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ckinimeate OF DEATH FILE NUMBER 2022021078
2 SEK “Sa. DATE OF DEATH rR a
ty , DECEDENTIS
LEGAL NAME (incite AKAs ary) (Fist Mise, JUL. 14, 2022
NELSON WAYNE LANGFORD t
Be : ‘© SOCIAL SECURITY NO. Ba AGED Last Birthday ‘5b. UNDER
1 YEAR ‘Se UNDER
1 DAY ©OATE
OF BIRTH 7. BIRTHPLACE (Giy and Sie o Foreign Carty)
(reas) | [Months] Oays oe MAY 30, 1930 HECTOR, AR
92
“Ba, RESIDENCE STATE or FOREIGN COUNTRY Bb. COUNTY ¥e. CY OR TOWN,
RUSSELLVILLE
ie ‘Ge APT_NO. BZIP CODE aaa gt
‘Ga.NUMBER
AND STREET 72802-8028
601 DARBYLN
'G EVER INUS ARMED FORCES? 70. MARITAL STATUS AT TIME OF DEATH | Ti SURVIVING SPOUSEIS NAME Qi wie, give name pari rt masaga)
(NOT REMARRIED) Tae. COUNTY OF DEATH
Yaa. IF DEATH OCCURRED IN A HOSPITAL | 125, IF DEATH OCCURRED SOMEWHERE OTHER THAN A HOSPITAL
“12d. FACILITY WAME QV nctineiison
give ran ‘2a: CTY OR TOWN: Yai 2 CODE
3,
\S HOSPICE - RVERVALLEY HOME RUSSELLVILLE ISSELLVILLE 1-500
TS FATHERS NAME (Ft tide, Las Ta MOTHERS NAME PRIOR TO FIRST We, Last)
OLAN LANGFORD. FAYE Tan
752 MAILING BODES prow to Oe a PO Cy, Sate
(2) Sa INFORMANTIS
NAME
DON LANGFORD.
ce RELATIONSHIP TO DECEDENT
| 12322 MEYER RD, MABELVALE, AR, 72103-2612
Ry
‘160, METHODOF DISPOSITION: es
6b, PLACE OF DISPOSITION (Nae cd caret. ceratay ter
‘SHILOH-WILLIAMSON,
‘7a. EMBALMERIS NAME 7b. EMBALMERS Tie. SIGNATURE (FUNERAL SERVICE LICENSEE OR OTHER AGENT)
JOSEPH CRIMM: Ie) PAMELA
J PEAK SMITH Ry
2 T7e. LIGENSE #
7a NAME AND COMPLETE ADDRESS OF FUNERAL FACILITY 4663 ei
RUSSELLVILLE FAMILY FUNERAL, INC.
Se
2757 E, PARKWAY DR., RUSSELLVILLE, AR, 72802
Ba Téb, TIME PRONOUNCED
DEAD. “e. NAME AND TITLE OF PERSON PRONOUNCING DEATH (PRINT TYPE) i
i
JUL, 14, 2022 JEFF PLEDGER, nt
ft
20, PART L Enter the
‘ventricular creas shorn toon
Taced the gaat 00 NOT rir farming vents such ax cre aes,
onesies esaaence ‘Enter only one cause on a line, oars
Be
wi
(Fina choase or a _GHRONG SYSTOUG HEART FAURE
resufing in death)
iat condone,
Daven iamnee
pp
a) ‘ary, lacing io be cause Tanya tame
on ne a. Enter the
) ‘UNDERLYING CAUSE
(eisoane 6 npr that Darbar
Ke ‘wating
the events
in death) LAST.
