VIRGIN ISLANDS OF THE UNITED STATES



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._ 302 TY DEPARTMENT OF HEALTH f— 153-22-000302

ER a TYPE, OR PRINT IN “LOCAL. FILE NUMBER CERTIFICATE OF DEATH STATE FILE NUMBER

ED fe) PRMANENT UNK / DECEASED — NAME FIRST MIDDLE LAST SEX DATE OF DEATH ( MONTH, Day, YEAR)

SHE HANDS00K: FOR Te

INSTRUCTIONS «=f, Ryan William Greene , Male |, October 16, 2022

RACE AGE. UNDER | YEAR UNDER 1 DAY DATE OF BIRTH COUNTY OF DEATH

. MOS, | DAYS | HOURS IN.

,. White » 0 |, be |, Dec. 16,1971 |, St. Thomas

a CITY, TOWN, OR LOCATION OF DEATH | Pra 3c regina HOSPITAL OR OTHER INSTITUTION —NAME <r ae IN EITHER. GIVE STREET AND NUMBFR }

a a2 z | CoaSton ;, Charlotte Amalie _ ya, Peterborg Via Little Magens

od = — - — ——

ra} a a ca * STATE OF BIRTH (IF Not IN U.S.a., MAME/CITIZEN OF WHAT COUNTRY MARRIED, NEVER MARRIED, SURVIVING SPOUSE ¢if WIFE, GIVE MAIDEN NAME)

ww 8 oy WIDOWED, DIVORCED ¢ sreciry)

5 aA 2 — wat Reswence | 8 Fort Worth, TX s US haMarried but separted |». N/A

3 . 3} 5 VED. gd DEATH SOCIAL SECURITY NUMBER USUAL OCCUPATION {GIVE KIND OF WORK DONE CURING MOST.OF [KIND OF BUSINESS OR INDUSTRY

CURRED IN

2 Pe, = INSTELUTION, GIVE 451-79-6647 Lawyer Law Office

a Secon ee RESIDENCE BEFORE 12. 130 13b

2 & w“ ADMISSION. RESIDENCE— STATE COUNTY CITY, TOWN, OR LOCATION: INSIDE City LimiTs [STREET AND NUMBER

o + . PECIFY YES OR NO

o SW c| & <p v4 USVI w ot. Thomas |, Charlotte Amalie ieee: 15 B Norre Gade

+4

Fs Y S = FATHER —NAME Finst MIDDLE tast | MOTHER— MAIDEN NAME First MIDDLE Last

3s £3 < Richard Greene ‘i Karen Dodson

=} q

2 £. ee = INFORMANT—NAME . MAILING ADDRESS ISTAEET OR R.F.D. NO., CITY OR TOWN, STATE, ZPP}

SE ae Kelly Tepera 3908 Sagamore Hill Ct. Plano, TX 75025

)

o 9 EB 5 (PART I. - DEATH WAS CAUSED BY: [ENTER ONLY ONE CAUSE PER LINE FOR (0), (b), AND (<)] Setdtete ONEET ant Gest

& f yd ow 18. IMMEDIATE CAUSE :

3 s 2 D

, rowning

2 8 O-@ lo)

2 ’

& EB

2 |g s ¢ cowomrions, wants [iy

e 5 z ea stating aie UNoeK: DUE TO, OR AS A CONSEQUENCE OF:

— = N -

2 5 28| qm ©

o o}]o = PART |t. OTHER SIGNIFICANT CONDITIONS: CONDITIONS CONTRIBUTING TO DEATH GUT NOT @ELATED TO CAUSE GIVEN IN PART | io! ” AUTOPSY IF YES WERE FINDINGS CON-

5 8 3 & Y po DETEQMINING CAUSE

F SI = 1w, YES 19b Yes

ce) 8 aS eae JOATE OF INJ URY (MONTH, OAY, YEAR) [HOUR HOW INJURY OCCURRED ( ENTER NATURE OF INJURY IN PART | O8 PART II, ITEM 18)

2 a 3 Xe 20 Accident on, October 16, 2022 wm: 1808 4 |r Drowning

a] = ar 2 = INJURY AT WORK PLACE OF INJURY LOCATION ( STREET ON BLF,D. NO., CITY OR TOWN, STATE}

= = FS Fs es L 2», No 201. Magens Bay Beach a;. Magens Bay Beach-Petersborg St. Thomas, VI

By = °o 8 D ( CERTIFICATION— MONTH DAY YEAR | MONTH DAY YEAR AND LAST SAW HIM/HER ALIVE ON |) 010/010 NOT VIEW THE] DEATH OCCURRED al THE PLACE, ON THE

E S 3 | 5 CTA 1 MONTH DAY —-YEAR-—s| BODY AFTER DEATH. (HOUR) DATE, AnD, To TAE BES)

[aa fl ok Qo. DECEASED FROM tm : 2c. 2d. 2le. M. TO. THE CAUSES! STATED.

be 3 BoA f  CERTIFIER | pene OCCURRED ON THE DATE AND DUE TO THE CAUSE(S) STATED. ; me October 1 6, 2022 1808 ,

a = CERTIFIER— NAME (TYPE OR PRINT SIGNATURE ; DEGALE OR TIME DATE SIGNED imOntn, DAY, ¥EART

S 4 tbe Tanicisco Landron a, /s/ Francisco J. Landron MD rx. October 25, 2022

w 89 234. Schneider Regional Medical Center St. Thomas, Virgin Islands 00802

> Ei BURIAL, CREMATION, REMOVAL CEMETERY OR CREMATORY—NAME LOCATION

co 2 Mc. Cremation a, !umbull's Funeral Home & Crematory |,,. St. Thomas, Virgin Islands

TT x, P BURIAL = BONG FUNERAL HOME—NAME AND ADDRESS

> oO 24d. 0 Turnbull's Funeral Hot Home & Crematory 3815 Crown Bay # 10 St. Thomas, VI 00802

ig ti N FUNERAL cane pared Gumb REGISTRAR —SIGNATURE DATE RECEIVED BY LOCAL @FGisTear

O E Dy A 25h, s/ Judith Gumbs 2bo. /s/ Lorraine Benjamin-Matthew ub, October 27, 2022

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