1. Deceased name: Bernice J. Nash
2. Sex: Female
3. Date of Death: December 11, 1986
4. Age: 80
5. Date of birth: May 30, 1906
6. Race: white
7a. County of Death: Ramsey
7b. Location of death: St. Paul
7d. Hosp. or other instut.: St. Paul-Ramsey Medical Center
8. Birthplace: Wi.
9. Citizen of what country: USA
10. Married, Never married, Widowed, Divorced: Widowed
11. Spouse: Irving Nash
12. In armed forces?: No
13. Social Security Number: 471-05-8563
14a. Usual Occupation: Secretary
14b. Kind of business or industry: left blank
15a. Residence state: Minnesota
15b. County: Ramsey
15c. City, Village or Township: St. Paul
15d. Inside corporate limits?: Yes
16a. Father name: Charles Peterson
16b. Birthplace: unknown
17. Address of Deacent: 224 No. Smith, #17 St. Paul, MN
18a. Mother maiden name: Alma ?
18b. Birthplace: unknown
19. Informant: A. Mortimore, 14 Cross Way Drive, Circle Pines
20a. Death was caused by: Cardiac respiratory arrest due to interabdominal sepsis and Necrosis of right colon
Chronic alcohol abuse
23a. physician attended him from 11-24-96 to 12-11-86.
23b. Medical Examiner pronouced death on 12-11-86
23c. Physician: Lynn D. Solem, M.D.
24a. Burial Cremation: Burial
24b. Roselawn Cemetery, Roseville, MN
25a. Funeral home: Godbout & Sons
25b Funeral home address: 560 W. 7th, St. Paul, MN 55102
26a. Filed 31 Dec 1986
Signatures of Registrar and Mortician