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Home My WebLink About1197 ~7~]~ OHIO DEPARTMENT OF HEALTH ~ ~ a.s~ n.«• DIVISION OF VITAL STATISTICS F~~` N" P~~~,n R~R o~w. h~ - - CERTIFICATE OF DEATH R`R~~~"~' ~~.~-T ; DEGEASED-NAME Fi•~~ Mi1.Il~ Lru SEX DATE OF DEATH /.N~~rb, l~, Ytw) Sa~u~el :.rover KI:'K~t , K~le ~ tamber i RACE ~b++~. ~~s?~. AGE- l~j+ r uNO[e ~ rE~~ UHDEt 1 DAY OAtE O~ t~ttN ~~1~..:/., I>..,, COUNTY OF DEATM ~ ~~/r~~. Nt. IS?~~~f~ f...~ ~ntl1~~ r~rwil r ,Noi. D~r~ fforn .Miw. !'~'^I ` ~ ~ ~ s. ~ s. s~ ( AuA.1.18 1 ~a. S oto ~ UT~, v~U~GE, Of tOCwT~OM Of OEAIN ~aStDE Utr ~ M~i1 NOSh1At O~ OiME~ IHSi11yf10N-NAME ~l/ set ~irb~r, si~r ~n~~r dI o~M) „ P+~rtsmOUth ~s,.~; , o..., l~es ~a Scioto ~norlal i SiA1F Of ~I~TN /f! wni i~ l~.S..1., iu~~ C~TIIEN pi WMAi COUNTi• }MAt~tED, NFVEf MA~R1E0, SUfYiVING S?OUSE '/I u~lt. sn~ ~~s/ti ~r~fl " ier~etryl ~ w~00wE0, D~vOtCED ~S?~nl)1 . Ot~io o__ U.3.A. _~~o Married Anna ece SOC~/?l Sf.CUl~f~ NUM~Et WAS OECE.~SfD EvEf ~N U S A~rED FORCES? i ~~p_n~+~~Vnr~ ! ) ~o. o'*O ~aa ~l rl/ ~~i. tn ~ u.a. ~s .iarn e~ st?ri~i! ~ ~_SUAt ~E3IDEMCE 1)0 ~~~7 1?e -.HEtE DEtEASEO ~ .~ED ~F DEATX VSU~I OCCUMTION ~6rtr ~iAI ~orf la~t drnwj ~;.~t o/ --~RirrO Of WS~NESS Ot INOUiit~ ! JCCUttEO IM ro.b~s Idt. irt~ if rrfi.e/I ; vSi!iu7~OM. GivE ~~ineer ,e _ - + D r ~ SSI QN. - ~ tf5 pENCE ~EfOtE RES!DEkCE~SiA/E COUwTt r~tr v~~~AGE Oi CUr Or+ ;:NS1D! C1~1 IIM~TS SilEEI An0 ?~UniE~ ~ 1p~r.l~ ~~i or ~e1 ` saa ~~O ~~e SC1ot.J q02't.S'TIOU'h '.e ~a. ~ fATMEt-N.~WE lr*~f .Ns.1Jlr :~~J ~MOIKEf-M~~DfN ti~M( I~n! .Hi/1/t L~ft ~ i ,s '~e r ir.'~cer ~ ;tta i ; INFORMANT-NAME Mw~t~?rG wppeESS ~~••.n R.F.D..~., i,t~ ~~!l.~., iut~, ii)I r Anna ~inker ',~e ]~f~ Grzndvie~+ Ave p 3 ~ ?A!T ~ DEATH wAS CAUSED BY: ENift ONl? ONf CAUS[ lER t~Nf ~ l~~. ~~b~ AMD f~SJ ~ p%~~T! DE~ATX ~ R ~s n - ¢ WMEOIATE CAUSE ~O~- l„I-j .~TCn~~'f_~_(7? ~1c_~-i.-~?.a~r-~wn~~ ~ OUf 'O. OR ~.S A COr~SEQUE?