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HomeMy WebLinkAbout0823 8T ~LUCIE C UNT~Y.~~I.A. . RFCORD VERIFIE~ '68 I~Y 1~4 PM~ : 3 ~ ROGER POITRA CLERK CIRCUIT C0 > ~ DEATH CERTIFICATE OF MARIE T. SHSARY Re: Lot 57, ALTADENA SUBDIVISION, as per.plat thereof on file in ' Plat Book 5, page 71, St. Lucie County, public records. ~ ~ t .•K. : K. A.tiRr - ..i - .~-i .t~~..f ~w~ w w~...~-~..~~_~. " ~ { I . ~ ~ + ~ ~~1 OH10 DEPARTMENT OF HEALTH _ ~ ; ReR. lhst. No. O &ate Fik No. ~1 DIVISION OF VITAL STATISTICS - ~ Primap RcR- L)iat. Nu. ~~Ql CERTIFICATE OF DEATH R``"~""~+~ '~~':s; ~ Fj ~ DECEASED-NAME 1~•,r .Nidl/r Lut SEX pAl'E~ : ,~T _'~fw :,Ytnl~ I MAR IE T. SHEARY :.Female ;Od~ N ~ ,a.,. y , . RACE K'j+«. K~~~s, ~~rric+w AGE- Lnr UNOE! 1 rEAt UNOEt 1 QAV DATE OF tIRiM fMo~Ib,;O~ , Ra ~ i i~dirr e(t IS~«ih) beJbJ+-~7I~nni/ Mor. Dn~ N~ani Mi~. Yeo1 ~ .r, . i.. white Se. 11 s?. Sc. f. 11/12/187~~ 70 I • 4` I CIiY, VILLAGE. O! IOUflON 0/ DEAtN INS~DE CIiY Ur+?Ii5 MOSr~IAI O! OTME! INSiliUT10N-NAYE (//_~f ~ J~ilt Pubff ! l~KJ /SNtih7f/ N n0) ' . • ;.,.~!I '..'i, S:, • ~ ' ~ ,b. Akron es ~a. Akron Cit Hos i ~ = - • . . STAtE OF ~IfiN !1/ ~H i~ (:5..1.. rr~r CITIZEN Of WMAT COUNit~ MAltlED, NEVE~ MAtt1E0, SUtV1VIN6 •Sf.~~~= ~rrt)' - w~ooweo, oivoec[o ~s~sc:h~ Reno. O~ - i a"YK~ron, Ohio o. United S ate ~o. married . t ~ SOCIAL SECUQl~f NUMtER wA5 OECEASEO EVER IN Y. S. ARMEO fORCESt ' 4' r\ ~ ~ ,~a. ~~-~0-2431A ;~....,..~.o.~~,, ,,,,...s:~..~..,.~...,~~«, I USUAI OCCU?AiIOH I(.ire kiwJe/ rn?! du~t lrri~t ~oi1 oj KINO Of WSINESS Ot INDUSiRT q~/~~t ~I/~ /~~~t ou 13akir~~lt_bCAl~1C~J1 1~6. t/WII ~ tES~DENCE-SMIE COUNiY CIiY, VILIwGE O! lOUiION INSIOE di? LIMIfS SilEET AND NUM~ER Ohio Surrcnit Akron 44313 ~s""~„`f 483 Parkside Dr. 140. l~b. llc. 1ld. Q5 U~. fAiME!-HAME Finf .Niddlt Luf MOiMEl--MAIOfN NAME Finf MiAdlt /tlf ~~S Charles Lehner 16 Theresa Herman i~ INFORMANT-NAME ~~Ur+G wOOtESS fSnr~~ er R.F.D. ~o., tirr or ri!lisq atur,:i~) ' ~~o Reno N. Sheary ~~b 483 Parkside Dr.,Akron,Ohio 44313 rwer DEATH WAS CAUSED BYS ifNfE! ONIr ONE CAUSE IER IIHE f0! /ol. Ibl, AND fcll ~~ROXIMATF INTElVAt I i ETWFEN ET N EATN ~ f~8. ' f ~ IMMEOIATE CAUSE ~O~ ' ~ ~ s ~ ! DUE i0, ~ AS A GONSEQUENCE f: ' ; I Co~Jitio~i. i/ ~~f. ` ~ ~ ~ ~Q . I ` u•birb aare rire Io ` lp! s fl-.._" •.