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HomeMy WebLinkAbout0551 ~ S . ` PF'Gt~E~~ ~ ~•ti:i ~ . ' 1 here N / p?M~GpV~p~pvRt ' J~ <<..~~,r;., r, or rre ~.~enrtr that ~h1s ~ 1 E~~- E V G~ E~ 4 ~ ~ t G 3 s~~ , ~ 4; i n a~ r-?t,t, ~ s~~` r° r 1 1 s l?~~' G~R~' E~ /~,!i~ i' 1`e B,i r,. ca~e tsz~tord ~ 1 ~ `~E~ v~R~ SQ~ ..'y ~~y . ~ ~ ' ~~~~:'s n, Gi~:~ 'Y Naa:fa Deaartmen~ , ~EG~ 0. ~ - {~e~_'i! Cate ~ . ~ ~ ~ -.1'~ 3~ , l.r ~ i . . ~ r ~ i . '^I.~ . ' ~ uJ ~ ~ ~ ~ ~ ~ ~ . . 6 r ~s: ' ~ w~ ~ , ~ = / 3 ~ ,t i~J. • k • . ;r;.'o~+~-~ . •:i~'`f ot;''jal~lt - . ~q'~ . ~ . iL~~~~:.. l•_ ' • , --•-?t.- s1..~_----- ~ fH~ iN1 ~ - - - - f~111~ { ~ ~ - - . : _ . . . ~ ' OHtO DEPARTMENT OF HEALTH ' ~ ~ ~ DIVISION OF VITAL STATlSTICS ~'N'' . ~ i a . l1.~. wa. l~te. ~ Iteslwn.•~ 1H.. ' CERTIFICATE OF DEATH . - OECEASEa-NAME Fi•rl MiI~M Lai SEX DATE OF DEATH IAt~ui, Qq, Y~r?) ' 9usie B Leuchaue emRle n 1 1 i RACE rtiu. ¦~p~, •...i~.• AG E- L.~ uHOEe ~ rEw~ UNDE! 1 GA~ OAiE OF ~1tfN f.W~w~, D+~, GOUNTY OF OEATH ~~Ji~r, tlr. /S~iti/1J IirtiJ+ ~rp1 Dr~r H~rri Mi~. Y~+?1 . White ~ s.. s~. ..I~Ia 1 CtfY, VIItAGf, O! ~OUTiON Oi OEAiN IHSIDE CIT~ UMITf NOSr1fAI OR OiNE! INSTIiYilOli-NAME /f/ r~i ir riliir, ~i~~ ~triN rr/ wr~kr) IS~e i{f iir ~r ~~J Lemon Townshi ~o Gar en Manor Rest Aome . StATE 01 ~ItTN /IJ sN iM US.A., srn~ C~T11EN pi WNAi COYNT~1f ~u1le~E0, NEYEt ~u?~l~EO, SUtV1V~NG SrOUSE ffJ ri/~, li~~ wrilir a~~~~' ~ i~r~Iq) WIDOWEO, OtYOKEO (S~~tiJ)1 ..9ci io Oh1o 9 ~o. Walter G LeuchRVe SOCIAt SECUtIiY ?({IY{E! WAS OECEASEO EYE! IN Y. S. ARMEO fOtCESi L', /Ytr, w~,~{ r+~l~~r~1 ' /~/7~+. pw Juea ~J~tnaael ; USUAL RIfIDENC[ 1?~. 0~Q~~pWO~ 1?~. 11~ ' WHFtE DECEASEG YSYAI OCCUMTIpN /Giri Ii~J r~?~ /~wr /rri~t r~i1 RIND Of WSINESS Ot INOUSIIr t~vEO. tf DEATN ~,~~~~w 'i OCCURlFD IN i ~~14 ~?ir iJ reiirrll tl INSTtTUTiON, OIV[ ?iouserr~ife I~~, il~me ~ tESiDENCE ~EfORE ~ES~DENCE-fTA1[ COUNTY QTY, VIIIAGE O! tOGT10N INSIDE Clir IIxITf 31tEEf ANO N{Ir~ER ~ ACMISSIOH. ISIHIJI'7flNIN) ~ ~ ~..R1 orid Lucie o t Pie ce ,s 2 04 N. 16th 9t. ~ MiMEk--NAME FisN •Uidd/I Vl1 M01NEt-MAIDEN NAME f~iaf .Uildl~ 1~1 ~ ' ~ ~s. James Be~.rd G. Cocheran ! N INFORMANT-NAME ruiltHG AoD~Eii ISr?eN R.F.D. r~., tir~ ~r ~ifbp, u+r~, n?1 lJalter G. Leuchaaer 2904 N. 16th St. Fort Pierce F'! a.. s rw~r i. OEATH WAS CAUSED BYs (ENiEf ONI~ ONE UUfE fE~ IINf /O~ f~), f?l, AND tdl ,wr~H ' N~ i~ N,E~YAA' t i. 1 ~ S IMMEDIAT[ CAUSE ~ ~ WE T~ A A C NS ENCE O~• / , GrlitJ~n. J/ u~, ^ i ~ vbirL rl~~ i• ~ (I ~ DUE i0, R AS A CO?