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HomeMy WebLinkAbout1931 , ~ OH10 DEPARTMENT OF HEALTF~~~K PAGE~?UU ; ~ 0..2 { a.s. o;x. r,o. s~.~. F;~~ rro. ? ~ ~,y DIVISIC~N OF VITAL STATISTICS S~ °ia. N°. CERTiFICATE OF DEATH R""`~"' ~ / OECEASEO--NAME th~t 1WIl~ SEX OATE OF ~EATH I•H~~ri. D~1. )'r+•J Terence T. Richardson ~tAle _ ~ 24~.1971_ _ _ RACE ~'b~~•, r.i.+, •.aic~. AGE- L.r uhot~ ~ rE~~ U?+OER 1 owr OA1E Oi ~~~TM I.W.¦r~, D+~. COUNTY GF DEATH ' is/ia~. r/t. lSl~c.l)/ ' Iwt~/+~ I~~+n1 .M~i. U~~i H~ai 4is. ,•~A~larch ~ 3 ~ 9C~,.. yahoga Vhite s.. 68 k. s_ GTY, YIIIAGE. Ot IO:At~Ot~ OF OEAiN INSIDE UTY Ur115 MOS?IiAI OR OiNER INS11iY110N-MAIMf (1/ s~t ii tirit?, ~~rt intt~ w~~tr/ n. Lal:ewood ~sN~d> ~ewood Hospital SfATE O< <~tTM f// ~N i~ U.S.A., ~+~t C~i1tEN Of WNAi COUNIIt r+~tti[O, NEVEt wtwttiEO. SYW~VING S?OUSE /IJ ri/~, ~i~t w~ilt~ ~wwt) ~~r~~~~~ KentuCk WI~WEq ~~vo~tto ts~.r.b) i. y USR ,o_ I~arried Theresa Gibbons SOCIAI SECUe~ir NursE! ww3 OECEASEO EvEt iH Y. i. AerED ?OetESt A 2~3-~5-96 32 ~Ye~, w, ~r rd~or ~1 !f/ ~n, ~in~ w. J~ai ~l re?rir~l URi fES'DENCE 1~e. 1?~_ NO yf tE CECE~SFp UwAI OCCUMi~ON IGirr ~irl ~l r~~~ J~~t I~r~~ s~if RIND OF WSINESS OR INpUSTlY ~~D. i? oEwTM rerli~ fi q~r~s i r~iird) s :CU!!ED ~N s ~ ~ ST!TUIION, GIVE I~O_ En lneer I~.PP(lll~ efl ra S~DE`~CE tEfOtE ; ~KiSS,ov. tES10ENCE-SiAfE COUHTr diY, YIttAGE OR lOGT10N INS10E CITY llrliS STtEEi IwO HUr~Et IS1~siJl 1ti ~r u1 . ; Ohio Cuyaho a Cleveland ~u. Yes ~a..1630p Elsienna Ave fAiNEt--NwAtE Firtl Alil/It Vtt MOiNE!-AUIDEN NAME fn~f .11ilJl1 l~/f ~~s Jemes L. Richerdson ~e Anne Mulligan ; INFORMANT-NAME 14All~NG ADORESS ISn«i ~r t[.F.D. w~., cu~ s;!!.t•. =~?I Mrs. TerencP T. +~~chArdsnn ~n. 163nR FlsiPr.na Ave p P n•+ h' ~ 2 ?wat ~EATH WAS CAUSED BY3 :fNiER ONIr ONE GUSE lER tINE fOR fol, 161, ANO (cll E~~tNXI N TE ~HiEOlvAwiM } ~ Probable coronary sclerotic heart disease. - e ~ IMMEDIATE CAYSE ' ~ OYE TO, OR AS A CONSEQUENCE Of: j C~~1i~i~~t. i/ ~~1. ~ riitb s~~t iiie t• ' ~~j~ ~~j' OUE TO, OR AS A CONSEOUENCE Of~ ~ it~tiws ~bs r~l~?