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HomeMy WebLinkAbout1027 ST ~V~ E C0 ECOROEO .L621~ `FC~Rn t~VRIF~~pLA. 1621?~??' ~l Npy 3p AIy 9:35 - i CE. ''`o~::n ~ v: ~q~~ ERK CIR~~~T ~OURT ~ ~ ~ ~wrr `,nt'~~~:l:••j yt;fi~ _ ~IIS ~If:Ai that this li i t~tl~ • v''' ncoe'd in th~ lil~s of th~ °~y ot a ~ 5~' ;+~t Mansfi~id Richiand . ~ ~ ~ , ± I~ j ~ - ~ • , ~ounty Ho~ith D~partrn~nt. : . ~ , ~rrs.r,:~,~~.,.~ aPuh? Re9istrar _ l' ~ ~ .'f. , . - ~ - Mansfiald. 4ha z P r~S- ~ i ~ • . ~ •,s`. . CH10 DEPARTMENT OF HEALTH Wolfo~ ~ p~ ~^2C _ _ DIVISION OF VITAL sTAT19TiCS Sb~e Kk No. P•~••n Ra- C~-- CERTIFICATE OF DEATH G~ ~ - PI.ACE OF f~EATH Z. S 1 E GE l~erc decaud t( ~Rt~KYIhM 1t~., OD11MT11 ~1 r~ La de~ce before s ,~!.1 ~Q~LLaJRI - STI?TE OiaiO C+CIIlITt 4~LL8Lld ~ Clti, V{ttAGE. Of IOCAi10N , t. IENGiN Oi SiAt IN i~ s. Oi~, Y1llAGf. O! IOCAiION - 1 Cit~ of t~ansPiald i D.O.A. City of Mans1'iald I. N/WE Qf /I/ ~N n Mi~rra' ~r .+~n~un~, ~ne ?N~st d/.a~/ STlEET ADOlES1 a-°-- ~ aiinnw~i Mansfiald usnereil Hospital 141 Tdsat Ssoorrd Strest ~s nwaE of ~wrN ~~ce .:~rr-uii~iso - ~s eES~oEna na~~ a~r ~uur3s L IS !ESlDENCE ON A fILfM? rES ~ MO Q rES ~ no ? ~ rES ? wo Q i 7. NAIr1E O .nt 1raWle li~t DwTE Moet6 DaT csr lme oFe ~i JOHN J. GSLLII~ o~n~ May 24 1965 ~ s. s~ s. aaw oe ~?ct - ~ a?~ of arrM ~ it. 7. MAlt1ED NEVER MAt~~E~ 7~ N~r 1 TMt I 11 Wir rrt. fo/ h.t~Ii~1 M~~~b Wp N~s.~ .Nr.. I'1a1~ Whit.A w~oowEO ~ av~o~a 12-15-191~. ~ i ~ ~ _ ~0.. uiwt OC+QMwtWN %G:.i I.+l ~f r«! I.,k 10~. [IMO Os WS1NESi Ot INOUST[r tl. ~tttlw.ACE (Tr~t~ M. as~ 1T. d1t2H1 Oi ~rr:.~ .w ~f Y.. .w i1.w+.~J s~rsall w11Ai C01A~ttYt Retired ~t 0 U A i~_ fwn~rs wu.E - i~. r?on~crs ~uuo~+ wurE John Ge11er B~therin~ Socucah 1s. wws oECEwsEO E~r[i ~M Y. S. wwEO wic[S~ ts. soCU: seDUnn NO. 17. INFORMANT'S N M Addass I ~ (Yu. N~p ul~~e~ 1/J }u. ~i~~ r~? « /rn itrtiril I ` -0' - ~~i `~~~-c~sfield r 0~1. r~ i CAUSE OF OEATH [E~ur? ~d) r~it 1erlnu w(~). (r). ~ ~ wl ~ETwEEN f ~wR oEwrn wws cwusco ~wo oEwrn I u~a~~ uusE d-~ c..t::....:/.., ouE ~o r?, ..c - ,~r~:.s dr ou[ ro ra ; ( ll~ss t~w 4q. - - - : ~ wK~ o~cas~ wM~n+~ tMrn~ n~un •~s ~rr • m r~ n[ r~mua Man~~ c~rr~ a.u an ~d t?. wlls AUiQ?g1 ~E!/O W FD~ i 3 .,G! e'~i~~r~~~~ rES i7 ?+o Z}~ i ~ zo.. naoo~ ~croE e+o.uao[ ~o?. oESCn~ Mow uuueir R~EO. I E1fM ~Ita/t II !I)af~ P..~ r.. P..~ 1~ ,r...is. ? _ _ f 3 ~ ? ~^Zj--~- ? v ~ 70c.' HNr Abstl. Dq. Yr~r~ o r I ~ IO/. iN1Ylr Oa.~1~iD 20r. ?IACE O~ INJVlr n~r ~~t ~A~. ~?Ol. dT1, VIIIAGE. Of IOCAiIOW ~ GOUNTr. S~AIE ' s-• - 1 M1NIlE Ai NO~ MMIIE Jr~. I~rNrl. ~MH. ~fr~ IJJS.. rfs:1 1 wo~ ~ wT worc ~ I ~1 6l.r~~ ~0~1 Jr~~_ . u__,~ ~rJ /o~ is ~~i Jrrt . - - - ~/vi/~ +~r~riri~~r • l~i~ A.M. rbi /~tr up~/m 1: a! q rbe Iue b~sl:Jtr. 1•a~ ~br a~u~~ ~r~tr/. t ATtJRE f s••• rar.i ~n. ~ooecu ii~.- o[ s~ ~ a~ • ~ ' Al. CtE ~ l3?_ OAiE i NA~rE Of CEYETE!? Ot Ctf~MATORY 2~I. IOCATI ~t . to.n. or ur.1i~ ~Suu~ i~~~•' ' ~ •+~M~E~ . ~ue. w0-? ]S. WNEW Ofl~CT S S?GNAIYlE ' ~uc, wo-~ Issrr~nc~ R. Zehner 4242 A ~ ~ ~s. w~rni ?+w aa ~ooeESS _ ` _-`-isteEEr uo.~ ~ / ~~~-~i~ ~N.!/1/~ _ Charlsa L. i~hppner ~ Bm. 98 South Diuond Strest Yansfield~ Oh~Q_ v: on~ fECO s~ » ifc~siurs- caurueE Zv. o rE tEC-o tr w. w~-~cc~srewrs siG?.wtueE` ~ ~ ~ , _ ~ i { . ~-1~~~1~y ~it~ t~ o% ~~y - : 1802 BROADIMAY FORT MYERS. FLORIDA 33~01 ; ~ a~ ~.~9 f~f101~