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HomeMy WebLinkAbout0615 3b~.2~ 5 MINNESOT/? DE'/~?RTMENT Of HE/1lTH ~ ~ Stcuo~ of ViVI St~G~Gu ,o~., CERTIFICATE OF DEATH yJM~~• ?ust ~oo~~ Nfr ~.fli 3.~Ai! O~ OtAIM ~o..r« D!ClA3lO - NAMf Robert M. Kalb male rlov 8 1976 - r .s.~~~------- - - - - •Gf 1!OlRONE~tM .U?+Ot~OplOatS-OAf! 01 N~~N ~o~r• 0~• •~~w •-~AC! f~[tv~ ~~-COUNifOIOtA1N •~wr.p~n ~ M +s u~i ~.wutts _ 7? A~rl1_~0~1904_ xhite Nennepin_ _ _ _ /e. •1 IttT~.~~ll~tt ow ~Ow~sw~N ~vc.<~..o~....~... iOC ION 01 DlA~M c. l1.MOipiAl Ol OiNlt q11~1(UTION NwM! ~or irt~~rt~. cht st¦tar ~,o w,.~c•. Diinnea~olis _ es NorthWestern HosNital_________ ~~IM?LAC! ~f~~r~ pA •pw~~ir ~our~~~l .CliljlHO~ WNAT t0 MAHIlO NfVf! M~~blD. 11.S~QVi! - NAME ~ COUNTiY WIDOW[b, WVO~CEO fKa/• Foetoria, Ohio USA Qarried Thelma Faye Perry `t~ ~ 2 wwS OECEASEOlV(! N1 U.S. 1~. ipC1Al :lCYtl1T NYMttI YSUA~ OCCY?Ai1pN tsn[ awo or wo~a • YNO O/ ~U~N~~S Ol ~wOUT1~T ?tti~f0 ~ORGES r~+• o.,~~.. Vp1t O~ MM~I~K lrl.LY[M I~(iM(pi no 0 1 0 7819_ _ gxeeutive , lec~rical B~ineer tlSIOlNC! - STAT~ ~S? COUNR ' ISaC~TT, VIIIAG[ O~ ~OWNSM s? N.~orw•ti•+n :~;innesota Hennepin 2d~nnea ~~lis Yes___ ipo.IATNl~-NAME ^ •?.{ItIN?~ACE ~sr~r~p~rp~uo- jy;AOC~lSf 01 O!ClOINT sT•~tT •'+e ru:.~i• ~ost O~~~t~ (puMf~tl ~ ~a?berY B. Kalb __US 4~06 3?th pve So _ ~ ~t~~ ?.~OiM!! - MAIOEN NAME ~?M~iH~iwCf tft~t~ p~ ~pwtK ~.~IO~MANT - NAME ~qp~ass N courtwi~ ~'va eill . US T. F e Ralb 4 06 th ve 3o W I0. ?A~T 1- OlATN WAf CAYflO ~i ~tNTE! ON~t ONE CwULE IE~ IINE 1A~, Ip ANO ~C~~ M Ou?GqOLfOE/tsEO ~~~~o~~M~i[ ~~~t~+~t ~ ~.iMME~~A)E CwUfE tKCa ~oa urwccrwa~r~w ; ~ ~ et•r¦ / : ' ~L- - • . L i ~ ~ • / 1 . ~--i-~^-t ..1-~. ~ ~ C ~.~:i ~ ~ i!~. ~<<' Y, ! ~ W s. oue ro, o~ ~s ~ • j , i~ o~ COHfEOUEMCE Of , _ ,n/Ll~v~-.. .~.ti f. r f ti~•~ : a• ~ r t - Z , ~ u C• OU[ TO, O[ AS • ~ j- _ ~ y~ h GONSEOUENCE O! ` . " ~ / Z?w~T ~ OTM[t LONMICANT CONOIf1pN3 ~.AUTO?S~ ~•w~~.w•.~o.+c~co.sawe d r[~1I~ Rl01 ~ pt~a?wwGC~VN W q~~• f' ~J4e . ~I ~ ..