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~ REWiTRATION 56~~ {TAT~ 0/ ILLIN01• ~uM~M~ ~h"~
1 DISfIIICT N0.
~~stu~EO CORONER'S CERTIFtCATE OF DEATH
NuMet~ 842
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KGd~~ w~r~M ~O+~K~p ~ DATE Oi IN1U~Y~'~'~r" 0~• ~~~~h M01+R ~ HOW INIUAY OC URRED 144~4~I~~I~i~\4Nwf'.Ir~~~~.,r.~~~
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' DATE SIGNFO I~+GNM
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SiGN!1TUT~~4~ ~ , ~
s~~~a~ b ' 4 1976
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O u A ~ ~ ~ ~OROhE~PMYSICIAN'S SIGNATU0.E ~ /14 ~ATE SiGNEJ ~+wriw p~. .t~~. }r t~
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