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HomeMy WebLinkAbout0391 dGJ.~ ' - - ~ ~ Y~ OH10 DEPARTM~NT OF HEALTH :t:x. u;u. ~c.. ? &,ce F:le \o. DIVi510N OF VITAL STATISTICS x~s,u~.r. x~. ~ i~-' ~ r.,,,~,n K.~x. u.u. w. ~ ~ . _ ! CERTIFICATE OF DEATH DECEASER-NAME l..,r .u:d.tte L..r SEX DATE OF DEATH r.Neu~, O.r, Y•..i i CrtTt~~aI':E i':+IIGY ~.~<<~AIE Jn.•.. ?fi~ 19b° ~~ACE W'Li+e, MfjIM1. ~1~(IIC~W ~ AGE- L,r uwoft i rE~t uwCft i p~t OwtE O? t~trM t.Newb, U+y. COUNTY OF DEATH ...i~.r. ~rr. (S)~:i!I~ , intLJ~j l~t.usl .~iai. D~~i NYYIf .?i~s. }'~•a1 ':1 b so. s?. c ' ~~s. f C•tr. v..:~Gt. C! ~O:w!~OH O~ DtATN SNSiO! Cttr i~rii3 MOS?~iwl OR OTMER :ntSTtTYT~ON-N.u~t w~I ir ~iti~q sirr intN.ir/ rr~~nl ~ . l ~s~~:I, St John t~ospital ~ ~+lEVS~a.^.d ~es ~a. • 5~SE Of i:sTM r/j ~.t is l:S..1..:r.1~t C~71-'R•1 Jf WIfAI C01CNTtT MA!lIEG. NEVER w?tt1E0. SNtV1VISIG S/OUSE /1/ ~ri/t. L~rt ~+iJt~ rr~~I ~ - ~~rt•" Chio a. USA ,~~~pe~ZTi~aE015Prcilf~ ~r John J F:a12ov ~ SECua~T~ +~ur1FR WwS pECE.lSFD EvE¦ ~N u. S. ~erFO iOKEii ; !1"n. u. ~r ~~~urKl (/J j~s. ii?~ wr ~r Lr~a ~1 ~arir~l ; sione No ~ ~ '..5.:4, O::~awt~0+~ IG,c~ 4ird oJ ~.~s4 J~,~ sr.irs s~it ~J [iN0 Of iJANESS Ot INOUSTlY - - . ~ r.b. . ~rtr i) ~ttir~J1 i - i3o. HOUSeHlfp 17~. N`7'~'°- + ° RES.DEnCE-51ATf ;COUnTT QTT, V~~tAGE Ot :OC~iION ~iNStQE CITY UM1fS STlEE7 AND N1M~~ER l5ltciJl yu es r~i - : ~ - -t C~vahooa u~. Clcvn'_a~d ~ae. Y~s ~a..1 ~i7v1 Flnri~r. = ~ ~:nEa-n.~+F t;.,r .Hi1Jr. L.+sr : wotMEi-+rluoiN NwwE F:nr .t1illlr L-:,t ~ - ' ' ~ -LS___-____-_-~.~.L....'~~2 __.._.__._._____-___-~.:rk___~.i1-_ __-~'1:.L•______ . ___._--_._-___.~.i:f3=~a_r.r..a_____-_- INFGR.AANT-\AME ~ wuUwG wDJiFSS r~n•u A.F.D r~., cuy or ri:last, itsrr. a.r1 ~~e .iOhn ' "al lo~ li7e 't?7'1~ - (~~'i; n :;vr i_lc>>iQ ;~r_ ~A~T i. DGATH WAS CAUSED BY: (ENiEt GNL? ONf UUSE IFt IINE fOt (~1, f~l, AND fd1 , ~ET~WEFr~txOnSET ~MOa~~xlrl ~ :a. • . , ~ - 3 ~ [ol ' i A.' L' ~-~1~ ' _ ~ ^ _!~-~~..JC_+-~Z-:~ - i ` i~'•., I ~ setk~u~arF twusF . , ~ OiiE i0, .OR AS A COrSEQU6NCE Of I ~ C ~.7.riori. i/ iss. ~ '<< ~ ~ y _ ri.% ti i ' ' ~ t f.b,:b r..t.iu tu ;pl ~-L, ~.'.~/i, '~'~C ' ,ww:.:~.tt C.uiit /.r/. p:1E 'O. OZ wS A CON~EQU 'CF Of~ _ ` I ,t..:»~ n• rrlt?• f N ~ l~i~s :aa:t :yt \ ic) ! , . i' . •i . ~ - 1 ~ ~ i . ~ • , • • + ' - • _ - a ~ • " T-- MRT Oinit S~Gn.f+CwtrT COnC1i~0AiSCoKdiriors rortriirti~j t~ dc.