Loading...
HomeMy WebLinkAbout0695 _ , ~:ry; . - - ~ ~ ~ EPARTMENT OF HEAL.TH ' R~R. a~u. tvo. r'i1 4, :~~.~OF VITAL SThTI5TIC5 r~~e tvo_ ; `~raS~s19 P~"ai.r R.R. ~~~u. tv~. I~y'ATE OF DEATH R`R~u~at's No~~I dECEASED-NAME lir{{ ` r, l..~t 5EX DATE OF OEATH ~.~to+rb, /1~~, Y~~r~ ~ Orvill ~ ~ d ? ~ ~''MARTIN ,.M~le ,._2 Au~ust 19?2 _ RACE ~'bit~, w~~re, rr~riw~ " f'~ LMDft 1 O~r O~iE O~ ~i~M f.~lawth, COUNTY OF DEATH i! i~.lirr. tf(. fSlttie !o. . x ~r I~y~~ .Ni~. Y~ 1 tr . e 2~_~uj~* 1~0 ~o. Athei s [~Tr, YI~tAGE, O! IOCAiION Oi DEAiHr~ S MOS~IiAI OR OiNER INSI~IUI~ON-NAME /1~ rut i~ ~Ubtr, jnt i~~tN ~.rJ wriwbtrl • ~ ~ r~i ~ ~e. At en ' ~dO~Bleness 1•icmorial. Hos ital ~f ~ STAiE OF Ul1M U~ wef ir U.S..~., w.~r~ C~l~i Oi UNilY a?wttiEp, NEvER w~tRiEO. SUtv~vwG S?OUSE r!1 u~!e, ~rt~ w~~,lrw ~rsr1 ror~tr~/ W~DOwED, D~VORCfO I S~r~iJ~1 Ohio 9_ USA ~o_I~I~r d ~~.Lo~ne Fields SOCMI SECJRIiY NUw~ER WAS OECFwSED EVER ~N U. S AlMEO f0l~fS~ I y~~, ~u, nr ~wl~nur/ II~ j[~. jltf YJ~ OI [IMtfl •.l itnicN ,~,~+i RESIpENCE 11e. ~o2r1 E]~~~ Ilb E•E DECEASEO ~EP DEwtM USUAI OCCUrAi1pN I(if1l~tf((Of MUI~fIO/f~I4/fM~lM4Il4~ K~ND W WSU~fSS OR ~HOUSTtf i ~C~~~RED IN u~erliys/iJ~, e~ewil rt~ir~Jl ~981 EqtatO ,,,,~o~, o~~E „o. Rroker „b '.5:: t^:C[ SEtOlE RfS10ENCE-SiA1F ~ COUHIY^ C11tf, vl?tAGF OR IOCAl10N " INSDF C~S~ IIMUS S~tEtl ~NG t~l'~AOkR~ ~ ~,N ss:orv. l~As > f~f es w..I ~ ,~,_Ohio ,.spthens Rural~Alexander) ,.a Y~o RD!~'i A~he~e,Ohio i fA1MEl--N~ME tirit ,\IiJJfe L.ut wOtMEt-MwiDfn NAME I uft .11~dJtr (..ut ~s. Frank Swnsner MRrtin Alwilda '•loodyard INFORMANT-NAME MAIUNG wuorfsi ~~nnr or X.I.I~. +ro., ury e, .,II,t.. ,uu, •,pi ,,,Mrs Lora e L Martin „bRD~• Box 179 Athens Ohio 1~ 701 ~~T DEATH WAS CAUSED BY: :ENifR ONtI' ONE CAUSf ?ER IINE IOR tol. 161, AND !d) 'A??iOX~M~IE ~n7ER+A~ lf~wEFr. O~.SFi ~nD GFwiM / / IMMEDIATE tAUSE ~O ---a~i~~-~` ~ DUE i0 t AS CONSEOUEta Oi: Cowditiewt, il, ~wr. ~ /y • (D~l I- ~ wbi~b ~tw ntr ie Ie1 i..r~l,ne ~•r,e r•1, DUE TO. OR A C OUENC Of: s/iti~~ ?bt r~dtr- ~ !)i~t r~wt lair ~ • r~' /ARi 11. OTMER 51GNIfICAN~ CpND1TiON5 (.ewJi~iaKt ~o~lr<<rli~~ to drr/b bx ot st/rltAls rst rii« i pr~l 1/~) AUIO~S'f IF 1ES ue~a h+diws~ towiidtrtd ~Yt~ o~ ~o Qrfn~iw~w~ CJYIt ~J dtrtb too. 19b. ACCIDFNl. SU~C~DE, MOMICIOE, OATE Of IHIURY HOUR MOW IN1UR11 OCCURRED /f.