Loading...
HomeMy WebLinkAbout1739 ocEF.:~.,~ k CLfF,K C;: ;C tkii rG9~ ~F~~an v« - ~E~ 2Z42.~9 1~? ~T ~ t2 ~!!'l~l ~~2389 OH10 DEPARTMENT OF HEALTH a NO' DIVISION OF VITAL STATISTIGS 5"" m` N°' °i`' r'°~ ~ ~v~ CERTI FICATE OF DEATH R``"`~` ~ ~ ~ ~ ~ O DECEASEQ-NAME 1':~sr ~fillle Ltt SEX OATE OF DEATH l.~to+tb, v~f, Y.eI W Geor e - Scrive Jr. Male Febru ry~~ 1973 _ RACE ~wf~. ¦~t?e, r.~.i~+r AGE- twr UNDEf t rE~e unoEe ~ o~r OATE O/ tllTM f~ue.r~, D.n. COUNTY OF OEATH ~ EI ~~I++~. Nt. /5ltsill! Nrti/+ fls+rrl .~i. D.q~ eurt .Wi. Y~'~ v a. White s.. d8 ss. x, b~ul 23 1924 Sunmit f-+ pit, V~tIAGE. OR ~OGTIOtJ OF DEATX INSiDE CIri 1141fi MOS?I~AL R 1~ j~~1~t i li +s~ i~ eifMr, sirt iJrett +wi wrrrMl LLI ` C9 ISI ~I7 7H NI ~'O~O~~~CY 8~t N Akron ,~.~es Akron General Medical Center a J~ STATE Of ~ItTM /I/ Mt i~ U.S.A., r~wf CITI2EN OF WMAT COUNT[Y MAft~EO, NEVE! YA!l1~, SU~1f1Y1NG S/OUSE ~!I ~riJ1, sire w~i1~~ a:Rt! w~pOwEO, O~YOKED /S1triJ~1 Gertrude 1Mebb Ohio United States ,o. married u SOCIAI SKUtITY NUWER WAS OKEASfO EVER IN U. 5. AiMfG fOKfi3 \l ! Yfl, Nr M •Y'iI :1: )ff. ~IIf M I/ ~ifq Of lllr~[f} F ' • ~~-14-62~5 ,m. "~es ~iii II Qi ~ US{IAt OCCWATION /Gie~ ki~/ u~s?k lest rrri~s neil o/ KIIO Of W51NES5 O! INpUSTtr c~ •,,,~.s ~ Rubber union A c~ ~uf~~ic relationc lfS10ENCE~Sf~TE~ COYNTY diY, YIlU1GE OR IOGTION INS10E p1Y LIMITS SttEEi .V+D NtW~t~ Rt ~s ~ft M MJ 1 1 S.:~1' 11 er R~i , Ap t. 3 O Ohio Sumoit Fairlawn ,~,~ies 7l W ~ ~i x ~ fATMEt~lAMF Fin1 .N~It l.ul NOTNE~-~1~lDEN NAMf Fnit .11idJlt L.ut } H ~s. Geor~e Scriven,Sr. J~ry Balaain Q a INFORMANT-NAME MI?1liNG wDOtESS tStrut sr (f.F.D. se., tit~ er ril/ajt, iwt, si?~ Mrc. Gertrude S riv 51 S.Miller Rd.,Apt. 3,Akron, OH. 443I3 V t~e. rwtT i. DEATM WAS CAUSED BYS ~EH7fR ONtY Of3E GUSE ?ft tINE fOt tt1. (3), AND fuJ A%itOAlw~~T= IHi£Z~~i c.q FTWEEN i A11 7_a_-t U ~ 1~. 'y - W i /./w• ~ ~ - lV _ ~YY!/~~~~! I~~~~!! ~O~ . . ."_4 ' _ a ~ M~ OUE TO, OR AS A GONSEQUEtiCE Of• ' Ce~diti~u. ij au1. 