•.v ? [~k • ! t 10~"rfiLiU~ ~~yi~ 1d~' ~ DuE TO. O! AS A ONSEQUENCE Of: I tratiw` Ibt rurdt?- ~ !)i~t rarfr Lut Id ~ ( Pwtt 1~. QIMEt SIGNIFIUW CONDIiIONS ( o+yliriosi ~owtriirrir~ ~o Jro~b brf ~of r~lrtrd/~"~uu~jittw iw ?~r i) AUTO?SY IF Yf5 ~rtrt 4~diwj~ [o~~iJ~sed r . ' • / r ~ f; y, /Yet or ~o ir 1rrr..ri¦;.t ~.w,e o! d~atb ~ . ~~s-._-- ~i . ~;1.._, ~ ~i.f"^XL~ t t_: _ ~`L e~~ ~T 4 r~ u~@S 196. ~ ~CGDEdi, SU~UDE, HOMiCIDE, DAiE OF I 1UR1/ HOUt NO lUR Q4CU! ! ! rr oJ i~jr i~ Par! 1 0? jot Il, iftw 181 f,- ~ OR UNDEIERMINED ISprti)rl IAlowrb, Y[rr1 ~T ~ ~ 200. 100. lOc. ~d. r i~ ~N1URY AT WOlK ?LACE OF INIURY A! bqnq /rr~, if?ret, Jrcfory, LOCATI 1 r o?h .D O., '~f~ i//~jt. ft4e, u~) lS~tri/1 ~es or rol oJJJfi~e Lldt.. trt. fSperil7J ~ ~ 70f. t- CERi1FICATION- Alo~tb U~> Yeir Me~tb D.r~ Yt.rr tAST SAW NIM/Ne 1~ 1/ .OE N OCCURtEG Af tbt ?licr 1 ( R) fbt drtr, • PNYS~CIAN~ Al EmN r•r MEW T ~ to ~ 1 AIiENDEO ~HE TO ~ r,-:Ye~ AftER; fbt ~ttf o ~ , ~ . . 8:35 P 4wor~/ad~r. lrs N 210. OECEASED fROM ~I - ' <<~ 21b. lC~~ " 21c. ~ - ~ 71d. M lbsr~rre(tJstdtd. CERi1fICAiION-COtONFR: (Iw tbt briit o/ tbt tx.rsir~li~w !/orr o/ dt~l tttJt~! ta•p jroror+~ttd ~ o/ tbe bod~ ~~d/or Ibt i~rrfrip~tio~, i~ sJ o~i~io~, dt.ub ff' MoRtb Yea Hoat? utrrntd oM llr~ d~lt ~nd drs ro!bs craul ~I it~td. C~ E , ~ ~ ~ 2?0. M. 27b. ! f ~ . . ~ . ~ CERiIHER-NAME ITl,r or pri~11 SIGNAT E , Depss q fit/t OA~E SIGNED ~ Simon A. Schlueter M. D. ~ae. I', . k1 - - f ' MAltl?K, AOORESS-CE~i1F1ER STlEET Ot R.f.D. NO. Cltll OR VIIIAGE STATE ZI~ ' 7e. 159 South Main Street Akron Ohio 44308 6UlIAt, ClEMATION Dw1E NAME Of CEMEtE~T Ot CREMATOl~ LOCAiION / it o st w~rwqJ (Sl~le1 ~ ;?~Y~t~Mation ~1e10~16~1968 Northlawn Memorial Gard gu~Q~t ,~auRto~i os~ip rur[ O~ f~r6AlME! IIIC. NO ~ fUHERAI OIREQ9t'S SIGNAiUlE ~UC. NO.) J. P. "l homas 6641-A ~~1~ 4153 s. ~e. ~ UNEtAI FItM AND AOD~ESS ~ ISTfEEf NO.~ , ICIIYI (STATE) ~21/) 't ~ ~i „ THE B IRLAWN EL 5• Miller Rd A r 0' i ~ DAiE REC'G ~T fEGISTGR'S S NAiUtE OAiE ~ERM~T ISSUEC SIGNAiURE Oi tERSOH ISSUIHG IEfMIT DIfT. NO. l R , ?e ~ w. ai . ~ ae~-yrr _ _ . . - ---~'~y"'? ~ ~ooK174 ~~0 ; _