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HomeMy WebLinkAbout1550 ~P.LL~G Ar: .t~bu~D -b? _ W G I l"_ ~ 0 WiT~I HllM ~ROGt n rJtTR~ ' CLE~K C' ' :U11:Cn11f~T ~~j:c Rf^~R^Y~F°.,fD~..~-r.~ , I1~111t ~4I ~1 ~0?~'1~'~?~11 ~r m a Q.~t- 3 c P~ ~~(~?~r ~ ~ 7601 OH10 DEPARTMENT OF HEALTH RcR. Viu. I~~~. Su[e File No. 7601 DtVI510N OF VITAL STATISTICS ; 1631 P`~~"" R`R. CERTIFICATE OF DEATH ReR~urar's No. DECEASED-NAME tint .~Gddfe Letr SEX DATE OF pEA~~I, !M, ; D.ry~. Yt~?1 Da le L. Youa z. Fema le ~ ~ RACE k'brr~, w~jre, r~~?iwK AGE- L+~~ UNDER 1 ~EAt UNOEt 1 OAY DATE Of ~itiH f.Hostb, U~~, ~ ~N 'sN'-: - iwdi.w~. Nr. ISItt~/) bir~bJ~~ I ~rrf1 ~Not. D~~t Horrt .Ni~. )'t.nl . -.Y Si~> Hh ~ te s~. 7~ sd. s~. d. Nov . 11 1 ':`~~T• '`~~t:.•x ti ~IiY, VI?IAGE, OR LOCATION Of pEAiH ~ INSIDE CITY lIM1TS NOS~~1Al O! OTMEt INS11iUT10N-NAME (I/ ~pt 1/~~ I fSOtlill)tt e? ~o) o..~. ~ ~,:a - _ . ~s: Canton ~~.Yes ~a. Aultman Hos it I ~ - =-<:•c3 STATE Of {IRiM /IJ wo! is L'5..1.. r~wr CITIZEN OF WHAT COUNIt1 AUR~IED, NEVE! MAtlIED, SURWVItI~~yj~~Z(~r ~Mf) ~ roruq/ W~OOWEq C~VORCED (S?triJ)1 y- . ~y .r~ z~. a. Ohio o SA ~o. Married SOC~AI SECUQ~T~ NUM~E! WwS DECEASEO EVE! tN U. 5. AlMED FOtCES? : ~ 1'-. A~~~,~ ~)'ei. ~o. or r~l~vu~1 Ilj ~t+, tirt u.er or Jaln e~ tnrJre `r`'~ t.~ ~ .='r~..:' .SU~I RESIDEHCE i?o. 297-OS-6156B ~~e. NO J~ :Ca?~~~ • ~ti ~ E A E DECEASED ` y ~ • ED If DEATN USWI OCCUMi1pN lGire ki~d o) YOI~'IO~t JYIIRs ~mf oJ KINO Of WSINESS O! IN R~±~4tit,1~ w~ CO~ ~ ^~CURRED IH ~-orli~~ liJt. «t~ iJ rtfi~tJ1 - . ~.vSTiTUTtON,G1YE t~o. S(.'h~0 eache »b~ .ES CErtCE ~EfOtE tfS~DEHCE-Si~iE COUNir Ciir, v~~uGE OR LOG~~ON tNSIDE GTY UwUtS SteEET nN0 NW~{ER ?Ds~.iSSION. IS~tfiJf 7tl or iss. O ub. C8 ~a~. 8 ~~e. ia. ~ FA~ME!-NAME I~fnt .NidJlt Lul MOTME[-MAIDEN NAME l-fnt .Hiddlt Lol ,s. Mary Lleanor Duff Y - INFORMANT-NAME MAIUHG AOOtE55 rSn.rr o. R.F.D..o., ~~rr o..;rt+s•. =~D1 Mr. Clyde C. Young 3913 Shepler Church Rd. S.W., Canton, Ohio Z ?ART 1. DEATH WAS CAUSED BY: fENifR ONtY ONf CAUSE /ER tINE fOR fo/, Ib/, AND fc/I ~~%IMATE INifRVAt ~r,~ 6ETWEEN ET AN DEA1H Z ~ e- ~ IMMEDIAiE CAUiE Carcinoma of colon with metastaeis 3 months ~v, DUE TO, OR AS A COPlSEOUENCE Of: Co~Jrtio~r. iJ ~w~. ~ - mbit6 t~rs rifr to ~bl iwsrdi~ts ~~r~t /~1. ~ DUE ~O, Ot AS A CONSEQUEIiCE Oi: L Nrti~r tbt r~ltr• , _ lfits t/rtt !tu (cl ~ ~ MfT 11. OiMER SIGNIFIUNT CONDtTIONS ( osdilio~i :uuribatiwa to arr/b brt wot r t i~t ~ i~P.