Originator: DALLAS HEALTH DEPARTMENT
Document date: 8/4/76
Document type: PAPER-TEXTUAL DOCUMENT

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JFK Assassination System

Identification Form

Agency Information

Date:

10/14/20

AGENCY :

RECORD NUMBER :

RECORD SERIES :

HSCA

180-10078-10273

NUMBERED FILES

AGENCY FILE NUMBER : 009177

Document Information

DALLAS HEALTH DEPARTMENT

ORIGINATOR :

FROM:

TO :

TITLE :

DATE :

PAGES:

SUBJECTS :

08/04/1976

HUBBARD, BOBBY

DOCUMENT TYPE :

OTHER TEXTUAL

CLASSIFICATION :

Unclassified

RESTRICTIONS :

Open in Full

CURRENT STATUS :

Redact

DATE OF LAST REVIEW :

07/22/1993

OPENING CRITERIA :

COMMENTS :

Death certificate. Box 169.

Releaned anden ore Foar E. Kernedy Panamairester Recoade Seibeobier Bos eE 2302 144 298 225

LCaaeE:07 E5823 Dabei 02-05-205B

v9.1

NW 55923

DocId: 32248215

Page 1

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WEIN IMPRESSED WITH THE SEAL OF THE CITY OF DALLAS,

THIS IS CERTIFIED TO BE A TRUE COPY OF, THE-PERMANENT

RECORO AS FILED IN. THE BYREAU OF VITAL

ISSUED: APR 15:1978

• LOCAL REGISTRAR

1 Vived

DALLAS HEALTH DEPARTIENT

00917%

STATE OF TEXAS

1: FLACE OF DEATH

• & COUNTY.

DAllAS

b. CiTY OR TOWN:! a

side city imit

LENGTM OF STAY

CERTIFICATE OF DEATH.

DIATE HE TO

7. USUAL RESIDENCE CARONO

CITY OR TOWN If outside city fort o

45 am D, 7/135

d. NAME OF IF

DAIDS

notatoro

HOSPITAL

OR

:INSTITUTION

A IS PLACE OF DEAIM INSIDE CITY

PARKLAND MeniliAL Hesp

124. 10.

DeNVeR

¡ RESIDENCE INSIDE CITY LIMITSI

¡I. IS RESIDENCE ON A FARMI

B. COLOR OR RACE

beNe

aried I Me Maried!

HUEBARD:

АКЦЕТ 4 1976 007S

80. 4194-

TEXAS

USA

WiLLie DelberT HunteD

ToMisoN

I8: SOCIAL SECURITY NO.

IT 64673 At Sue Sellail

MEGAT CAUSE CUS MATU

RT. 1. OTHER :

SCARCAN CONOMONO CONE SUING TO GEATH

MOMCIO

20& DESCRIBE MOW IMAR

IAL. DISEA

YESO

NARY OCCURRE

As cord till ald to decond th

Сеті піст темо

110376

Do los

5840

TEXAS

REGISTRAN

AUG 26-1976

TO CITY. TOWN OR LOCATION

COUNT

and lois in the

62011

TRi MAME OF CEMETERY OR

8-18-216

LAU/EL LIAND

29 GUNERAL DRECTORS SENATUS

LAmm-s min Chalilate

Ishnsies P. Wielis

signature of witness

signature of investigator

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