[Certificate of Death for Jack Ruby] Page: 1 of 2
This legal document is part of the collection entitled: John F. Kennedy, Dallas Police Department Collection and was provided to The Portal to Texas History by the Dallas Municipal Archives.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
! / 4? /' /'
STATE Of TEXAS Q S J - 0 /,^ 0 •£* 7 — ^ / CERTIFICATE OP DEATH ^TaTJS t„F wn
l- PLACE OP DEATH iV";
\
•S
ii
, PLACE OF DEATH
. COUNTY
Dal Ias
b. CITY OR TOWN |lf ouuidVeTly [irtiih, yivt precinct nc j
Da I I as
<.. i e-nsih or stay
in f £>,
20 yrs.
d. NAWf OF (if no? in hotp'tal, givi> Ur<t«| eddrou)
HOSflTAl OR
_ institution parkland Memorja! Hospitaf
#,is place of death inside city limits?
3. NAME OF
DECEASED
(Typo <y print)
YCSR
(a) Fjrit
NOO
(b) Mlddl*
08503
Z, USUAL RESIDENCE (Whore dcf.v>At*d livod. If institution: riii'idenc# boforo odmisiiciri)
« STATF COUNTY
— .X§*M. Da I las
c, CIT*! OF; 1 OWN (If Qjltniii city limit}, give prccin:.f no)
Da It as
d. $Tft£Ei AbbfttSS (If fyfoJ. qivQ lor.Atio't)
- 223..„Soulb...£.w i rta
«■ '$ fttSIDCNCE INSIDF CITY LIMITS? " ' IT IS RESIDfT-JCF'
Tf-MM
,-{c) Le;t
5, SEX
lacK j...
-Ma.i£
6. COLOR OR RACE
Milta,.
10a. USUAL OCCUPATION {t;?ivt" lind of Work dona
during m<>i1 <sf wyffcin^ lifo. ovoo If 1
--Night cJ-.ufr.-QWi}&r--.|..
U, FATHER'S NAMS
7.
MorrJod Q Married [JJ
^iciowod{^3 Divc«rccd|_J
eCcAScD bVER 'frf U^. AlhlEb fffPlcft?
(Yoi, no, of tintns
Yes
(!l yci, £|lvi> wot Qt dales of servico]
I Ob. kino of BUSINESS or industry"
;jii£r±a.I nrnent
i &. social' i"ecuriit"Flo
imi.L
?. date or birth
NOQ
«. D/Off Or'DFATl'l
ON A FARM?'
Y^G NOR)
-Ji^nua ry. 3.*, J.26.7.,, „
✓ '■>. A$F (!nyP,rt _S.JjNDER. i VW
l«1 birliiday) Months pays
March... 22* 1.91 I .,..33.
11, 8lft 1 HfH.Adi Of coi^try) *
Ghic3.sc>.,... 11! Lnoi 5
H. MOTHER'S MAIDFN NAMfc
Fannie Rutkowskj
17. INPORMA!^
JfJMtS 21.HR£
I !<jmi [ m-nutoj
l?. CTOtN or WHAT*COUNTRY?
,U.. S. of Amor[pa
f. iwukm/WU
Earl rVv ffsiA-P Jr.jjJt-t.
18. CAUSE OF DEATH (F.Mmi Only oho ceuso ptr lififl for (ej. jb|, and (c).]
PART 1. DEATH WAS CAUS1:6 BY;
immediate cause h Pulmonary emboli as immediate cause of death
t
Condition*, if ony.
wlncli lyoyc r >k<f 'n
sbovd com* («).
fteting tho Oftder-
l/rfi^ |®s(.
secondary to bronchiolar carcinoma "of the" lungs
due to (bi as., per letter > Drr Earl. F. Rose^ Da 11as • Couir:y
Medical Examiner> dated Februarylj 19 677
. .._ f)ljp to (r|
PART II, 01HLR SIGNIFICANT CONDHIONS CONTftlBuTlNG TO DFAlM li0i NOT~RffATF6
TEXAS OEPAKTMENl Uh HEALTH
20a. ""aCCIETen-!
o
SUlC'iiVf
□ '
"HOMiClOi-' "jT6bTDESCRIW Hbw'iNJURY OCCURREO
□
?0c, VlMt Or HOM' Month DAY Vr
injury
ft rn
F"<
BUREAU OF VWl STATISTICS
ItjliKVAt eilWLIK
ONSII AW O;A*I'
IV. WAS AuioPiYTtir
FORMED?
YFSH no [ J
JOd, INJURT OCCURRF'D
Wfltlt At I-, NO' WMILl .....
wfttn u *' wj.ii [j
?0o. place of* 'nj'jp.y ir O' k^rrio. ffcc'o'y.
Mrflffl. offic« LlljildJfiiJ, OtC )
?or. city. i6w'n;oFI6cati6n
county
statf
}i . BURIAL, CREMATI
Remove
7 - -^A
IV.. . , , (ind lost jew iSo decoesoa
MeidZlnques.t_J.9D.ueKV.. 3', .19.67. wM
"™ >"•'• 1 ^ ^ on ♦}* oW . eid ip the lioit c>f im tfft@M dae. from the ceuset ii«iod
^ /' or ADDRFSS " ' ' "j 22c. DATE SIGNED
•CL J£&-Ylu/ 410 South Beckiey Dallas, TexJoK2-3-67
23d. LOCATION
USfjecify)
(C<ty, 1 Awn| <>r (<^in4y
I ?3L> DATt
?3t. NAME or CEMFTFRY OR CREMATORY
)
Ch i r ano,_Co£ike-£dxjnt Y , I I Lli>p I s
25b. DATE RFC'D flY LOCAL REGISTRAR
—ui i raoo,^.,uqi
Kt>. RFGISTRAft'5. FTle NO.
... West! gwn CemetGry
24. fufifRAl DlfttClOiTs'SIGNATUftf ' ."..S f/f / "
li FEBfi-'tflCT
■J\i. fiH lSlHAR'S SI&NAlURf
•tt Jjic.
Upcoming Pages
Here’s what’s next.
Search Inside
This document can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Legal Document.
Dallas (Tex.). Police Department. [Certificate of Death for Jack Ruby], legal document, January 3, 1967; (https://texashistory.unt.edu/ark:/67531/metapth337764/m1/1/: accessed February 10, 2025), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting Dallas Municipal Archives.