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HomeMy WebLinkAbout2856 ~ ~ , ~ / ~ i Ita'' / 31w I! Oi I~LIN013 \Y¦i!• J ~ 0'S'fr:' ~1t, ~Yj• ~ . F~t~~~s~Ee~r~ ~ MEDICAI. CERTtFICATE OF DEATH ~ ~tU•.~B:R y~`~ .-•ci~~tC~- ntA.YS n~:r ..owc ~s' SE7~ OAfE Qf AfH .a..r..o..,.a.~~ • Jv°~,'t 20, 1973 ~ OTL9rRT s~~~iT u~1~ a. pt~~ a~~~ 't tArt....n.rc.:~o.~ra~~~~ .~euw. ~AGE-t~s, ~h~~ 1 ~ Af._~lti(.it'1 QAY DAIf OFl~RTr~ ~rorrr.wr,wq IC~{C~Of 0l11T ~~tor~?` • : ~ ~ u..~`~iITE `~'"a~.s.~'~ ; o.`.s • •~;..s . ~ - ' Coo~ s ; ~ / ~a. ~'n.. ru.a. o~ ~a.o a`a~~~c~ r~~iti' •~.uo~ a~. ~.a:..ra? o. o..u ~.s~rto~w.-ruwE Ur ur ~r a.~.c•. a.a ~~~cc~ •.o .~.~a? ~ ~ I~IL~JI _ ,b CRICAGO H~IGH'I'S, ILLr10~~~ TES :~d ST. J11~~tRS HOSPITAL a'~ii+HP~A' • ~~~lcN O~ w?u?T tOUNIR-Y T~~QR~EO. NEVER MwRRiFO. NAME OF SURV~WNG S?OUSE lr~.~~r ru~4 ~NU ~ , ~fC f~=~~ ~ l% ' w°o~t~l~t~~~~f eo a•.~~.., D~ . e''',3 ~ o~~ ~ 9 v _s ____~_~o ~ o~r Sc~ ti • ~ /k P. ~ZC~~t SECVQ~fY 1VU~ •5ER TUSUAI OCCU?Af~~N ,c~r~o O~ WSwEii O+ wo~s~t~ ;U.S. WAR V TfRAN--rWA! OR ~ATES O` SEitY~CE ~W.o? ` 8-~-0106 ' ' ' 33 i~b_Sj}L~a,~/¢LIl ~~~b ~~~}JI~~1~L1''~x ~ ;»e. ~ R! S~~ENCE sr~`~ ;~~r. ~ ar., u.~. r~. w a,~.o o.ar c~ w~. •~s~oa u~~ ~ snccr uo ~ur~t~ . # ~ h!s/wl i illinoia : ?ab. COO1C ~k_ NA .,RFS? ~ ua YBS ~ ~~e Q07*•ORT~! P'L. 2630 ; -,r n~s~ +~~oat Ns~ MO1MkR-AtjtiGEN NAINE r~+s~ .•ooaa w~ f - - 5...: ~ ls'~~ I~ ~ ,a , ~ ~Jil~r- ~ 4f - ~ ~ ~ , _ 1 rNFpRAIAN~'S S NATUQE ~ ~ tElAT1ONSHIP . AAA!UNG ApORESS ~s.~e[r ••o +o. o~ o•. at~ o~ ro.•. surc, t•n s t~,,, f''~r I ,C1 . ~jb`ITTTN(} C~f;RY ST. JU4SS HOSPIT!IL ; Id \ . ~!tt WAS CAUSEO Y: ~~~~~•~~~r[ ~wrt~... t [a?ta~ a.ay OME c~ust rt~ u~t ~o~ ~d. t?1. u.o Icl] •a*.ta¦ ors~~ .+o oa.r« PARI _ ~~r[O~~it C~.JS4 ' . i ~o~ ~/a~/7/I~C~t-N~r Sf/oc_K 2~-hrs. : : wc ro w•s . couc~uc.cc o~: ~~/~~~~A n j~ w n i coro.ra~a. .r C'S f/` C~ / f/FA ~C ~ ~ /7 Sl= 0~'rY 5//~ .,s~ ie~ rrl~ul( C~u1( IN pyC /O W\S ~ CONSCCV[+C[ J+: • 1•~l~K IM[ VYDI~' - ~ ~.,,f~ ~L-/b'c= ~C'~l L/7F1> /~i~ ~/F ~G?S~l-FiE~~'S/S !~1'~'r' ~ ~ pA2i u. Q/M~R SIG~`1~ft~A~:T COND~TtONS: ta~.ar.ws twn.w~wc ~o a~~.. ~~r wr uutto ro v~uu cM1iM ~.ar . w Al1~Q?SY YES. ~o. : lY[S/r0) . ~+~•~s r s~r~~~..~.