+CE Of l o~Jiriou, it ~~7. AI~r~ ~ ~ ~ t~r ~ ~ ~ t?1 ~ ~~~1^-k ~ ~L- - --~~~Y ti.'1"'~1. - ~ a~iuw~ !~I r~d~r- DUf TC. Gf AS ? CONSfOVEti~_f O? ~ t~rrt Lur ~ ~ ' ~ !A!T 1t. OiMEf S~GN~fiiANT COr~Dtt.pr~St n~/id..~~ .o~n~br~i~s r~: J~~fh err s•.r •~lud to ..ari~ p~~~ rw I~r~ 1 v~~~UTO?S~ ii IfES rrri pslr~v ro~iJnt/ ~ 1 r+ o. s~ /~tn~ur~s s~rst JWl ~ _ ~~ae (we ACGOE~+T. SU~UOF. ~OM~C~DTO~rE OF i~+lu~r ~ -TNGUe rOw ~rrlu~• OCNttEO ~E¦r~. w~rr.a ol ,.~sry it ~at 1 0. ~~?I 11, tli~ 1Ml ~ ` Of Ut+DEiEliw~r+t0 ~S?~.~irr N•.wfb. Pir. i s ~ ?Oa ~ }00 ~ 1J M~ 7i~d ~ ~NKtR~ ~T WOt1C ~ Il1.CE W ~Nlulr .1r 60~~. i~r~. ~rrr~l ~OU~ -1lrert K.l.!). ~o., cilt vr ri!lit~. it.ui. z~~i . a~ ~S~ftdr ~n or ~~l •(~~r ~ll~.. t~i. ~~~t:if1l , ~ 1W ! J ' :E~tii~UT~O?+- .N•,~rh !)n l...r; W.wri I)1. Y~..r •ND i~Si 5~1w ~ r~ nE~ i~ D~O HOi DEAfM Q~CUftED .~t t~t ~Ittf( 1~ a ?MiS'~~AN ~ ' A;~YE vN 1riEW TME LODt~ ~MOU~1 f+I I~fI, M~{, /I t ATtENDED 7HE TO r ~ (~y j .Mo+r/• I)~i l~r... ~~~?ER OEAtN t~• ~~~t 4wrb/ ? J~t i )~a OfCEA3E0 ~fGM ~ ~ i7~o f • lY, l~ " ~ ~ _ ]~e 1 ~1•~j ~ M rbruuiUl ~wrrl. ° CfR(IitUT1pN--CO~OMEf tL~ ~~n~ ~.r il~ ~i_w~~.n~.~ H• ~ r~..•F f !hr dr~iJr~t r~i .w~,r~~tJ d~ad E r~r bod) i~/: or t6t i~~rue~4.es. iw ,.y~~~c~. d~~rh p Mou~ !L~ l~~~r Hor~ ~ o~.r»i/ ~~r l~lr d~r t~. r~t c+r~r~ it~ud. I 2ta M ~~s ~ - CEIt!f~ f~ f rpe er yr~~u ~ -rS:GhAlUt J I)rsr~~ u~ OA7E S~GNED :t ]Do. • ~ ~ ~ iJ0 a ?~c ~ a rA~t~wG ADO S Fl1IlrEf ;f~EEi Ot ~ f 0 ~~t~ Ot r~t GE SlAtE ji? ~ ~ ~a - - u;~rAl, C~EMATIO?~ OA/E HAMf O~ CEMEIEf~ Ot ClFMATORt IOCA~•ON f( nt, rdl~sl, ~r [~rnJ~) {fyt~) - ~ ~?prr~)~[ ]ao ~3i12'~al 1se~~tl t.3.1_4 ?~c ~.,~~.131 ~ ~3.r~- i?id-~~t ~ N,?rE Of E1MfAlME! !UC r+O~~u?+EtAI fClOt S SIG fU~E ~ (lK. Hp.) 1 ~ ,s .,ohn T. rrtii 62?o a ~ ~e - - ~ - 'M~ fuaf~Al /IRr ~r+D AOOtES1 ~SNEEt •~p ~~~tri • ~SUfE~ (j~?) ~ » F. C. D~ehl~r !~.~rt_,ar~ La. 41,~-42~ I'I~nth_~t. ~o~~~ith. Qhio _j~,~~2 ~ OR1E ~ECO N ~fG131N~-S S~G?~T~~E ~Owlf •Etw~T iS3~EU ~b~Gr+~ii~F pi p~~ Np t ~f a. ~o : ~o ~ ~r ~:~19 I ! ~gS ' ~ _ .