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Home My WebLink AboutC-2672 - Transfer and Compensation for ServiceAGREEMENT REGARDING TRANSFER OF MOBILEHOME SPACE AND COMPENSATION FOR SERVICES AND COSTS NEWPORT MARINAPARK (Mobilehome Space No. 7 -A ) COUNCIL AGENDA No. F -3(b) C -2-,�%Z BY THE CITY COUNCIL CITY OF NEWPORT BEACH OCT 12 198T APPROVED WHEREAS, the City of Newport Beach, a chartered municipal corporation, is the Lessor of certain mobilehome spaces in the park known as Newport Marinapark; and WHEREAS, pursuant to the Lease between Eva Xeisler (hereinafter "Lessee ") and the City of Newport Beach, executed on October 1, 1985 , (hereinafter "Lease ") a Lessee of a mobilehome space in Marinapark cannot transfer the mobilehome space without the prior written approval of the City Council of the City of Newport Beach; and WHEREAS, pursuant to the Lease, Lessee has requested the transfer of a mobilehome space and also requested that the City perform certain services and incur certain administrative costs in connection with the transfer of the mobilehome space; and WHEREAS, when this document is executed, it will represent the consent of the City of- Newport Beach for ;the transfer of Mobilehome Space No. 7 -A in Marinapark and agreement of Lessee to compensate the City for services performed and costs incurred in connection with the transfer. NOW, THEREFORE, the City of Newport Beach hereby consents to Lessee's transfer of all right and interest to Mobilehome Space No. 7 -A to Stewart Berkshire & as Vendee. Lessee agrees to pay to the City of Newport Beach $ 2,500-00 to reimburse the City for performance of certain services and cover administrative costs as provided in the -1- J w Y 0 Lease. Lessee agrees that said sum is reasonable compensation for the performance of services and reimbursement for administrative costs in connection with the transfer of the mobilehome space. Vendee hereby acknowledges that Vendee has received a copy of and read in its entirety, specifically consents to and agrees to comply with all of the terms, covenants and conditions including but not limited to the Section pertaining to Term of the Lease, a copy of which is attached hereto. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be made and executed the 18 day of September , 19. F37 . LESSEE k Eva Reisler VENDEE Stew&A Berkshire r BettV V Berkshire 2 ATTEST: City Cler RPROV9D LAS TO.FORM li:.i - t �i� i 3 REQUEST FOR SERVICES I, Eva Heisler , entered into a Lease with the City of Newport Beach on October 1, X985 (hereinafter "Lease ".) Pursuant to the Lease, I request a transfer of Mobilehome Space 7 -A , to Stewart Berkshire , as Vendee. I request that the City perform the following services in connection with the transfer: inspection of the site, preparation of transfer documents, analysis and investigation of information on Vendee, explanation of terms of Lease and Marina Park rules and regulations to Vendee, preparation of reports, agendizing and obtaining City Council approval of transfer and other necessary services to effectuate the transfer of