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HomeMy WebLinkAbout0487 OH10 DEPARTMENT OF HEALTH ~ ,~6f~ RtR 1)~w. fvo. ~7 ~ S~~~e i~~~'~ ~ i DIVISION OF VITAL STATISTICS Pnmar. NeR l)~u _1 CERTIFICATE OF DEATH RaR~urar'~ n.. ~7~/ OEGEASEO-NAME l~~e~ .t1~Jdlr /.u~ SEX DATE OF DEATH ~.~ler~h, 1).+~, 1'~..~: CG~RNF: I.IA SCIIUER~:N _ ~ I~ ~n~alc ~ ~~;IU}~~;r~, 1974 RACE ~~1[•e. ~~~~u++ AGE- ~~~r U?rD[~ ~ tF~~ U?~Dlf ~ DAt O/~tF Oi ~~~IM ~.~I~.d.. 1~..,. COUNTY OF OEATH ~~J~~». II ~~r •.~I)I Lul6I.Il ~It.~r~) ~I~~. ~IeYn ~I~A. ~ N.1 ~Viiitc• s. 74 . se~ _ s~ ~ eMay 31. J~Q~?~_~~t~tahnLa i t ~ C~1?, v~~~wGE. O~ lOCA1iOH Of OE~1M IHSIOf C1I• IfM~IS NOS?IIAt Ot O1Nt~ IHSI~~U~~ON- N/~M( ~I/ M4/ INYIF~I, R11I ~t•irf ~rJ ~rw1f?I !~?~t~h )t~ o~ ~eJ , . ,s L.~kcwood . es ~e Lakt•~~~a~~~l ts11_______ sIA1[ W~~~IM ~ll ~m i~ C'.S.A., ~r~~ C~t~ZEM pi wNwi (011HT~r Na~~~[Q wEVE~ r~u~EO. SUlr~nNG S?OUSE ~N r~la /u~ ~+.Jir w+rN ~ ~.rrn~1 w~00wE0. O~vOlCtO ~S~iu?~1 ~IUIIC ~Vew York • ~o SOCtAt SECUR~T~ NUM~Ef wwS CECE~SED Ev[R ~N U. S. ARrEO tOtCfS~ ~ 7-~t, ~Y~~. ro. O~ YAIAOYII p~, Jnt•. o( ~rntr+? LS~~~~l !FS!DEVCE 13a 2 ! 3 -~C.-~-.1_~~i4~].~ ']e _~`1L ~'.~f GECE~SEG USU~I OC~U?AhO?+ ~(.nr I~~J el ~~.I lart Jr..~~ ~o~t e~ r~r~D O~ tUS~~+ESS O~ ~~+OUS1~~ f 0 if D[A1N j.+t lilr. t~ ~r ~l rrt~.rJ/ ~ _u~~FOIH "~TU~~ON,G~VE Ca . ~,,,Si~rlin~; _Linclcr Davis Co. ~[S~OE~+CE ~E~O~E fES~DEN~F-SL?E COUHTY Ulr, v~~~~GE Of IOCwnO?~ n.S~DE C~tr l~r+~tS S~~EEI •ND NUM~EI ?DMiSS1pH. rSPeuh /e~ o. wa~ ,.o Ohio Cu aho ¦a Clevcland ~.e s~•~ /A1NE~-NAME /Hif .M~JJIf I..~/! M~O~HE~-MAIQfH NIN[ I~nI ~LdJ/( /r~1 s 3 t „ Uanicl Bucklc , Anna ' Z INFORMANT-NAME M~~u?+G •ootess r. h./.D_ o. ~.::..Rr. ~~~It. t~lJ ~~o Mrs. I;l~~:~nor Schn~~iclc ~ ,~b T Z ?AH ~ DEATH WAS CAUSEO BY: !fN?ft ONI~ ON! CAUS! UN! ~O~ IaI, fAl. AND ~a11 ~~~~j~44fE ~NiF~~~l _ EIwEEN ?~SET Ar~O DE~IH " Z i IMMEDIAIE CAUSE ~O~ ~ Q-~^~" ~a~~ - ~ OUE TO ~ w w CON fOUE?+CE O~ Ce~d~now~. i! ++f. ~ L~ ~ a ~ ~ ~ / ~I ~ ' , .L rh~.b t+.r .:~r ro Iel . - ~ i++w~J~~/i [rrt~ /+J, pUE TO. Ot AS A CO~+SEOVFHCE Of Z ~I~tr~s !b• r~dr?' ~ , _ /).ws r~r~r lrir ;~1 M~T 11 O1MEf S~GH1fi(ANT CONDIhONS( o~J~n~ie~ iowln~rrisj fo d~rlb Lrf ~~I .dottJ to ~~r~r jntw iw p+r~ 1~+/ AUTC? t 1? ?ES u~.