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HomeMy WebLinkAbout0904 ' ~ j REG~STRATiON r~ ~~~~~0 DISTRICT NO / iTATE OF ~LlINO1S ~E~G~BEQEO ?L~ ? MEDICAL CERTIFICATE OF DEATH ) ~ECEASED-NAME ""s* "sT SEX DATE O~ DEATM ~tN•o~r.~u~ , JOHN BALLAR 1 N 1 z. MALE MAY 30, 1974 RACf .~~+a. w~~~~. ~.c~~c~~ •r~~~+, AGE--a~~r N R 1 Y -1 AY DATE Of OIRTM ~«owr».w+..c.a ?IACE OF OEATH tov+~• E~C. (f~[~~Irl ~~~iNO~t I~N.1. MOl. . Oa~! ~ MOYf~ . MiM. . so. 67'se. • ; s~. ' b. MA 2 1 ~o. C 1 iorw ~T.~. o~ ~o~o o~s~~~tr ..ur~[~ ~ rs~pl dw + wof?~i~l O~ Oirt~ ~wiTTU7W~-NA~ If AQT IM (~M(~, O~tl[ S1~Qf !MO MyM1(AI ~ /RMrol ; h. CH 1 CAGO HE I GHTS I LL 1 NO YES ~~a. ST. JAMES HOSP ITAL 6:RTNPiAi.E ~f~~~( c~ ro~[a:r C~T12EN OF WMAT COUNTRY MARdEO. NEVER MARRIEO. NAME OF SURVN~NG S?OUSE ~w~wa~ r.rt, ~r ~uc? ~'v*,•~ WIDOWEO. VORC tsnunn ; e .:~,~v5~.: ~v. U.S.A, ~o. M1~1RRI~D MARY ` ~OC~AI SEr'Ue~ir NUMBER USUAI OCCUPATION ; uNO o~ WS~ESS Ot trr0ust~r ; U.S. WAR vETEtAN , W~ At OR ~AtES OF SERVICE 5 :i~+i~tA~ER GEhER~.L ~ hr1~;E 340-10-5625 ~~o. .:.~N`T~:NANi:E ~ ~3b. t.EC'? F{I~'- : ~x. N[1 ; ~ao. - - i RES~afNCE sr~.e • cov~~ ' CIT~. t0'rM. TM. W f.7~0 OKiD.C~ w0. '~wswc at~ ; sr~iit ~MO hJM~I• ; ;1*Wro1 ~ ua i LL I N01 S ~~+o. COOK ~~k CH 1 CAGO HE I GHl'S ~~.e.YES ' ~a.. EAST CRA IG ~ fA', HEQ - NAME ^"s~ r~OME ~ ~~fr MOTHER-AANDEN NAME ^y~ M~~c ~•s~ . 1 , S. i:R tiAI,LAF:Z:iI c:AZ HERINE GEORGI ~ ! v~QRMANi'S SIGNAiUR~ . RELATIpNSHIP . MAi~ING ADDRESS s*~«* a~o ro. o~ • o., r~• o• •o.r. sr•+a. r•~ ~ ~;,o ~ v~.-~,r!C~,w~ ~„o ADMtTT1N6~ CLERK ST. .WMES HOSP1TAl ~ i ° ~EATN YVAS CAUSED BY. ~~~O'~~~~~ ~~T~~~~` . [(wt[~ o~ir OME tws[ rc~ l.wl ?o~ 1~.. IOI ~wD Icl j 1~Ett[Cw Cwsa~ •wu aa.~- G~CT ~••rto~~r[CwS[ ' :at e t~ l C :~c tl<L~(~C `~-if ~ i~.~ i-L~ LL ~ J~. U l[/~' , ~ Uu[ f0 0~ ~1 . coMStOU[rCE Ss~ ' j ^ ~ ~ . ~ ~rD~r.e~, u •M. / / ? / ~ • w~ .~.E ••Sf rr. :bl . l ~ (.'K L ~C-' L4 ~~C , ~_-4 ( ~i. ~ ~~yCL~~7 : ....co.•. c.~;~ o i p~t *c o~ •s • ce¦scau[~e[ ar . : s•r~w. •r. uwte~- , :-~v) t~us[ .•S~ I 1 ~ fC~ ~ ~ ~~PT , ~1-~EP N:~.CANT COIVD~T!OtVS: co~+arayf ta.n~w:t~K ro awTM w* ~+or u.wrw roc.~.Y w~n: w rur . a-- A~jppSlf ~Ef. .u... cw ~ 1 r[i/~3~~ : . s w•=:-. »q...