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HomeMy WebLinkAbout0225 . , . t 241661 . OH10 DEPARTMENT OF HEALTH ~ ~`R' D"`' NO DIVISION OF VITAL STATISTICS f~~` ~O. ;~Z~'-`- Pr~mair x~R. n~u. :~o. ~ CERTIFICATE OF' DEATH Resis~rar's No. r ~ DECEASED-NAME ~ fi?st ?liddir L.ut SEX OATE DEA !i f o~rb, DJ~, )'~+r) ~ fJ~ a. -j 'y RACE R'bi~~, Atsro, ~rtaitr~ AGE- [.~~t UNOEt 1 rEwt ut~OEt 1 OAr DATE OF {!!IM /:~fowt , a~, C N7Y OF DEATH i~.:..w. ttt. IS~rtil)J ~1/I44~J f~a+rrl Moi. U.+~i Horrr w t ~ • se k. ~'~ca~" ~ ~e. Cuvahoga ~ Ci~T, YIIUGE, OR tOCATiON OF CEATM INSIDE CITT lIM1iS NOStITAI OR OTHER INSiIiU • N-NAME fIJ wet iw tifbt?, jirt ~tsett .ewd ~ysibtrl ~s,.~~~„~, e..o, St. A1 xis os~ital n. e ~e. ~ d STATE Of ~iRTM IIJ +~ot iw L'S.A., e.~~re CITiZfN Of brMAT C tlt+tRT nARR~FO, j1EYER ~wi~lEO, SURV~ NG S?OUSE Ilj ~riJt, si~r ~rsid~s ~~iet1 toyprr~ ~ WIOOWEO, DIV~tCEO /SOrri/11 ~f~~~~ 9. . ~o ,~Bess e t;cFau s.~ ~ ~tAl SENRiiY NUMlE WAS DECEASED EVER Ita U. S_ ARMED fOtCES? 2 83 0 9 2171 fYtr, ~te, or rwtrou. (IJ ~si, ~irt tr.+r or d.un o/ ttrrittl uSU~t ~ES~DENGf t~u. 12A. M ti,7E 9EtF>SEO USUAL OCNTAi'ON (G~t't ~ind OJ ti r~ dow nn~s nosf O/ ~ [IND Of WSINESS O! iNDU QY ~ Uv~~ IF DE~1H u.orli• li t. trew i sftcradl • • Gc-r~::o trt t ! / r~~r;o~.~~~E »a- ~~~.crz~~'~ t~ r.~!_ G~L~ f,5 _=tiC£ LEfORE RES~OENCE-SiATE COUv•T ~pTY, VIIIAGE OR IOCAitON INSIOE CITY llMliS EEi AleD NUM6Et ~c~ ~:,uN. • CuS~ahoga Nzwbur h~leights 'S""'"""'°' {~603 Beta venue Qhio ,.b. ~.d. es ~ _ ~i FA:'niR~-.:A%Y= F:^_. - .1f+.IA/t ,l MOiHER-Mj(OfN NAME Fir .~Gd.ilt a'.ull t~`~'~' ~s. i ~e ~ Y ' ~ INFORrV1ANT-NAME 1+A1tING ADDRESS (Sr . or R.f.D. rro., rit~ or riflrsa, rt~~~, rr0) F „o Bessie Ed:•:ards 4603 eta Av ,~te~~bur h Hei ts 0. 44105 DI 1 0898 Z tART DLATN AS ~1!USED BYI fEN7fs~ OYtY ONE CaOif IER [fNE fOR f, f6), AND !dJ A??ROXUtAiE IN!Etv~t ~ tETwEEN OnSEi ANO D~w~ z ~ e. ~ / ~ IM~i1fD1A1E CAUSE tol . ~ ~ ~ K ~~K ~ ~ DJE T 04 AS A CONSEOJ'NCE OP: 1 ~ Coadiriaus, i/. ~~y. 4' ti~bicb s~ve r~fe !o (61 C ~~-•'`"iG."J~' ~j~^t..~ _ ia~~diote taa.ss /a). OU~ TO. OR AS A CQNSEGUSKCE Gt: ~ i z sfatiRs fbt rwdtr ~ - ~ l~ina ttKit Lru F.. ~u.'_~ Me: ~1. OiMER SIGNtHCANT CO[sDiT10n:5 t oadnioec tor.sF'rrtieY to dratb 3ut aot rr:a:ed to ~rrse :irts i~ p.crt I(r1 AUiOPSY li YES e ns /indiesc coxriloed ~ /1"t~ or ~p iw d[t!rwtiriaj trrit o/ dr.+fb ~r 1Ca.~~, 19b. ACCIOENT, SU~~~OE, HOwuC~DE. OAtE OF ~NJUR~ NOUt HOW INIURtI OCCURRED fEw![r w.rtart o/ ~.;a-~ i,. p..,r! o~ p+~r f1, ifra~ ?F1 Ot UNDEIERM~HFD tSptti/~1 l.