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HomeMy WebLinkAbout2615 J ~ ~ ` ~ / 293469 • 1808 OH10 DEPARTMENT OF HEALTH ~o - s R«. n;x. tvo• DIV ISION OF VlTAL. STATISTICS R«~nr's l~io• r~;~n K~s• o~u• r• CERTIFICATE OF DEATH DATE OF DEATH ~~~~•~6. Dn. Yt°~ • ~UiJlf~ Lu~ SEX DECEASED--NAME /~int --1~1J~~~~2y CZY_> ~ r OF DEATH - ~ A~~~E- 6AU ~ ~Z F~ ACE ~'b+«• ~~j~~' ~~~~«+R AGE-'- UNDER 1 YEAR UNDER I O.aY ;A` ,I F NtTM (Alo~tL. Drf. GOUNTY birtW+~ (1~+~'~~ .Moi. D~7+ Horrs M'~• e. A ril 11 1910 7e. Cll 3t10 S ~ ~i~w. dr. ~so«:h~ White Sn. 6 Sn. Sc. rsr i~ eitbn. i«'~ ~~ntt wrwisrl RY, YiIIAGE, OR ~OU?~ON Of OEATM INSIOE CITtt UM~~TS 1iOK~TAI Ot OTHER 1NSTITUT10?i-~'1AA4E «I ~ ~ (S~rti/l ln ~r ~si ~d. Eucl d il@ 1 OS tal ' j 7c. e8 SUtV~YtNG SrOUSE /IJ rije, sir~ n~iltr r~ws1 ~ ~ WIOOWEa, DiYO CEO ISIsc/(~I 4 V 'ATE OF LItTH flJ wN ir U.S.A., ~~TIlEN Of W?U?T CO~HTtY A?AR~1E~, NEVEt MAlR1E . „ F US:~ ,o. Widowec~ t ' °'""~Yugoslovia o. ~ - l1TY NYWE~ W~ ~ECEASED EYE~ !N U. S. ARMEO f0 ~t~, sirt a~+? er J+ltt eJ f„~i~t1 ~ ~ . , y.. ` ~A?,SFCU /Yef, w~, or xrkws~rrl NO j.j~ KINO OF WStNEiS O[ INWSit~ c . r 09- b7G4 ~ze. . ~ N fGiet ki~d ~I ~+rt le~s lrriws w~it Fisher Bdd ~ l-i i.~11 »s. , L~ . - Sewer ~hSIDE GTY UMITS STiIEEi AND-NW~iER i. w ' d' ! 4~ ` pn~ VIIIAGE OR IOCATIOH 't ~y - CpUNn (Slen/1TeS ,~..75 East 233 St. A t 155 li~ :~'Q' - ,i"' : ~ Ettclia ,.a. t.,e i c.. ' ~a'%>, . - ` lisrt Mildlt • ~y - J U ~ - 1ab. Cil1 S~10 8 {tc. Lut MOi„Et-MAIDEN NAME ~ r - ,Ni1Jle Kusterle c~ ;;~.:r ~s; ~"~'yr~, r~: _ ; _ Anna 16. ~painter _v [ - '3 - T!1!. n (S/rtrf sr K.F.D. wo., cifJ er ~illitt. rl+tr. :~b1 - "'f _r aM,IIIHG AGDtE15 Oh10 44060 F 8306 Stirrup Ct• Mentor, U • ~ AME - A~~ROZ~~ii ~µTEtVALT t R. 17b. (6I. ldl~. ETW N ~ " ~ Baucher r• TH W~?5 CAUSED BYL tENTER ONLT ONE UUSE IER tINE fOR f~). • ~ qa1E U bL?lGti%'~ ~l c~ ; : Y . ~ . ' _ . ~t ' 'Z'GJ ~ - teCU ' i ! IttC411t 001I ~:iAUSE ° , c~? . ~s" DUE TO. ~t AS A CONSE ENfE OF~ L~ a~,~~X ~ " ~ ~Corjitl~~t. i/, ~r~, : 1 + . . rbirb ~~~s rus re ibl i ~ `jjj~ ~ ~ ~ ;iw~tlide s~t~ OUE TO, OR A CONSEOUENCE ~ c. a ;Nrtiws fbr rrJtr- t/ AUiOtSr If T S arrre ~rd+r~f to~iidrr~l , ~ , :IJ?