from Lessee to Vendee. I agree to pay the City the sum of $2,500.00 to reimburse the City for performance of the above services. I agree that this sum is a reasonable amount to compensate the City for performance of the requested services in connection with the transfer of my Mobilehome Space. Dated: I/ —/� - 'Y 7 , Signed: Eva 1•^eisler ATTORNEY OR PARTY WITHOUT ATTORNEY IN4ma and Addnm /: TELEPHONE NO.: l FOR COURT USE ONLY John R. Cohan, Esq. (213) 277 -1010 7XI The last will of the decedent named above Irell & Manella having been proved, the court appoints (name): 1800 Avenue of the Stars, #900 Los Angeles, CA 90067 nil ATTORNEY FOR IN~ Co—Executors i —MAR 19 1987 SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGEL STREET ADDRESS: 111 North Hill Street MAILING ADDRESS: Same FRANK S. ZOLIN, COUNTY CLERK CITY AND ZIP CODE: Los Angeles, CA 90012 .D. BRANCH NAME: CENTRAL `Q Ry r I rnN DEPIIr' a. Administrator of the decedent's estate ESTATE OF (NAME): b. 0 Special administrator of decedent's estate NATHAN MEISLER 11) with the special powers DECEDENT specifed in the Order LETTERS CASE NUMBER: ® TESTAMENTARY OF ADMINISTRATION (2) Q with the powers of a O OF ADMINISTRATION WITH WILL ANNEXED O OF SPECIAL ADMINISTRATION p 714,552 WITNESS, clerk of the court, with seal of the court affixed, Date: MAR 19 19 7 Clerk, by , Deputy •tea IS E_4, 1 ��7111OOU � AFFIRMATION I solemnly affirm that I will perform the duties of personal representative according to law. Executed on (date): March 2, 1987 at (place]: Los Angeles , California. 7.f , Rita Sinder 00 4'z -ham Eva MeiSlelr RSONAL REPRESENTATWEI A,, ` Z�Z—j Anne Mills CERTIFICATION I certify that this document is a correct copy of the original on file in my office and that the letters issued the personal represen- tative appointed above have not been revoked, annulled, or set aside, and are still in full force and effect. Date: MAR s CRANK S. ZOLIN Clerk, by '_ (/� , Deputy (SEAL) IURS1 / Form Approved DY the '- _ Probate Code. it A67. 465. 501. 503, 540 7 -,I 0 r.TTrVlr LETTERS 1. 7XI The last will of the decedent named above having been proved, the court appoints (name): th EVA MEISLER, ANNFMILLS and RITA SINDER a. 0 nmou= Co- Executors b. Q Administrator with will annexed 2. ' The court appoints (name): ay Fl a. Administrator of the decedent's estate b. 0 Special administrator of decedent's estate 11) with the special powers specifed in the Order for Probate (2) Q with the powers of a general administrator 3. ® The personal representative Aragthorized to admin- ister the estate under The Independent Administra- tion of Estates Act . Q with full authority 0 without authority to sell or exchange real property or to grant an option to purchase real property. ' WITNESS, clerk of the court, with seal of the court affixed, Date: MAR 19 19 7 Clerk, by , Deputy •tea IS E_4, 1 ��7111OOU � AFFIRMATION I solemnly affirm that I will perform the duties of personal representative according to law. Executed on (date): March 2, 1987 at (place]: Los Angeles , California. 