HomeMy WebLinkAbout2937 ~;4~~?n1 ~ /
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OH10 DEPARTMENT OF HEALTH
RK~ p~~ ' DIVISION OF VITAL STATISTiCS NO.
R`~~ i'"`~ CERTIFICATE OF DEATH ReRistnis i~lo.
QECEASED-NAME tuu ~Ihrd/e I~u SEX DATE OF DEATH ~.~1~.~r6, pay, Y~a)
So hia G~llu Faa~al~ October 19 1 70
~^CE N'hitt, r~aro, rr~ri..+¦ AGE- l..nt u?~DER i YEAf UNOER 1 DAY OAtE Of 6~ttM ~ U~.url,, p~~. COUNTY OF DEATH
t~/W. tf~. (S erilTl bn~bJ.n ~~~.n~l ~ _ )'e.n1
I 7 .lo~. O~~i !lnrri .\lis.
Mhita 5a 7? Se S~. 6 April 25, 1893 R n
CITr~ VIIIAGE, OR IOCATION OF OEAiM INSIDE CIT~ IIMl1S HOSP1iAl OR OiHER INS~IiUiION-NAME 111 uat iM dlbth a11't )IIKf JM~I MY~IKII
l~pr.;/r ?~i o. w~l
Cincinna~i T< Yaa ~a Jevioh Hoa ital
STAfE Oi lI~TH lll wo1 ia ('.5..1.. u~ni~ CITiZEN OF WMAT COUNTR~ MARlIEO, NEVFf MARlIED, SURViVING SVaUSE ~l/ uiJ~, Rirt r~iJew srwe)
nr~tql WiDOwED. DivORCED ISprril~l
~ouaania _ 9. U S ~o. W~doved
3pC1Al SECUtIi~ NUM6ER , WaS OfCEASED EVER IN U. S. ARMEO fORCES>
11 t.. No. nr MNIMr1YNI ~1~ ~ef. dir~ u-.+r or d~Iri o/ ~ntinl '
1?~. ~2e ~
US11Al OCCU?ATION /(•irt 4~+r.1 nf unrt Jo+~r dmira suif o~ KINp OF lUSINESS Ot INDUSiRY
rwbrs r;/r. ~r .N;.~rl • •
u v »b
lESIOEtJCE-SiAfE COUNTr CIiT, VIIIAGE OR LOCA710N INSIOE Clir llMltS SIREET AwG NUMlER
~SDrcily f~r or ~01
0 ~•b Nm lton C ncinnati ~•a.
fAiNER-NAME f irit .1lyddle L~it MOTNEt-MAIDEN N~ME 1 int .11iddlr l.n!
1 S. 16.
INFORMANT-NAME MAIUNG AODRE55 ~~n~.r o. R.f .v..u., u~~ o. riurjr, uare, :i?I _
17e. ~7e.
rner i. DEATH WAS CAUSED BVS :ENiFR ONIY ONE f~USE /ER UNf /OR fol, fb), AND (cJl Ar? XtMATE INTERV/1t
tETWEEN N fT AND O
1
WAlDIATE CAUSE Ca rd i a c f a i lu re
C~alifio~r, i/ ~rY. DUE i0, OR AS A CONSEQUENCE Of:
r~iro s.se,:.e to ~~b) racture Of T'1 Ylt fe;nur OSt o erative St tUS
~~b1r~ ~~yf~ DUE TO, OR AS A CONSEQUENCE OF:
ittfi~t ~bt rwdrr- )
~~riri1"~' l,~, Accident f~ll - same Ievel
?A!T 11. OTMER S~GNiF1UNT CONOIiiONS ~ oxJ~ri~.~~ curn~bytisg ~o Je~~b br~ xot rrl~t~dlo r~rfr ai~re iw prr~ ? la1 AUTO~S11 iF YES u~nt ~iwdiwai :owfiltrtJ
I)'~s or wo i~ drtrraieiwa tr+nr oJ drN~
~ ~ 190. !Y~ 19b.