~tb irt ~o~ r~l~tt1 W i~rt siv~s is ?rrt wJTO/ST tf YES ~•~r~ ~ydrrii corii.:~.r~ ~ ` - }lYts or ~u! i~ /trtnri~~ss r.~rs~ oJ d~+tlr ! l 90. ~ i 9b. ~CC~JEti:, .,U;GUE. hO+k.C.DE: GATf OF t~IUQY ~ MOUi ~MOw tNJNRI/ OCCI;[REO lF~r~r wfrr~ oJ wlrsT u Nr~ J or prrt !1. ~rew 1KI na „~JF:E2~w.NE~ ~~T~:~i)I i ~lowtb, D•Y. Yta/ ~ ( f :~a ~ ~CD. = i~:. ~ 2Cid_ ~ i wi w0lK ~?iwCE CF ~tv~tilY As o..wt. /srr, ~ntrt. j.rtre.). i IOCAT~O~ lSne« er R.F.D. ~o., ret~ ~r sill~st. strts. api •»~:rr~ yo os ~~I ' og..~ i:d~., «r. f51~ci/lI ~ iJ~. _:i~~:F:Ui.GS- .ltorfL D.q )'r.c-I .N~~ti Dn Y~~~ 'whD l~tT SAW Mue/MER i Di0/D:0 NOT ' ~EAT„ OCWRREG .ia f~a ~l.r:~, or InTAUn++ 1 1 ~ AUVE ON i v1EW ThE 300T' iMOUi) rbt ...ur. aw./. to ~ w:if~DED Tni ~ ~SO / ~k:' L. ' .N~rtb D+~ 1"t.rt AfTER DEATM. ( t~t i~s: ~1 ~ 210. ~cLFASfD f2^vw ~ ~ ?Ib.! ~ ]tc. 1- ~ r ~ ~ ~lo. ° ~ ~ % I 21~_ : ~ ir carsslsl st.u~d. - ~ CfR::f:::.i.O~~OiO~ER U~ tnt i.nis oJ tb~ tYr~i1utio~ Hei. ~J J~.tL Tie dtttdt~t uvs pr~r~rYrd Jr+d . ~ •.r ;b~ i.:•.i> .r,1/~r :La uat~:ip.tiow, i~ rT oAiuior, 1e4i .~1o~tb Oq Ytsr H~p 3 •..JII[~ Jy :j! 1Jla iw.! dm~ io rot t.ui~rlrl ~t~ttd. ~ ~ ir. ' 7'b. M, Cc~t.?:ft ~wntf !7)~a or gri~ti StG~'„tE r • Dt~rf~ or ~idt DAtE S~G~vFD / ; l. :a ;c~%; /•-•i) ~ _Ct~".~ / 1~;,~:~ " ; - ~ 13c. rw.:~NG ADJ2ES5-CfiilflFR SitEEt O~t i.f.~. Hp. G~i7 OR V~~tAGE SiwTE i~? i • i~.C• " / ~if/iC +~i/~ V -;?;,..~:tOn~ L..:c E h.wE Of CE~afTERY Ot :lErATORT ~.:dnT10N fC:q. ~dl~~~. ~r t~rst~i ~~r.tr• ~ ~ . i , %al :2a~ - ~2sc. HO~. ~TOSS ~ `t.:~. ' y .7ec ~-~CVtZ=•^C~ a - :.arF ~.i :.~.swirEt (UC. MO.! !fUxEtwl D~tFGT'J2'S_SyG7~AiUlE IUC. tiO.i ~s _ • V~i- a1 ~d ~e./ , ~ , sn~~ 3} fu~E~w.•f.IrsANp AG3ZESS ISTtEET NO.? ;CiTt) • , ~STATE) ! IZt?) ~ ~ r C:- Fv:'JC. =.l~- ~?t':= 4,.~ ~J P,.;~tt' -'•`V= Z :.LE'JE~h' ~t OHIO 44135 ' D+~If lEt"0 {T , jlEG+L'~~YS iutE 'QwtE ?EW~i ~SSJFO_~, S+G:~ATYtE Ol fElSON ISWfhG ~EUrIT piST, NO. ~ i„ ' , ' ~ ~ t. ":',:i,. :~t=,j.. ~r ?OCAt 3EG ' • ~ , _ ~ a . - - _ l~o.~_~~ / :.ri'`:.-~~--- :l~o_A?.';- `Lf.•~_-._.~: , • . f , ; _ ~ . ' ~ FIIEC AND RECOROEO ~ - ~ _ ~ . . SL ,~~~E C~UNTY FIA. ; ROCf - R ::`RA~ • CLERK G ~iCU1T COURT ~ ~ RECORD YEYtF~EO~ ! JAN 29 1968 ~{p! l I 4 OI ~~T{ ~ ; - " . ~ ~ - - : . - - _ 21Q591 - ~ ~t 4001! ~V~ ~V~