HomeMy WebLinkAbout1934 ilC~ : Y.c.. OR lEG1~lE IRIMING 1`?'2564
~ ORIOIlIAL ~YATE OF ItUNOiS fiwtE NlE'
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~~~c~ MEa:CAL CERTIFICATf OF G6ATH ~~~~T?*~ 8~~ ~ NKy~R EO/ ~
1. CE Of ~fATH t. USW1l RESIDENC (w~n NawN ~w1. N ia~~, e~uNn~ h/«~
STATE STAT ~~9 ~-1
~wNas .~CCTM Isl.an~i ~illinois
d e. INSIDE capord~ /iwiq wI I~ C~r. Y~71ep~. a l~corpad~ To.~+ c. a INSIpE cerpoed~ l:.ih w1 i~ ~r'A~r. Yi!lop~. er l~corpad~d Tov~
j *~'oline ~ Ca~hri3r,e
^ ~ Q OU ID co?porol~ li~rb o~ iw ~ IH k« w ~ d' 0 1 terperob fi~ od i~ A fc ~r ~I ~ ,
~ Raod ~~Na Tar~i ~w f
R~s • • 1 Yea
~ t, NAM O HOS?ITAI OR INSTITUTION . RESIDENCE A~ORESS ( net Na w Rt.O. a~d I'bd Oic~)
Lut~erar. ~!osaital ~i da~?s 207 3 iT St:~et
r It ~N i~ Iwyif~l ~r i~sKM~. Y~w ShNt ~ Nw a R.i.0. wd h~~
~a - y.'D+'d dsc~ raiife ON w iuut rK ~Lo
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Duane Clir.ton Zbmlinson °~TH 3 lt 67
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F ~ S. SEX R/~CE 7. AIARRIEO. NEVER I~AARRIEO. TE OF ~1RTH A6~E
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Z~:alo ~,1'~ite "~~~.°o~'M°xcE° 6 2t~-95 '~'7~
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F ~ 10~. USUAI OCCU~ATION Ob.KINDOflUS1NESSOR INDUSTRY 11. tIRTHrIJ?CE (C~r a~d Har+ er ' oorhY) Gti+M e~ v~
= 3s~ira3 Farmer Ca*n5rs3~e, Illinois `°""''''j II S/
~ 1~. F/1TNER'S Wll . 1~. 1dOtHER FUII . :
~ """'E Albert C. Tomlinson ~10~' ~E a J N
H ~ 1 S. Wa d~aa~d ~wr U. Arw~d faca) t1. SOCU~L SECURIIY 1). INfORAU1NT . •
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• • p,~k Illinois L'idrMt
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S CEMETE~Y . Gr.ace. ~hwrch..C.e~a..... S16W1TURE . .
TION ..0s4o.. t.. HeT~'Y. Co:. .Il~. A~DRESS 2~2 .F. CAUY'tR ..St~n~
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s ~OG1ik RE615TR/?R
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f I HEREBY CERTIFY THAT the foregoing is a t~~nd correct copy of the death recsp-i ~€~c ;y
! the decedent named at item 3 and that this r~cord was established in accord t~L~~e~''`.
provisions of the Illinois statutes relating to the registrations of birth%,,~t3.~~ ,.~j~~~'; ,
i~t .
aad deatha. ~ ~,r r ~ ~ t~.=~>•'g ;i~
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DATB ~ .'.~_Z-~.--_~'` ~ .
SIGNED r-~-~ - • ~r
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Del~y~•~t~trar.^.a „
AT Moline , Illinois. FFTCIAL T TLE L cal Re is~ •
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