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    Stone Death Certificate

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    John Wright
    James Henry Stone died on January 19, 2015 in Conroe, Texas at the age of 32. The immediate cause of death was hanging. He was found hanging in his bedroom. An autopsy was performed which confirmed hanging as the cause of death. The manner of death was ruled a suicide. Several amendments were later made to the death certificate, including correcting Stone's marital status from never married to married, and changing his surviving spouse's name and relationship from John Allen Hoskins, significant other, to John Allen Stone-Hoskins, husband.

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    Stone Death Certificate

    Uploaded by

    John Wright
    7K views1 page
    James Henry Stone died on January 19, 2015 in Conroe, Texas at the age of 32. The immediate cause of death was hanging. He was found hanging in his bedroom. An autopsy was performed which confirmed hanging as the cause of death. The manner of death was ruled a suicide. Several amendments were later made to the death certificate, including correcting Stone's marital status from never married to married, and changing his surviving spouse's name and relationship from John Allen Hoskins, significant other, to John Allen Stone-Hoskins, husband.

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    Stone Death Certificate

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    James Henry Stone died on January 19, 2015 in Conroe, Texas at the age of 32. The immediate cause of death was hanging. He was found hanging in his bedroom. An autopsy was performed which confirmed hanging as the cause of death. The manner of death was ruled a suicide. Several amendments were later made to the death certificate, including correcting Stone's marital status from never married to married, and changing his surviving spouse's name and relationship from John Allen Hoskins, significant other, to John Allen Stone-Hoskins, husband.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7K views1 page

    Stone Death Certificate

    Uploaded by

    John Wright
    James Henry Stone died on January 19, 2015 in Conroe, Texas at the age of 32. The immediate cause of death was hanging. He was found hanging in his bedroom. An autopsy was performed which confirmed hanging as the cause of death. The manner of death was ruled a suicide. Several amendments were later made to the death certificate, including correcting Stone's marital status from never married to married, and changing his surviving spouse's name and relationship from John Allen Hoskins, significant other, to John Allen Stone-Hoskins, husband.

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    DEPARTMENT OF STATE HEALTH SERVICES

    VITAL STATISTICS UNIT


    TEXAS DEPARTMEN T OF STATE HEALTH SERVICES - VITAL STATISTICS
    JAN 23 2015
    1 LEGAL NAME OF OECEASEO llndudo N<A's. U an,1 IF'nl. ..-. I.al)l
    I
    JAMES HENRY STON E
    ,1 - DATE OFBIRlH (mm-o:tyyyy) I AGE-Last Binhday
    3.SEX
    (Y
    1
    APRIL 22 1982
    32
    MALE
    l """I
    ALSTATUSATnMEOFOEATH
    7.ALSECURITYNUMBER

    STATE OF TEXAS

    CERTIFICATE OF DEATH

    1oa. RESIDENCE STREET ADDRESS

    18

    1F1woiaA 1 YR

    I oa,.

    Mo
    O Manl8d

    D Wclo- D - l'i,l Na.......... D Unknown

    142-15-007851

    2. DATE of DEATH ACnlAL OR PRESUMED


    'JAN UARY 19 2015
    B. BIRTHPLACE (City & Stm11 ' Foreign Coa.nuv>
    MOUN TAIN HOME AR
    9. SURVIVING --.........E'S NAME (II wile, QMI name priDI IO ltrSC maniagul

