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HomeMy WebLinkAbout2244 261823 i ne~e~, a~r aa~ ene r~?~e~u~t c~w~. ~ti. } trus photocopy ot ths reoord on fils M tNs atfio~ ' ! 17 et~ 1 ~ ~~.4~~~ ~ . t 9 7 7 , = ~ ' ' ' r , ~ , , y~ : • • • : " ' , ~ : : ;s'~ rf'> EL1tRiA ONI REOISTRNt .~~•s~ ~ : g ~ i , . ,h ~ - ;=.t ~ ~~.''~I ` 3~V~= Y~OH10 DEPARTMENT OF HEALTH ~i. H`R'-+''~~. DIVISION OF VITAL STATISTICS s„« ~~i~ ~to. s"°"~' •'~`S`f ~~-F'~ ` CERTIFICATE OF DEATH It.R~sv~r's DECEASEf~-NAME , F+nr .~IidJ/s fru SEX DATE OF DEATH ~1lu.~e. l)r, 1's.n! Mildre~d R. WRIG~d'T ~emale ~'une 34~19F9 RACE A'~~~u, r~jro, rw~ri.+w AGE- I-~~r U?~DER 1 rE~R UNpEt I Dwr DATE Of t~RtM ~.1fo«d,. Ua~, OUNTY OF DEATH inJ~.. h ilprii/l1 biN~.~} Ot~nl .lto~. !)a~• Norri W~». ~~~rch 22 189 Lorein t~ite ~ se s~. a ° ' C~IY rll~Gf. OR IQCAi4QK Of OfA~M 1NSIDE CItY ~IM11S NO3rIlAl OR OTNER ~NST~iUiION-NAMf /f/ wu~ rit6tR F:tr ~treet ~sJ w~~rb~rJ ~ Elvria 7Sp`~~~•gor roI 7a. ' „ Sivrie Memoriel Rospitel ~ 51ATf OF lIRTH fl) wof iM L'.S.A., rrwr UTIZEN OF WHAT COUNTRt MA~RIEO. NEVER MI?[RIEO. SUtVIVING SWUSE ~1) uift. a.tr w.aiJtw w~wrN e'p"'"' Michi an 9 TT.S. ' o~~ar'r~ei~`° `s"`:,,~ Clvde B.i+tri~~t ~ SOC~AL SECURITY NUM~ER WAS DECEASEO EVE! IN U. S. AtMED FOKES? - ~~~~2_ ~ 1"e~. ~o. or r;4ROw'~O 11) >ef. drrr rvr er d.u~t ~j ~nrirN l le ~ _ • s~Wal QCCUM1iON ~(.nr fiwd o/ wur! .l•~wr drnwy~ wrnif o/ KIND Of 6USIN[SS O[ ~HOVSItY ~...rF~aR i~!~. urw d rtdri.U . „a. AousewiPe „b c~+.n ilome_ ~ - ~ . tES~DINIE- -S?a(f COUNIY C1iY, YIIIAGF OR i0Ui10N iNStDE U11f UM)1S S1REEl AND NUdt!(~ ~ , ,..Ahio- Loroin $lvrio ~.p•••~VAB ,.106 Ber lev Drive 1 At111 C ~~~M~ 1•..i .~I..f.U~ 1..~.~ M~llllEt ~4/Alhf N N~M( f...r ~iW.t.. I a+~ „ Robert ~ J. Mprston A nes- Ra or~ ; INI UItMANT NAME MAl1UtG wi~pR~•.; ~~n,.e A.l.l~. .r...: .~ir ~•ll..~.. .r..r.. ,.hl ~~a Clvde $ Wri ~ti - ~~b 106 Berkl Brive- A1 a r,,vt ~ ~ DEATH WAS CAUSED BV: '~?+~u n~+ir c~Hr uust ?t~ u?+t rcut ~e~, ~w. ~NU ' - - _ - _ - - - a[~w~~ra yr.ti~r w..o o~~rH_ ~d. IIMMEOIAtE CAUSE ~ol C c r ~ • . ' ~ - - t n~diri..~~. if aur, DUE i0. Ot w5 A CONSEOUENCE OF: - u~Liib a.ar~ •i~e lo ~ Ibl_~~.i-l~i~ '-1-t-1 it'.~ . . t ~ ~.a .1.•.~~ rrws~Ji.:tt ..ryfe ~.+1. DUE f0, Ol AS A CONSWUENCF OF: ~e.,r,sa rGe vrJe.