STATE FILE NUMBER 2001-MN-517845 LEGAL DATE FILED JUNE 21, 2001 MEDICAL DATE FILED JUNE 21, 2001 FIRST NAME EVELYN MIDDLE NAME MELEN LAST NAME DONAHUE MAIDEN NAME PREFIX SEX FEMALE DATE OF DEATH JUNE 07, 2001 DATE OF BIRTH JULY 05, 1914 BIRTHPLACE MENOMONIE, WISCONSIN SSN 477-03-7090 AGE 86 YEARS FATHERS NAME EDWIN HELSOM MOTHERS NAME ELLA DENIS MARITAL STATUS DIVORCED SPOUSE’S NAME RACE WHITE HISP ORIGIN NON-HISPANIC EDUCATION 12 = GRADE 12 OCCUPATION CLERICAL U.S. VETERAN NO INDUSTRY PATTERSON DENTAL SUPPLE RESIDENCE 825 SEAL STREET #703 SAINT PAUL, MINNESOTA 55104 COUNTY RAMSEY INFORMANT’S NAME MICHAEL J. DONAHUE INFORMANT’S RELATIONSHIP SON INSIDE CITY LIMITS YES PLACE OF DEATH MN HOSPITAL FACILITY/ADDRESS SITE OF DEATH IN HOSPITAL INPATIENT CITY, STATE OF DEATH SAINT PAUL, MINNESOTA COUNTY OF DEATH RAMSEY DISPOSITION METHOD DISPOSITION DATE JUNE 11, 2001 CEMETERY NAME ROSELAWN CEMETERY CEMETERY CITY, STATE ROSEVILLE, MINNESOTA CREMATORY NAME CREMATION AUTHORIZER FUNERAL DIRECTOR 3384 FUNERAL HOME 0219 HOLCOMB-HENRY-BOOM FUNERAL HOME PHYSICIAN LICENSE NUMBER 24492 HIPAA NUMBER PHYSICIAN NAME MICHAEL B MCGEE, M.D. PHYSICIAN ADDRESS 300 E UNIVERSITY AVENUE ST PAUL, MINNESOTA 55101 CAUSE OF DEATH LINE A CARDIORESPIRATORY COMPLICATIONS OF IMMOBILIZATION CAUSE OF DEATH LINE B HIP FRACTURE CAUSE OF DEATH LINE C FALL TIME OF DEATH 22:30 FOUND PREGNANT AT DEATH NO PREGNANT LAST 12 MONTHS NO MANNER OF DEATH ACCIDENT AUTOPSY NO AUTOPSY RESULTS ME/CORONER NOTIFIED YES DIAGNOSIS DEFERRED INJURY OCCURRED INJURY ADDRESS 825 SEAL STREET #703 ST. PAUL, MINNESOTA INJURY COUNTY INJURY DESCRIPTION FALL PLACE OF INJURY DATE OF INJURY JUNE 07, 2001 TIME OF INJURY FD: 1 INJURY AT WORK NO |