‘ia, WAS AN AUTOPSY PERFOR
|x
‘PARTI Emer otrer foniicant condiions continuing io daaih,but not resulting in he underying cause given in PART |
Bib, WERE, FINDINGS AVAILABLE TO COMPLETE
‘THE CAUSE OF DEA 4
122. MANNER OF DEATH
"23, DID TOBACCO USE CONTRIBUTE
u
NATURAL
TO DEATH? hf FEMALE ®)
336 TIME OF INUURY Bic. PLACE OF INJURY (ag Decode hare, conarctan ia reviaart wooded a8) i= TNUURY AT WORK?
‘Ba. DATE OF INJURY (MatDay¥)
x ‘Se. LOCATION
OF INJURY: (limba, Stat Aoarmnect No Cy, Ste,
Zp Coxe)
Bi. DESORIBE
HOW INJURY OCCURRED: Zig. F TRANSPORTATION
INJURY, SPECIFY
"B6a. CERTIFIER(Check only on8) ei
B Hospice galore Mee =the best t my krowndge, ath occred vt he cause) ard manne stated.
SIGNAT JEFF A PLEDGER HOSPICE RN DATE: JULY 21,
TMIAILING ADDRESS OF PERSON SIGNING ITEM 260. ‘28c, LICENSE #
PLEDGER, HOSPICE RN
220 JOHN BABISHLN, RUSSELLVILLE, AR, 72801-4500 a
‘7b. FOR REGISTRAR
ONLY - DATE FILED
AS an Deny A e411 => .
SF
~ wt
en
es)
i
ARTEWO THIS 1S TO CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT COPY OF T
FILE IN THE ARKANSAS DEPARTMENT OF HEALTH.
ERTIFIGATE ON
Ry
thinkLouie Lent 7900104 wi
SEAL Sine jogistrar
Manian ees JU L 2.7 2022 a
) Orne
eho. WARNING:
‘A REPRODUCTION OF THIS DOCUMENT RENDERS IT VOID
iy UNErSS EMBOSSED SEAL OF THE ARKANSAS DEPARTMENT OF |
30,0 NOT ACCEFT
TH IS PRESENT.
FTISHLLEGAL TO ALTER OR COUNTERFEIT, THIS DOOUMEN
z
ee aa
i Tors mr
0 7 a
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Gs aa Sako i Pa WVAWUDRO) 9 BLS ay . ena a i tH Mt | ckinimeate OF DEATH FILE NUMBER 2022021078 2 SEK “Sa. DATE OF DEATH rR a ty , DECEDENTIS LEGAL NAME (incite AKAs ary) (Fist Mise, JUL. 14, 2022 NELSON WAYNE LANGFORD t Be : ‘© SOCIAL SECURITY NO. Ba AGED Last Birthday ‘5b. UNDER 1 YEAR ‘Se UNDER 1 DAY ©OATE OF BIRTH 7. BIRTHPLACE (Giy and Sie o Foreign Carty) (reas) | [Months] Oays oe MAY 30, 1930 HECTOR, AR 92 “Ba, RESIDENCE STATE or FOREIGN COUNTRY Bb. COUNTY ¥e. CY OR TOWN, RUSSELLVILLE ie ‘Ge APT_NO. BZIP CODE aaa gt ‘Ga.NUMBER AND STREET 72802-8028 601 DARBYLN 'G EVER INUS ARMED FORCES? 70. MARITAL STATUS AT TIME OF DEATH | Ti SURVIVING SPOUSEIS NAME Qi wie, give name pari rt masaga) (NOT REMARRIED) Tae. COUNTY OF DEATH Yaa. IF DEATH OCCURRED IN A HOSPITAL | 125, IF DEATH OCCURRED SOMEWHERE OTHER THAN A HOSPITAL “12d. FACILITY WAME QV nctineiison give ran ‘2a: CTY OR TOWN: Yai 2 CODE 3, \S HOSPICE - RVERVALLEY HOME RUSSELLVILLE ISSELLVILLE 1-500 TS FATHERS NAME (Ft tide, Las Ta MOTHERS NAME PRIOR TO FIRST We, Last) OLAN