7.f , Rita Sinder 00 4'z -ham Eva MeiSlelr RSONAL REPRESENTATWEI A,, ` Z�Z—j Anne Mills CERTIFICATION I certify that this document is a correct copy of the original on file in my office and that the letters issued the personal represen- tative appointed above have not been revoked, annulled, or set aside, and are still in full force and effect. Date: MAR s CRANK S. ZOLIN Clerk, by '_ (/� , Deputy (SEAL) IURS1 / Form Approved DY the '- _ Probate Code. it A67. 465. 501. 503, 540 7 -,I 0 r.TTrVlr CERTIFICATE OF DEAT I FILE NUMBER STATE OF CALIFORNIA LOCAL REGISTRATION DIrtRICT AND CIRTp¢AT[ Mlweln Vsn 0-851 `(1.Z) THIS IS A TRUE CFRTIF'aU ANGELES DEPARTMENT l FILED IN T14E COUNTY OF LO, A OF 14SAWN SERVICES IF IT BEARS THIS SEAL IN PURPLE INK. 4 ,.': 38 D6r[�dt !, RElR11 $v'M1;L,S ELF 1A. NAME OF DECEDENT -FIRST MIDDLE ME UST I 2A. DATE OF OEATH WCNTH. DAY, YEAR) 128. MQUA I NATHAN i MEISLER JANUARY 28 1987 11003 S. SEE 4. RACE/ETNNICITY B. SPANIW /HISFAMC B. DATE OF BIRTH 7. AGE p ONDEw 1 TEAR IF v »Olw 24 »our White /Jewish Qx January 3, 1899 88„Aw, "°""! DAY! MQUR. YIM E. DECEDENT B. BMT»PUDI of DECmINT a. NAME AND BIwTHPLADI W FAT»u 10. BIRTH NAME AND BIRTHPLACE OF MOTHER PERSONAL IETATE M FOREaN COUNTRY) Poland - Abraham Meisler, Poland - Chana Meisla�, Poland DATA I IA. CITIEEN OP I1B. V DK[A!m wwS Ev[w w 12. SOCIAL SECwTrt NIPA - 13. MARITAL STATUS A. NAME SURVIVING SPOUSE (p wpL ENTER w ».T c«,NTRY MIUY.Rr 01VE DATE. «SERVICE. MR 1yOTF !!'lark USA 19__ To 19 -- 557 -46 -1197 Married Siva .IS,,PRIMARY QCCNA90» 1!. NVYW p YEAH 17. EMROYEw pF !lV- EMPLOYED. SO STATE) 1E. KIND OF INDUSTRY Ow BVSw!!E TKII OCCVFATKIN ' Manufacturer 62 Self:Employed Sportswear 19A. USUAL RESIDENCE- ITRE[T ADORES! (STREET AND NUMBER OR LOCATION) 11PB. 120. CITY ow TORN Wilshire Blvd. 11809 Los Angeles USUAL 10390 RESIDENCE 120. COUNTT 1129. STATE 20. NAME AND ADDRESS OF INFORMANT- RELATIONSMIP Los Angeles ; California Rita Sinder daughter 15925 High Knoll Rd. 21 A. PLACE OF DEATH 1218. COUNTY PLACE U.C.L.A. Medical Center Los Angeles Encino, California 91436 OF 21C. STREET ADDRESS UITTIET AND NUMBER OR LOCATIONI 121D. CITY OR TOWN DEATH 10833 LeConte I Los Angeles 22. DEATH WAS CAUSED BY: (ENTER ONLY ONE CAUSE PER LINE FOR A. B. AND C) 24. WAS MATH REPORTED MMEMATE CAUSE TO CORONERT (� days APPROYI- (� NO CAUSE CONpT1pNl, IF ANY. WE TO. OR AS A CONBEWOICE OF MATE INTERVAL 25. WA! MOFIY PERFOgMEDT OF WHICH DAVE ..SE TO _ BETWEEN DEATH THE IMMEDIATE CAUSE. (B) / v ONSET NO 26: wwl AUTOPSY FE FOF.E[ STATING THE VNOFw- WE TO. OR AS A CONSEQUENCE OF AND LYING CAUSE LAST. _ , DEATH m) NO 23. OTHER SIGNIFICANT CONDITIONS- CONTRI8101I TO DEATH BUT HOT RELATED TO CAUSE GIVEN 27. WAS OPERATION PERFORMED FOR ANY CONDITION IN ITEMS 22 OR IN 22A NnNR 23T TYPE OF OPFRATK)N DATE NO PHYSI- 28A. I CERTIFY THAT DEATH OCCURRED AT THE 12SB. PHYSICIAN -SIGMA AND DEGREE OR TITLE 120 . DATE SIGNED 1200. PHYSICIAN '3 LICENSE NUMB' HW0. DATE AND PLACE STATED F1K)Y THE CAUSES I -1 (] o I 1� I_� �//JryW /p�- ,,,I�� U STATED. 