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

--'5+'-22
YES
FATHER· NAME

MIODLE

<:2,~·c,~. ~

25

INSRMANT' NAME

27

'"

\ \-...

MAIDEN

26

-",.

.

'-~\'~\,\

.....

<.c~<,,',\\o. \'\,,\

MAILING ADDRESS

t,,,,, \<::\1

"' ...... r

2801

l

'

oS"\"

PART 1. OEATH WAS CAUSEO BY (ENTER ONLY ONE CAUSE PER LINE FOR (a), (b) AND (e»)
IMMEDIATE CAUSE

30

10

da. >

12

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.

'"1../

Day

Y_

It;

:N COMPLETED, this form attended tile deceued '"""
.,.-- .t:I --c 2-.
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
(OateP""~
>ccurred.
010
C v..
I!!J No 41
42
1

31

CERTIFIER· NAME (type or prInO

VeA.~

a~rt.

MAILING· CERTIFIER

STREET

R.F.D. NO-

ale, - IJ.t,w /lA.>/<M. 110
BURIAL. CREMATION, REMOVAL (~

;p\.:, ~, 0... ' OED AREA: to be com·
by physician.

LICENSE NUMBER

HADED AREA: to be com·
'Jy Funeral Director.

C'.-

~~-k.f¥.~~~tQ~~~~~""'T-:::-:-_--1~W;:J:.:..l.:W::.l:::::a.....:~....I-.~~~~i:-_______...ll55~\~~'·~~2...,~aL__

I.certify that this is a true transcript of the inf

v. Lyn , Registrar
Carol ngobardi-Fortier, Deputy Registrar
{\ffa DeGaetano, Ass I t Registrar
, 1999.
Dated at New Haven, COnilecticuc, U.S.A., this _ _ day of MARCH
~'r""I'n

"'TkT~

..... _ _ _ _ _ _

SL-12513