1 February 2012
Sub: Reporting of Death U/S …. of UPC.
This is to report incident of death of patient in our hospital of Late Mr. Joan Smith, S/o Mr. William Smith, Resident of 1239, South Plaza, New York, USA on 31st January 2012 at 1530 hours due to sudden cardiac attack.
Death Certificate of Mr. Joan Smith signed by Dr. Sean Peterson who treated the patient is attached herewith for taking on record.
Death Certificate No.123 of 31-1-2012