- j ~ hrwa r.rrnr l.ut 1 - _ - - - ~ PARf 11. OIf1ER SiGNIf1UNI CONDIflONS1 ~•a.lifiu~tf [oHlribw/irtali ~IfJfG BN! 70I lflJl[~II// ~?4)C a~~~1f /q pJ~f I(JI AU70?St If YES ut~t (~rdiq~+ :vAUJntJ , ~ l~rs w wo rN J~trrwrruws ~rv.. o~ d~~ib ~ ' ~ ~ iC:: ~p..~i.ir-~Ie.a/a.- fj~ It~~eJ~t IV~D lib _ i' i ACCiDt~+T, Sb:C~OE, NOMICIDE, DATE OF iN1URY NOUR MOW IN)UR~ C}CCURRED rLNrn QdlY/[(I~ tHJY~) IM pJI! I~.. p1.t /I, ittw !KI - 04 Ur+D'.TF~?~iNEO 1~haihl 1.11o~tl~. l)~t. Y~r?1 f i ]Oo. ?Ob. IOc. ~Od. i ( iN1U7'/ At WORK PIA~E OF lN1URY It hoinr. (.+riu. sls~[t. i~dor~, IOCATION i~brtt R.l~.D. Kv., ti1~ or eill.rae. ilrt~. :.p1 ' n ~ •Jpauis ~et wol ~.l/ur bIJF.. dt. /]praiJ~ i 1]e. 10~. CERT~f~C~fiON- ~io~+~j~ Dr~ l~~.r. -Uuwrh U..~~ lrsrr AND tASi S~wa~iMEQ 1 O~O:Q~$.tWF 1 QEwtM QCCl1~RE0 .it ~b~ pl+~r, o~ ~ 9HYSK~I~N `AUYE ON V1EW TME 60DY (MOUt~ Ibt d.ift, rAd, t4 1 AiTENDED THE TO J1]~e 30 19~91 •~luwt4 U.~) )~t~r AFTEt OEA1M. ~ =~jy 0~r ~t ~ 1 w1 'j /~1uy ~~r, ?5cy dw. t 2ta. DECFASEO fROM ?Ib. ?Ic. ~t~ N t 3 i , 1~j 21A~ V. ~le M. /I/l ~JM~fUI il~ltJj- ~ CEQIIFIUi~ON-COtONEf~ !)a dit G.uit Ib~ ~~awiw.~lin¦ 1/oqr oJ dt~fb Tbe dnrJr~r :~ri p~owor/N~rd Jr~d rbe hod~ .lNai ~/Il[ fNlf)flaJll4M. iw s~ •~/•rwio~. de~tb ?1~ntb Ua~ 1 o~r Horr or,rnrd OR lDL ~IJII J/~I ~Yf IO ILt (dNf[~fI l~wllJ. 220. ~ M. 71E. M. ~ CERtIF1ER-NA,ME IT~pt nr p~iwt~ SiGNAiURE , . 7)t6~tt or Ji11t CATE S~GNFJ ~ ! a~a ~~e. :.f - 'i~-- ~r ~ • ~f.~ i ~ n. ~ - L I f wA~IING ADORESS--CfRfIflfR SiREET OR tF_O. O. CIIY Ot VIItA E STAiE Z,? 6 2~ Cleveland St El a Oh 44~0 dUR1Al. CREMATtON DATE . NAME OF CEMETERY ~ L AitON ~l rt~, ~il/~~cr, ~~•~nl~I ~StilN i~ ~1pa~ / ,.o. ~urial J~ul 2 6.~ Brook a' ~~a ~hia NAME OF EMlAtME! lIIG NO.) fUNERAI DItfCTOR'S SIGNAiURE ~ ~ , {ttC. NO t i : S. R~roTd M ck an A zb.- . _ ~ , . ~ ; , ~ ~ - . ~ FUNERA? ftRM AND ADDRfSS (SiREEi NO~) 323 Dliddle !\VC.Y) ISiATE) (ZI?) R~rold Dicken,Ft~42a~ c. ria o~~n 4~e3 DAiE RfC"D \Y R~S SIGNAiURE OAIE ~ERMIT ISSUED StGt1AtURE OF ?EfSON 155UINfi tEtHIT DIST. MO. 10CA1 R • .3 10. ~ . ~ Gf C~. C. ..a ~ ~ FitEO bN0 RECDaDE~ ST. WC~~ C01lNt1 FL ~ F.OGrA p01T1~f - o c°. ~ CI.EyC ::t:;:,t11~ COURt m~ C y~„ ~ PEC~'R~ ~dEf'.~fiEO...~+~^'~ ~ ~ ~20 12o~eM'Z3 .~s.ao :z, 3 ~ 4~ ~ ~ ° ~ ~ eooK217 P~E2235 261823 ~ ~ o~ ~ - 3 ~ a~ a p y ~ r~w . , r ~-~-.„s: s- ~ w' _ -:7 ,.~:a'~'~~