LANGFORD. FAYE Tan 752 MAILING BODES prow to Oe a PO Cy, Sate (2) Sa INFORMANTIS NAME DON LANGFORD. ce RELATIONSHIP TO DECEDENT | 12322 MEYER RD, MABELVALE, AR, 72103-2612 Ry ‘160, METHODOF DISPOSITION: es 6b, PLACE OF DISPOSITION (Nae cd caret. ceratay ter ‘SHILOH-WILLIAMSON, ‘7a. EMBALMERIS NAME 7b. EMBALMERS Tie. SIGNATURE (FUNERAL SERVICE LICENSEE OR OTHER AGENT) JOSEPH CRIMM: Ie) PAMELA J PEAK SMITH Ry 2 T7e. LIGENSE # 7a NAME AND COMPLETE ADDRESS OF FUNERAL FACILITY 4663 ei RUSSELLVILLE FAMILY FUNERAL, INC. Se 2757 E, PARKWAY DR., RUSSELLVILLE, AR, 72802 Ba Téb, TIME PRONOUNCED DEAD. “e. NAME AND TITLE OF PERSON PRONOUNCING DEATH (PRINT TYPE) i i JUL, 14, 2022 JEFF PLEDGER, nt ft 20, PART L Enter the ‘ventricular creas shorn toon Taced the gaat 00 NOT rir farming vents such ax cre aes, onesies esaaence ‘Enter only one cause on a line, oars Be wi (Fina choase or a _GHRONG SYSTOUG HEART FAURE resufing in death) iat condone, Daven iamnee pp a) ‘ary, lacing io be cause Tanya tame on ne a. Enter the ) ‘UNDERLYING CAUSE (eisoane 6 npr that Darbar Ke ‘wating the events in death) LAST. ‘ia, WAS AN AUTOPSY PERFOR |x ‘PARTI Emer otrer foniicant condiions continuing io daaih,but not resulting in he underying cause given in PART | Bib, WERE, FINDINGS AVAILABLE TO COMPLETE ‘THE CAUSE OF DEA 4 122. MANNER OF DEATH "23, DID TOBACCO USE CONTRIBUTE u NATURAL TO DEATH? hf FEMALE ®) 336 TIME OF INUURY Bic. PLACE OF INJURY (ag Decode hare, conarctan ia reviaart wooded a8) i= TNUURY AT WORK? ‘Ba. DATE OF INJURY (MatDay¥) x ‘Se. LOCATION OF INJURY: (limba, Stat Aoarmnect No Cy, Ste, Zp Coxe) Bi. DESORIBE HOW INJURY OCCURRED: Zig. F TRANSPORTATION INJURY, SPECIFY "B6a. CERTIFIER(Check only on8) ei B Hospice galore Mee =the best t my krowndge, ath occred vt he cause) ard manne stated. SIGNAT JEFF A PLEDGER HOSPICE RN DATE: JULY 21, TMIAILING ADDRESS OF PERSON SIGNING ITEM 260. ‘28c, LICENSE # PLEDGER, HOSPICE RN 220 JOHN BABISHLN, RUSSELLVILLE, AR, 72801-4500 a ‘7b. FOR REGISTRAR ONLY - DATE FILED AS an Deny A e411 => . SF ~ wt en es) i ARTEWO THIS 1S TO CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT COPY OF T FILE IN THE ARKANSAS DEPARTMENT OF HEALTH. ERTIFIGATE ON Ry thinkLouie Lent 7900104 wi SEAL Sine jogistrar Manian ees JU L 2.7 2022 a ) Orne eho. WARNING: ‘A REPRODUCTION OF THIS DOCUMENT RENDERS IT VOID iy UNErSS EMBOSSED SEAL OF THE ARKANSAS DEPARTMENT OF | 30,0 NOT ACCEFT TH IS PRESENT. FTISHLLEGAL TO ALTER OR COUNTERFEIT, THIS DOOUMEN z ee aa i Tors mr 0 7 a