1 ' U✓IjKM zee t,wwC'K n�D 1 � 28, 7 I CIAN'S iV /` I G 43708 IATTENceD DECEDENT SIHCE 11 LAST SAW DECEDENT AIrvE I' 1 CERTIFICA- BEATER NO. A. YR.) 1 (ENTER M0. DA Yw.) 12BE. TYPE PHYSICIAN'S NAME AND ADDRESS UCLA MEDICAL CENTER TION 1/25/87 1/28/87 ;WILLIAM G. STEVENSON, M.D. 10833 LE CONTE AVE. LOS ANGF 29. SFCaFY ACCIDENT. SUICIDE. LTC. 3O. PLACER mJURY T. INIUgr ATwMR 32A. DATE OF IMNgrHIONT ».OwY. YEAR 1328. MNA INJURY 1 INFORMA- 33. LOCATION ISTREETANDNUM D[RORLOCATONANDCITYORTOWNI 34. DESCRIBE HOW INJURY OCCURRED (EVENTS WHICH RESULTWIN INJURY) TION / CORONER'S USE 35A. I CERTIFY THAT DEATH OCCURRED AT THE HOUR. DATE AND PLACE 9TAT[D FROM 1358. CORONER - SIGNATURE A NO DEWEE Oq TRLE i35C. DATESIGNE. ONLY THE CAUSES STATED. AS REQUIRED BY LAW 1 HAVE HELD AN (1NGUE3T- INVESTIGATION) 1 I 1 I W. DISPOSITION 37. DATE- MONTH.DAY.YEAq yF�A y1A� 3VIAITsiJ�e `�3emoiiaiD 38. EYBAWFR'I UC ENSEMIMSERANOSWNATUpF Burial 1/30/87 ar ^TORY NOT EMBALMED 6001 Centinela Ave LA 4CA. NAME OF FUNERAL DIRECTOR (OR PERSON ACTING AI SUCH) 40B. LICENSE NO. E - � TrT 41. L L A GISTu� �R 42 DATE ACCEPTED BY LOCAL REOISTRA Hillside Mem. Pk. Mort. bb 1358 it .y , �s JAN 30 1987 1 STATE A. B. C. REGISTRAR 1 Vsn 0-851 `(1.Z) THIS IS A TRUE CFRTIF'aU ANGELES DEPARTMENT l FILED IN T14E COUNTY OF LO, A OF 14SAWN SERVICES IF IT BEARS THIS SEAL IN PURPLE INK. 4 ,.': 38 D6r[�dt !, RElR11 $v'M1;L,S ELF 0 iiE CITY OF NEWPORT BEACH PUBLIC WORKS DEPARTMENT Jc_cTlov 7- " DRAWN - DATE APPROVED PUBLIC WORKS DIRECTOR R.E. NO. - DRAWING NO, P_ x.007_ W Z) SS 9 L P, 'A W. CITY OF NEWPORT BEACH PUBLIC WORKS DEPARTMENT Jc_cTlov 7- " DRAWN - DATE APPROVED PUBLIC WORKS DIRECTOR R.E. NO. - DRAWING NO, P_ x.007_ C 7z AGREEMENT REGARDING TRANSFER OF MOBILEHOME SPACE AND COMPENSATION FOR SERVICES AND COSTS NEWPORT MARINAPARK (Mobilehome Space No. 7 -A ) WHEREAS, the City of Newport Beach, a chartered municipal corporation, is the Lessor of Certain mobilehome spaces in the park known as Newport Marinapark; and WHEREAS, pursuant to the Lease between Eva Heisler (hereinafter "Lessee ") and the City of Newport Beach, executed on October 1, 1985 , (hereinafter "Lease ") a Lessee of a mobilehome space in Marinapark cannot transfer the mobilehome space without the prior written approval of the City Council of the City of Newport Beach; and WHEREAS, pursuant to the Lease, Lessee has requested the transfer of a mobilehome space and also requested that the City perform certain services and incur certain administrative costs in connection with the transfer of the mobilehome space; and WHEREAS, when this document is executed, it will represent the consent of the City of Newport Beach for the transfer of Mobilehome Space No. 7 -A in Marinapark and agreement of Lessee to compensate the City for services performed and costs incurred in connection with the transfer. NOW, THEREFORE, the City of Newport Beach hereby consents to Lessee's transfer of all right and interest to Mobilehome Space No. 7 -A to Stewart Berkshire & Betty J. as Vendee. Lessee agrees to pay to the City of Newport Beach $ 2,500.00to reimburse the City for performance of certain services and cover administrative costs as provided in the -1- REQUEST FOR