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Home My WebLink About0031 . ; ` ' 16351)3 , / ~~~C.C ~ Qi . OH1~ O~PA^T<<EN7 OF •~LTH ~1v / • ~ p~. ~ d' OIV.~ION G:' vITAL STA'~ .C9 Syk !~k Ns ~ ~ ~ ~.~..n Ra. an. Ne.---~~!~r'''~'- CcRTIF1~.A i E OF DEA7~-: Rarwai ~ xo t-~ ~ 1. P E OF DEATH ~ t. SUA RcSSaENCE IVVhere deceaxd I~vcd. ,~au~twa~: c' i~ dcnce tK(we admi~sioe( GOYM GUVA~10P,a ~ STATE ~/•1:; QOUNTI LU~/8hop;a _ dn. v~tuw~ oe iouiwn lEw'viM 01 STAY ~t~ :z ` s. un. Vlll/?GE. oi iouiia+ ' clcveleana ;:uci id i ` I. NAME 0/ wl i~ b~~~fd ~r iaNrrNn~. ~ir~.r ~1lrtu/ r. STtEET A40tiSi . IqS~ITAI OR _ . ~NSU,vnoN ~t. Vinaent Chcrity ;i~spitr i, ^5;. ,;e:.'.^T~- ,~r. ~.~~IIAC! O~O~AflI~ Ili;l'~ CITr lIM1iS1 IS l~SIOfhGE ~hSl)! CITY ~~MIT3~ i:11plN~1 ON~ i rEj~ Np TiS ~`i ~.G ~ i YES n ~10 7~ 3. A E OF F~est At~ddle l~~t t. DwsE Month Day tar DECEASEO ~ ot ~rr.e oa rur.q Yuro - ~z'i.lor o:w:y S. SE~ I~. COlO! OR tACE ~ 7. MI1Rt:iD i:CVEt atA2i~ED ` t DATE Cf t1~iM AGE fl~ ~~ni II YsMr 1 Y~~r ~ 11 @~~ Kn. ~ , u~ ~'r~ilq) N~~rBi~ D~~~ N~~q /W~. G i.ale .Yhite ! yr~~OWED D a~voscco L~ 1-30-190~ 6~ ~ ~ ~ ~ IOw YSYAI OC'QNAl10N / n~ wr~ 1~~~ 10?. KU`O Of WSiKL1S O: tNOYSTfY' il. ~IlTN?LAGE (S~~/~ f~~~i~~ I2. CtT1:EK Oi ~ ~rri~ ~w d~iiy lil~. Nw il Mind/ ~ ~ t~r~li)I WHA: COUNT~Yi . Z Auditor A~.:a:,~ Vis:,s :o. ~ ~:3u•re. ~'~nio l.~h _ t.~ 1~. IAT11Et'i NwME t 1!. MOTMLI'S MAIpFH NAlrE O ~ = Joseph ~iller ~ :::ir_v Hruby p ~ is. wwi oEC~ws[o EvEa ~K u. S. AWID (OtCFS~ ~ 1~. SOCIA~ SFNi:iT NO. i INFORMANT'S NAME ~sdress • ~ O fYu. ~O rd~~~~ II/ xb [~?r ~rr ~r luu ~arin! ~ . , ~ ~ ~ ~ E. ~ ~'LGS-i..» 3;..~1 ,..~i s. Jean ..,tllor 75S iie:~Ioc~_ 1:r. ~ Ii. AU5 OF DEATH I~+n ~~f~ ~~t turr prr in~ f~r (o). is1 (c).j IHTERVAI {EiWEEN U C-~ ~Afl 1. OEATM WAS GUSEO ~r~ / 7- ~ ~ ONSET IWD OEATN lY C~ W IYMEDIATE GIIS b) f~/!S_) /l ~ f"~ ~ ' • ~/:'/a~~/,'~'~~/,EtitC~ / ~r"/ i ~ ~^j ~ ~ ~ ~c`=/.'/TI'/'vf/T ~'1~!//! , ' ri fU/':=.~'/%~%i'~E'/)C :/?4c!~ W ~ N ~ G~liwa. i( rf oYE TO (?l..r~E Ll % ! / i ` ~ 1/f ,;1 ~ e~~/.C' YS /t~ ] - ~ ~ ~ - ~ ~ - - G~, A rl ~ ~ ~ ~n- ~/~(~t~~ : ' ~,'Y~'i'' fI/`: _•~.''/l!// if C ~~1=l.-'//~ y~~~1=/,-'S ~A.i t.