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HomeMy WebLinkAbout0521 ~ ' - - - - _ _ _ - - _ - tr . OH10 DEPARTMENT OF HEALTH 167V"~4 r R~~. D„~. i,~, ~p~~ o~v~sioN oF VITAL STATISTICS s~ r,k rj, P~~•+n R<<- ~-~-L~/a-- CERTIFICATE OR DEATH Ne 0 • PLACE OF OEATH Z• 1 CE l dea I~.cd. u~urtYt~on: e~- `°u"TM Curah~ga n~~t Ohl• d`;" eetaa,r,~i„'~uya~1 apa i~rr: wuwcE. w~ou1w« c. IENGTN O/ iTAY IN 1~ arr. vnuat. oe ~ouna+ Laketi+ood ( lakeaood NArE Of /IJ ~M n I~ip~d iutrirws. ~nt ~nre~ raij I. iTl~T ADOIEfS u+suTUna~ p MO'~T~` °t ~ak~vood os Itat 14555 Madison Avt. ~s ru?ce w oewm ~oE an cuun~ ~s ~oEMCe u+s~oe a~r iuuns ~s eES~o~cs on w ~niws ;d rESI~ wo ? res • tw ¦ ~ I rES O No t ~ AME O F~u ' k OI?tE ~ eu ~ o~n~° WALTER ~N. ~ HOPP o~*~ 11~`I~4T N ~ s. SEIt GOlO! Ot uCE 7. M1Alt1ED ~ 11EVER w1ltIE0 DATE Of ~itiN AGE /b ~r~r N MMn 1 Ywr (1 ~Iir Ms. 1~alt - I Mhlte nnoow~ O taro~ao 11~11~18 ~"~`u•r~ M•,~a,~ vn: I y,., ~ ~r.._ 10~. YSYAI OCQ/?A110N IGir~ fi~l ~J r~r! J~u t0~. [INO Of NISINEit Ot INOYfTRY 11. ~1lf1MlACE fSr~f~ ~nip t?. dT12@I Oi ~ Rt~'1`t~s~"pr~'~'~~""''~" 6as Ststion C~1~'~?~and, Ohls t~T °O1N"~' z o u. r~rMEe•s ~ u, ran~rs rwoe~ wu~ z Jacob Mopp ElKina Franz @ ~s. wwt oECE~ EvEe ~K u. ~ AwED roetEST soau sEanm No. i~. INFORMA T'S NAME Addceu c ~r.,...~~.~.....~~ ~u'~`1f1°M`~f'•'I•~,•"•`•~ ~2T1-•OfT••~650 Donald H~PP~ 203fs El~wood Avt. ~ ' ~t. AUSE E [ • ~ ~~e r~ri< <e? ~ ~r . . (c . l1100 > 0 rwn oEwm wns uusco ~r. o~+sEr rua ot~ y~j , I~III~I~fE GIIfE (d c ~ > ~ ~ : 1 W C~~IitNSi~ if OYE TO f?1 ~L~ ~ rbirL ~w~ ~w A - W t1~rt tax (~l. • V K.C~,~-~ a ,.r:.s ..t.._ L~ L ~ t,,(l~t.Z L~ ~3~-- lp~j ~~su /~tr. OYE TO fcl Z = ~.n en~ ~~ncur tM«ne~s cwrnnrn~ n ws~ ~~t ~~f bYTi~ T~ i~t T[~~~/ll M{f?{{ CMMtIM i~~u n~in ~f~l 1~. WAS AIITOKr t~ ~ rn ?ER?ORMEDt + ~ s rES ? NO q ~ ]0~. ACCIOENT S1qCI0E MOMIQOE 1'0?. OESQI~E IqW 11WlY OCCIIR~ED. fEster utn~ iajr.~ i~ Pi.t 1~. Por U.J ;u~ lA_1. i` ~ _ ? ? ? ' 70c. T1ME Of H~a 1W~t1. Di~. Ys~ - E ~ IMIYd k ~ € 20d. INIUf? OCN!!W 20~. fLACE OF IN1Y~Y I~. t.. ~if ~t. ~ 7M. di?, YIIIAGE. OR IOCATION OOUHTr. S~A~E M1NIlE At NOT 1MMItE ~ /~r~. /irqr~. ~fnH. ~~n Mls.. ef[.) 4 WO![ ~ AT WO~R ' ~ ~ ~ =1. / iraw/rl rI~ ltrr~d Jron . t~ ~t /or i~s b~ ~firr - . Dtob wrnAeJ ~ tIr /~te ~atd i~ I: t~ ~it Mu 4~~eld~~. /.s~ tbr ~~ru, ft~td. ~ ZI~_ SIGIVATURE lWpH w rittr) 2~?. I1DDtEis y!c_ O/?TE s~W+EO l.~-~tiz jl i~~e~cfl! E' ' ~ ~ 1b. WR~At. C~EMA- i7~. OATE t~c. NAME Oi GfYETEff O~ pFMATO!'y I~. lOGil (Cih. to~w. or coYntfl lStal~ l i~~u~a~ ( 11/t T Laker+ood Park Ce~etery ! 6ockr Ri~er Ohie . 71. NAME Oi EMMWEt 1L~e. No.t ]S. S 1 N!E ~uc. Mo.l Fred G. Nlcksls 111 5T4~A I ~ • 4595 ;4 i~. fYMEfAI /IM1 A/p AOOtEis (STtEET MO.~ (Q~) - ( s ~A T E) - i ^ NICKEIS FUh'ERAL Hp~IE, Ii~., 14500 !ladisen Ar~., Lakeweod, Ohlo 4410T 2). O~tE ~fr'p ~1 - ~1 y~1f S SI tl ~ r. o~rE ~[co sr 1 w. ws-eECisrwF•s sww~ruet N IOCA fEG. ~ lEGlfitAR I > ~ e Ft! ED AND RECORDED ~T. LLCI~ ~OU`lTY, FL: . - - , , . _ 1~"?'4 . . IIICROFIIY Y~tO 1 HFaEeY CEA11~F:~y11fi~t}s ~ ~t~j o~? ' l e~ibility of writina, typing or OF n+E ~~h H .itl- ~1, ~_e is ~ l~: 53 ';~ri r~ting unaatiefaa~ory in this ~~v~s~ot~t af t ! wirr~eu ' ; oc ument ior microf i laing. ~A,~ ~R ~ , ; ' ~ ~ - ; ~ . : ~~,~~i~~.,'~ ~ ~ ~~L~~RK C!RClJIT COURT , 3 ~ ; Q` j, cs ~ i • ~ ~ ~ ~t , ~ ~~o~, ~ , -ti:. t ~ ~ ~ ~ •t a~i73 ~ 515 R o+sTR~R