2 o ~vilci jsrt ris~ te 101 ~-ft ° f ~ : ~ f - U ussli~tt tnn~ p~E TO, O! AS A GOHSEGUEMCE Of: rr•ri¦s rb• r~ln- G] /~j stoe lttt (c ~ /AtT 11. OTXE! SIGNIFICANT OONDITIONS~~~/iti~p s~ntriirtiss to fs~ irt w~f reJ~tsJ fe t~ru ~sa is ~M 1/~1 AUTOISr If TES rne (~lixss rs~:il~r~s fYa w~ it letn~isiss c.wre ~j Jr~:b W 19oN0 19b. I ACGDENT, SUICIOE, FWw~dDE DAtE OF tNJURY N011R MOw ~hNlRtl OCQIRtED fEues a+Irrr oJ i+yr~~ n~ krt 1 ar yast !l, ir~w i1f1 ~ Ot UNOETERM~NED !S?ssi/~l I~i~st~. D+1. Yeo) ! F-i IOs. 20A. 2Cc. 20d. • ~ INJUlY AT WOR1C ?ULE OF INJUlT At bos~. /.rrs, itr~tt. '.+[tor~, lOUi1pN fSb~st er R.f.D. so., ciry or rillast, u~te. :+11 F! lS?~tillln ~r ~e/ o~~ ifd~.. ~ts. (S?~ri171 F•~ tW. `r CElTIFIGTION- Mo~tb D.q Yso .M~,ui Da~ Y"ta ANO LAST SAW MIM/N:! 1 DID/91C.'aif D'eATM OCCJRRED At fbe~ F/.rtt. ('L~ [zl iN13iGiAii: ' il'~'a AM Vlcw •Mi /(M, .~l~v$~-- rbe ' . asr_ ~d 1 ATTENDED TTIE t0 A/~rub Dv~ Ytr AF1ER DEAfM..- P• tbe best s7 Q t,/ ' s r- ~~t Fror~eds!. dst t~ H ji.~ ]te. DKEASEC FlO1M " / ~ Zlb. ' ~ 21c. ~ - ~~j ~ i 21C. ~,'i' ~J1~ii ~~tj,~~l, !br r.rrrns) ums.i. Q~ CElTIFIGiION-CO~QNEl: Os tbe i.uu ol rbe rs.,si~wiow Nuw nJ /sab Tis.krels~rt r~r pesavM~_ ' !bt ioJ) r~J/ss !bt i+tttitit.ttioR. is sj o0iwro~. 1«tb Abatb - i~r~~~/~i;: No~s W E+ oranrN e~ tir dit~ ~wJ Jrs to tbt r~auNtJ srats/. ~`s~!.,`~~s yCt F, - ~ ~ : ne. M. 2n. : ~ - Y : n?. H~' CEQIHEt--NAMf IT1D~ N Drisl/ SIGNATURE ~ t- ~t ' ' • ~ S'r/1ED ~ ::i~*f +~t'.`. H H / ~ /a- ~ ~~~i'~_• ~ ~y • ' ? w~~ ~ ~ Qi 27°• ~ - ~ ' -t' ~iT- 13b. ~L`- / R " _ ~S_~"'`" , V %j ~ ^ - / ~ MAI?~NG AGORESS--CFR1iF:FR STREFt O~ f.0_ NJ. . Ot~~ . ~ fU~€'" t..-~ Zi~ J C-~ J s• .S O 21e. yY~~ ~ , z/; C ~ ~ t,-.,~~: _°.'~=:"~y.~~ ;d~~i•.~~`Gi~>-~~~ ~ ' WR~AI CtfM/1T~ON OA1E NAME Of CEME~EtY OR ClEaAiOlT IOGT~ ;'i r~,;,.~:~,~.~~ jtk , w rorwti) ~St.qr) Wz ~S~"f~lrial 2/20/~97 Niles Union Cemetery Ni~ Oh G; O , Q iso. ue. ~ac. ~u. _ • ~ • \.J. NAA?E Of EMM4MER (UC. NO.1 i~ EC~Oy S TUt`H :-~f} '-.e (UC. NO.1 \ N :s.P. T. Var~ey 61?0-A ~e. ~ T~/t,t/ ' 34~3 ~ ~ ~ ~ H fUNERAI FIRJN AHO ADDRESS (S~REET NO.) ~ (GTT) ( (SiATE) (Lln x ~ THE BILLOW FAIRLAWN CHAP 85 W. ~diZ~er Rd. Akrort Oh. 44313 n. ?~-1 ~ EI pAiE O sEy~ fA!'S S1 ATURE 1~TE fftM~i ISSYED 1StGt1ATUtE Of fE~50N tSSU1NG IERJMIT DISi_ ti0. IOGI EG. / f~-+ H A n ~O 7.j ri ~ ~ ~ ~a. FEE, PARKER & FEE. P. A. L_~~ PA~E~~~ • PO TO FFIGE BOX f000 L l FORT PIERGE. FLORiDA 33450 TEL[PMONE:130d)461-5020 - - - - - - _ - .;a~•, - ~':'n ~.aay,s~~ t•E ,n: : - ~,,M ~y.,,.~.d~,~..ra ~ -:"d _ ' . ~ ' ~ .-:i _ . r. _