~~. ouE ro <<i - . . Z p Mtt It. ~f~ W/MKA/ CMNfIN~ CNf~q~tlN r~ oui• ~~t w~f 1u~1[~ N t~~ T~~~I~a~ P~al~~f iM~111M inu n i~n if~l ' IV. WAS AUTO/S~ ! fEttQt/MtD1 ~ t t /~'OS~'~ / , i-'/ I 1fES (~~NO D t S aFV~iC'F ~ - - , . ~ - ~ ]Gr. AOCIDEMT SYIGOE MO1rtI~dDE ~]W. DESC:.iE MOW i..I 2T OCCUtRED. (Ewlt? aMr~~ ~J iw~ar~ iw Pat 1~~ Pot ~J itr~ ~l.I V ? ? iJ IOc. TWE OF H~o M~stb. Uq. Yrr~ - - a~ INIYfY i. s. ~ ~ ~ - ~ lOd. IHIYn OCQ1~tED ' 2G~. ?IACE OF iAtfUR'~ s.. is or ---20i. CIiY. VIIIAGE. OR IOfATtON COUNiT, STATE W1111E Ai NOT WMIIE i ~aw, f~cbr~. u•::~. afn i:.iA.. woeK D wT woac ~ -~~Y L: p ~ 21. f r~.dd rk /~.~u.l - - t~-1 ~~_~~-~~i l~~t liv bin Ji~r ~ . ; j ~ Df~fL HfMIf If ~ +n Iht let~ rurd r~ i:•Rl t~ eu! of w~ lwor•!tl~t. (ra ~ t~rin if~ltl. [,j ~ SIGNA7UR/E ~ (D~~+rt cr ti11t~ ; 22. _A3DiE:S-_ ~ - - - /./D . ?~c. DAiE SIGHED , ~ ~ %7rtl,[2 Cf. ~=-f~ ~~2 c•~' i,-,. , . . i.~ ~ !i,~/!~ ~/s'~ I~ ~~~C/ _ ~ s N ~L- Wt1Al, CtENA- 21~, OATF ~Zu. hA-~t Of CEI~tiE[: Oi CiE~tASGK. .:Ja. .:~UiiOl4 (Cit~, lo~n, or touot7l (Sqtcl . IION. ~SRrif~) 1 fj~~~,~+~ ~ ~ Cremation 1-23-67 C.~ . .,lanr: . ~ atior. . _~~veland Qhio A 2~. tiAYE Of EYiAWEt ~ tuc. No.) 2S. fUNEfiAi G::EC7Jk'S SI.,:~:.:l,iF lu~j _ No./ / / ~o ~terle O~:ren Jr. SSE5 A ~ ' j~ ! . 2 ~ ~ . ; ~ ~ , 2~. HIMEfAI HiY AND S~ ~ ~ (SttEET NO.) ' ~ tUTY)-- , , , ISiATE) ~ i ~Serl 0're .idri 16049' i:uci~r. ;ven •e Cle~rs 1'1. Cnio ~ ~ 17. DATE tEC ~ 'l~. fEGJS ~At' ~SIGNAiU~E 2V. DATE ~ECD ~Y ~ 30. SU8•iFGtST[~o'S SivNATURE ` N lOCJ1~.~ i~. ~ tJ ~ SUt-ttcutw ~ ~ ~ ~ sM ' fi t v~ ~ e f ` ~ . ~ ~ _ `;t~ l~ : ~ ~ , °~r . - ' . . -r!~"'.41; ~%r ;~:,~~,~s++ Y{q 1~.•{ bEREF3Y ~ERTIFY THAT THE ABOVE IS A!. ':X'r ' . • ' :~--c~i~-~ t;~PY O!' THE R~CORD V'~HICH IS ON FILE 1.~; • ~ ' i _ • ARTtIiENT OF HEALTH. CLEVELAND. G~-: t' . - .I~Ilf17d~'a5 MY HAND AND SEAL AS LOCAL REG~':.- - ' ~ ' :OA L1TAL STA715TtC5. ~ ' . _ ;7 _ i ~ . l.._ 3 . ~ . 4~ w.4:.. . ~ ~ - ~ . ~ "JaN 2a 1-96T . i ; ~ 1• - - ReGISTRAi? y,ssas = '131~% - . . . -.~."',RS'~'~t~'•' •~-•7rs.-^~---~"•Tr~n --rs-__r--'-___.~- ~ ~ ' ~ ~ ~ . ~ ~ ~ NICROFIIY 1~[0 ~ ~ Legibility oi writing, typin8 ~ ;This Instrument Was Prepared By or printing nns~?tisisctory ia ~ thia docw~ent for ~aicrofilming ~ HARRY C. FISCHER ' ~ 401 Fl~t Fedetal Building p g ~ ~flfflpAflO B~~Ch. F~.~. ~ ao~K170 ~~E 3i - . - 'r i: - : - - h y,-s,. d~2``~-±r 'd - 'H" P k~ ~ K~,.,'~~y., ' ~F~"` .'~'Y'-~+?_ .~~.A ~ , _ "