ACGDENi, SU~CiDE, HOMICIDE, OATE Oi INlUitY HOUR NOW ItJ/URY OCCURtEO ~Entn sJtLrt o! iwJrrr i+ Part I or /..nt I!, ilew IN)
Ot YNOETERMINED ISAtt+l)1 I.H~wIb, U.er• 1'trrl
~ ' de t ~ob 10-1~- 0 ~o~. Fell at home for a ed
~M1UlT AT WORK PIACE OF INJUR`I .~1 b+ar. tv~wr, ~hrtt. ~.~Uu», tOUT10N I~hta~ or R.I~.I). Rn., ritl or tifluat, ifute, sip)
ISj~tily )ti er ~n) offi.r bl err ~Sps~+J
. no ~o+pr~~iodox ~ewish Hcme 1171 Towne Ave. , Cir,cinnati,Ohio 45216
CEtT1fIGT10N- .~IoR~b U~r ~[JT .~IONIIJ !).+i l~~~r AND IASi SAW MI~njMER 1 DIDiDID NOT DE~TH OCCUlREO .1t Jbt 01a« ~O
. ry~~pp?~~ AIIVE ON v~EW 7ME 6ppY (NOUR~ tbe dalt, r~, to
1 ATTENDED TME TO :~lonth p~r )'~o. AfTER DEATH. !bt btst o~ w~
t~orrl~dat. e t~
21~. OECEASfO fROM 216. 21c. 71d. ?l~. M. 16t ~riru(sJ ttatd. _
E CEtTIF1GT10N-COtONER- Os tbr bafii o( !L~ esdaik.rtioa N~.~r u! dr.eth 7-h~ da:aCewr ua~ prr.enrwcrd Je.id
t ~I ~h AOdj IqI%0/ lG[ tNl[7!ljJJJOAr ie s~ opiMi~rr, dr.+~4 ~ :1lontb DaY }'~ar Hcr?
xr~sr~d ow tbe dute r~d drr to tbr c.uru~ iJ st.+ted. .
E ctober 1 1 0 11•10 A. M. ~~e Octaber lq 1 70 11:10 A.M,
~
CEtTIHER--NAME IT~yr or priu! S~GN TUtE Arxrre or hrir j.~ DAiE S~GNED
~ Frank P. Cleveland, :~~.D. ~ ,Corons 13c11-4-70
~ WIIING ADOtESS--GERi1FlfR ~1rEEl OR R.i.G. NJ. CiiY GR v~tII~GE S:wiC 2:a
3 3223 Eden Ave. Cincinnati Ohio ~t5219
WRIAt, CtEMAT~pN OATE hAME OF CEM:TERY OR ClEMAiORY , IOGTtOt~ ICiIJ, rill~a~, or torrnt~l 1St.ut)
' (SI n/rl
; ,.,~urial z.b. 10-23-70 Tea le Israel Ceoeter ~.d. A b Count Hev ork
~ NAME OF E~rlALMER IUC. w0.) FUNEt.al DtfECTOR'S StGNAiURE _ - (UC. NO.)
I
~ ~s. Jack Srofe 4954-A ~6 ~r? •`-~'j<: ^ i' ~ ~ 815
fUNEtAI iiW AND ADDRESS tSivEET ?~W.~ f 1C~Tr~ • J/' (STATE) (Zt~)
$ Weil Funaral 8ome 3901 R din Road' ~Ci cinnati ''Ohio 45229
~
OATE REC'D ~r EGISTRAR 5 S~GNAT R DATE IERi~T rSSUED SIGNAtURE Of IERSON ISS NG ~ERMtT DIST. NO.
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~ 30. 3!.
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~ I~~~._ , s to be • true ~nd correct photoCraphie copy
~ ~~p'~~,~.e with the Cincinnati goarc~ of Health.
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