~ pwd~ut~ aur~~J• I Z +vI) .h J.tr.wv~~.+~ ...r~r e/ J..+1 ~ z - icn ~O (~ve ~ •CGOE?~I. SIi~C~OE. MO~'C~DE. O~~E O~ it~lUf~ ~+OUR HOw ~ruun p~CV~lEO ~f wrr. K..i...i o! .wtr.~ p~.~ I o. p~.t IL ~.rw !N~ i ` Oe U~+DfTE~M~r+ED ~~p~r.l.~ r~I~,wtl.. U.r. l~tarl f 70e Mo 76. 70d. _ . . 'w~fi AT wOfK ~t~CF Oi tWUf~ 1i b..wr. l,..r, ~h~~~. l+«o.~.) IOCAiION r1n~u n. N.l.l). Mo.. ~.t~ vr u//..~r. ~~+ri. i~rl :J l~p~r.(i ~e. o. +01 •.!7~~~ bfJt.. rit. ~1prt~hl ~ T ]C• :0~ :90 ~ F- CEfiif~C~nOn- Al..w~i~ 1)..r lr~. AI•.+d• I)~i 1... •NO t~St S~w N•.~rMf~ D~D L~D ~.Ot j Gf~rq p(CU~~fD i: r(•~ pli:~. o. /M15~UAN ~UVE Or~ ~ v~E~n rHt appr~ inpu~~ ~1•~ J..rr. ++J. n. 1 AiiENOED iMf j fU ~i••wU 1)~ l~a. •'IE~ fnin ~7 ~br 6..~ 0/ n• - ~ ~ ' ~ J I~ irJRi. Jrr r.. ~ 7!0 ~ECE~SED fe0y / ~ ~ 1~e / • ~ ~ / ~ 2~d ~ 7~e 9 a /FI ~J41f~IJ ir+r~J. _ 1 _ ~1-L_ - ~ CEtf~HCA1~ON-COfO~~I~ I!w ~h~ /~~u~ ol fb~ ~.~..~~~~noA llurr n~ Jr~lh l br J~.~JrMr u.~ ~rqMryYUaf~I.~..~J ' • • Of ~A~ ~qdt +wJ or fbi ~+~~~ht~lio~. ~A s~ op~~rar. 1~rlh .~I~~tl. U.~~ )~t~r HOr~ a..rntd ew ~b~ Jrlr rwJ drt ro tb~ ~~ri~~i/ ~r..ld. )jp M ]7e N i CE~iifstl-H~rE ip~ er .~ntl NGr+AtURE NrR..~ ~ulr -i D~fF S~G~+tD n ~ ne C ~ ~ C!1 ! ~ ~~e ~N " - ~ IuAf(eNG AppRE~SS---C(f/l{IER • St~EEt O* ~ ~ O H ~ C~~1 O~ VIIf? E S1At! I~~ ~ ' ~C % / ~7 ~ ) ~ 7~ p l l' " - 7)e ~U~~~l. UEM? rON OAIf NAwiE O~ CEMETEtr O~ CffMAiOtf ' IOC~IiOr~ u~. ul/rRi. a. ~orn~~! /\i..ir~ Nov. i R 1974 ~.oRurial ~.e ' Knollwood Cc-~ti~etc~y _ Mavficld lts. , Ohio N~ME Of EMSA~MF~ ~l~C NO ) ~UNEf~D~~FCiGe S i~GN~tutE~. II~C NO . 7 t r ~s Anton nc~stai Ja ~ c=t-f -~'l~-s-J 6234 ~ - ~ . ~~UNE~AI iUM ANO ADDfESS lSifFET NO 1 ; ` j tGl'~1 ISiAf[~ ~li~.~ ~ T n 7~ Corri ~an F'i~n~~r~~l <~nics. I2~..- ~ '~tltu , C:I~Stcl:uul,._Llll__~L1 1 O~iE ~EC O N •f S S~G?~ D~tE ?E~Mrt ~SSUE~ S~GN~IUfE Oi ?El50~+ ~SSU~NG tE~MiT GIST NO ~ ?t )~[G ~ ~ / ~ lv ~ ' ]O = ~ ' ~ ~ . _ ~ _ : . . - - A ' - - - ' S _.}z ~ ~ , ' _ - . "'J L'J~{.Ci~ ,'J - . ' ~ - ; ~ : U£' . 1~-t~, . .i1~ - t;' ~s, ~ I ~ _ r - ~ • } i . _ . ~ i00~~6~ fACf t. s~ " # - - . - ; f R . !~y . •a7~`~~a . ~ i ' ~ ,'~w.. ' ^'`!+'LIO~,~., ~~~r~ ' 2 ~ 4 ~ / ` i