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Home My WebLink About2384 l`748_i2 r.~ ~ OH10 DEPARTMENT OF HEALTH ~ R.s. a«. r~. ~d s.,~. r~u~.Ho. a r~~~~ DIVISION OF VITAL STATISTICS ~ Priiwa4 Re~t. Dist. I~o. ~ N ~Q v . ~ J , CERTIFICATE OF DEATH rf;•• ~ ~ - ~ ~~r . ~ ~Y ~ DECEASED-NAME F;.u .tili~I/e Lu~ SEX 't a, s- ~ ' .c~ I~TH .•.~1~.+i. Dq. Yt.r! ~ ~ : Q FiENRY G . RICHARDSO ma ],~e~4~ . , 'ob{e~c , ~4;~ ; .~.968 RACE ~b~a. ~ip~, ~~eri~p AGE~ V+f UNDER 1 YEAI VHOEt 1 OAr DATE Oi ~IR[N ' ~ EATN r ~ _ T~. "_Q . . e~ .~Iw~. Nr. IS~~cihl ia/~1.~ INw~1 H~rri u. Yewl t~ ~3± F Q , , ~ : • s.. s.. ' k. a..1-18T . ~~n . i CIT11, YIIIAGE. O! IOCAT1pN Of IWTN INSICE CITY llMlii MOS~ITAI OR OTNER INiTIT4T ~ r A~1 W ~ ~ /.S~ttif f1 N N~ ~ 'r' -t.'~ - t - Youn stown ~ ~es North Si '~-4~ f ~i ` C,3 . STAT! OF ~IRTM /1/ wN i~ US.A.. s~at CITI2EN OF WNAi COUNTRY MAtt1ED, NEYER NAtt1E0; _ Y 1i~~~ ; ~ f' f ~ iw~11 • , ~~a~~ur~J USA W~OOWED. ~IYOKED IS~f J~ . ~ • . Ohio ~o. a • s _ r i SOCIAt SECVl1~r NYM~ER WAt OECEASEO EYER IN Y. S. ARME~ WRCESt ~ • ~~'.j ~~R{ ;a 3.','' ; 1 (Ya, N. N wlwwl Ill7t+. Ii • •*r: ~~r- r•, . iiK ~1? l~! ~ - . : ~taaiiio' r:i. USUAt REStDENCE 12~. 296 l.O Cl~I4O I??. N~ ~ `-i: . wnEeE OECEASEO , x: . i . UvED. If DEATN USWI OCCY?ATIOtI fGi?eli~1~/wr41~Nl+air~sNt~/ KIN~ Of WSiNESS'`OR 1 ~ _ oCCU~tEO t!1 w.tut fi/~. ettr i/ rrlirdl . • u~ .`t>• ~h'STtTUT~ON,GIYE Partner Richardsoii~ cession tES~DENCE ~E~OtE lES~OENCE-S1AtE COYNTI pTY, YIIIAGE OR IOCATiON IHSIOE dTr IIMITS STREET ANO NU11~ER AOMISSION. ISN~i/77~+„++N Ot'1?_O ~.?Mahonin Poland ~~a, V°S~J,... 9 Lee Street ~ fAiNER--NwME Firif AIiJJft Lut MOTMEt-MAIDEN NAME Fblt ~Yil11e L~f ~ ' Charles Richardso ~ Ann Collins Y y INFORMANT°NAME MAIIING ADOlEii Ittrr~t ~r R.F.D. w~.. ru~ ~r rill~te, u~t, si?1 ~~..~:rs . Nenr Richardson 9 Lee Street, Polanci, Ohio Z ?wRr DcATH WAS CAUSSD BY: (ENiE~ ONll/ ONE CwYSE IER IINE IOR td, O), ANC fd) A?~ItOXi N TE ~nTEevwl iJ Z 1~. / ' ~ ' , j ~ ~ IMMEGIATE CAUSE • / ' • • ~t ' ~ C -•`~l \ ~ - ` _ . DYE i0~ OR A~CAHSEQUENtEp~ ~ . ~e~liti~~i. il ~~f. ! ; ' ~ . ' t / ' vbiti s~r~ rJtt Ie ~ < - " iswtdirlt r~rit /i1. pyE TO. OR AS CONSEOYE E W~ ~ ~l~riwt fbt r~ler• ~ _ l~i~s ~trt~ J~tt ~i 2 iw~t n, OtNER SiGN~FICwNT OOt+WiiOnit~.