SERVICES I, Eva Meister , entered into a Lease with the City of Newport Beach on October 1, ;985 (hereinafter "Lease ".) Pursuant to the Lease, I request a transfer of Mobilehome Space % -A , to Stewart Berkshire as Vendee. I request that the City perform the following services in connection with the transfer: inspection of the site, preparation of transfer documents, analysis and investigation of information on Vendee, explanation of terms of Lease and Marina Park rules and regulations to Vendee, preparation of reports, agendizing and obtaining City Council approval of transfer and other necessary services to effectuate the transfer of from Lessee to Vendee. I agree to pay the City the sum of $2,500.00 to reimburse the City for performance of the above services. I agree that this sum is a reasonable amount to compensate the City for performance of the requested services in connection with the transfer of my Mobilehome Space. Dated: 5 - / — Y 7 , Signed: Eva Meisler Lease. Lessee agrees that said sum is reasonable compensation for the performance of services and reimbursement for administrative costs in connection with the transfer of the mobilehome space. Vendee hereby acknowledges that Vendee has received a copy of and read in its entirety, specifically consents to and agrees to comply with all of the terms, covenants and conditions including but not limited to the Section pertaining to Term of the Lease, a copy of which is attached hereto. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be made and executed the 18 day of September , 19 87 . LESSEE `. Eva 1"isler VENDEE �RO�D AS TO FORM City Attorney -2- ATTORNEY OR PARTY WITHOUT ATTORNEY Wame and Address!'. John R. Cohan, Esq. TELEPHONE NO (213) 277 -1010 FOR couRr Use ONZ y Irell & Manella having been proved, the court appoints (name): 1800 Avenue of the Stars, #900 Wma Los 'Angeles, CA 90067 L F ATTORNEY FOR !Hama): Co- Executors b. 0 Administrator with will annexed `?AAR 19 1987 SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS AN ELE STREET ADDRESS: 111 North Hill Street MAILING ADDRESS: Same FRANK Sp. ZOLIN, COUNTY CLERK CITY AND ZIP CODE. Los Angeles, CA 90012 (F BRANCH NAME: CENTRAL AV F I FnN DEp(Ir• r� #* ESTATE OF (NAME): %ON;3. general administrator NATHAN MEISLER ® The personal representativeklrgthorized to admin- ister the estate under The Independent Administra- DECEDENT tion of Estates Act LETTERS FRI with full authority = without authority to CASE NUMBER: ® TESTAMENTARY OF ADMINISTRATION to purchase real property. ' ' = OF ADMINISTRATION WITH WILL ANNEXED OF SPECIAL ADMINISTRATION p 714,552 WITNESS, clerk of the court, with seal of the court affixed, Date: MAR 19 1 7 Clerk, by , Deputy +a isE , AFFIRMATION I solemnly affirm that I will perform the duties of personal representative according to law. Executed on (dare): March 2, 1987 at (place): Los Angeles California. Rita Sinder )PERSONAL REPRESENTATIVE) Eva Meisler ��a--.) A -1 Annt' Mills CERTIFICATION I certify that this document is a correct copy of the original on file in my office and that the letters issued the personal represen- tative appointed above have not been revoked, annulled, or set aside, and are still in full force and effect. Date: MAR f FRANK S. ZOLIN Clerk, by / __l/ Deputy (SEAL) lURS1 Form Approved by tM Re6Ate Code. It 663. 