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Home My WebLink About1017 a Flt! IN WAH 1Y~EWA~1fR OR tEG~AtE IRiNTl1YG . ~~-!+O ORI(iINAL STATE OF ILIINOIS s'"'E "~E wuu~t~ ~1~fN NO.s r' MEOICA~ CERTIFICATE OF DEATN p,s ik~:io°ZO•2 HUwt~Et f~ 131 1. ~IACE OF DEA1N ? USU~?1 RES~DF?JCf fwiw~ sk~m~d w•a. r~ ~H~.~r~•~M. •fvA~K~ ?l~M~ " ~ Stwrt b COUNi1l • SiA1! s COUNtr ~e•...~.wJ ~ ~uiNOis ~18~i6~ 7 innig ~ (~amnai~ c. ~ ~NS~OE cwpo•o~• ~~~~h a~d C:y. Y:l?~. p. /~co•poroeed 1o~w c~ INIOE ~o~e 4n~~N owd .w C.y. Y.llog~.~iuo.pp?oT«77o~w " Urbana Urbana i ;E ~ d? OU1S?OE cwpaa~ ~~~w;y o~d ;w • IiNGT?~ o~ Sr~ d ~ OUiS~DE capaor• wd lfNGiN e~ ~~o AihatA e~ ~o~ntiA:p /w+~ . . . ~N ~t a I.~ TowwtA:p ~f. - . • . . . . ~ . Rood D:~~nc~ No..... ~1 8 Raod 0%i~•:c~ No............ ~l~j 9 v - 3a NA1AE O~ HOSPIi/1~ OR ~NS~ITl711~N O• 1NNi~~µ 0~ STA 1. RES~DENCE AODRESS IS~.ee? G No. o. Rt.O. o~d ?a~ Ol6c~) ` a~ Me~. HOS ~~l 9 aays jN 309'~ E. Oniv~eraity A~e. A. 11 ~o~ bfp:/~l o. „~~.t.~~. a~.e S~reer i No. a t F.p ~¦d ?w~ ON.ce N S~ ' q O~d drerdM~ ~~s~d~ ON A~AlM! rfS ~ NO ~ l. N~~E O~ . cr~~s~~ b i..~uaE~ ~a -~;~~ii~ OATE O- F ~MbNiN~ ~o~.~ w ~ " OfClASEO WALTER EtX3ENE . DOWISNG ~f/1TN A r11 5 19~t S SfX e~~CE ~ MAitifO NfYER MI?RR~ED DI?lf O~ l~RiH I?GE I:"w ~~e•~ '~r"~"~wO' ~r~'~' _ j ~'.e i~ WIOOWEO. d1VORCED (fp~td~) 6 ~ -8 ?:rGes~/ ~'r~ ~aw wws ru t ~8~c~ei8d 1v~Y ~ ~ ri 10~. UiUAI OCCU~AiION ~Oh K~NDOFSUSINESSORINOUSiRY 1~ 8~R1NPl CE (C~h n~d +ro~e o~ ~o~e~y~ cow~~~~1 ~l. C'~'+N'd r~ Ua!? ~ ' ~ ~st?a er ildin Materiala Co Centralia, I11. ~ ~ 17. fAiNEiI'S FUIt 1~. MO?NER'S FUII ~ NPME MI~ipEN N/1ME ~ N llis Re er O 1 S. Wai oeteo~d ~.t~ :n U. S. /~.Ted Fortcs? le. SOC1l~i SECURITY 11. INfORMANT ~ ~rM, ~e, er Yw1ws.~) lG..~.o. r OM~~ e~ w~•c~) NUMEER SIGN/~TUR • G~USE .Z.i n0 ~ ~26~~~~1 b. /1 OR S c. RE TtONSHN TO GF G~ATN ~ _ ~0~ v~sraity Ave. sEo ~ It MEOIG?l C/?USE Of ~EATH < M~1 1 pEAiM WAS GAUSED IY. I Ee/~r My eor+e per ~.we Iw (AI. l~? ~ IC) 1 IMTfRVAt {E~EFM W ~NYEDIATE CAVSE ( ~ ' ONSET AND DEATM ~ N • . . . _ . . Gad.?iws. :l aro. A~w ro (~l ~ Z .A.cA qo.e .;~e to ! ,a ~Mobo.~IMMEU1l~TE J . . . ' C^uSE (w?. sra.~q I rM UNOERlY1NG e,,. re 1C1 V c~w~ 4~t. ~ ~A 1~ IHf~ 1 NI fCZN N I 1 S Nib~LL 1N6 0 ATH IJT N R tA H M~NAI N~ 1 N o. ~utorsr ~ fii'1LN IH M~t µA~ o{ t [ ~ 19~. ~~r~ o~ Naw~neM. 1/ AM~ •~N~ •~w~~U~~ N M~~~fM ` i 4 _ rts ? Mo ~ O ~ NOTE: 11 •n inj~ry i~~ohr~d ie tbi~ d~~fh, M~ Co~o~~t nunf b~ ~ofili~d. i ~ ?l. 1 I?v~b? car. 1 d?Md~d ?~eceo~ed ~~o~ - - . ~ ~13- . ~o . t4G ~Ae/ ! bM wr 1M d~ew~~1 ~M~ j ~ w~ . 19 owd deaM occ N ~~M-. hos the ~ne~ w ~A~ doN ua~d a6w~. ~ , ~ ~ l~cen~ 7/_ ~ ~7l f/ ' ~ 8 ~ .M.D. Nu~nMr.JV Dele. i n Siqn~l~~a~. . . . . . . . . . . . . . . . . . . . . . . - - - ~ ~ /Wdr~s~/. . . . n~~ . . . . . . . . q~i~ . . . ~ AonaA7 ~ / ~ 7 ~ 22. 01SoOSiT10N: lURIA~-R a• 1)- fUNE AL OtRECT ' _ ~ ~/8/~~-.. ' Cf~ETERY . . R08AI$1'~1. . . . . . . . . . ' SIGNATURE ~ . . . . . _ . . . . . . . . . . . . . . . . . . . . . /?~DRESS . W. niversity .Al~~, tOCA?ION . . r~$1rypg,1g11~..~1,~ - • . . . . . . . . . . . . . . . . . . . ~A ~1~. . . . ....N r.~12. . = <:,;rr+ORitr _ : ~;'NO~S R~c~,.ed lo. (S;qeeeJ ti'•^~ April 8, 196~ ; ..a9~P lSS • lOC/1l REGISTR/1R - - - y- ~.s. ` • , I - I~ DEIdPTIS R. BII~1G~ County Clerk, bereby certify, that the ~ s~#?~ched is a true aad correct copy oY the record oP DEATH oY ; > , , ' s:,, =~o~ " ; ~ Nalter B1~gene Davlin8 as made fram a copy of the original ~ K~ O n p •T~ ~TL . ~ 'r ' ~ ~ ~ vCA ~ e~titlcste o! aucb death on fiLe in this ofPice. ~ o~~y~ : - ~ • a a.-~~ , - ~ , . , Z DNr~-nQi s ~ . , • aSIW' 'a~' ~ ao • - _ I'~T ~ - " 0 R DATRD: June 1 2 ~ ~1 ~ ; : ~ _ . ~ _ s ~ ' ~ ~ ~ - ~ ` ~ _ '-A."_ ,al^ 'S"4. Y C: . . _ ~ _ a!s~~.'~~"~.. "