    ,_,,,,,

    !'Ob.APT NU,

    10l.ZIPCOOE
    1
    n301
    12. MOTHER'S NAME PRIOR TO FIRST MARRIAGE

    IQe. STATE
    I
    TEXAS

    MONTGOMERY
    11. FATHER'S NAME

    STATE FILE NUMBER

    10c. CITY OR TOWN

    CON ROE
    10g.INSIDE CITY LIMITS?
    1 181Yos
    0No

    JOAN MCGIN NIS


    WALLACE FRANKLIN STON E
    13. PlACE OF DEATH (CHECK ONLY ONE)
    11F DEATH OCCURRED SOMEWHERE OTHER TJ-W,l A HOSPITAL.
    IF DEATH OCCURRED IN A HOSPrrAL
    I O ........ F-v
    ONuRlnn tm>I
    l'i,l Decadlol'> tm>o
    O Otho, (Splcilvl
    O Iopa!- 0 ER.Ou"'""
    0OOA
    ,s l,;IIYIIVWN, Dt" tlF ...... ,..-..,.;uTYUt.UT M:PRECIHCTNOI ,e. FACILITYNAME(llnol insllution,QCWSUNIDddrMSS)
    14.COUNTY OF DEATH
    .::
    ,
    ,
    MON TGOMERY
    ,
    CON ROE n301
    17 INFORMANT"S NAME & RELA'1JUMM1IP TO DECEASED
    18. MAILlNG ADDRESS OF IN
    C
    P Code)
    1
    JOHN ALLEN HOSKINS V - SIGNIFICAN T OTHER
    CON ROE TX n301
    20.
    SE
    Of -.....
    -..-- u,n,..,... UH -.an.n.n-. 21.
    19 METHOD OF DISPOSITION
    ACTING AS SUCH
    Ctemalmn
    O Ootultioo
    0&,nal
    Sec101 ________
    ' D Entom"""""
    o--CORA LEE MCLEAN ,BY ELECTRONIC SIGNATURE O au,., 1-1
    11ccc2
    10N, "1c"';::.,1 To;;,: :::..,::-,-:::-::,-..:,sw;:;,1, ,---------lL01
    ::cry:c.-::aoma=::::IOIY::::-:,...,=,-::;p1oa1;::!:!,1f-!-2=;_-.-.,.23,-;.......,.""',.T"""
    '" =1"'11ome="'o1"'com=...
    l..22li''a:
    . PLACE:o.sl1Fo,,,,..,.,,S""ITION
    5paca
    s. MCNUTT BROCK CREMATORY
    CON ROE TX
    25. COMPLETE ADDRESS OF FUNERAL FACILITY (StnNM and Number, Clly, Stnta, Zip CodeJ
    24.NAME OF FUNERAL FACILITY
    {
    1600 PORTER ROAD CONROE, TX 77301
    .5 MCNUTT FUNERAL HOME
    ; 26. CERTIFIER ( only one)
    O Co,dying pnpidan-To ,-NS o1 mr i..nowi.dgu, d8illtl DIXUINd "' 10.,. c:.wse(s) and rNtM8I staled.
    (8l Modal Eaunimd.Jusllcu of ine Puce. On lhu basil OI ard'ot In my opnion, tlCCWNd at Iha time.dale Mid plMat. Id dull ta hi CM&Sl.'(S) ..00 INll'V"1f liuued,
    28. DATE CERTIFIED (rnnHSd-yyyyt 211. LA-EN::u: NUMBER ,30. TIME OF DEATH(Aclual Of prnumed)
    ! 27.TUREOF CERTlflER
    ,
    JAN UARY 22 2015
    jj WAYNE'L MACK BY ELECTRONIC SIGNATURE
    12:14 AM
    32. TnLE OF CERTIFIER
    _ 31. PAINTED NAME. ADDRESS OF CERTIAER (SlrHI and Numblll, Clily,Stale.Zip Cadet
    -::: '-.
    I
    ,
    JP
    WAYNE L MACK 19380 HWY 105 W. STE 507, MON TGOMERY, TX n356
    .5 !
    Approaimale intorval
    33. PART 1 . ENTER THE CHAIN Of EVENTS - DISEASES, NJU
    l RIES, OR COMPUCATKlNS - THAT OIRECTLY CAUSED THE DEA TH QQ.lQ! ENTER
    Onsal to death
    ;j U
    TERMINAL EVENTS SUCH AS CARDIAC ARREST, RESPIRATORY ARREST, OR VENTfUCULAR ABRIU.ATION wtTHOUT SHOWING THE
    .X
    ETIOLOGY. 00 NOT AIIBREVIATE. ENTER ONLY ONE CAUSE ON EACH.

    ...0Ii

    I:
    r,

    IMMEDtATE CAUSE (Final


    ! x resuling
    ....... condolion->
    :_ i i In dNlh)

    '

    G!.---------------------------N
    a.HAN
    Gl
    0"8 IO (DI U aconsaquenc:e af):

    ":t,':!' ----------------------------------
    ti
    ,
    :
    ,
    -=i UNOERL
    lisled on tnaL Enlar Iha
    YING CAUSE
    \
    ,
    ----------=---,--------c:-----------------Oue lO (or as acon of):
    .Iii 5 :::::a
    in daa!hl LAST
    Oua

    con.equonco ol1

    .e:

    il if CAUSE
    PAJIf 2.
    I UIn SfGNIFIC CQN91T19NS CONJRIBUJINOffiPEATH BUT NOT RESULTING IN THE UNDERLYING
    GIVEN IN PART L
    o;;i-., laO'

    ';

    37 Dill TOBACCOUSE
    TO DEATH?
    D Yes
    0No
    O Prullllbf/
    ISi Unknown

    34 WAS AN AUTOPSY PERFORMED?


    0No
    181Yus
    35. WERE AUTOPSY FINDINGS AVAILABl..E TO
    COMPLETE THE CAUSE OF DEATH?
    0,Yes ONo
    39 IF IHAN:)t"UMIAu.m INJURY,
    SPECIFY
    D eriw,IOpomto<
    O P.iuangar

    "'PV' '- 38. IF FEMALE.


