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HomeMy WebLinkAbout0857 3 j • _ . . . . . . . • • • ~ ' n~+»t~r'"a CO~~' O~~A ~"A~,rAM'.Cd~~= ' " ~ . ~ C.w ~ • • . . ~ ~ ~ e`+ .,.n.»~ 'ig ~ ~ .,,M.t. ~ ~,r s~~•r. wo. REGIST TiON~. /TATt 0I ILLINO~! asrnct~NO. 6•~1' MEDICAL CERTIFICATE OF D~ATH - tEG~SiERED •O ~ ~ , ~ , ~i„¦ NUMSER M~~ ~y~ 5~ OATE F ~EATH «?..r r. DtGEAStD-NAMf t3raeber Z, ML~.A s@~OL~er ~ 1973 tERl.1ANENT INK ~~~d . s.. oe~on'. 1. . W1TE Of 61RTH lro~M.w~,rwl ~U?CE OF DEA1H ~"n :N or r?p~cw.i AGE-w~ V. r~,.,ueool b RACE rnuT ¦~ow.u~c~w~r u+au. ' p . ftt.lt~cu~r`1 ~uTMO~+ hqJ~ Mos. . w~s ~ Moua! rw. ~A ~l 2V 70. I1 :.~s!t~,ciioHS , : White s~. 64 : Sb. ;~Mtu o~ or~a~ ~wsnrvrar-NAMf _ u~o* ~~'^'c~, ~nc m~a ue Mur~ ~ ~rs~nc emr cu~. ~orw. r+~?. o. +wo as~e+c~ ~o¦~c~ ~ ~~wwo! i Q~RANS 1\DM. 1~1NE5. 1LL 601~4D A Y I~ O Y I+7 C~ ;~~Q ' . 7c. ' 7d. ~~R f 4i~w1Y!~! -?Ql1sE twuow ~s. v~?r0 i6. - ` B~RTHPLACE Is~~i[ o~ ~wua~ CITIZEN OF WHAT COUNTRY ~~W~p ~Y`~ KED COYMf11~I `S ~area s~~t e. Indiana s. U.S.A. ~a SOCtAI SECURiTY NUMBER USUAI OCCUPAiION ;~u~ ~ W~u ~~WST~r ; U.S. WAR VETERAN ~ WAR OR OATES Of E E , ;`~~`~y~ World War II 31i2 ~ Ca$8 I.aborer ;13D. General ' ~x. . ' ~ - . . " - " " ST1tC ' COYMTr i ~~lY. TOAM. TID. M ~OhO W1TMC1 MO. ~ 111Q0~ Cti11 ~ ~i~[R ~MO IIIYM~I\ RE5IDENCE ~ ' ~ ~ ~ Kankakee Rankakee ~~.a.Yes ~ 3b5 N. Fntrance ~ - Illinois ~~.e. ~.~•E 140. us* MOTMER-MAIDEN NAMf r~~r - - fAiMER-NAME "~st BASti -r-~ y a araeber ,s Olac~ye iNFOR ~E . ~ RE 110~NSH 1;~IIING ADDRESS s*~c~T wo wo. o~ r. o.. an w roue. sr~TC.:~ X ` ~,j ; 1LY8~} ; Veterans Adm., Aines, II. 601t~1 , •~~71J~ ~19aV~~~7~C~~_V~ ~1C ~??AOi/M~TtIqTIMAI 1 17a~ ~o te!] ~errcewowsowoourN ~g. OEATM WAS CAUSED 8Y. [c~ic~ o~~r ONE uws[ n~ uw[ roR W. lel. 2-- rwRt ~iCO1•,~O.O" fILE6~hD ~tEGpRDEO UNKPIO~TN - WC~~ ~Oi1N1t? 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