- ~ /)t/~ [trff /~tl ~ ?A!T 11. OTME[ SIGNIfiGNi CONOITIONS.f~~diliori s~iur~eWi~j te Jt~b irt aef it/~ftl !o t~ri~ ti~t~ m~of I(~1 AUiO?S~ Ii YES rr~rs Fsdi~ti r~nr..:rr~/ ~ ~ IYIi H N i~ /~trrniwi~s seru dt~tb ~ I~e. If~_ e ACCIDEl/i, SUICIDE, liOMICIDE GATE OF IN1Ufr MOYR NOW iN: Y p~NRtED (E~ta ~wtr~t oJ i~jri~ i~ ~rt I~r Nr~ /I~ ifts /d1 O~ UHDETERMINED (S~~riJ~) f.Ne~tb, D~~, Yter1 ~ ?Oe. ?Qb. tOc. 20d. 4 d INIUlY AT WCtK ?IACE OF INIURY At boa~q /ow, ~htN, /wtfoi~, IOCAi1pN :et ~~X.F.D. it0.. tit) 1? till~je, it~ft, si~J ~ ISprill lri n se) ~~Cr ~lls., rtc. /S~~ci/71 _ + ZW. ~W. a CERi1f1UT10N- Y~~~j Dq Y~u .No~tb U+~ )'~~r LAST SAw Mur/MER ~ D~O.~ O HOT DfATM OCC~•,iED Af tit ~l~cr a~t & fN~SIUAN: Al1YE ON VIEW TMt tOpY (lIOUt) t~e Iil~. es, q ~ 1 ATTENDED ME TO A(~st~ Qr~ Yt~ AiTE! OEATM. Ife •~rf ~J w~ lsrriltJjt. Jrt t0 - 21~. DECEASED ~ROM ?l~. !ta ~lt. l1~. M. tks~rufiJit~trl. 3 ~ElTIflUT1pN-CO~OMEl- O~ t~~ L+iii tlr~ rs~~i~uti~~ H~+r /t~ TI~ l~ttlr~r ro y~prstsl J~+/ 1N ~~I~ ~,e!/~t rit iwrariprio~. iw ~~~i~~o~, /ew8 1M~Ni D~ Y~+r BN? ' Ks=ntl t~s l~t~ ~sl Jr~ b tie c~ri~~i) r~.us/. n,. ovember 24 1971 1:21 P. ~ CElTlflEt-HAME /r~k ~r ~ri~l1 flGiiAiYlE ~ D~ptt ~r !ill~ D/lTE SIGNEO / ~ r,.. S. R. Gerber M. D. Coroner ~ . D. Coroner Dec 1 1971 ~ MA1liMG ADDlESS-CEti1f1EA STtEET O! R.F. . NO! / UTY OR VIILAGE i1AiE Iq - 2121 Adelbert Roacl Cl~veland Ohio 44106 ~ Wt1At, CREr~Ai1pN OATE MAxE Of CEMETEtY O! ClEMAtORr " IOCATiON (Cil~, ~i//ip, ~r to~nl~l (Sl~tt/ ~ ISItti11 UT181 S - J4. tf 11-29-T1 No Cross 1 . an h' ~-5 NAME Of E~t~AtMEt AIC NO.) fYHERAI ~t'~IG U ` (uC. rW.) _ „ a. vai~ 4124 a sooe fUNERAI i1W •np AODlESS (STtEEi NO.) (GTn (SiATE) (jlry ~ 27_ ~H:1t~7~t\S F~~li~ F~n~~ T~~r n. V DTl Cn 1 C ~~1 ^U ~'.1 ~5 OATE !EC'O tY !f~ •S'~~t'S SIG~+y?UtE • OAiE ?ElM1T ISSUED SIGNATYlE Of /ElSON ISSYING ~EtMlt W~, Np, J ~~4 ~ 7 / C ~ ^ ~ ~ ~ 1~ ~ rGG ~4 " ~ //a l0 / 7~. I' ~ ~ /ar - _ c . . ~ . r ~z~t ~.F~+~. . _ ' 2~a~ ~ ' _ . ?EY;I::~i ':~~:~Y~~ _~O. ~ ~ ~~tirP`,i= ~.,~r ~J+1~S~~'~~. ~ /iLEO ANC RECORpE. ~i _ ~ ~ : i ~ ~ . ? l I'~"' ' ~ . > '.r::'t~jiL~?- ' 3T. LUCIE COUNTY fl ' • ~ t.. RQCEP, POITR~S ' CLERK C~~iC . ~ ~ • . ~ RECOR~ vcR~f Ep COURT : ~3(,1 P~cE.~UU ~ = . • ~ ~ n . r ~ ~ ~ Fte I ~I I o7 PN 'TZ < ? . , ~ ) _ t' • , . i r - c~.,. a~•,, ~ ~ r~'~ ~s ; ~4'` . : K: . / ~ ~ 7 . 4 . i , ~ . - =a ' . j. ~COK 1~~ • 1 .i ' • ~ '7 . t , - . . . . _ . - ' - - - - - . . . - _ " . . . _ . - ' `--z,'