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HomeMy WebLinkAbout2603 I ~ ~ ~ i _ - - T... ~ 47 ql [ 6F iILINO~S ~u~~" ~ -~,iv~. i•.- : ~m. ~ r* :~IStRa11a7N -i - i o:>>~,« ~:z . ~ ~2S ~ t;~~;;t,?~s~~` ~ R~tEDIGAL. CERTIFiCATE OF DEATH ~ NU?~t3ER ~ r,ssr ••.uc:i usr ~SEX DA!E (?f U[~!N •u•~ r.w e. r..~r ? D~l.fr.5t.7- :tA.titE 'p tEi?U?NCNt thK ~pp~ v EIVL7~7 ~_~--!•P+L~~~--+~-T~ .'v~ f.wrd Cv+~qss'. ~ s~Cly l1~ _ u~urn Hc~a.vh~anu~i k/?~E •N~~[ +E:~o_~•tnci~ :?ou~. 1?~iE-us~ lJNDfR ~ Y~ EAR' V'r!C~R 1 DAY 4FIE QF BIRT?! Irt~w?v.c~~..ra~~ 1PLA~E ~ DEATf~ ?e~+.~ooi b~ Ex_ (srccn.y surNC~±}•n.l. Mns. . wn •~,wr r~w. ~ rrrsnuc;ror.Y 1~fhiLe ' : ' ~ ~ept6~¢be~' 15 ltjl~ ~:Q. RiOC's I'la1~d 4 S~_ ~ : Sb. : ~c. 74~~. T~_.M K`~C O-ST1t.ti ruMlE~ ~ K.O( C~t1 ~ wa`Slft~l 011 OiME~ ~K7~iVf~C~1-IJA~ ~as 1W7 u~ [:T~:[~.3-~! !(NEt ~40 ~l•~~E~I 4 ; /rttl~Ol ' ~ TBY ~7d_ s;r• ~.'1tr~10 ~S HO ~ti81 n,. Hock Islaaad ~ ~ - SIRIHPIACE ~~rar~ o. rwocr CliltE~i Of W?iAT COUNTt'f MARR~ED. NEVER ML~RQ~~D._~~~ NAME OF SUR~~"s~iG SP•'J13SE ~~~ME`~ ~•~~v ' • to.iwtarl W100Y:E0, ONU4t_D - e_ Illinois _ 9_ USA ~o Harried -Pauline Z. 1~trikin IA! SECL~1ni~ fvUMBER USUh: O=CUPATIQN ;K~;t titstt+ ;U.S. itiARwET:t/iN .Y:AQ 1i L~:IEi O: SEh'icE ~soc ~cD't"~i~~~3 ~ . , , li3e il, i _ ~~3~.d7-2~.73 I,~_t~echan~c : Ar~enol ~ 1es r - RESiDfriCF i:,E • cw~wT. ~ c.n. ia~. ro. ew •o.o crt~ra ~o. • rws~ac c-~r sTwcn u~, w:.oc• ~ ; IraIY~~ . - Iliinoi3 ~..;Fcoca I~lar~d :,<<_ ~~ck Is~~d :,s~. 7ee ~~--~3ra ave. s~.o~te '-~u MO7HtR-kWOfN i'L~.~1!E n*s~ r::.xe i - FA!Ht~--l~A`Ai •~xs~ CL1Tv - - Charlea 81ggs 16. Nettie is iiivFt?CtM Si(3NATURE , REIAiIUNJNIP . MAIIWG ADatESS ~s~nEt .a.u w•:_ w e. o.. tn~ c+ :c.ti. s•~ !i ' y;,,,,_ Wiie :~}~0~- 23rd Ave. FAC~ Ielasd, Ill. 61201 1'--'-'--"'-'-' 1 ;70.~ ~f^• ~r~ces.wia ~wr[~~.~ :g_ DEAiH ~+NAS CAi1SED 8Y: (a..n o.~• ONE uusc rce urc roe ~d. lel. wr rcll ~e*~ccN e«sn •~.o - ~ ~ PA2T 1. ••~cwait c.vst - [~'r f t, ' . 