~~ cuse Gut Ic r~w (Yti ~r ~o ir dtlt?wiuwj c~we ~J ~t~lb ~ ?A 1. O~i1ER SIGNIfIGNT CON01 1^~ 1~~ tor~ ~Q~u•iiwr;rs a le~ti in(~t IaftJ ~va. ~ 19~. nf ~ L ` 1~d,(~,t,a.a,,bl 1"~'~'a'`'L t~"'~' t I sr /~rt lf, ittw lal ~ N ; . ~~Y~ - ~R HOW IN1Ylr OCNRlEO fE~tt~+~rrr ~1 iwlrry iw yn ~ ~CUDEHT, SUIGDE, MOMI DE OATE OE ~Nw Ytnl ~ • DR UNDEiEIMINED (SPtti/f1 t.M~~i, L~1. 2a. 300. a~ - 20e. fShstt ~r R.~.D. Re.. ~u1 sr vitb<<. r(att, rio! t: fS lOUiiON ~ iN1UlY AT WOILK ?IACE OF IMl11t~ M boM4 I~~. lhttl. I~tf~r~, r. . (Sprrill T~~ or we/ o~rtWJ~., sfc. ISIsriJ)? i OIO:DID w01 DEATN OCCYlRE~ At fbs ?(~tt e¦ ` c': p~. 7~. Yt~r ~D LAST SAW MIM/MER fbe d.+ts. ssJ, N i~ ~.C ' Ytn blarlb Dq AUYE ON V~EW iHE IOOY IMOUt~ tb~ btit wf ,llowrb D~I ~~~o,~~b Dn y~n AFTER OEATN. lJY~ ,~ro+~•lidjt. wre to CEtTIHUTIOK- TO J ~la. 21i. M. fbs ttrrefrl ~~~e~• ~/M'fS~C1AN: ' , ] ~,O ~ 1' 2I J tr Z ~ ~ ~ ~y 1 ATiENDEO iHE ~ "b. cnp 3 i~ta. DECEASED FRWA ~ Yt~r /forr i: cn py~ Hor~ dserb Tbe lru/~wt NO~Ii~wo~~r~~ p~ ~ 4~ ~ ol ~b~ ~ l~nd ~ b~.rrn~s~~°M ~fM~ Piw i~ J wbr l orrrrrrl e~ fbr a~ti rwI dre f~ tbi c~wt r1 tt~td. ~ L: r--~ ~ M. 27 . ' Dr~?.e or rirlr DATE StG Ea H ~H ~ ~ i ZTa. SIGNATURE ` ~ • ~ ~ L ' CERTIF~ER--NAMf (T's e? Pnw~1 ' L~ L ?3c. ~ ~ 23b. f~7~E Zlt ~ ~ ~ ~ C,LLS ~Iri OR Y~ItAGE y ~ ; ?~e. ~ STREET Ol t. .D. NO.~ [y~~ ~F~~ ~ ( ~ W11Uti(i AD~tESKERi1f1E ~ _ ~ ~L lCi~~. vilbss. or rornt~J (StaJt1 ~ : 73E_ _ ~l ~'i..' ' • IOCATtON L~ V NMIE OF CEMEiER1f O¦ C~EMAiORY ~leveland ~~110 WlIAI. C~EM~Ai~ON DATE Jan 31 Zb. l V ~sA«;~j, z,~. Lakeview ~uc. No.i Burial 210. N~ ~ fUNE~~ ~~tECTOR'S SIGNAIURE /"1 T ~ ~ ~ / . ~ ~ ~ ~ ~ NAlAE Oi E/+~IAtMER . ~ - ' / .':-i - 3798 A ~b. ~ .r - • - ' . iz~n E.C.Brickman ~ ~ "~~,i„~ ~sr.,Tei ~ 2S. ~STtEET HO.) Ohio 44117 ~ {{~tlEtAl ftW ANO AO~RESS 21gp0 Euclid Ave. , Euclid, is ~c gRICI~iAN t SONS INC ~ DA1E ~ERM~T ISSUEO S~ /l~ URE Of ?ERSON 1 SU~hC.t~~~T / ~ ~ 27. ~E ' ~1 ( :l ~.n ~ATf AEC'D ~r E r - ~ ~ J1~J.-~ IOCRI AEG ~ f : 7 / - ~ c ' lL .'"'~9. a'' _ . . . ~ , . ~ - 4 fi 5 xty " ~~H'V' . ~~,:'~.,'r t- '~.HS „hr.« ~~~~a~~'~z~~~~ t> ~ F s , ~ ~ _~.:n~".~ ~~~~r~~'_~'. - -~~ti. . _