~iri~.i s~.erilrr;¦s a/r.ri ?.u •rl~rd a~~rr~ p~rw i~ Nst /(•1 AUTOISr If YES rrrt /iwli~p s~uilatl Z /Y!t N M ir itlnsisi~~ s~rtt ltdi ~ ~os. ~ ACCIDENT, SUIGIDE, HOlA1pOE DATE Of IHJYtY IIOUR NOW INJYtr OCQJRRED fF.+M~? wtrrt iwjrr~ ir ~nf I N Nrl 1!, ilar JlJ OR UNOETEWINEO (S~tsiJ)1 NM~~Ib, Dy, Ye~i) Q ~Os. 20?. 20c. JW. IN1UR~ AT WORK /IACE Of INl{1tY At i~sf~ ~heH. I~st~ry. IOCAiION (ShtH R.F.D. si~I~ N~ill~sl. lt~le, =i?1 W IS?~ri/s yn NI ~~ce 1l/s., ets. (S~eril7l • } 10.. 20/. _ F~ CfRTIf~UTION- A1~w/6 W~ Yn? A(~~f~ Wr Yto ANO IAST SAW NIM/ 1~1p/010 NOT OEwTM OCWtRFO Af Ibt 1l~t~ es „ IMYSICIAt~: AIIVE ON YIEW TME i00T ~MOUt) ' Ibt drlt, , f•-~~~_~~-. ~ 1 AtTENDEO TME 10 Mss/i D~~ Ym AfTER OEATM. !b~ itrl 21~. OKEASEO ftOrS t. 4 1968 Oct. 4 1968 t~~- Oct. 4, 1968 :i~. . ( 0 P. r~. ia~ r`.;i;i u+i~ CEfTIfICAT10H-COlONER. O~ tie i+ii~ fbt t~~iwti~r H~o d~ui Tlrt 1ts~1~M wa ~r~Nr~st/ l~~d ~J tb~ N1~ ~wl/~r t6~ i~reiripti~i, ir •~?isur,lti/i Ab~a1 D+~ Y~s N~rr i~rrrrr~l ~r ~k ldr ~n! dw I~ iit co~~lr1 ~~d. ~ 1 . ~ 'I - w?. i~?. ~t. CEtTIt1ER-NAME IT)?e M?/iNJ SIGtiATUlE r'~~• ( Dtptt N Iult DATE StGNEO i John J. Turner M. D ~~a. ~ _ 1~~:~Z.- - •'1 „~_Oct. (l, 1968 [ ~u?ItING AOORES~-CEti/flEf STlEET Ot R.f . NO. ~ GTY OR VIIIAGE • STATE 21? ?~a 64 Ridge Avenue Y~gstown, O io 44502 ~ ~UR~wt, CtEr/?TION DATE NAME Of CfMETEI~ O~ CtEMATORT tOCATiON (Ci~~, si!/~jt, ~r t~~al~J (Slr1t1 ~ . 'S~'1'~ : 10-7-68 Forest Lawn Cemeter Youn stown O:~io o u r ~a 1:... 9 . = NAME Of EM6AWEl (IIC. NO•1 FUNE DIlEQOR'S SIGNAIUR! (IIC. NO.) :s. R bert D. Gus afson 5591_ A: ~~~~c~ -.~-•?"r-~ , 5431 'o ~ iV~+ERAI fllw wHD AOO~ESS !S~lEEi NO.? ~ GTY) (STA~Ej (ZIry The Shriver-Alli on Co. 292 W. Madison Ave. Youn st~own Ohio 44504 ~ r' OATE !EC'O ~'1 ~EGISiRAt'i SIGH tYtE DAfE IEWIT IiSf1EO SIGNATYtE Of ?EtSON ISSU~NG IEWIT DIST. HO. t l ~EG. ' ~j~'~ ~ 1 » / ~0. ~I. 1 ~ # ii t i i • ~ ~ ? GC ~ ~ C~ ~ ~ , ~ r -n r m A W ~CO c~ r ~ t+t ~ ;t ~ t~ J~Z ~ ~ ~ -~~o - ~ co .-'~*,c~ ~ r ~ Z~ ~o D ''a i~' ~,-~c ~ ~ ~ ~ A~ ~ aooK 1~5 r~~t ~3~ ~ ~ . . - .