Loading...
HomeMy WebLinkAbout0001 . ~ OH'.~ DEPARTMENT OF HEALTH ~v~• v 254136 p"`' NO' DtVI510N OF VITAL STATISTICS ~~e File No. Primary Re~. Diu. No. Resiunr's No. CERTIFICATE O~ bEATH OECE~ISED-NAME F~?++ ~1~dlt /t» SEX • OATE OF DEATH ~.~fe~stb, I~a>, 1'tn VICTQR GOOD MAI.E OCTOBER 13,1972 ; RACE ~bitr, resro, .a.nir.. AGE- 1r,r LtCDE! 1 YEAR UNOEt 1 DA11 DATE OF NliN r.~~o.rb, p.q, COUYTY OF DEATH ~ i+~1i+r. ~IC. fS?stit)1 L..t:..l.+ •e.rrr) ~Noi. D.~, N~wr Jlir. i WHITE s,. s~. ali~ L,1898 CUY~HOGA _ . ClTY, YlIUGE, Ot IOCAt~ON OF OEATN INSIDE CITY tIMITS HOSrITAL Ot OTMER INST~TUTION-NAiMf (ll Kol rr titbtr. ai~t rtrttt rsd rrw~erl ~ r (S1r~' fer o? se) ~ 3s ~~~E~D y~~ ,~LEVEIAtJD riETROPOLITAN GENERAL HOSPIT~IL _ SiAiE OF ~ItiH fl~ ~9t i~ U.S.A.. u~e CITI2EN OF WHAt COUNTRIf wtARtiED, NEVEt ~?wtR~EO, SURVIYlNG SIOUSE !IJ riJt, jH't 4.UdtM IW~ttI ~o,,,i,~~ WIDOWED, DIVORCED fSperiJyl LUC ~IarkleW e Pennsylvania o_L~hITED STATES ,o. M~iRRIED Y SpCtAI SECURITII NUM6ER WAS DECEASEO EVfi IN U. S. ARAIfD iORCES? e~ C (1'er, w, sr x~k~ow1 !IJ ytr. tis~ ~+e J~Iti ~j serritel . USVAI R[SIDENCE 1?e. `~~+O~~~J~Q 12b, ~v'H~cE DECEI~SfO USUAI OCCUfAT10N (Girr 1i~10/ ~o?k 1au darri~ej:ost oJ K1ND Of WSINESS OR INDUStlY t~v6D. rF CEAiN ~~orii~sliJt.n~wilratirrdl i U~_UFREG IN ~haT 1T' i'lachine 0 erator ~36. Steel ttlanufacturin IntSTITU7IJN, GIVE l~o. . iES~DENCE BfFORE tfSiDENCE-STATf COUNTY CI1T, VILIAGE OR tOG~i1W! INSIDE CITY llMliS SiREEi AND NUMdEt ~~v.i55~oN. f5?sri/~ Yu w ~s1 ' uo. ONIO ,.b CiT.'41i0GA u~ CI.~VEI.AND ~aa. 'es i... 2228 AKIi+1S Rd ~ FATXER-r:AME tisst .11~ddlt !.u! MOiHER-~AtA~OEN NAMf 1=ir;t .11idJlt Lrst Th~;;:~~ Gn~d ~s. tn r ' ~ ~ IPlFORMAN7-PlAME MAItING AODRESS (Shttt O? R.F.D. ~o., ciy or riilrsq :ratt, sipl 4 „a. i"Irs. Lucille Allen ~~b. 2228 @k~ns Rd Bro ~ P ~ 4 ~ ~~?ei i. DEATH WAS CAIJSED BYS lfNTFR ONl9 ONE GUSE vE! lINE fOR lol, /61, AND (cl1 At': ROX:A:w-k INIEKVAI itTWE N Gh Ei ANJ EAt~ LI Z IS. - / i t` lol ~;ti~: Lt C.~ 11:.•_.. T. i~ \l(.L" ~ IMMEDIATf ~AUSE ~ ~ DUE TO, OR A CONSEQUENCE~OF: _ . a ti Za •1.~~'~l' ~ ~ ..z. frbi,b~a~ve riie~ o ~ (EI ^-u--a ~ J~~ ~ ' • :<'~t~ i~estdidt t~rst DUE i0, OR S A CANSEQUENCE OF: Z sr•ri.a rb• r¦do- _ t~;aa rarfe [~rr ~i. l~ v ~ v...:.tl_ y., fARt 11. OiHE[ SIGNIFICANT CONDIiIONCCo~dilio~u ~ont?ibW+~s to d[atb Lr~ +of rdi/td ts srarts p~~d i~ ?nf / f~) AU1015Y If 1fES rrnt podiwg sos~idr• (Yrr es ro ie d~trr~isit< <.rr~~ ~I de~~b N T~ 15~: Y~~. L~ ; -.