~J ~ ~ d u 22> ~"IO:NT, SUICIDt MOANCIO! OR UNDEiERM~NED 7?.04iE O~ 1NJUlT ~orrw o~• ?c~w Nou~ t•INJUtT A w t s~[c~~• s~s o~ ro u, ~i OEfEt~EO CKC~ W• ~ 0' f' ~.?lA(', fWIU I~~MO~+~.IUr~,ff~[«.IKip~~.Olltl j~f.IOCA?iflN fi11[AOn~/0 rW~[• CR~.vKlK~pipwtiSM~~ COU~T1 fi~r~ _ ~ ~YRO~K tfCJ W V IJ~ HOWiNIUlfOCCU!!!~ Ic+~[¦ raruwt o• .rww• .w ~~wr ~ pw ~~wr u. ~rtu20~ J U ~ p 77a-Cl~TYIC~TIOM-M1iSIC1AN ' ]~-C!\itlICAT10N - MtO1CAl EZAMINtI Ol CO~ONt~ W ~•Mw~f~ r1 ~~cer+~/ Inw. '7/ y ~ G rv O~ I~f 1~~~~ ~I IM ~~rw~1~MN ~I1~! Wt ~~/Y ~M i~~~~U~~M. y A1~ ~M~M ~NM ~ g . p !es~ .e~ trwJM. ~ii w . IIY. Y.A N~ NI~ ~bn N~1? ~ccw.~1 M, ~~e ~Mt Iw w re cws~~ stid ~M.e. iM /ecele.~ 'Z w•. .~r Dso~M ~ccv~ M M Iy ~Mt~ MI rw~ r1 N~ /YM ~t~M ~M~~ ~ N M~MNCfI If~ N - M M. rAe bt~~ ~I w~ ~N~II~~ IN N M~ sh~~~t ~Mr~/. , )lc. ?M1fIC~14.- 71GlI~i~~ ' > )I.MlOICAI ~SAMINE~ Ot COlONE! - SI(iNAfUtE ~ ~ !l I i/ ~ r ` \ ~ J ~ ? u~ ~'.~j y.~ - ~ \ .i C. ~t- ~ N 7I~.hIT~IAN-NAME IT~~t O~ M~~71 N 7LMEOICAIE~AMIHEROtCOtONER-NAME ~*~~t ow ~wirr~ { H. F~ R. Plass, M. D. ~ ~ ?J¢MAIIWG AOO~fSS ~w~s~tur. rtO~c~t cu.~~+~~ ow to~ow[w 1?OA~o~ NfD• o~• ~W a ~ 1935 Medical Arts Building Minneapolis. Minnesota 55402 November 11, 1976 ~ ~ I~~~ tutlAL,CtlMATION.!lMOV~I 2~?C[MtT[!TOldtMAtdf-NAME Ic.tOGAT10N ~t~r~.v~l?~CC owCO~r~q IsT~ru > artc:r? 0 cr Lake~?ood Cede~ :~innea olie Minnesot W ~d- D~TE Of KIrAi,(y[MA110~~ a jS~fUNIlAL NOM! - NAME 2S?iUMElA~ MOME - AOOtESS ~ eWO ?l Y • u~ ~ct 1~ ~9?~ Thoneon Brothere 2535 Park pve Minneapolie, MN ~ J .6 a OwiE filED fr IOCAIlEG11TRAR 2~ OCAL t[OIiT~ f~ NATUtE 7. M fIC1AN IYN( L 011ECT0~ - S16NATUlt < 'V ~ V~~.1~„ + D~ J~ L 1? 57 ~ . m - ~ ' '.4 ~ . ; ~ I, 8uth K!_ ~~'~;f ~ Dep~u'~ Local Registr- of Qi.tal Records for the City o= ~ ~e~;,3Ki,naesots~: hereby certify t the above ia a true and correct pdoto~copy•;o~. ~ja ~ecord qn file n the s Health . Depart~aet?~.' .=:i i . ~~r: . J ; , . _ - _ • ~ ' - ; . ' -~~-t~.. ~i1~/ ' G . . - Dateds . eputy Local Registrar fl~' i:i~~~~ ~ Aqy alterationr~_ s~'e~",+a~' xere made under Lhe autharity of Minnesota Statutes ~ 1969, Seetion 14~i~.72 aud ths regulations of the State Board o! Health. € ~ ~ ~ 3~k;~5 . F~LEO AND q st, ~~~~E ~ECORUED ; RQ~R P~ITA ~l~l. REC Rp y CtRGUIT C011R7 1 ER1f1E0~. 266 PA~ 6 5 aPp 5 114?P~1'1~