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Home My WebLink About1999 :~osz~s r~r OHIO DEPARTMENT OF HEALTH Ra~. Di~. No. J~ DIVISION OF VITAL STATISTICS t'~` v° Priaury R«. Dist. No. Sy0 / CERTIFICATE OF DEATH DECEASED~-NAME f i?i+ .N.sJlr Lst SEX DATE OF DEATH ~~M~iu~, Dq. Y~w1 1?~ i ~ ) / RACE ~'~we, w~.o, r.m.rw AGE- ' uNoc• t rE~t unot~ i r o~rE cr ~iteN i.+t~~wrM. 13. . COUNTY OF DEATH isdin. Mr. lS?~t~1f1 ~nf6d~~ !y~ u .No~. D~» or?i . i~. '~nl J_ So. ~ S! Sc. JL U L 1~~._ L ~ 70. l~ ~ 'r CIT~, VItIAGE, OR IOCATIOH Of DFATN tNS10F CtTT UMIiS . NOS~~UI O~ O E~ ~nS! TUltO~: - F~Mf ~I) eot ~w tRbtr, jirt lt~iff ~Al s~~MJ /s~ft~/7 TH s? ~0/ ~s. ` ~e. STAt O/ ~I~iN fIf L'.5..1., ~rrr C~t11EN Of wN GOUN~~Y ~tAR~~EO, NEVE! MAtt~EO. S ivING S?OUSE ~1? ri/r. ~iri A~il~~ wA~) ror ~I , W~OO~MEO. ~1vORCED f5?r[i) I • a. a ~o. ~s. SOC~AI SKUR~iY NU~IE~ WAS DECEASEO EVE~ iN U. S. Al~tED FOlCESt /Y~f. +e~. ~r r~4~orsl fl/ ~n. liat ra or duu o~ rovirtl .E b - o ,~e. USUAI OCCU~Ai~ON IGfYt ~M~ IJ YO14I~N Jt/JI~~ tOfl O~ R~ND Of WSINESS OR IN[Wi~fY r or~r~s !i/i, n~ iJ rttiri - , v F 17~. UA. ~~~E REi1pENCE-~TAiE COYNTr C11~, YII~AGE Ot tOCJ1i1pN INSIGE Clir lIM1TS STtEEi AND NWAlE! ISIIltI1 71! M NI l1e ~ l1E IIC. ~ IN. 1l~ fwiMER--MAAIf Fr?il t l~l MOiME!-~tA1DEN ME Fi?rf Alill! LU ' i IS. ~ . 16. ~ V 4 / ~ INFORMANT-NAME ww+~tHO ~wORE3S lSn~n ~r Jt.F.D, s~., ~:r~ w?iUi~~, u~u, d?I I t7o 17 ?ART pEATM WAS CAUfED S :[Ntff ONII' ONE CAUSE 1[! E FOR l~l, I?~, AHD /c): ~ ROXI TE INT tVAt '8 FIt~L t+~: -~::.•S;ZDFO . ~MMEWATE CAUfE I') ST tf<^.;i ..:f;:hiT F~A_ _ : DUE TO. O! AS A CONSEQUEHCE OF Ri: -{~`'~aS ~ j ~ i o~Iiiiesr. i/ t~~. ~~~f,< :.:U:" oClJRT t .s~irb ~~rt rue to ~e? r~~diae roi~ Itl. . . . ~ ~ • . ~tau~s Jii rd~r- TO, OR AS A CO?+SEOUfNCE W. • G~ :~w l.~wa r~rii laif ~i °~.RT ~1. OTHft S~GNIFICANT CONDITIQtiSCe~it~op [o~f~~~rliAj ?o Jt~Jb r td fe rr2~~ ~ ~a) AUTWST If ~ES vttt ~~Ji~p toati/n~/ ~)"n or ~01 i~ /eter~erais~ [~r~t o) lt~li j (~oo {~Qb # ~CUOENT, SUICIOE. MOMICIDE, DATE OF IN1U~Y I HO1Jf NOW ~NIURI OCCUtRED ~Falir w+tyre ol iqr?) i~ Pot 1 or ti?f iftw /8) ' Ut+DETERMit+ED ~SpttiJ~1 f.Nostb, Dr~. )'rnl ~ i E :0.: ?OD. ~ IOc. 1^vd. _ ~ t r+IUR~ AT WO[K ?IACE Of IN1U~r 1! ~~wi. 1~•w. ttr~H. ~~uory. IOCA~~C~+ ~~!.