466. 601. 603. SAO jVriCbl Courr. U of fafin- pia — __ 0 nT rI3`c - . LETTERS 1. 0 The last will of the decedent named above having been proved, the court appoints (name): EVA MEISLER, ANNCMILLS and Wma RITA SINDER a. T� liwax tst Co— Executors b. 0 Administrator with will annexed RM2. The court appoints (name): > a. Administrator of the decedent's estate b. Special administrator of decedent's estate (1) with the special powers 110L.— in specifed in the Order for Probate r� #* (2) Q with the powers of a %ON;3. general administrator ® The personal representativeklrgthorized to admin- ister the estate under The Independent Administra- tion of Estates Act FRI with full authority = without authority to sell or exchange real property or to grant an option to purchase real property. ' ' WITNESS, clerk of the court, with seal of the court affixed, Date: MAR 19 1 7 Clerk, by , Deputy +a isE , AFFIRMATION I solemnly affirm that I will perform the duties of personal representative according to law. Executed on (dare): March 2, 1987 at (place): Los Angeles California. Rita Sinder )PERSONAL REPRESENTATIVE) Eva Meisler ��a--.) A -1 Annt' Mills CERTIFICATION I certify that this document is a correct copy of the original on file in my office and that the letters issued the personal represen- tative appointed above have not been revoked, annulled, or set aside, and are still in full force and effect. Date: MAR f FRANK S. ZOLIN Clerk, by / __l/ Deputy (SEAL) lURS1 Form Approved by tM Re6Ate Code. It 663. 466. 601. 603. SAO jVriCbl Courr. U of fafin- pia — __ 0 nT rI3`c - . CERTIFICATE OF DEATH . STATE FILE NUMBER STATE OF CALIFORNIA VS- 1111 -831 THIST411S {E CERTIFI:D LwY' -" TMENT 1 FILEHEALTHE Sr VNCESOIFLO E BEARS THIS SEAL IN OF PURPLE INK 38 Diroctirt of Hedth SeNlc_ Ems, ] E�� El IA. NAME OF DECEDENT -FRET 1 IN. MIDDiA I IC. LAO, I I 2A. DATE OF DEATH Ir1ONTIH, DAY, YiAp 128. HOUSE I NATHAN i MEISLER JANUARY 28 1987 11003 3. COX 4. RACE/ETMHKITY S. SFANIDWHIXPAMC S. DATE OF BIRTH 7. AGE E MDEII 1 vuw IR urou 24 HOME White / Jewish ND ax January 3, 1899 SS EAR. MOMTNE DAYS MVES MINUTED DECEDENT E. BIETHPLAC[ OF D[CEDEMr 2. NAME AND BMTHFIAC[ OF FATHER 10. BIRTH NAME AMC BIRTHPLACE OF MDTHu PERSONAL IRTATE OR FOREIGN COUNTRY) Poland Abraham Meisler, Poland Chana Meisla�, Poland DATA t IA. CTxEN 0. 118. IF DECEASW .6 EVER w 12. SGauL BOOM. NUMBER 13. MARITAL STATUE 14. NAME OF SURVIVING SPOUSE OF WIFE. [NMR WHAT COLNTRY MILITARY GIVE DAT.. D. BORYIC[. 