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SACRAMENTO COUNTY
DEPARTMENT OF HEALTH AND HUMAN SERVICES
3052011022395 CERTIFICATE OF DEATH 3201134001008
STATC OF CAJTCWM
• BUCK MK OeUf / MO ERASURES WHfTEO' TS OR ALTEMIKH&
STA'^ FU MJMM »S-1WHEVJ«| LOCAL REOSTRATION NUMBER
t . NAME OF DECEDENT- FIRST (Given) 2. MIDDLE 3. LAST (Famey)
PAUL MARTIN TONSING
F U N B 0
AKA. ALSO KNOWN AS - Include ful AKA (FIRST. MIDDLE. LAST) 4. DATE OF BIRTH mm/dd/ccyy 5.AGSYrs. |_ ^ ^r^ f .NOER24HQ_-£ 8. SEX
Montta I Days
03/03/1917 93 M
9. BIRTH STATE/FOREIGN COUNTRY 10. SOCIAL SECURITY NUMBER . EVER IN UA. ARMED FORCES? ' 2. MARTA. STATUS^ RD-* IM Tmt ol DaM 7. DATE OF DEATH I. HOUR (24 Horn)

KS 300-10-8109 H«* D* D1
YES I I NO
14/15. WAS DECEDENT HISPAWC/LATHO(AySPANISH? ,W yw. Ma «rcreeheet on beet)
I I UNK DIVORCED
16. DECEDENT'S RACE - Up to 3 racie may t e k
02/04/2011 1140

• v t s [ x ] N O W H I T E
HS GRADUATE
7. USUAL OCCUPATION - Type of work lor moal of Me. DO NOT USE RETIRED 16. KIND OF BUSINESS OR INDUSTRY (a.g.. grocery atom, road constructor., employment agancy, ate.) 19. YEARS IN OCCUPATION

CEO OWNER PRINTING 60

20. DECEDENT'S RESIDENCE (Street and number, or

8052 SUNSET AVENUE

<£ 21.CITY 22. COUNTY/PROVtJC E 23. OPCODE 24. YEARS IN COUNTY 25. STATE/FOREIGN COUNTRY

FAIR OAKS SACRAMENTO 95628 CA

26. INFORMANT'S NAME. RELATIONSHIP 2 r INFORMANT'S MAILING ADDRESS (Straat and nun*er or rural route numbar. city or town, state and np)

1! RICHARD TONSING, SON 4742 BAMBOO WAY, FAIR OAKS, CA 95628

28. NAME OF SURVIVING SPOUSE/SRDP'-FIRST 30. LAST (BIRTH SJAME)

31. NAME OF CATHER/PARENT-FIRST 32. MIDDLE 33. LAST 34. BIRTH STATE

PAUL GERHARDT TONSING OH

35. NAME OF MOTHER/PARENT-f WST 37. .AST (BIRTH NAME) 36. BIRTH STATE
—
RUTH MARTIN KS
39 .DISPOSITION DATE mrrVdd/ccyy 40. PLACE OF FINAL OISPOSTTION S A C R A M E N T O V A L L E Y N A T I O N A L C E M E T E R Y
02/09/2011 5810 MIDWAY ROAD, DIXON, CA 95620
UJ </>
41. TYPE OF DBPOSmONTS) 42. SIGNATURE OF EMBALMER LICENSE NUMBER

BU • JOHN BARTEL EMB7315

|| 44 NAME OF FUNERAL ESTAB JSHMENT
NORTH SACRAMENTO FUNERAL HOME,
45. LICENSE NUMBER 46. SIGNATURE OF LOCAL REGISTRAR 47. DATE mm/dd/ccyy