3----- - ,a, Acute myocardial infarc~,i - i,~~'i'"TI' _ ~ (wE M nf ~S + C4~SEiY Ew~C O~: _ , ~ ~ - ~4•F u.rn..;~s. , l ( L L t !C. Li C; .lF_c rr'P ~ L ~ ~ - _ cn[ s~S. ro ~pj ~ . ~ ~rM[p~i[ C~YS< 111 p~JE ~O O4 ~5 ~ CCFSEGti [ a' . ( St~TU~p iM[ YNJE7- f J~ Jr,{ ~ ~ - t~1~9 UVSC t~:~. ~ ~ T~~ L V"i / 4 f -G"_~ "f/ ~ _ ~ ~'~1-i-<<~ _ ~a , _ ` , . • AIF ti YES PARi OTMER .IGNIhCANT CON~~iONS:~~T'~"+ CO"''"~"r"'~ ~'~TM w~ ~~U , b. r+ r~ri . v. , s w r e.+~w c.~K CI . M . a----------- C~• . ~ ' ~ ~ - L _ Tee - " _)•c.. . (~.C~'~ ~ ~ (!'.rrC~. i?~. '1Y~ 5 - ' ' CATE C1fTOPE~iA7iON, IF ANY , M 1P OR ~~NO'NGS OF OPERA?ION : r~.- - - - No ne ~:^h. P_ a 1~wxr.., wr, ~er . ~nra^ rt~cl ,~~n u,~ .a~ H~r/ ~•.owT«, _it ~r~ : H~Jt~R v~ if AtH - - I T~l(t~17E~J Tr.E ~NCaauncw~ ~ , ~ ;.:;.Et~tD:~:.}~, 6 2 1955i~',:~ 3-3-71 3-4-71 ~ . - - ' zte . 20 A. I ' _ - - - - ~ ~9~42~_ G':'&:/FS" TII.:T T(YT7fli-R~FT--0F MY"'~`'M'I E•rM:F 77t/c I~tiATNQCCUNhF:J~ hlQTE: IF AN INlUQY ~IVAi t:JVOC~EO =i~1 iY.tS [~f~?''{. U~i TI:F: /Ia)'F. dT tIi ,r1K~:?ivn rr..~cf:.~~n t•?:+lal TTIF. !'AtI~F:i31..T.f~3i~ TNE CORO~s:~ Ml'Sj i!t NU.~c+EU. ---`Tn ~,wrr».o•.,.~.~: ,ILVTi:;15 ItCENSE i~:01,A8ER fILfO ~ S:~tJATUk~-f d , ~1E S'(:.tdED at~uc~E couN Y' ~ ~Q.~= ~.f~`- ~~1~•~ '~rm. 3-4-71 36 I 8821 R06Ed POtTRAS ~~,_,L~. - - - - t CL~~X MAIIIN.~i ~ P ' sfa~' i c• r. e_ ~r n~ a.~w e~.:~~ M ~ cu~TCO T ~j-~~~„qth;~;r~!'"R'8ck s!vnd, I:f~nois q~CQRt~ YrP.IFtEt~ ~ - , - • QiAi ~ ' I ` ` '•iERf ~R• GREM11(ORY-IJAA!t :IOC~?IION on o~ tow~ s~~rc : D/.(E ~«r.~~,.,wT.~v~~ SEP ~3~2 ~ ~ " - ~ ~ ' ~ ~ ~annock ;zk Eoak Island Illinoisj:a~_1+4~:r_5z1 7~ f~ ?~„~Bti~~s3' ~ ~ , ~~iti~: ~ Ch~.PR . atRi~1 ~\J ~IV~[• FU13EkAl HJ%~ j.~ - ~!lAI:.~•: c.• r o. c~n aTOww sr..[ n• . ` . z~ go~~_~s~ e~ ~OS-20tb_ Streat Rock Island Illiaois _~.61?Cl~_ iUtJ:iAI G'1Y ~S ~ ~vr.f W OK:t S~:tutOSS LZfi.St ~r,~ L:a ~tG?d~~!"' ' ~ ~302 - - - ~ ~ 2x- ;sr t~K~t REG~~Te~['S S~GrvAtURE ~OAIt RK'Q SY IOCAI tEGISiURI.~+.M.a•.+W~ ~ ~ria~. ~ . Tacey, •Tr. by ''e . Re y. ,"•i~rch 1 1 ~ aoo-•~~ NIMY~AS OEIAttti~fNi OF HJM1G - VJif/W P~ ~ ~wsto c,a ~ue u. s. s~~?,onw cEnwu?~e 8001~ ~~J1 ~ ~l,,~i~ - g~~~~ - ~.~err'~L'~•:_ . . _ G.._i ~'j ~ ~ r+eF