557 Married ERR Eva USA 19-- TO 19-- -46 -1197 15. PRIMARY OCCUPATION IE. NUMBER OP YEARS 17. EMPLOYER OF EW- [YKOY[O. SO STATE) 18. KIND OF INWETRY OR MUSINGS THM OCCMATON Manufacturer 1 62 Se l,; mployed Sportswear IBA. USUAL R[ND[NC[- STREET ADDRESS (STREET AND NUMBER ORI LOCATION( 1128. IBC. CITY OR TOWN 10390 Wilshire Blvd. 11809 1 Los Angeles USUAL RESIDENCE IND. CoUPrtr' IBS. STATE 20. NAME AND ADDRESS OF INFORMANT- R[LATCHSMv Los Angeles ; California Rita Sinder daughter 15925 High Knoll Rd. 21 A. PLACE OF DEATH i21e. COUNTY U.C.L.A. Medical Center Los Angeles PLACE , Encino, California 91436 OF 21C. STREET ADDRESS (STREET AND NUMBER OR LOCATION) 1210. CITY OR TOWN STREET DC. Leconte Los Angeles 22. DEATH WAS CAUSED BY: (ENTER ONLY ONE CAUSE PER LINE FOR A. B. AND CI 24. WAS DEATH REPORTED 'N'M EOIATE CAUSE TO CORONgT A) APPRCY- O CAUSE CONDITIONS. li AMY. DU[ TO, OR AS A COND[WWCS OF MATE INTERVAL 23. WAS BROgY P[IIPORMED) OF wHICH GAVE RID[ To _ BETWEEN DEATH THE IMMEDIATE CAME. 181 / ONSET NO 2E. WAE AUTOPSY PERPORMS07 ETATNO THE UNDER- ME TO. OR AS A CONSEQUENCE OF - AND LYING CAVBF LAST. - DEATH ICI , NO 23. OTHER SIGNIFICANT CONORIOMS- COMTRIDMNO TO DEATH BUT NOT RELATED TO CAUSE GIVEN 27. WAS ORERAYRON PERFORMED FOR ANY CONDITION IN ITEMS 22 OR IN 22A 23t TYPE OF OPERATION DAM NO PHYSI_ 2BA. I CERTIFY THAT DEATH OCCURRED AT THE 1288. PHYSICIAN -WOHA AND DEGREE OR TITLE 1289. DATE &ON[D I28D. PHYMCIAN'S UGE 311E NUMBER N HO, DATE AND PLACE STATED FROM THE CAUSER I MD I I //� / /� /( /�//fj�P/ �r t �) g /�� G 41708 CIAN'S - - --' I IATTEHDEDDECEDIMSINCE I I UST SAW D[CEDEM ALIVE I CERTIFICA- (ENTU M0. DA. YR.) I IFNTEJI MO. DA. M.1 128E. TYPE PHYSICIAN'S NAME AND ADDRESS UCLA MEDICAL CENTER T1ON 1/25/87 i 1/28/87 WILLIAM G. STEVENSON, M.D. 10833 LE CONTE AVE. LOS ANGEL 29. ]P]CRFr ACCIDEM.EUIDRD0. ETC. BOO. PLACE OiINJURY 91. RNJURYAT WORK 32A.OATI OFIHJVRY- YOHTM. DAY. Y4E 132,. MOVR INJURY INFORMA- 33. LOCATION (STREET AND NUMBER OR LOCATION AND CITY OR TOWN) 34. DESCRIBE HOW INJURY OCCURRED (EVENTS WHICH RESULTED IN mJURp TION / CORONER'S VSE 35A. I CERTSPT THAT OEATM OCCURRED AT THE HOUR, DATE AND PLACE STATED FROM CORONER- C"ATURFANDOEGREEORTRLE Sac. OAMSIONEO ONLY 1358. THE CXU3E4 STATED. AS REPUTED BY LAW I HAVE HELD AN CINOUMT4.93TIGATDN) , I 1 3e. DISPOSITION 37. DATE- MONTM. DAY, YEAR 38Y11113106 E$iemorial°"1 ar"fcTDRY �j�1 y!FrAp 39. EMBALMER'S UCENEE NUMBER ANO SIGNATURE Burial 1/30/87 NOT EMBALMED 01 Centinela Ave L ADA. NAME OF FUNERAL DIRECTOR (OR PERSON ACTING AS SUCH( 40B. LICENSE NO. 41. L AL GIS7R- TItE�.� 42. DATE ACCEPTED BY LOCAL REGISTRAR Hillside Mem. Pk. Mort. bb 1358 v i�� j JAN 30 1987 4�� STATE REGISTRAR VS- 1111 -831 THIST411S {E CERTIFI:D LwY' -" TMENT 1 FILEHEALTHE Sr VNCESOIFLO E BEARS THIS SEAL IN OF PURPLE INK 38 Diroctirt of Hedth SeNlc_ Ems, ] E�� El 1 � . ....��.�,�r. Y,aty^'Tt`t+- °"'��'. '7C •� �iL`� >rf"'.�' ��;r -;.7 {. b.. r.�iy =• •r•, .. r. '. °4'1+: +Air"r�r !+1"Y.V P'Si� .•��' �M "'• rf •.. WLN•v b•�` _ � KI Y4 t • qq .. 2 CITY OF NEWPORT BEACH PUBLIC WORKS DEPARTMENT sc c Tio4/ DRAWN : / DATE APPROVED PUBLIC WORKS DIRECTOR R.E. NO. DRAWING NO. P_ c o0 7_ ` 1.1 i` �l V In • \1Y .. 1 ) d \ 5} P: L\. _�. 5 9•YN� i h .. Y.�I � r, J. ) r� i + . X41`, f ! 1 � ."1F1 Y'L:n.,e r j.• _ - .i.i ^'y..; _�i,o•.:. `��x'�..., wr:ca'!�i�.a�i.•::i`. ii CITY OF NEWPORT BEACH PUBLIC WORKS DEPARTMENT sc c Tio4/ DRAWN : / DATE APPROVED PUBLIC WORKS DIRECTOR R.E. NO. DRAWING NO. P_ c o0 7_ `