HomeMy WebLinkAbout0424 ~ .
3r 50 OHIO DEPARTMENT OF HEALTH 14(~?~3
7 ~ p;~ ~ DIVISION OF VITAL STATISTICS r~ ~
~~+•~+n ~a ~ CERTIFICATE OF DEATH kow~r. t~to
1. PLAGE OF DEATH l USUAL R[SIDENCE la/be~c dece~xd I~.c c
_ ! a~,c - ODUniY aeece bc(we adm~u~on
~ ' STATE Oh io aou~+nr Mahon in
R dill. rltlAGE. Oi IOCATION t IEHGTM 0? STAT IN 1? q QTY~ 1/IIIAGE. Ot IOCATION
% Youngstown ~ AustintoWn ~
• _
,;~o: . _
_ + - ~ N/WE OF p/ .~r iu Mi~nd ~r isim.u~~, ~n~ us~u ~!t•eaJ I. iitEET ADO~ESS • . - .
u"~n
no« North Side City Hospital 60 3outh BeverkyGAar~; .
a nwcE of oEwrn u+s~oc on uxirn a eES~oE,+cE ~HS~ce.aw ~~se. , .t- ~sw~cE o?+ w ~nw~
: ~ J trES ~ uo - - - • r '1 , • ' `
~ : C7 ~ts O No ~ ~s . p.
7. NAME OF Fust ~4ddle !~t •-3 ~ TE . :~ott? at Yeu
DECEASED Conaoll ; , , ' •-,q~n~~Act,~ 5; %1Qb5
- : -a ~ m•E o. ?uNn James L. y ~ : ~
i i iER - i. GDlO! O! f/1CE 7. MAtt1ED MEYEt MAtOEO ~TE ~Il~ 9. E N/? li_Mair T~ (1 Wlir f~ ~n
i '
i Ftale I iihite w~oowEO O orv~oecto 2-22-3~ r ni.
.~I x....' n~,._
~ ~"~~i
~D~ IOs. YSYAI OC~CWATION (Girt !id rn! J~+~ tp~. CtNO OF WSINESS Ot IHDYSTtY 1L ~~R (S.rJ ~r ~~ui~s- u. Z[!1 OF
~ ~f Me d~vf:y I:h. ~N:nd1 s~~sl~j~ 1MMAT GOYNTtY7
= Assembler Youn sto Steel Door Youngstcfynt ~~hio U. S.A
F 0 q. fAiMECi NAME - II. rOTNECS lUllC wurE
` Z Christo her Connoll ~ Margaret Burke
~ ~ ~s. wws cECEwsEO Evea trt u. S. AWED /OtCES? u, soa~i sEae~r~r ~p, a. INFORMAN7'S~ NAME Addrn,
~ r 11'tr. r. ~t+~J~ (1/ ~ri. t~?~ ~o ~r l~r~l iarir~) I
~ O No ~ 278-10-5278 Mrs J.L.Connoll 60 S. Beverlv Ave.
~ 1~. CAUSE OF OEATH I~++n ~d~ ~rt s~ss~ ~n bsr /er l.~(r t IMTE[YAL ~ETwEEN
r~r oEwrn wws uusEO tY. y ons~ ~r+o oEwrM
~ uw~urE u?usE r r~o.
~ - - ~ mT -z.
.-~+i
p =
~ ~
~ OYE_ TO f~l ' _
r ~r usit • ~ ~ ~ . G O
~ x~iss fk al~r- ~ ~ G~ n .
/~ia~ sw~ l~rf. OUE TO fd- A ja_r.~--
Z ~ - rr~~t.q. ~~n 'fu+~nc~ar C~Mnw~ Mr ~~n~ r~ n~• ~r nurs~ n o tur.ua so twa n 1 AYTO?ST
" r s C~Gc.,~ • c~awco~
~ ~ 20~. AGQDENT sy~qo~ f101~11G0E 201 SCtItE MOW tNJYtY OCQlRtED. lEatr? +ttot • ~ QN NO Fi~~
~ ~ O GO O I~n?~A ~ W r ~.t a. m
- ~ m~. nre or H.... x...~, vq. rti. • e n - m• ~
~ ' . ~ uuuR n. _ ' 0'R
. .'D 0
~ 10% IN1YR OC01tfED 20r. /MCE pi IHIY[1 f0 M I~Ii! bo~~, ~o~, an, 1/ItIAGE, Ot tOCA~1pN N, STAtE
~ wOe[ AT ~ MOi M/MIIE I IKtNJ. ~t?rn. ~f~i N/~.. ~f~.j ( _
_ AT WOtt 0
4 . 21. ( ~?t~~Jr! t~t l~t«re! /r~w ~ f~ ~ / I~rt tsv dirr O - - '
. D~~tb Krer?~! ~ • • r~~ tjr l~a rt~r~! i~ I: al N rbr ku e/ w~ ~w~~l~/p. liow tbr ~ou~ rr~u/.
% SIG TLIRE ) 2». nootESs
(wj... « r;ri. ns. a?TE s~c++co ~
~ ~ ' ~ ~ ~ ~ G,J ~ ~/~f~i ~o Oylli~ ro.-L - ~s
' ?7~
, 17~• . CtfMA- pATE t]c. NAME O! CEriEtEtY O! CtEMATO[T 2]I. tOGT1pH (Gtr, W~a, or count~) (Sptc)
u a (10-8-1 6~ Calvary Cemetery I Youngstown,. Ohio
,
!1. MAME Of EY~AtJ4Et Np.I ?S.,jNMERAI DI~EQO['S S~GNATY! -
tua wo.~
Joha J. Higgins 6062A 5053
u. ~.~u Aw ~ nooe~ss (iilEET NO.1 isrwrE~
~ _ ~ Hi ins Funeral Home 4303 Youn~st~ 15 hio 44515
a. a?rE eECO n I e[ ~sr~?e- s~ Tu~ irrE eECO ~r I 30. S{H-tEGISitAYf SIGNA1YtE ~
~ w~ac~stus
~ > OC~`.~',^~ F
~ .
- ' - _ - _ -
~ - _ - ~w- -
~
1 _~_5 ~
.~T .a;i.. ~ t _ . ' ~
~'-YSid~„~' i
~ -:5
Ry ~ ' ~1 1}-C S~
_
.n _ r . ~''~}'~a _ _