~ e..u ~ - ' ~ N N~t~ ~90. ~ ~R1 DA1E OF ~,~;RAT!Q~, tF A!~Ir . MA}Ot F~NO+?~GS Of OPEZ/?TION ' ~ > - ~ C,_ 7 ~ : ~l~P!/Y~S !-s. /r~lle'~n /I7a/ ~cA'/~ • i ZOb. ~ . q~=:•~~'~ !H; 'a~~~...3~~.r[~a1 • 1ry~f..,G~r.~t~a~ ~~Ol~sti•~+~rj U+Owiw,O~r,r4c/ .MOI:R OF OfAiri 4 DECEASEU =RO :t, ~7 TO ~7 ; ¦c~ .u.c o. ' ~ . ?!o / ~-~_7~ 41b. / 7~ 7~ :~Ic. - 73 i~ld C~~~ ~ V / t'f'kTlFY TilAT T'O T/!F. BEb7 OF ?lY KNO~ti'I.F.DCE THIS DEdTHOCCtJHRBD NOTE: IF AN INJURY WAS INVOlY~O IN TMiS OEAIM, t O~ TIIt: [?ATE. AT f/E' TI?fE: A:?D PLACb: AV~ PK~:?l TflF: CAG~JA'(S) STATF.D _THE COtONER MUST SE NO(tfIEO. _ . SIG?1A*UQE ~ ,DATE 51GNfJ l~owt..,o~~,~c•n ,I~L~N~~S lI~E1V5: N~f.'.3°i i ~ no r.> , li.l~fa«~~ - I~ 7- ?_~-7~ ~n~. 3G ~~is/_ ~ ~ .Y.A'i:tiG ADD'•c SS-CERflf.f? s•~cn wu+s~+ o~ o. arr o~ ro.w sun , a~? ~ ~C~ ~~~x.~= j~ cs~ y. ~'H.ln ~ f~F.~~H i~ ~~~_,,v~~, s F~~ ~/~i ~ aL'i'%-!. CR~ :!aTiVN, .CEM`_TtIY QR CR~MAIflRT-PlANE .IOCAiiQN un o~ ro.w ~~/`~~r~t[ . ~AiE I~ow a~~.~t.'~ ' ~ I~ 210•~ L.~/ l ~J~ ' 23t~~ r /~J/ ~JY_4 / : Y~~~ •~~~~~_~J~ 41d. / ~ i . • ::1C•..4. N \1~ tn[Et ~~D w~..~[~ ~ O. 4t~ o~ tO~w /'~~~Tl ~ra - , i- ~~1 ~ ~ ~ _ 1~~-.! ~ r~~,v~~~~--~I~,M~= ;x~~'`~%--~P~~~«~~~~~. .,Y' ~ • c ' ' ~ ~ ` ~tE~ Js ~ :i~, ~,.~5 l~~E^~1, tiut•..~ e f ~ L ' ~ ^ . ~ ; :v'1:.. ~ f /-i'' ~ ~OAtf tc~. ~ aY IOCA: iE~3'S'~:•41~c~r..,o~t.~un i t_~' [ C/ . / a~~C.- / CL~~ 1.' ^y97 /r.~l ~'16!. s V~ : JO (197!/) I1'tno'z Den~r'~^cnt et Pu~uc Na:.ttn -O~'i;r of V~t~! ReCO?CS ~a~1:~ v'-. .o_! S S-:.•.:~+~-, +•E ~ ~ ~ - - - - . _ . _ . . . i . 3 -•-~•>r,ny rERmTFY t1Xa~ i'.~i ~'oreg~ing is a true and correct copy of the dea~Yi 3 ~~^or!'. for the dec '~~~~M `lo. 1 and that this record was establist?ed ' , ~~~G~ ~ ~ '"i~ ~'d ' Iz m o ..~sL>~c ~~;dance with the provisions ~r the Illino~s ~ - r~ ~.:l~;P.3 re? at~n~~~ t2},e r~}~.~8'~xati ~n of births, defzths and stillbirths. - r•GG•° ~ L • ~ _ . ' • , ; . ~ ~ ~ ;p ~ STC:t!!~:D : -~~l~i :.~...v ~C~i, + _ • ' F--- . , ~ ~ ~;•tT(;qrp ~.~;T(}T;~~ ,~Il~~4A~S 60 11 TITLE: LOCAL RE~TSTRtiR . ~ ~ ~ , ~ .f:.r., . ~3 ~~:iq~~Y~ ~ " i flLEO AM~ ltECORDE iT WCIE COUMTY f~ ~ ROCER ?OITRAS CIEIiK CI~CUIT COURT RECORD YER¢F1E~~... : 8Et Il Ii zz ~H'l~I ~c2;3.~ ~a~~ - ~9~~85 ~ - -