+~t~r ~J/Y~! 4~ ~/ly~~ !1~ O'~~~ ~ G~ p~~~ i~tw 1 NI ~ OR UNDE7ERM~HED (Sprti/j1 l.~fu~fb, I)~~, Yt.+rl ! ?Oo. 10e. ?Oc. JOd. _ - INwRr AT WOtr fIACE Of INIUlY 1t bOart, f~~w, ~f~[t1, f~[tor>, IOCAiION fSfrttf or 1f.f~.D. wo., •ir> a..~;t1.,ar, 1l~lt, :~p) t~ IS~tci/) )ts or we1 o!/~u blda.. ~u. (Sy~ri/)I 70~. ~ 201. CEt11NUT10N- Aiow~l. U~~ 1'r~r .\I..w~b I)ry )~crr ANO tASI 1wW Mih~(~f~ 1 r/O~U t+UI DEwiN GCCU~~FO A~ tbt p!a[e o~ ~MfS1C1AN. ALIVE ON VIEW 1Nf 600Y !HOUR) tbt J~ft, ..wd, ~ 1 Al1ENDED 1ME TO n Jfowtb Dr~ i'a... ~Af~fR OkI.IM ~br br~r o/ ~r a -+b ~ $ ~ ~ 3 - ~.~G ~ ~ Irj ~we~ltJae. Jrt !o ~ 110. OECEASEO fROM _ --l?~A. ?~c. 8 72 ?Id. ~i" ?I~. AM. Il/flJYl[(l~~f~tet. CERTINCAT~O?~/--COROHER Us tbt b.uis e/ !be ~z~win.uiow 1t~u. oJ dr~tb %'bv dr~rdr,ri rrf p.oM~r~,td Jt.+J ol tbt 6od~ r~d/or tba iNrriri;.uiow, iw ae~ opiwior, dratL .No~tb U.+~ Year Harr o«rntQ ow tbs dote owd dre ro tbr r.uue/i1 ~~.+Ird. 3 ~ ??a. _ M. 12b ~ CElTtf1ER-MAME (7~)pe or yrrwU 1r.N'~TUiE Dra.et or fiIle ' GatE SiGr~EO ~ G.. t~T. Baum aerte I~'ID „b. - /3~'•~ ~ „~d d -TZ MI1tUNG ADDRE55-CfRTIfIH SiREET OR O, NO. ~ OR ~tIAGE StATE I • 7,d_ ?~!ashin~ton reet Albaxi.y ~hi.o 4.57~~ - ~URIAI, GREMIli1pN DATE NIUMf OF CFMETffY Ot CRF~t/1iOtY IOCAiiON /(il~, i.ll~ ~ ~ ~~~YM/)/ ISf.ut/ . I S~r~i/>1 < ~.e.Burial ~.6.2 A 2 ~<<.~A exander _ ~ ,,,AtY?en3 County, 0 io = NAME OP EMMLMER (UC. NO.) fU t ~tECTOR'S S~GNATUlE n ~s. D~avi d H Ht~ ,hes 59Fi p • u~c ?.oa _ ~ ? - ~ ~2 2 ~ ~ fUNEtAI i1~M AND AOPtE55 (SiREEi NO.) ~VIY~ ' ~SiAtE~ (r~~) _ „Hu~heg ?~'»n~r~l li T MQrr1n , A~l,ens~' Uhio l~57U1 ` , OATE REC'D {Y lEC,1SiRA~'S SIGNAiUtE OwiE /EltMti ~SSUEO SIGf~ATUQE Of fERSOH ISSUING fERMIt DISt. NO, ' LO [EG. ~ r• i r ? ~ . Q' a 'l~. ~ - I 30. ]1 i i 1~ dl'~ ~ ~v J ~-z r ~3d'-s` ~ " ,~,:•s ~,.~,*~'°'.'~l-YE~ :s :x`" ;~;~.fi i..s. 1 r i r ~ `i -r ~ ~;~'~-...~-_ez c . . - :~~r,.&-.~~"~