~rt K.I.D. wo.. cih 01 11/Ii`l. flJlf. SI~I ~ ~ ~pr.n> >n or ~ol oeir. Nds.. u.. rSO~cil)I i ; ~o. za. .:ERi~FiCAPON- .No~tb D~~ )'rir .Nnwt6 Dry YNS • ANO t/~ST S~w N%MiHFA O~D.:,.O t+OT DE~TM OCCUlRED .1t tbt ~:it• ~nfSICIAN ~ AI~vE Ov ! ~~fw 1MC 60D~~ (MOU~i !b~ /~ft, ~st, t~ 1 AiTENOED iME TO .Ho~tb D~~ 1 r... :~~~H Of~tM. ; lb~ I~~I of ~/~j ~ ~ a•~ S lwoud~d~~, lrt to .'a~ DECFASED fROM / ' 7~ ~10- /-~T ~ Z'~ ~ - / y~ - 7~ ! ?~a V, ~ f ,q M f~sc+wrfil rtutl. EQt~FiUTiON-~ORONER. (J~ tbr ~~~i~ o/ fbf tx~~~~atio~ Nor+ u~ ~~~rb T6r dtttJ~w; YJ) pr~.ROrs~rJ dr~J ~ r rb~ bud~ ~~J, or Ibt iwavias~ho~, iw n~~ op~~iu~. ltrt6 .11o~uL Ur~ )'ra Herr r..~~ os rb~ d.r~ asJ dre ro tbr c.r,iii~ ulrrd. ~ ~ l7a. M. 27b. ~ ' CEl~IF~ER-NAME ~T~pt o• ynwl/ S~GHATUtE U~ a~~t ~r ~rl![ DATE SIGNED ~ Zlo 1JE ~ ~J ~ 77c ' J - ~ / ~ NA~UNG ADDRESS-CfRiiflER STREET OR R.f 0. NO ~ Cttv OR vUI~GE SUTE ZV .ia ~`-c_._l.. S/ :i 3 ~ .L dllRiAt, C~EMAT~ON OA1E NAME Of CEMEiE OR ClEMATORI IOCATiOti r~ rts, t~J/aat, ~r rorwlrl iSlrle/ , ~ ' ~ i1i1 ~ ` . /r ~ ~ ~'9'~L;i r1~ ue L- 7/ uc. lae 1_t' r.. c~.e--,.~ c-'~- t--~ ~ . ~.wh~f Of E~+lAlIMES IUC. NO 1 FUNNAI DIlECTO~ S S'G~+~t~RE (IIC. NO ) ~ ~ t:_. ! ~ ~l~[ ~ ~'L V V ~-Q 1C _~__I I ~ _4 - _ ~ ~C..~ ~ C C /L~ ~ V ;r • ~„+aERa~ ~~Pr.~ :.r+D ?DDRESS iSr~EEi HO ~ ~C~i~r ;St~iEr 12~r) 7 ' ~ ~ I Q , . ~'1 ~ S~ : ~ - c ~ c+~4-v d t rTC~ ~ ~ c. ~ ~ ~~f' YEC D 6~ •~~EG\S AR S SIGNATURE DATE IEtMti ISSUEO ,S GNATURE OF~IftSON ISSUING /ElMtT DISi. NO. t'J~~ l ~ f r . P ~5 ~ ~ I ~ ~ ~A h ~ 1~ } hi . ~ ? / . ~ . ~r~: ' t~. ~ _ ~ ' s~~ . . . { ~ . ^ . . ~ I i •sr~ e~rtify t.~at •..a• a:~n.• is a copy tIa• ori61~a2 •~rtitisat• aa F~ •:•+~;:s~ ~r~4 asd p~a~r~~d 1~ tM?• L*: ria~o• o' Vital Statiat! eR .,f tli~ riars~ ~ .--~wt~~ zi~alt~ D~parta~xt. C~lla~. ~~o. ~ ~ ~aia.e' _ q~ 3 3~a1 ~ ~ J~a~ ~'axwra. •~i~trar ~ ~ PA6E~ ~ :~-~rist 54 ( ~ ~ , ~ _ - ~rt~~~~ k- `K~ ~ ~ ~ ~ , ~1e~~` ~ , ~"y .