ML
FD720 • GLENNAH I TROCHET, MD 02/08/2011
101. PLACE OF DEATH I02.IF HOSPITAL SPECIFY ONE

MERCY SAN JUAN MEDICAL CENTER • — D S T C D S T D

as 104. COUNTY 105. FACILITY ADDRESS OR LOCATION WHERE FOUND f 106. CITY

5 o SACRAMENTO 6501 COYLE AVENUE CARMICHAEL

107. CAUSE OF DEATH inter the chiai of events — daesesi. rvunes or comefceoone — that ctrec* ce-aeo death DO NOT ante' terrinal events i-cn K B . DEATH REPORTED * 0 C O R O * "
as cardnc arrest respirator) arrest or ve-Mx Jar Ibrlabcn without s-ounrg the etiology. DO VOT ABBREVIATE.
FX]YES [JNO
IMMEDWTECAUSE w RESPIRATORY FAILURE (AT)
(Final disease or ^
conditio- r HRS 11-00649""
109. BIOPSY PERFORMED''
"" CONGESTIVE HEART FAILURE
YRS D** Lx]K
leading to cause
on una A. Enter
UNDERLYING
CAUSE (disease or
mmry that
c

-
CARDIOMYOPATHY
V ^ r 5
^ % YRS
110. AUTOPSY PERFORMED?

[JYES [X]NO
m
t?X$r
initiated the events IL 111. USED R\ DETERVMNC CAUSE'
resulting in death) LAST
[ J Y E S • « )

112. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RESULTING IN THE UNDERLYING CAUSE GIVEN IN 107
HYPERTENSION, ARTERIOSCLEROTIC HEART DISEASE
113. WAS OPERATION PERFORMED FOR ANY CONDITION IN TEM 107 OR 112? (If yes. est type o' operation and dale.) 113A F FEMALE PREGNANT H LAST YEAR?
im
NO • YES [ J K C • U\K

115. SIGNATURE AND TITLE OF CERTIFIER 116. LICENSE NUMBER 117. DATE mm/dd/ccyy

II Decedent Last S H - Alive • CHANDAN DEEP CHEEMA M.D. A47747 02/08/2011

(A) mm/dd/ccyy (B) mm/dd/ccyy 11rj. TYPE ATTENDING PHYSICIAN'S NAME. MAILI\G ADDfifSS. ZIP CODE
CHANDAN DEEP CHEEMA M.D.
02/09/2010 12/15/2010 6608 MERCY COURT STE C, FAIR OAKS, CA 95628
119.1CERTF" THAT N MY OPNON DEATH OCCURRED AT THE -Z.H r»TE. A t * PLACE STATED FPOM THE CAUSES STATE: 120. INJURED AT WORK? 121. INJURY DATE mm/daVceyy 122. HOUR (24 Hours'
rv-ong 1 Could
SeatJnoIhe
Qvts Q N O QUNK
MAVNFR OF D ' A - I I | | Naluial | | A c j J e n l j [ Humtada | | Sue.*, [ " "
trNaaajajeVO • daton

123. PLACE OF INJURY ( a * , home,

124. DESCRIBE HOW INJURY OCCURRED (Ev

125. LOCATION OF INJURY (Street and number or location, and city, ana op)

126. SIGNATURE OF CORONER / DEPUTY CORONER 127. DATE mnVdd/ccyy 128. TYPE NAME. TTTLEOF CORONER/DEPUTY CORONER
I
CENSUS TRACT
IIIIIMMrillNIIIIIIiWIIlHl
•010001001702468*

CERTIFIED COPY OF VITAL RECORDS

STATE OF CALIFORNIA
COUNTY OF SACRAMENTO
!> s s iiiiiiiiiii
* 00 1 195029 *
This is a true and exact reproduction of the document officially registered and placed on
file with SACRAMENTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES.

DATE ISSUED:
February 9, 2011 LOCAL REGISTRAR

This copy not valid unless prepared on engraved border displaying date and signature of Registrar.
tliiXtitinrrfJl
'.•'UTS..'ANY ALTERATION OR ERASURE VOIDS THIS CERTIFICATE
•.•Mi