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HomeMy WebLinkAbout1380 a ON10 D[rARTMENT O!~' HEALTH "-R'~~'~" ~ p„~. , DtVI!lO~PI Or' YlTA6 fTATIlT1Cf ~~r;k ~?~r ~'s- ~ CERTIFfGATE O~' DEATH ~+u'. 1~0 . ~ i: ~ L ( re iestitutron: es~ CaVMIIY ~y.a dence befut ) Ci~~~'iA o. s!~lfE ~y~ C1011MTY ~~s tlTr. VIIIAGt, Ot IOCAT1pM i c. IEMGTII q 3TAt IN 1? c. CI~'1'. YILlAOl. O! IOCJ~TIOM EAST CLE1/EIAND I $i~t ~br~~l~ 1. NM1E 01 !IJ rH I~iprd n r~ie~~rr~or. ~ir~ ,n~.r ~//rr~~1 ~ I, fTREl1 ADOrEii a ~ 134 ~wsnruTia+ HU~20N RGAD 1.~176 E• ~s rucE or oe~tN ~N~oeiiTr urirst ~'~"~T + Ks~oEr~e ~ks+be air i~r~tu I t ~i ~siDE?~te a+ ~ rxwv- res ~ r~o ~ rts wo O I rts ? no C'~ ME F ,r,e . ~Nk Lw pATE ldoo a~j ~-~s,r 1Q,~e~a aN~ .'AR'I~iUR~ r MIHITE ~rn 8~ 2/ 65 S. SEII '"s! OR rl?CE ~ 7. wnl~ Q/. pAfE Of ~ttTfl /AyG~E ~(IrsI rw~ N~ir 1 YwI tl N~Mr !1 Mn.y ~1~ I wii1~ I WIDOMIEO OIYO~ilO ?~o-9B ~C ~,~1 M~u~i~ D~)~ + N~~n ~ A4~. - ia. vw~u ocas~~~oN fc;..4~.r . r~ori J~u lOb; K1NP0f ~t O! INYVfTf11 I1. ~I~TIMIA~G! lSt~t~ n ' ~ei~t +~M ~I rrwiilM IM~. w*w :l rN:M/ b /ra~¦ 1~. WNAf iOVMTl47 Op~nt~r ~ 4i~nt,ing C• ~i~alaAd ORi~ ~ r~tM[t•s w~we - . t~. nwn+trs auuoH+ ?u~ ~ .4Ji~iY ~V~ ' . .i ' ~ • ~ ' YO~A A~iii 13. WAS pfClASEp E11E~ IN Y, f. AMAED /O~Y? . ~ 1~. iOC1At sECUrtsr Mo. IN RMANT'S NAME ~ ~ , ~dd~ess ~ (Yn: y~r rsl~~wJ~ l1~ ~r~. ~is~ r•r ~r ~j i~?rir~) ~18-21~89 ~y~ r~ w c.G~t..~t.~ li. A SE ATH I ~~M r~ru ~rr ir~ w(r). (e). IMt[tVAI RT1MlEN M~T 1. OEATN 1NAf tAt13E0 t~~/J • • OM1E~ AMO OEAIN IAWEDIATf GYSE f~l ?a.t? I Yt- ia~ • w. rivrl pre ,e~r M OVE TO f`) / t~~ ~.1~t I~C Y~ / i~ t•?I~ ! ~Ilt~'t - ~i+r~ e~rn f~1. n/itit~ Nt ~r~l~r- l~j r~s/i Int. DUE TO (ct, Hn 1~. Oravs pw~ncaaT Cw~no~s c»T~i~~n~~ t~ Man •~7 Aw ~tUt~~ t~ f~~ T~MU~a M~4s~ CM~MieM ~iq~ rr ~ui ~l~1 1~. WAS AUfO?fY _ ~A+ i+~ -~Ls! i r ~s•~,~. r Lf+rf tr+,.f`G.~sL. i!/J r~ .14i n 10~. A EMT iYK1pE l~OMICIDE I p~. pESCRNE qpW 1lU11l7 tlED. (Psur ~rn ~j i•ry e~ rrt 1 n?rvt U~J n~s Il.l ~ O O O ~ 70t. i1ME Of H~a /N~et1, D~~, Yrr u IMrlf? i. s. ~ ~ ]W. INJUh OOL1lRlEp ~]0~. /IACF pr IH/U!r j., i~ ~r ri~~l 1~~~. ~ 701. CITY. VlIIAGE. O• IGCATtON COUNTf. STATE { WNIIE AT MOT w1111E Jiatn~, ihtp. ~~rr 1J/~.. rfr.) M~Ol1( ~ AT 1NOb( ~ I1. I~rt~rfe! t~r t~riy~! /~~~r . t~_.,_ ~~1 !ut ~~r brw dn~ •4 Z S ` • Ch~r1 • ~r ~ rI~ l~t~ itri I. w+l fi~ Mt ~f RJ ~ROIItj(I. JI07 tbt aurrr u~r~l. n.. N URE fn.r.... arr.l 2n. ~vo~ss 77c. DATE ~iGNlD c~-~•~+..+ ,c.w/r I~s ~ e E' o I 3 s.~ T~W~IAI. rl DATE ~)?r. PI/IME Of CEMETE[f OR ClEMATOfI' IH. tOCATiON ~Cit~. to~a. M t ry (Sbh) ' I ~ ~1GeV~A1~ ~'ilt. i Qd~~lifld It. MAME 01 EAMALMEt Mq,~ S. WME~AI DIlEtTOR'S SI (llc. MO.~ J er 097 1~ 3369 ?i. rNMERAI N11~ AMO A00~[if ISTlElT l10.) IG (3TA~E) . 1 ~ ~a F~?.i.~ps Co 13633 8uclid An+e. Cl l~d Qzi~ . - a?re ~ro w ~ ~EOISTfAS'S i1fyR1AT{{RE ri. DAT! ~Cp ~ ~o. sus~rcc~srurs awr~u?vuse ~ . ~ ' 9 r' ° ~ 4 ~ ~ ! r - • f .r . - . City of East Cleveland ~ - " ~o~ oF No 4'7 2 9 , . . : ~ 87'w7B OP OffiO ~ ~i:;.+;, il.oo n~~ ~AUGU~ 196 i~ IL~ .AN ~R~~~QQK Diatt3ct No. 1804 1 pl !d fl''Q'P' !f't~6 ~ ~.~~c~,~l ~ ~ U g dkd ~at~6 65 QCT 19 PM Z. 4 The attached certificate fs an e~et copy taken and copied fram the ~ i~ ~ r ji;~ q recorcis of this office af the certificate of the of R 0 G~~~' i j;::; S. C LE R K~ S1'. LUCIE COUNTY, E~ y~-~ F L.0 R 10 A , FRICK T. PES, . ~OOK ~~t~ ~S~ D~