E::-LEIl=)I.~NT=TO~CO=N~Tm=O=N~R=EPO=RTE=D='N~rre=M":"3=o:-~-~:==:=~~~:=::=::-=:-::-::=-===-"::'::'==~=iltistics in the town where MEDICAL EXAMINER/
(NameolO.,.,.1Ior1
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>ccurred.
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CERTIFIER· NAME (type or prInO
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MAILING· CERTIFIER
STREET
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