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HomeMy WebLinkAbout0488 ~ - AFFI DAVIT State ot _ Oh 1 O Sa Registrar'a No. { CORRECTION OF Countr o( Cuyaho~a DEATH CERTIFICATE F`tle No. 4 INFORMATIOIi AS IT APPEARS ON ORIGINAL CERTIFI~ATE OF OEATH ~ ~ 0 Naroe as recorded CORNELIA SCIiUEREN 3 nue ot oeacn November 15 . 1974 place ot deatA ' Lakewood Cuyaho, a Clty or Ylll~te Counfy ~ `s 1 . ~ , ITEMS TO BE GORRECTED OR ADDED ~ # ; «e~, 14 3 Re~ ~ Ohio snou~a r~aa Florida } ; ~ ~ ue~o 14 b ~ad8 ~ Cuyahoga Should read St . Luce Item 14 c ~ Cleveland sno~ia reaa Fort Pierce ~~e;, _ 14 e ~,~a ~ 11430 Clifton Rd. Should read 2409 ~uclid ~ Item Reads as SAould tead } PERSON SMEARING TO THE ABOVE FACTS ~ ' I, Thomas A. Corrigan being first duly sworn say that Nam• . I have personal k~ ed~e that the toresoin~ [acta ue true and correct. , ~ , ` 3-21-75 ' ~ Slgnatute -'1~: -t~ ~ _ c - ~r ' f N~m~ of p~non er~cuf~n ~/I/d~~lf Dete si`ned j i Si`nawre of NOTARY PUSLIC • _ ~-M~~rnw~lliFj ~Sa~lrf~yWjP ' ..............,.1............. _ (•J. ~:~.iG~S+iOtt t:pire~ Aut. 2q dQ78~• i__..... , ~ ~ ~ ~ ' . ' a~~'f : • ' r FILED AM:.~RE::JRDEO ` . --.;4. ;-',`.~t_ ,••:i _ . ST. LUCiE ~.Q~!!T~ flA_ . f ' : ~i' ~ • ~ i~ ' i'iG~~.? ~ •.i'FIAS ~ t , `ti'..-~,.:y~:~, . . ~ . . . - CLERK "lr;.utT COURT ~ • -n* ' ` REC~Rf~ VER,i{E~...~~ ; j . , . , : ; i~ PM'~~ : L ~ _ ~ OE.c 1~1 3 , ~ - . . ' j'-` ~ , . , ' - . ~ " t;-.,`'L' ~l . ' _ .,~,y+ at1.=- ~:.t_~;yQ;~' , ' . . . ~ . . . , ~j~~~ ~ ~ a Y~w ~ ~ iv = 1 : • ~ • i~~~~ YKE `~tW . ~ . • - . . ; ~ ; 3 r