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HomeMy WebLinkAbout0149 . ~ . _ 30'70'74 ~ ~ 23 OHIO DEPARTMENT OF HEALTH " ~ RcR. Uis~. No. Sta~e File \o. ~ DIVISION OF VITAL STATISTICS ReRiuraisl\o. ~ P"'"", R`R. o"~.'~°. CERTIFICATE OF DEATH ~ DECEASE~-NAME P:nt .N:ddlr l.iu SEX . DATE OF DEATH ~.Vo.rrb, D~~, Ye.rrl ~ ESTF~R OCHS KELLEY ~ , Female October 30, 1974 ' 3 RACE ~'b~t~. ~~6•e, u~rirrw AGE- l.~u UNDER 1 YEwt uNAEe ~ 0/~Y OATE Of {~lTM ~.~lor~b, Drj, GOUNTY OF DEATH j i~.fws. ~tt. lSprril)1 brrfb/+~ f r~n) .~or. Dr)i ftoen .11ir. ~'fQ•~ 3 White ~76 se_ k. 6. A ril 17 189~. Fairfield ; ~II~, VItIAGE, Ot IOCAiION OF DEATH INSIDE C1iY ?1/~IiS ?~OSr~TAt OR OTl/ER INST~iUT10N--NAMf 1Ij w~! ~rWl~t?, jl~~ lI~lt~ dMd ~YNj'tIf ; lSOtri/l ln sr r01 Lancaster es ~a. 203 Lanc.-Newark Rd.,NE.Lancaster ~ STATE OF ~IliM ~l/ ~or i~ U.S.A., ~wt Ui11EN Of WMAT COUNTRY /rARtIED, NEVER ~uRi~EU, SURV~V~NG S?OUSE !Ij riJi, ~i~t iwrsJtr rwrN ` ' ~ ior~fr~/ W100WE0. DIVOtCED IS tti/71 ' a. Ohio 9. USA ~o. Marriec~ Dr. A. M. Kelle i SOC~AI SECUt~iT ?+UM3E! w~3 OECfwSED EVER ~N U. S. AR~?EO fOtCE1? fl'n, ~o, er r~4~or~1 (/f yes, ~?e dotts oJ sman) ~ = . ~iS~DENCE ~~e. 280-48-8845 T ~:b No ~ ~ECFASEO USWI OCCUMiION IGirr ki~/ o/ rorllowr lr.;rj snf oj Ktr+p Of WS~NESS O! ~NWSIlT ~ ? . F OEA7M ~~r4iws lij~. n t~ if rdiredl , ! Housewife (Re istered Nurse) Hamemaker ` ;,r:ON, G~vE t~e. _,~.CE ~EfORE tESiOENtE-SiwiE COUNi1f UTY, VIItAGE O! lOUT10N ~tiS~OE CITY t~M~TS STREEt wrr0 ?+UM~Et ~ t I •D~ iS:Oh. l5lrril7 )~r ~r w~1 ; OYiio ,.b. Fairfield ,.~Lancaster es ,.._203 Lanc.Newarl~ Rd. ~ _ fATHE!-NAME ~ I'iqf ~N;ddtr Lesr ++~OTnEt--iw~~DE?+ newE !:n? .\li/Jfe [ru ~ ~i: ,s. Charles Henr Ochs ,6 Franke, Marlette Elizabeth Ochs ; INFORMAiVT-NAME MAIUNG AGORESS ~Snr~t or K.l.U. ro., urT or.:Il+s~, u+~q s:II j = - e ~~e 203 Lanc.-I~ewark Rd. NE ncastsr Ohi o ; ~ ?A!T DEATH WAS CAUSED BY: 1ENifR ONLY ONE CAUSE /ft IINE fOA lol, 141, AHD ftl) A~?ROX~MAiE ~hTEtVA. ETwE N N T AND w! ~ ' f , I8. IMMEDIATE CAUSE Carcinoma of descendin colon i 6 mo r~ths I OUE TO, O! AS A COHSEOUENCE Oi~ ~ Coaditio~i. iJ or. ? t ~ u~bir6 ~ar~ riu !o Ib) ~ i ~~~f~~« ~~~f~ OUE TO, OR AS A CONSEOUE?