~/1 1~) U ST If YES n~nt /i~disp [o~i+dnsd ff ' m so iw drfniwixiws t.uue o/ dr+lb ~ ? x vo. Ye e 19A. ACCIDENI, SUICIOE, HOMIUaE, GATE Of IN1UR~ MOUR Y ED lEwtrr x~urrs o( iwjrry i~ Qrrt I or p.n! /1, ifsw 181 ~ OR UNOEIERMINEO ~SDtti/)/ 1.11o~fb, D~~. )'t.nl ~ ,J ?Oa. 20D. IOc. 70d. ~ IN)Utr AT WOlK ~IACE Of ~N1Ut~ At bo~t[. ~.rrw, urnf. f~iror~, IOCATION IShte! o? R.f.D. wo., tit~ or ri!/aas, N~1r, zip) x (Sprcil) yn or so! ~lhre blda.. «r. lSpecij~l e - ?W. 7 . t- CEtiifICAT10N- .tlorlb Uo~ Fr~r~ .1fowlb Ur~ )'~~r AND LAST SAW N~M/HER i DiD/DID NO7 OEATM OCCUlRED At fbt pfart o¦ PMrSICIAN~ AIIVE ON VIEW THE 600Y (MOU!) fbt daJt, aw~ lo 1 AITENOEO !ME ~O .11nwlb Daj Ya~r AfTER OEAiM. fbt bt:t o 9-6-71 11-2-71 Not 4:15A k•o~~~~ds~, j•< <o Zlo. DECEASED fQOM ~Ib. 71c. 2Id. 21~. M. !b[t~rirltl tfrte~. CERTIFlCATiOr1--CORONER~ ORlbt bl~i~ o! tbt tx~wrw.rtiow llorr 9~ ,([JIb Tbr J~.~dear u.u pro~orwttd dt.u1 ~ ~ oj rb[ bod~ ~rdi o~ !be iw~ tuia~liow. iw w? ohinia~. dtulb .1lowrb Du~ )'rJS Now uc.rr~td o~ tbe dett awd dre to rbe iawis~~/ sf~ttd. ~Io. M. 726 CEtTIFlER-NAMf (T~pe o~ priwtl S~GNATURE Dra.~~ or Jif/t DAiE SIGHED ~ zJo John A. Fike „b John A. Fike M.D. 11-5-71 ~ ~I11lIHG ADDRESS-GERilF1ER STREET OR R.i.D. NO. CITT OR VILLAGE STATE III ~ 120 Dartmouth Ave. S.W., Canton, Ohio 44710 ~ 13d EUR~At. CREIMAl~OH DAiE NIUtE OF CE~tEiER~ Ot CREMATOt~ IOCATION I(.itl, ~~i!leat, or rovwll) ISI~lt1 ISp i/ 1 zao~tt'2'iel ztb 1I-4-71 zJt_ Union I.st~tn Cemetery z~a. Neve2'Te, Ohio - ?+,u~E OF basAtMER (UC. NO ) fUNEiAI DfRECiOR'S SIGNAIURE (IIC. NO.) ~ : ,S Richard F.. Brock 6449A ,d Cledua T. Reed 3128 iUNEtAI fIRM ANO ADO~ESS (STtEEi NO.) (CIT~~ (STATE) (II?y ~ ~ eed Funeral Home Inc. 705 Reff Road S.W. Canton, Ohio 44710 ~ - ' DATE tEC'D ~Y lEGISiRAR 5 SIGNATURE DA/E tERMIi ISSUED SIGNATUtE Oi ?ERSON ISSUING ?ERMtT DISi. NO. ` `~=~=71 A ~es L. Coleman Saa~e :e. zv. 8 so. n . ti~: ~ r:., . F r~~ a~ : ~ 22~4 PAGE~549 - ~ _ 3 - ~ ~ ~y ~ ~ ~~~~~r . ~ _ _ ~ ~ ~,x ~i _ _~,~~W~_,~w~