~SEWENCE Of, 7 Nili~~ I~i r~~lir• /~i~~ [unt /ut ~ ~ ya ~ f ~A~f 1. OiMEt SI 1/ICANi QdD tONi.~. i~i~~~ iilrliw I~ /~~eb I~I wN r~/rf~/ f~ swi~ ~ l utq ir ~ar1 //1/ AYiO/fr 1/ YEf r nt.'~Iir~~ t~nil~p/ . ' Il'~ r M ir /~l~r~~r~~s r~iu IJ I~+ri 1~~~~ IM. - ACC~Ofrii, SYICIOE, /fOMICID , OATE 0/ IHl{!~~ NpU~ MOW ~NAItY OCN~~ED (Esl~r ~.urr~ i~jrq i~ ?.nI /~r ~nl ll, i:~~ II1 OR UnDE1EWIHEG (S?~~iJ)1 fM~wl~, Dr~, Yis) E ~ ?0?. ?Oa. ?0~. ' IHJY~r AT WOt1I ?tACE Oi IN/u~T AI ?o~I. /.n~r, lhN1, J~t/~r~, IOCATION /SIrrII ~r K.F.D. ril~ p tiflrjr. N+f1. s:11 ~ 1 ~}Ty IS?~cilf )a ~r w1 ~dfn I/J~.. ~la /S~irilll ~ _ ~y' Y - ~ 7 ~'r CEti~/ICAi10N- Mor/~ D+) Y~~r .~Lrlb /ar) Yt.n AMC lAii SAWy~/NE/ L~)O~0 NOi OEAIM OCCYttfO .1~ I~• ll~r~ ~ ~ rMrt~uwa~ AuvE oN nEw iNE W0~ ~NOYt) ~b~ 1~~~, r~ i~ ~ ' ~t' 1 AI1EN0[0 TNE TO .M~~rb D~~ YM A~iE~ OEA M. f~• ?~~f •I ~ y/ ~ JY ~t fr~rf~d~e, 1r~ I~ ~ 71~. DECEASED /lOM ~i~. llc. ~ !1/.? l1~.7= 00~1•i ~i~ ~~r~r(il ~brd. ' CE~TU~UiiOra-CO~ONEt. O~ ~i~ I,nii Ibi ~:~~i~.ui~~ H~rr ~I~r/~ T~i b~drW r~+~ ?~w~wrrtJ Ji+/ , lb~ ~s/~ r~//~r Ibt i~rnli~~~io~, i~ w qi~i~w, /ir~b - ~1b~f~ W~ Y~w fhrr e ~ ~ •trrrr~l /i~ dr/i s~l p!bi [rruli! iwid. x • ! # . ? ~ ~ ~ ~r Y. ~ . ~ CE~TI/IE~-NAMt /T~'~ n?riwJ/ SIGNAfYtE U~/?ii • IiI/i pA1E 11GN O ~i d ~ ~ ~ ; y~ Gilhert P. Trl~r~oner MD ~ ~ 7~ , ~ I W'/ ~tA~UHG ADORESS-CERf1IlE• SitEET Ot f.f.D. NO. GT v~tIAGE SfAIE 2~? ~ ~ Y~ ~ 2?_30 Centr~l Ave. Middletown Ohio 4+5042 ~ " " ^ ~ ~W~AI C~EMAiION OAIE NAME Oi CEMETE~I Of UEMAlOR1 IOCAhON fl ~ry, ~d/o~I. ~r aor~1~1 ISI+tII ~ ~ ~ ~ ;;:~'~'ri.al ,~,A r 1 C5^ot~in ~F~i13;~M~:~or nl Anrk'.~:jH&util2tOri:iC0l~ritY Ohio , j ~ ~ ~ NMME Oi EM/AIMfR (liC. NO 1 iUNElAI IlECJ ~'1 f1G AiY t (tIC. NO.) : ~ ~ 9. Jose ~h 9chramm 18A / • . • _ -.~-.-.~_~1 7 , ~ iYNl~AI /144 ANO AOD~ESS (Si~EET HO.~ / ~qI ~ Ii1~lE) (j~f) ~ / ~~112son-9chramm Memorial .Nomo 80 o ev lt Blvd. Middletown Ohio ~ ~ ' OAiE ~ECO {Y ~lGISf/ALf f~GNATtI,( OAIE f t~U1 ISSUEO S~GN lU~ f tE~SON It NG /f Il ,,A o~sr. NO. ~ ~ 7«~ ' JY ! ]v Gl~t'.f f~ ~ 1(~-«<~ ~ !0. ~ 7 ~ L. Ldt-~0~ ~ / Q } ~ z ~ - , ; = _v._~. . .a _ ~ , ~ - _ ~