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HomeMy WebLinkAbout2235 . . _ - - - - - - - VMIV ~Jtr'/CfQI l~t.l~i ~ Vr titHLl M ' ~ ~ DIV1810N OF VITAL :TATISTIGB ~k ~ ~ ~`""O ' CERTIFICATE OF DEATH ~~s~ • DEC~[/?itO--NAi~lt t~ ~•r+ fEX OATE OF D[ATM ~~M~. a!. Y~../ CHARLSS Ml. HI1R'OM t.Msl• J 1 R~E ~r~..~e.k.r. AGE- t..~ w~ott ~ rut uNO[t ~ wr DYI?pTEr,O/ ~1~TN rYw~.Oi.s. COUNTY OF DtATH e~~~cil li.ril+~ h~rn1 Mn . 1. ~r~ 3~ Sa- 3t. dt~l. 1nltA4l. q lOCw1WN O~ OEwTN ~NSL~OE d~ l4 :K NOf11TAl Ot OTME! INfiliYilOK-~~ fN ~M 1i p~+ ~?N/ /~i w~1rJ 7?. 7t_ 7~. liAt! O~ ~1tTM 111 ~ w U.S.A.. srs~ CIIIZEN Oi w1tAT tAlillTif wt~1 ~NEVE! ~aAN~MlK~/f1 Wt~I1vIM6 il'011iE !11 r+f4 ~ sr~J t.wn11 S KOl`l"'~i 0~0 ~ ~0~~~ lt. sou~t stcunnr ?~uwet MIAS OKEASEO E~/N IN Y. f. Af~lEp fOKEf? 1\M~ ~ 5~ Ij~. • N~ M 1~~N~tf) ~O ~II 7y. s~ r~ M tMp ~I /M/KfI uw•~ ~ts~ofwCE u.. w?,~~e OKMfl/ yfyAl OtCIWATION rGi.. rr.l N¦«~ ~•••+~~s••u•l c~?a o~ wsu+EU oe ~NOiarn ~ ,ivu?. ir oun~ ,r~,~;.,~~i/,,..r.i/.N:.11 ottu~it~ x~ I~~L~OS1M1d~ I=1i• O• iwstirutww O~v! .ES,~a+u ~b~o~[ ~~,owc~-sr•rf oo~w+Tr at,r, v.~~uwE w~ouTwn cm Mn sT~en ~.a ~w~we ~a~~u~a+. ~'~is ~a.592 Pas'!c Da~. Ohio , . Fnuklin ,k. Colua~bus ~ ~ fA1Ml~-NAYt fLN JMiYli Lrf M07MEt-YAIOEN NAME FLtf M~~ -s ~?~~11[ ~1'LOti 1~(~1r'Y ~.N~1 ~ ISt~en M[.F.D. s~.. siy dfLM. aH. +i?I " INFORMANT--NAME ~ Mrs. Charl~s W Bis?ton 2 Park De. Coluebus 0 0 ~ _ o~?n+ wws c.~?uscn sr: ~EN«. a+~r ~ u~ ~~~E •a ~o z is. - ~ lIOGE~ P ITIIAS L ~ 4~^ ~ M~MiMATt Gllit ~ TO. O! AS A Or• ~ ~ ' RECORD YEklf O z iZtri s~ii~ ~b~is ~ ' - ~ ,~~a.~r~~~ ouE ro. o~ ns ~ aousccue~cE a. ~'46 - ~0 ~ :l~s r.w t.r ? O OW~i •.~irir~r sMr.ihri+s a l~ri Mt .w reltil a~.~ne ' ir M~ I f~l ~Y~1FOItT F~i l~Mw~iM~s~ri ~ i ~ ' L .~a'f'v.~ 11~. iN. r IlOG06R. /1Np dOE OATE Oi uWtV MOYt MOw IN1Ul~/ OG~Ittm (6f~ a~fwt ~11i I~ ~ 1~ u. IM~ 1~1 " O~ iM1oltEl~1 SK~/f: [!