~w~ u•~t ~ ~ 'J~p ~CH • ~ ~ ~97 lI I ~•i ~ ~i4` :•~~f C~ „•~::A^^~N A~Y MA1QR F~ND~NGS ~f OPER~TION ~ i ' pb. € ~ ••'E~v~tC iNt rnri«. o~.. ~U• rorT«. c~r vci•t •wD ~~fT 5~+~ ~~r/ rowt~ U~r. r[~~I MQUR ~f ~EATH p~ ~ ~'FC.F>>t~ i'v~,M I> T~ ~wEc.~~.tow _ l ` . . i i ~ 21D. % li ~~t! 7~~ / ~ ~i ~21c. ~ • LL ~ ~ l / 7y ~2~0_ t ~ l. M. b ~ l ~ _ ~ ~ ~ 3 ~ F.'XTlF'}' THAT Tn THE 8ES'T OP !fY KNOWL6DC TH/S DF.ATHIk'C[~XRED NO~ : IF AN IN1U~Y WAS INVOIYEC ~N TMIS DfA~H, { ~M' THF. I~ATE. AT THF. TIX6 AND PLACE. AND FROM TN6 CAUSIiIS) STAT6D TME CORONEi MUSf BE NGTIFIEO f ~ S~Grti~'„2f 1 r .~'OATE S~GNfD ~»orr«,o..,.c.•~ ,IlUN01 l N E NU~I. ~ ~ , ~ , ; : - « . j~t .c- l ' ~ ~ no ~ - ~ , C ~1 ~ ~ : rn. ~ , - / y ~ n~. ~ t, ~ ~ ~ M~!t NG A~DYE55-CER1tF1ER s~~cp ~~o ~u.u~ o~ o. cn. ~o~~ ~ . , sr~rt , i~~ ' L. ~ ' ~ ~ ~ ~ " : # ~ 23 . ~ l. ! ~ ` i f`i " ' C i . (C' ~ k ~ BUQ~~L CR;~e~*~^N. .CEMETEQY QR C.REMATORY-NAME L AT10N :Lr~ e~ ~aww si~Tt • DATE WowT...D~+,~[~~) ~ REM~VAi ~srec r.t ' - ,.o ~!=ria1 ;z.b ~~ss~~r.?~~tion ;za~ Glen~roo~ I1 ;zaa.~~•ne 1, 1G~4 'uyEQAi M~ME NAME s~~ccr ~ro +ur~c~ c~ • s. o. c~i. u~owa sr.r[ tn ~~r~rdi -Nr~nos '7~C Chicago ~o. ~hi ca~o Hei• ht-s, I1 60411 _ ~ ~un:EQ~t CiR;C~jJRS SIGNATUtE - ,~ur+te~e o~~t::'ors ~,.~.~as .~ct~se kwret~ ~ J , ~j , C~1'7 ~ ~ 25e ~ ~L c.a ~ Y (~~~?--1 J ' 2 . J7 4 / :'•:C~: a"-~'=~ RQS S~GNA~UjE FDA~E !E 'D 8Y ICCAI REGISiRAtlw+~...c~~.~c~~~ ~ `r,~ ? i l \ _ / ~ ? _ ~ :C ' t? i V ~~~1 L~ 1' 1 ~ ~ /l Y~~i 1 . 2Gb ~ ] ~ - ~ ( _ ~ v:a 200 (1?' ! r) ' Illlnols O~D~K~~t of PuDllc Hea1tA - OIf?ce oi vttat Recoras `6~SfD 7N !o6a U S S•~NU~~D :E~•~~'C~TE' ~ , ~ " • . ~ - ~ ,r ` • i ~ . • , • •r, , ~ ~ . HEREE3Y r'ERTIFY _tha~!the foregoing .is ~ a true and correct copy of the 'deat$ ~ ~:-~~cord f~r i,1te decedent in Item No. 1 and that this record was established r,~ 1 f i led in ~my ~ off ice~-in accordance with the provisions of the I llinois ~ +:~tutes ~e3a!~i;ng~~ to the registration of births, aths, and ~illbirths. _ . ~ ' i r~ ~ ~ ~ • SIGNED: ° Fn_r,' ~E~~~. ED ~ - . . $T.L~~C : _:;',:'iTlf FlA- ~ : CHiCAC~ HEIGH~r~ iLL~oIS 60411 TITLE: IACAL REGISTRAR _ F;:~. -~:ass ~ ~ f ^f ~yURT ' , - ,..r1 i s , . BOOK238 PAGf 903 - aPR ~~l 33 ~~'~J ~ . 3ossoo _ - - - - _ _ - - . ~ s~ z . ~ `~a" ~,.~.x.~ , Y ' ~ ~ ~ ~ ;F, - -