~CE OF~ ` ~rrti~s tbt r~Jfr- I ~ i- _ l~iw~ uvrt !ut ~i i ~ M!i 11. OiMER S~GNINCAHT COHOIi10NS (.os/iliowi to~fn~r~i~s !e dretb 1rt ~ot r~6ur1 [o c~nt ~ivt~ iw O~rt I fr/ AUiO?SY If ?ES arrr hw/~Mp ~~.,:J..•r ~ ~ (}'n er woI ~w dt/niw~~~ws c~ri~ o! rr+~b ! , ~ ~ IVo. IVO. i ~ ACCIDENT, SU~CIDE, NOMiC10E, DATE OF ~N1UR'/ NOUR NOW INWtY OCCUtlfD fEwftr wrfrrt o/ ~w/rry i~ D+rI I~r P+rI /L iitw !ri~ - j ~ OR UNOETERMinEO lS~triJ)I ~.~lowtb, Dr~, Yta?I = € ~ 700. ]00. JOc. 10d_ ~ i IN1JR~ Ai WOtlf /IACE OF INIU~r .1! bost, j+r+w, lhtlf, (rlfOry, IOCAT~OH IS!?/t! KJ.U. w0., (iI) O? ~Jl+~I. lfwh, iiAl ~ . ~Sprcill 7n or ~ol o~~~ Nls., Nc. IS?eri171 ~ ; 10~ T01 2 . z CERTIfICAiION-- .110~/b DI) )~trr .NOwfb D/1 Yf~r ANO IAST SAW M~M/MEt I i~/O~D NOi DEAin pCCURtEO At !bt pl.r[t, O¦ ~ ?NYSIUAN~ ~ Al1YE ON ~ViEW fME W0~ IMOU~w 35 fbt d+ft, ~Md, !O ~ 1 AiiENDEO iME TO .Mo~~h Dq )'trr iAFiE! DEAiM. ~ ~hr bu~ of ~1 kaoulrJSt, Ir~ to 7to. DECEASED ROM 4/25/74 z~s.10/30/74 10/30/74 ~~a. P~M. /h~ ~wrrrfr/ ur~rJ. CERT~f1UTION-CORONER: Oslb~ in~if o( !bt ~s~wiMrliow Norr oj 1~rtb Tb~ dttt/~w/ rr~ prowor~r~J 1e+d o~ ~br b~A~ +nd/or tbr i~~~iti~+riow, iw oD~~~oh, d~rtb .ilowtb D+) Y~+~ tloarr ' r o~~wnrd os !bt 1r1t drr la tb~ r+rulil tbu/. ~ 1 ~ -,:ta { 7to. M. 27e. - M. - i GERTiHft--Nw~wE rT~~~ o. p.~.ri 51GNATURE Dr~rtt o? fr!!~ ; D~TE S~Gt+Ea - ~se Dr. Arthur B. VanGundv I~3s. Arthur B. VanGundv, M.D. i~~~ 10/31/?4 ~~Ltt~G ADORFSS-CE~i1fIER Si~EEf OR R.f.O. NO. UtY O! ViIIAGE STAtE Zt? i s 843 N. Columbus St. Lancaster, Ohio 43130 ` ; 6URtAl, CtEhtAT10N OATE 1974 ~~E Of CEMEiERY OR CREw?TO~r IOCAf~ON f( ul/+jt, or torw~~/ lS~~ftl ~ - /~petilrl ~ Burial Nov. 2,.~. Forest Rose Cem. ~.a Lancaster Ohio ± ° NAME Of fM~AIMER I~+C. NO.) fUNElAI O~RECTOR'S SIGNATU~E II~G n01 ~ ' „ Frank R. Smith 6800 A ~,6. Irvine G. Smith 3844 ~ fUkE~~t f~tM AND ADOtE55 (Si~EET n0.) iC~~r~ (St~TE~ (I~~~ ~ ~ Frank E. Smith Funeral Home,405 N. Columbus St.,Lancaster, Ohio43130 ~ OAtE ~EC'D ~T tEGISiRAR'S SIGNAtYRE DATE tERMIi ISSUED SiGNATURE Of fE~50N ISSUING ?ERMii OIST. NO. - IOCA E - 7a ~b 31 A. Mildred J. Miller 10/31/74 „ Linda L. Strohm #23 ; ~ eooK 239 PAGE 149 _ ~ E~~a _ J~~,.u",..'~,'.-. ..k._ . . 4 " . ..a.. ,.~~~G~.~~