~l~ari. Dr1. Yu~1 z ~ ~oe. ~ iN~+ nr ti?.~c n~ of ~~uwr .u b.., f••. ,r.sn, 1~*•?r. ~ouT~a+ ~Sr.nt « 1t.F.D...., ss~ «.itf~w. urR. st?l L fSNdlf fn «rl ~Fr. M4•. a~. ~SN~+Is) i 701 ro~ CunHGt~O~-- Ab.ei Duf Y.+. 1M..r~ Drs Ywr ~wo ~wtt snw Mu~/~e t ao/oro~ Not OfwTN o00ue~~ tb 1t~~ N atw tMe woir paey i NRf~C1AN~ ~ TD u111~~fi Q~1 Ywr ARN 1M. f?f f f.1( occEws~ no+~ 3 ? '1 'Z j. ~j '1 '1 a. ~ ~t.. jl t w~.~r~`wi.~ ~Ett1HCAT10N--OO~OMEl. O~ t1~ i+rir ~l~ ~js+~riN Nwa law? T?~ I~s~~t ~I~~~+~~ ~ Y~r B~ N ~ie id~ ~/iN ti~ i~r~til~. s s qiws. Jt~ti ~sserd N eM tIs ~I /w a f~e crr•li~ wal. IY?. t2~. - 7~- w MT! f10Np cm~n r'r~?. s'w+" l Jas~s N. W~bb li. D. • 7 Z• MAI[iNv ADO~-~-CE~~I/if1 ii~lt7 Os Lf . ut~ o~ +~~uoe ~ t~ J~ 61. ii~bb. M. D. 4373 E. Li ston A~~. Caln~bns 0ldo NislAlf ClEMATION OiATE NANE Of CEYEfEtY Ot (26MAiOfr IOCAT'AM ~C111. wiffrlM M ~'~71 (SANJ ~ N~• I / 11 ]Ic. ~~O~OQ Ci~e~ 2N. ~ ~ 0~ _ w~rE a r,~?urea ~uc. ?w.~ s ~ ~ :s.~b~rt E. O~Sha hn~a l+9~~ H . 0 ba tm~a . _ ~ - ?u~EU~ r~w nra ~oocESS (STlEEi MO.1 ~am n ~ Sban6t~sa~r ~ral 405 8. ?otim 5t. Colwabus. Ql~o $321 S o~Te eEC•o ~r ~ca~ au? ~ a?T e~uT ~swEO SIGNATUtE d?ERSON tiiYlliO lEWli oa?. ~q. ~ou ~cc. . ~ . t t ~1~ a . "s , . ~ , _ ~.i,~~/,~2~~f~j :YA . s-~~ ~ - ,,W " THIbt IS A COPY OF THE OFFI~UIL. G ~ , ~~~T ~ ,~R ` . ~ : ~1~ ; ~ ~ • _ .i,e + ~ _ .~'~d ~ ti'~' ~s r . ~ i~`. . ' ~;..*~aLt-?~,r THE COW~BUS DEPARTMENT ~OF' ~ , - ~ ' , , , . . , , s : r~'~, . ~ ~ ~ ~ . =r ~ . ~ z!~: ~ ~ f t~ t . ~ : ~~c_.'3.- ~ • . - ~fiJ~r ~ ~ ~ ~ - „e.~ ~i ~j . ~j~,,.'~-Tj ,f! ' _ .a .~,t--~. q"'~y•?, Si- •~,r . • ~~/N~~ ' - ~ ~ i.~-~f,. :a~~~'~:~ s • # - • .3 - _ ,~s,~~ ~i~;,~:~ RFrtSTR AR T3TSTRTC'T ?.5 4 l,~•'C ~`s _ • = '~•r...:.•~ ~ ~ . . p ~ 6QOK ~?J1 PAGE~~~ _ _ _ - _ _ _ _ - - - w , ;