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HomeMy WebLinkAbout2876 ~ra~~~~3 M~RYLANO STATE DEPIIRTMENT Of NEAITM & onts~oM or tn~t ~oo~eo~,, w. n~sTOM st~~. ~u~ro~, ~wtrwr =~ut S r~ 3 as~ , - ' CERTIFICATE OF DEA~H ~ ~ ~ ~ o' ac[uto wu~ ?.a ~w aa a?~ o~ ou?n+ » noue . . Li ~-s Itrv. « v~r r~a+r~ r.er . ~ ~ s~x ~ ~ s. o+?rE a a~TM • ~cc~ ~M~~1 • ~ ~ . Ma. r ~ : r ~ a+ bs1 MrNi00r) ' ' 1 A 1 ~ i ` ~ o 'o. BtRiMP1A(E (LoN ~r ior~ 1?. (If1IEM Of WN~i (OIMITtYT ~ M~ttiED~ I~VER MARR~EO? GOIMir OF OEA1N • c ~ L Ml~ppy~fp pIVpR(Ep ~ ~ ~,y. t v n ~ 0 LIPf Ot TOYY1i OF DfATH n. wu~ a rasnru oe ranrunoN ~e ~a:~ Mtp1~1 It~ l1SUA10C(UTATION (Rwd ol work ~ 12! 1(iMD OF MbIIESS OR !~s sMM oidnss) dYmy wost et wakuy ?Iti ~wa if rNrN ~ II~USRf \ s~ : V d i . ~~a lo. USUU tESt~F1i(f (Whw~ du~os~d iwa if Nntif~Aio¢ Rasi~d~nu bbn Ik. UtY OR i0'MfN ?y ~aot tn u~as~ 17a SitEEi AND MI{MBfR _ ~ ~ > " • ~d~rss~on) S1ATE 1~. (OIINIY~Ai , ra O ~ ? ` r ~ 7 ~ ~ it FATMERS NAIAE Frst WdM tost IS. YO11iER'S MRIDEM NAME frst Mid~ lmf ~ Frederick F. LAapley Nattie Carr " t~ 16a wAS Df(EASEO EY[R W US. AtMED fOR(ES1 1~. SOf1Al SE(UtIiY N0. 17 Addnss ~n ~ t res, ~s~o.~ a +.~.a ~ .s~..~.~0 , ~ ~n°Scnow~ a Admi s ion fora~ .S / 3 E' t (E a!r an cae. vr M. kr (el. (~11 11 GUSE OF OFA1N .ru ~ f~/~ I~C+L'~' n ~ cc.~r ?~tl t OGTN MAS (AUSfD fr: G f T r, - , ,1 IMYEDIAif WlSE (a) i ~ ~ ~ ~ ~ ~ 7~~r•~~1~`:. • . pllE T Ot AS ( E OF ~ ! ~ . ~ _ ~ r.. ' mc~o~d! a ~ ' { : : tr 10, Ot AS A Of i . ; c .,0? ~ ~ . y { ~ , • ~ (O~If ~ iRIWTING i0 OEATM Mfl N01 REUTfD TO il~ iE~WMAI OISfASE OtC01DIilON GIYdI YI IART 1(~) " ' ~ ; ~ _ • :_-i . . ~ J4 ~=1•:- ; ' . r ~u. co~w• MMIOI OIElAiION WAS PEtFOR11ED ~~urors ~ae. s v~, wEa rwowcs co+a~oEao M ccemwc . ~t!'''} . t : ~ ~ . , ~ :4 .i. ~ Fc." ~ a • . C~ : ~ ~ #~'r ~~.r-..r ~ , +t / ra ~a ? ~f ~ : u caErr i. Of a?xNrr 2!c ~ow wlUn occuRREU (bwr n.M. ~I .~ur~r wron I+.n t, wi. Q~ r, ~ ~ 0~ AM MonM Dor rwr ~ • • rx * . . 1 ~Y ~aF~ ~ o~ic. x~. ~~cion.1 111. 10UT10N Skwt er R.f.D- Ib. Ci1~r ~r TowA (owh S~a~ , : • ~~M~ ~ . .~2 ~ i i ~ - '~1~~. ` ~z : : - c i = ~(I~ hospitd) te t eosed fr . 19 . to 19 tAot (I) (vre) lost • ~ a ~fliiidlc~osed olive on ~ 19~and at ~n (m~j (our) opinion d~oth a rred on th~ dote and~hour and from th~ ~ i. causes state abdve, (11 (we ~did ~Md~riot w bodr oher deoth. ' ~ ~i~ ~c?a?;,:E rn ,rt s~c~~ ~ ; ~ ~ t ~ ~~G/ ~Ci2~ acRCt "%i+rs~ ~ a~°croe O nns ~ ~ .,a ~,~~.c~s 21~ ADOtESS i ' ti.w (r,a) ~ ~ ~ ' ~ ' 'r' ~ ~ ::e~ rpEyAllprG. 1b (~AfE (IWIIRY ~ ( ~MAtU[T ?)d AIIJM a lown) ((ou~h? lua' ~ . u) ~ ~u ~~~rl 3.. ~Q ~~~~~E..L[-+~~ ' 7~ ; :'1. FIN?EitAt P .rQ.t. ~ ~t: ~ 04~ Q~1I r~ A 7l/. ~1~ S Sh' i as ~I!4~ /l~f~ /fr%3•`..1.,.'-. rf•~/.I~~~ ..~t~~t f~ ~J ~;7 •'P~?~~~f ~=t.l.(.{~~ ['~-~r f ? - - . ..~~-.~t• . . -rY~.~et-° - - ~ ~r ~ fI~ eZ ~ . #'tLfD ~N~ ~.c~ ~ ~ ~.IUC~E ;;OWIi'Y~1#. C flOG~r: ?O;iR~S C1ERK C: :CtfiT C08R~ ~ RE~OC: ;!£i:;flfQ.~~ ~ ~ ~ Z ST PH'7J 254033 , 1 ~ : # ~ ; OR~3~~~ ~ SOOK - -,,.g ~ I ~ ~ . - ~ . ~