GEORGIA DEATH CERTIFICATE
Slate PIN Number 20156A00002602?l

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. LEGAL FULL NAME IFirsl. Middle. LDSI) 1111. FEMALE. ENTER LAST NAME AT BIRTH . 2. SEX I 221. DATE OF DEATH (MD. Day. YBar]
MATHEW NIALE ACTUAL DATE OF DEATH 0110212015
'i'??oc?wsimij??f 113. 795m;? RE UNEER 1 {"57 BATE . Day. Year)" 
1' WE ans' 
21 i I I 0310711993
EQUENEETSWE 7'5. comb-1,? "2'76  T?w? - ?u
NIGERIA GEORGIA ICHATHAN SAVANNAH

. 
Ba USUAL OCCUPATION I an KIND OF INDUSTRY OR BUSINESS
BANKER I FINANCIAL INSTUTION
0. mm STATUS "1?16. I 
NEVER MARRIED .  SOLOMON AJIBADE
MAIDEN NAME Last) ?j 
HANNAH AJIBADE  CHRIS DLADAPO I BROTHER
m- mu- -m Inna-nuns: 
I SONE COLLEGE CREDIT LEADING To A DEGREE
15.0RIGIN DP Em.eIc.} 316. "m  
No. NOT SPANISHII-IISPANICILATINO NOLOETAEIABLE 
17:. IF DEATH OCCURRED IN HOSPITAL . 110 DEATH OCCURRED OTHER THAN HOSPTTAL 150001111)
iqum?m 959.32% 
1B. HOSPITAL OR OTHER INSTITUTION NAME 1111mm either give smear and no I I 19. cum-Tom or LOCATION or Dam-I i 20. COUNTY OF DEATH
DRIPPIN DRIVE A SAVANNAH i CHAN
f? 
BURIAL . in. 0111112015
211: WE I 2411 ENDALHER CIEENSE ND. 7 25. 
DAVID LEONARD CAMPBELL SR I 2957 - I SIDNEY A JONES AND CAMPBELL Fa
[2?59. FUNERALHONEADDRESS . 
124 IN PARK AVENUE SAva GEOREIA 31401 _w . 
20a. SIGNATUREOEPUNERAL DIRECTOR 2012. FUN. DIR LICENSE NO ANENDMENTS
DAVIDLCAMPBELLSR . . -  .. I . . .. .
27. DATE PRONDUNCED DEAD M. Day. Year) 20. HOUR PRONOUNCED DEAD 
01102120161 {03:45 All . 
29a NAME 200. LICENSE NUMBER . SIGNED
I .: 01102120151-
30. TIME OF DEATH 31 WAS CASE REFERREDIO MEDICAL EXAMINER
. . .


A BLUNT FORCE TRAUNIA MINUTES 
MMEDIATE CAUSE (le 
dmdeud?anm?mh Mudflatle .
B.
DTIID. Dru-mot 
C. 
Dana's-m1!
0' . . 
Pan II. Enter mm IP death bit no1 related to cause i 3:1. WAS AUTOPSY 34. FINDINGS AVAILABLE TO .
g?nn'l'lf'al'l 1A. opp-551117
 WES. 
35. TOBACCO USE CONTRIBUTED TO DEATH 311 IF FEMALE (w 10-51) PREGNANT I 37. ACCIDENT. SUICIDE, HOMICIDE. UNDETERMINED {Specify}
NO NOT APPLICABLE - - . -
30. DATE OF INJURY . 30 TIMEOF 40 PLACE INJURY (Horne, Farm, snai'Eanry. O?ce. _'?7111 KT 111012111 [Yes or NO) 
0110112015 I 23:38 .  D,   
42. LOCATION OF INJURY City or TOWN. State, Zip. County)
1050 CARL GRIFFIN DRIVE SAVANNAH GEORGIA 31405 CHATHANI I 
4:1. 
PHYSICAL ALTERCATION ENFORCEHIENT PERSONNEL 
45. To the 01.521171 :15th occurred and pIace' 'j 46'. '06 11130?31115 ot'eia'mznanon andIc? inUe?slig?DIEO. in an The Iumefaata 
and due IO Ihu cause?(s] sialed. MadIcal Oer??nr (Hm. LICense .3 and phi: and? In Oman) Sim Medina? ExaminerI?CDrOner (Name. Title, Lian? NO.)
I 131 WILLIAM WESSINGER DORONER
450. DATE 0:117:11)  HOTJR OF DEATH 
0510012015 00:40 AM

 

 

NAME. ADDRESS. AND CODE OF PERSON 
WILLIAM WESSINGER 602 67TH STREET SAVANNAH GEORGIA 31401

40.REGISTRAR T39. . F?ar) 
- {Sf DONNA L. MOORE
?Wm?  0511212015

Fu'm 3M3 (Rev. 0452012). GEORGIA DEPARTMENT OF HUMAN RESOURCES DO NOT FOLD THIS CERTIFICATE