~lo~td, D~~. Ytal ~ 20a. ?Cb. 20c-- 70d. INiUAY Ai WOlK ~t~CE OF ir+:ut+ At bowr, Jner, u~e~t, /~ctory, tGCwHC.~+ /Snree o, R.F.U. ~o., tit~ or ~ iIlate, ft.rte, :i01 fSOsrill T~j or eo) od+re blJS.. ttr. ISprci171 ~ 2C~. 20f. 7J9 f- CElf~ffGATfON- .Noulir Dr) Yt~~ ~~1~slh Dc) Yt.:• ~NC l%;i SAW MIM/MER 1 DIO/DID KOT DE~.TN OCCURiED .1t tbt ?/stt, o~ („~'~'~.'Y\~. IHYSICIAN~ AUVE OAt Y1EW TME 60DT iNOtlRj fbt datt, an?, l0 ~ ~ --T-~~ ~ 1 AfifNDED 1HF jJ~ £ •Noalb Do~ Yr.:r Af7ER DEAiM. t~ s_/~ tbt i~sf o/ +M) ~ ' ` - e - 7 Z-. z~d_ > ~M_ rbe ~ lyre(i1 jt tad. ]Io. DECEJ15E0 FROM Jlb ?Ic. ~ I CERTIFICAii011-CORO~iER_ Ow /l~t o.uis :^r .a•~+ir.st:,.K NnL• o/ Jrarh 7i,r J~tr.:~et uas pron~rsrtd dt.ui I Of fL~ LOd) JiS:O! IG[ 1GC[3flXJ7(9b. LA N/ O; i~en+r. da~tb • ~ .11o~~L D~) Yts? Narr : o~cvrred or tbr drte .r+d d.. • to rba r..:..e!i) rt~~rd. i ~~j ~ ~ ~ ~ 27C. N. Y29. M. ; CER(~F~ER-;iw.rtE l7rp; or p.;s:l G~..~tuxf ~ts•rt o~ tidt D~iE SIGy ED i , ; r ` ' , ~ . n ~/.s. n r, ! . ?la. f~1.~~C: (i i, 1_ 1 Tl~~~': ~..'i7 . ~-.-.w '-L Y`~ ~-ci-r-ll~'i / 3~_ Ji 27c. j 6 ta G 7L = t.J_St~G •n..ecc~ ~sr` ~r• ~ _~~eE• r'_ t ~ .P . Lfir O~VIt!~:sE ti STPfE ZIY ~ * ~..f _ , ~ •^•~i ~ C ~ ~ '--J 1 ~l` \ ~ i'~ ~ _.t - ~ ~ G-~,:l~ tZe. - ~ f~ - . - ~ ~r~- S i 6URiAl. CAE~wA:~JN) W.1[ ° N._•eE ! F i"~:~: G =-'~Clr 14;..T10N (Cit~. s~i~l~jt, or rovet~lr (Sl+fri 1 / i 7 ' z~ux~'-a' ,?,~';--°--1'; f % ' , :y :.c: ~*~~.~r,- .~,eveland, Chia 44145 ~f - - - --1--- - - - - - - - NIWE OF E:.~..!2A'_k 1?IC- K~.~ Ii4 ~i~~r~tREQ i-S cIG..A U E (ltf- NO.~ 1 J { a --~~'~f~~`_~ ~s. ro~;~r _ Y. .~T ~ . ,.r,;;:~r~.~~_r~~.% ~~~r 4617 6~ M ' ~ t.+:n.- C~iii.~r'~ fUNE2Al f~v?, •:77 ,aL;~ - - . rc- - " ICII') (STAiE) lZ1• 1 , ; _ ~ „S~+DL:~1J :fi:'__ c_ . "'S _ ~ ~hi.s ~ ve Cleve 0 4414~ 35~ 4525 ~ ~ _:r--1~ , ; ~ ps•E i~C'n !Y ,t_~"5.':s J1.:' ! •.•C ?C !i~.~i7~fi' S{GNR L'RE OF fEt50N I.SUI.iG ?EtMIT D15T. NO. i ~ l'l~P'V-~ 1 I~ ( ? V~- ~ ~'r(fl ~ t f.j `:~~~.~_s ~ `::;r..~~.;~ _ 1.- ~--_-~j:_f~ 'aN7 1.~.. ; :~-'t~-t . . _ ~ ; ''s'. - ~c ti . ~ AN!: PEGGkOEd . _ ' - ,.j , j . J f LEO , ~ ~ s~. WC~[ r_ ~~Mty fL~. ~ . ` - [k Pfiti~A~ ~ \ ' ~ c~ERK :u~r covRt Sc~:-~i~l~:; . ~ ~ f , ~o~GR~ YFF;' ~U..~-~-- ' . ~ y I~ 2~AM'7l ~ ~ ; ' ~ . : - _ . - ~.~~ai as BUtK',f "r.dCf: . i ~i6b1 - _ • n. tntai 5=AT~STlCS f ~ - a ~e I ~-~r ~ ~ ~ ~ ~ ~a-' ~ . 'y~~ . . . ~~'Y''~'~~'~~'"~'-~'-~~.'~~ , ~'E?i.~