TIITLIUNN) sorte: caRoLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF THE CHIEF MEDICAL EXAMINER 12008-06959 ‘Chapel Hill, North Carolina 27599-7580 REPORT OF INVESTIGATION BY MEDICAL EXAMINER é DECEDENT: Cet las > Shep / Fraley Fist Last RESIDENCE: _ 2©. Feu woh Lins cl, Orn ‘Number ad Suet Giy, Ste oy ace: _/ > ‘SEX: JXMale QFemale O'Unknown RACE: Black —_Q Native American Q Oriental White — Q Unknown Date received GRes INR | HISPANIC ORIGIN: Q Yes QNo Q Unknown INFORMATION ABOUT OCCURRENCE DATE TIME ‘ADDRESS OR FACILITY ‘COUNTY | ONSET OF INJURY} > [ORILLNESS lef. og, 202 Tan Breve Lave |Ovarge DEATH au “ a ~ |O Scene of death O Hospital OQ Funeral home veew orsony 163/13 fog /240_ Jp Seah SBS Raa ME, NOTIFIED ILAW ENFORCEMENT AGENCY: _C7 2d, FFICER: LO. TELEPHONE: ap aeaalaia [Death occurred while in custody: Q Yes fANo OQ Unknown AUTOPSY: Q None J2ME. Authorized O Non-ME. Autopsy facility: ©OC/7Z BLOOD SAMPLE: Q Mailed — @ Obtained by pathologist O Reason not obtained: IF CLINICAL ALCOHOL DONE, RESULT: By whkorn: 28sec #LeLELee EE PROBABLE CAUSEOF DEATH: @-P6nding ‘OCME REVIEW DETECIVINIE — NAT UPA. | ANone CAVES CONTRIBUTING CONDITIONS 'UTING CONDITIONS CO Accides ide Q Suicide O Under MANNER OF DEATH: Reaeaee Dae: I Nawal © Accident C Homicide © Suicide & Penang | tran i Bac Sects tat onl i ce a ih ‘with Article 16 of Chapter 130A of the N.C. G knowledge and belief beni ese a D Cf2h6 Orauge Medial Examiner (Review (aioa) Signature of Medical Examinér County of Appointment M.E. NumberMEDICAL HISTORY O Alcoholism O Diabetes Q IV drug abuse Q Ischemic heart disease 0 Smoking Q Seizure disorder Q Cancer Q Hypertension O Depression Q HIV/ AIDS Sbtver _2STAMA, __Atending Physician __._Ciy MEANS OF DEATH Q VEHICLE: ‘Type of vehicle associated with this decedent: Q Passenger car Q Pickup truck Q Truck--more than 2 axles Q Motorcycle Q Bicycle Q Farmvehicle Q ATV Q Moped Q Other Q Driver Passenger Q Pedestrian Q Unknown O Seatreswaints Q Airbag O Helmet Q Child restraint Q None Q Unknown Number of vehicles involved Q GUN: O Rifle~-Caliber O Handgun~Caliber___ 1 Shotgun--Gauge Q Other Q Unknown Q INSTRUMENT: Q Blunt Q Sharp Description: Q TOXIC AGENT(S) SUSPECTED: QO Alcohot OQ Others. Q DROWNING: O Pond OLakeorriver OQ Ocean QO Pool Q Bathtub QO Other Life preserver:O Yes Q.No O Unknown Able to swim: Q Yes QNo Q Unknown Activity Q FIRE: — Suspected cause, ‘Smoke detector: Q Yes QNo Q Unknown Q FALL: — From to ACTIVITY OF DECEDENT AND PREMISES FATALINJURY Activity Me OR ake OR ILLNESS: ‘Type of place /ES4 ACH Ce Specific location Fatal injury or illness occurred on a job: Q Yes CKNo O Unknown If yes, was employment: Q Primary job Q Secondary O Volunteer work Q Unknown Name of this employing firm or agency Approximate distance feet ‘Type of business or industry Decedent's occupation DEATH: Type of place SAH Specific location Examples: Activity: Running, lifting hay bales, eating, typing letter, driving commercial truck, sleeping, bathing, watching television, fighting, etc. ‘Type of place: House, apartment, trailer, school, jail, bar or tavem, hotel, restaurant, store, suet, hospital, farm, highway, factory, ec. Specific location: Bathroom, assembly line, kitchen, front yard, office, parking lot, emergency room, roadside, ambulance, car, etc. ‘On a job: Any activity tiat is income generating regardless of age of decedent including farming or parttime work: also include noa-income ‘generating volunteer or charity work. DESCRIPTION Ltt Sec afppwug CONDITION: QLinact Decomposition Skeletonized ot Q Embalmed Q Charred Q Prolonged immersion O Exhur RIGOR: Q None O 1+ O2+ O3+ LIVOR: Q None O Anterior OQ Posterior Q Lateral HEIGHT: —_—_—__ inches Q Estimate WEIGHT: ______ pounds Estimate BODY TEMPERATURE: Q Warm Q Cool Q Cold HAIR: Color _______ Q Beard Q Mustache EYES: Color Abnormalities TEETH: Upper Natural Q Dentures Q Abnormalities Lower Natural Dentures Q Abnormalities CLOTHING: O Notelothed ALU ASSL ES: ee ese sess gener Eee eo erase eseee Eee PP CECH (Oo voluabSct augepry BODY DIAGRAMS report Indicate nature and location of wounds and other lesions (scars, tatoos, medical therapy, etc.) on these diagrams.