    ONol pragnm11 wctm past year
    O Pregnant al tme at d8a&h
    ON.............. ...,.,.,. ..........,. .........
    ONot pregnant. bul pr8'JWll "3davs 1a one Y'N' bekJl8 doAlh
    D 0111url5poa1,1
    O Unknown Mix...- ......... pas1,TIME OF INJURY 4Dc. RY AT woRK?
    40I. DATE OF INJUAY(mm-dd-yyyy)
    Pl.ACEOF INJUAY (e.g. OIIC8denrt hOme, c:or1ilrudiOl1 5168. r. wooded 1
    a N)
    "I
    r D Y
    lSI No I BEDROOM
    JANUARY 19, 2015
    12:14 AM
    40e. U,K..;ATION tStrNl and Number, Cll.y,S&ale,Zip Code)
    4IM COUNTY OF IN.KJRY
    36. MANNER OF DEATH
    D Nat<Hlll
    D Aa:idlnl
    lSISwade
    D HormoOe

    l.,Uf'I ,

    g ::::.:.:....

    l'"(I).

    Gj
    CON ROE TX n301
    a: 41 DESCRIBE HOW ll<JURY OCCURRED

    "'

    HANGED SELF
    en 42a. REGISTRAR ALE NO.
    01-0139
    FAA NI WRER nnmnu;.,1.:uu

    l"Od.

    2c. REGtstRAR REGISTRAR - MONTGOMERY COUNTY CLERK,


    1
    ELECTRONICALLY FILED

    AMENDMENT TO CERTIFICATE OF DEATH

    VITAL STATISTICS
    Texas Department of State Health Services
    RECORD ID. REGISTRANl'S FUU. NAME AS SHCJVtlN ON DEATH CERTIFICATE
    JAMES HENRY STONE
    PLACE OF DEATH COUNTY
    CORRECTION

    ABSTRACTs

    CERWICATION

    MONTGOMERY
    ITEM OR ITEM NO
    1.
    8.
    9.
    17.

    tTYORTOWN

    CONROE
    ENfflY ON CERTIFICATE

    ---

    JOHN ALLEN HOSKINS V - SIGNIFICANT OTHER

    TYPE OF OOCUMENT

    DEATH NO
    007851
    DATE OF DEATH
    01/1912015

    CORRECT INFORMATION

    JAMES HEN RY STONE


    N EVER MARRIED

    AFFID OF INFORMAN T, JOHN ALLEN


    STONE-HOSKIN S, V
    COPY OF COURT ORDER, CAUSE NO.
    SA-13-CA-00982-0LG

    OR'.';'.TRY
    07/09l2015 )
    08/0512015

    JAMES HEN RY STONE-HOSKINS


    MARRIED
    ;, .JOHN ALLEN STONE-HOSKINS, V
    UOHN ALLEN STON E-HOSKIN S, V - HUSBAND

    BY WiOM lSSUED ANO SIGNED

    BOBBY LEE NOVAKOSKY, N OTARY


    PUBLIC, STATE OF TEXAS
    UNITED STATES DISTRICT COURT
    FOR THE WESTERN DISTRICT OF
    TEXAS, SAN ANTONIO DIVISION

    IHeREiiY trnnFY THAT I HAVE EXAMWEO THE DOCUMENTS LISTED ABOVE ANO THAT THE ABSTRACT IS TRUE AND CORRECT

    DATE FILED
    VS-173 REV. 9/94

    MONTGOMERY

    42b. DATE RECEIVED DY LOCAL REGISTRAR


    1
    JANUARY 22. 2015

    >

    o-oan

    OB/06/2015
    STATE REGISTRAR
    Texas Department of State Health Services - Vital Stabstlcs

    DATE Sl SUEO

    08/06/2015

    08/0512015

    ...e.

    I
    I

    ,\

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