~~c..r~ - 19e_ 1V6. ACCIDENi, SUICIDE, HGMIC:OE CRTE Ci •~t1UtY NOU! MOW INIUtY OCCUtRED /E~tn w~1we o~ iR~arry i~ ?art t w pn! IJ, iJSw IS) OR UNDETERMINED /SpttilYl ~.~I~n:b, Uar, Ytar1 I O _ Mb. ?!k. ~Od. 'I INJUtr AT WOR1C t1ACE Of IN:JR" Af bcset. l~+?s. ttratJ. Iratorl. lOGi1dN (Str[st ~r R.F.D. wo., tit~ er ~ill~tt. ~Wle. t~01 F 4J ISleril7 7~r or ao1 o~iu blda.. err. (SFacitf) i j; M~. ?9/. N1s. . i CERTIfICRT10N- dloslh Dr~ Ys.? SSvwlb D+r Y~~r AN4 tAS~ SAW MIM/HE! 1 DIDjOW~iWt DEATN O~CURRED AR !bt l~/.rrr, oe IN1fSIC1AN: AIIYE OI! VIEW iHE 60DY (HOUR) tb[ adfe, ra1, tu j I ATTENDED THE i0 AloRtb Dq Yen IIfiER DEATH. tbr b~i( eJ w~ f 4«oa•lra;r, are t~ ~ ,~~a. oee~?seo F~a~: SEPT.20, 2S7 ~~b.OCT.13,1972 ~~~OCT.13,1972 ~~e. ~~~i :OOA M. fbe ~arne(sJ rtst:d. i CERTIFIUTIGN--:ORONER: O~ fbr b.uis o( tbt ez.+~ia.uio~ Hoarr nl d~.~b Tbt dssr/rnt r•oi p.o~orrcrl 1r~d • ~ o/ /ht b~dJ s~Jl or lur ierrrtia~riow. i~ s) opie+ow, dt.+~b Mo~tb D+y Y~~r Ho~rr Stc_ ottrnrd ow 1F~ dcte ~wd drt fo tbt t+rttfi/ sL:~td. ~ 270. M_ 47b. _ ~ x CERTIf1E[-Nl.M[ (!y'e er Dn¦~1 SiGNA1~Jly ~ Dspet or fitf / DATE SIGNE / j c ~ ~ , ~ 130. i_i~.•... , ~~'i:'_tr 27b-~/'- t~ /l • I s ~1?~ lt~.-•~ 1]c. G/_i/:-~r'. ~ 1tA1:ING A~RESS--<FRi1FlEt DIREEi VR R.r_p, ?fJ. L~ Gi'( OR VIIIA^v£ S?Sit I;.r " g CLEV£I~AN~ TLFTRt~POLITA,~ GE~:~RAL 1?USFI"fAL 339~ SCFAtJT0~1 ROAD CLEVEL".,~iD O:~IO 4'~109 € ~ ;~~?~~i,.CREi::.i~i~N~G:.tE f:AtitE Of CEMETERT OR CREMATOtY [OCAiiON fCih, sil:aSe. o?ca~~r.± t,:.rh: up~~~~~~ - ~ b em_,*__ic~b '~-14T72 i~•~. t~illcre~t Crem ~b. ~t~~~ _ ~ HIUr.E J- EMUtInEo (UC. NO.J fUNE D EQOR'S SIGNATURE ~'+~'•1 ~ ~ ,K ,S i~ar~1G R. Cassidy b135-A ~e. - ~.-w ~ 5152 _ ` S~4 fUtiEQAI F-RM Aw~ AOJRE3S ` I~T~EET NQ.).i\:1111;~` lrT~) {SiAiE) - l21I1 ~ - ~ ~ Rd Brecksville Uhio 442.~>i _ - , ~~-:.i~y FUnpr, a Hc~r~Si_ In~r ~~s ~a ille. . , ~ - - - - ~ - - - ~ r _c •r ~T - - S y. ATl'4 DAT~'/ fi,JE,'~ S:GTi/1tUt OF iE[SCN KSUIV~: oseµ~r ~yitT !i[: ~ z~ ~ yt,;~:~ - ~ ~;.t C.-~n I8 ~la~~~ : io-i~=?-~~ { f ~ ~ _ ~ _e ' F•~ a~ S '~d , . , 2541A~ ~ - . ~ ~ ~l ' ~ i FItED t.ttC~ ~tECORDEO ~ . , ~~ESY~ifr`i=~ ~7i r.F~:~s25•~t ~ ~ ST.lUC1E CO~~Mtlf FLA. c: • -,t~ ~i i. ~.t~. _ ,h, S~ ROCt~ r'OITRAS ~ ~ Cr Y: ~i ~ . ;.a_,i ~;rr=~=~~::.1_ , ClERI( CI::~UIT COURT ~ . . . _ . REG~RD ~E~i: ~:0~~._ ~ i . :-~r+~., ~ ~ ' /l.' : ~ . ~ ~~~;.'~f~'~~2" _ MAr t0 I oi PM 73 fl,,, ; ~ . _ - _~Y _ ~ : ~ ~ 8ooK2i4 N,,._ ~ ~ _ l% ; _ • ' ~ r._i~ ~ F,: ~~sp.' ~/i ~ . ~ • . . ,:v~.I,~ RC\Ni~ ~ ~tn~ .S~Ai~i~r~.,l • ~ ~ ; ` ; t ~ ~ - ~ ~ ~ ~ f ~ ~ - _