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HomeMy WebLinkAbout0539 r . - j, - ' . ~ 3~~~ ~ERTIFICATE OF DEATH ~ ~ ~ STATE OF CAUi~ORN1A-~-O[PAR?MENT O~f HEI~LTH ~ " +i~t/ ~~4f M~:Yb!A ~ 01'iKE Oi TM< STATE REGIf7RAq tii VIiM SlA11571Cf ':R'4 c.wuvV ...•1F'" '~7••~ c~'1 .~Yet4 _ ' _ . 'T~-~ .t'_-----' 1 ~ IASlAJ1Y! ~c~ DiTf "i'Kq~1i- w~» . T~ r:!L! 4~Yf L~i' UECEAStD ilil;r kAMI ~ Ir rK'Mi 1AME 1-~ ----------1-- ~ - .Joseph ; S. ; Keefe ~February 22, 1977 ! 1:30 A,.~ ~ SF1 T i.. fL`ltM OR RAC£ S 81RiHP[A.E cv e •..1fE Of EiRI~~ i -11 ,E • - -j - - L_ ~ -:a _ _ ~ Male Caucaaiaa Pennsylvania ~July 21, 1911 55 , ~'~T~_ - - 1----- ~ - ~ - ~ f OEi l.l1k.~:i ~ N~Yf AkU PIRIHP~ACE (1F iATXER ~ L:~pf~. +IAYE a?'i: c'~'N~ +'i 4Gi+~~; ` E'EC~`~a~ ~ R~Ke_ fe - Pennsylvaaia _ ± Hen.rietta Fleming - Penns~?lvunia _ _ _ M C!"ltN OF MHAT :^'J!(TRY SC~U1l SE~l1RIiT AUYBcM -.~arc .~~u...• Fi~~a~: T f:}M~ 'r1Fy~.'h. . . . Si ' a•~ . . _ ~ ~ ~ ~ --~EO a~av• i . . United States 209-10-1258 ~ Harried i Mary Glad s i ~u ~A57 ~'tIUPAT i~Y 15 ~'.s~: ;~a,~ ~ ~F ~ ay.[. `~rL±l..iMnOrN.b i•:W:~,r Ua r~R~r : A~!.~ i=:F^~~yTR• ~ y~: _i_ _ . i - Co troller 10 ears Amefican Perto Chemical Chemical Coating.s '8~ rCACE C~ OEATM--ANK Of l/JytTA? ~7R 01HfG tr..hT~Eti• ~a_ :n ~~3e SIREET A^r•Ri:c ..n:~r ~w •~.~rhv R• r. , `'`~~FE ~Daniel Freeman Memorial Ho~ital ~333 North Prairie Avenue ~ Yes LEaiN !!c CitY va T~?WM ~~18t ~OIJNTY--- - 8~ • • ' - . ~In~lewood i Los Angeles i2 days xxxx~ 2 days xxn. USUAL ~~t USUAI RESIDfNCE--SiRfET ADDRESS .st~_cs a~c wr~:t :i iwRr•.~, t9s ~~pi titr :~R~Rarf !w,M 20 NAYE AND Ni~IHC. ~C~OR`c.5 n.L~<.y :ti' ~ f RESIpENGE • Y0' " D(~TY pCiiN?[61~ ~ 944 Country Club Drive ~ Yes Nary G. Keefe ~~srm+t:~ t~n• 19: CITY GR TONRi h9c CC1:7/Tt '!9t SiATE ~ . , 944 Country Club Dr. ' Wooste ~ Wa e ~ Ohio - ~,Tooster Ohio 44691 °ta iC k3,~R 4s n w. r.a. 2U PFi~S'.CfA9 ~ s. • n. ~ r a- - • ~ . t~-: -rpC••;v ~ . . 1 n ; , f . tu o - ~n.t ~ ~i ~ a~ . . PHY~ICIANS l - . ,.i u,. . _ 1. ~'1 S vr~ . f~.r . T. ~ r: OR COROfrER~ 1:~ , . ~ . . . , • - - CERI1FICa"Ok ~ ''b:>t:~,. . ~COaES " r ' ,a,..- ~7?.'ZI-2) 2-~'1'1 2-21--7~ ? ~ ' ~ Z 2~• v[: n r.~.a '~v~aw+ort 2b DATE 2~ BA.~~cF ~ ••.4t •e: . - ,.y- : f~~ERAI j;- _.:..rr. 1 `lk~ifff~~~8~~t~~'~ery _ , . . . P~Ra~C~tOR ~Burial ; 2/25 77_ Woos~~_Ohio .~~y~,..r~'~~ Cl '5 \-4F ~ •~fF~? OMk~ Ti'~R ~o~ ~r~n.:~ ,_i~ a, a 20 ` . . • a~RE6lSTR/1R i E .o ~ . ~ ~ r 4 _ . 1~T REC •~k jMcCormick Mortua ~ ~ I~Ea 2~ J~~] ~ D?NT 1 L•E~^+ i a5 CA~FSED YT ~ r? iY u'.? . ~\E ~ 1USS ~E ~.aY~ iOP . 9 T!~ , ~ . ;vf~fC::~r -t~ I , . ' ~ e A ) ~ • ` ` `1L]CF IL~ '~~tl~~~~~'~i - - - - - - - v ` ~--t ~ ~ i M :UE :Q O? ~5 a CJNSEO ti;'f J: ~ i ~ a ! . ri:. . ~ t,i., ~~~.~~'~~1. ` Z 1~__y .Y ` -.E {.~e`' ' MYEDI IB1 /~!-1 I~ ~ ~ t ~_i - •,aS,~> _ . 1 . " ~ 'alf f:' •k i5 \ :;'tiv-_JF4 F C~ ; ~ _ ~ ? DEaT?1 ~ . t~ai•. ~ ausE i ~ a ! _ ' ' I J ' a+:T +.e 1,C' ' • _ _ _ _ E i . ~C Fac* V-r~rc ~~:sMi~. ~YT C0~7,', •.i - ~ t~ } ~ ' . . Z + ~ ~ _ ' _ a '~3 _~~t`~•f• .•r'.., _•~tc~.~.v 3! e.... os o . . ?5 ..~.v~ . 7'r.a . •til._R. , • Q i . ~ _ . . ~ . . . . _t.------ , - - - ~ - . W Ih1URl ~~•,E l ~ ~N_1:HY .r~ei : . w..•fe~ .a : . u~ av~ <-rtt ~ te~. ~ a . , , ~ • ~ - . '9 - ~ INFG~1AAi1GN ~ - - , ~ 1-- - • - - - - tdi' DE3(.6~BE M;~h !•f ~f~ OL::P:tG ava.ea~•.. e..~ ~ . . . . . . . . . . . . . . _ . ~ • ! ` ~ - - - - STATE B i ~ ' ~ - ~ REGI~Tn~R ± + ; ~ ~ - j - - • - ~ ~ , ' THIS IS A TRUE CERTIFIED COPY OF THE R°_1:0:2G :~~ED IN THE COUNTy OF LOS ANGELES OEPR't ~ MEtIT ~ _ OF HEALTH ~E.4VICES IF tT BEAftS T1fIS SEAI I:V ~ . : PURPLE INK, ~ .~-<< ~iuc"~'c~u~CTr FLA. ~ ~ t= EB 24 i977 s2oo ~•ROCEti POt R,1S r'.~~K CtRCUtfi CCVR * . - r 4 ti~'F~FfEt1 ~ ~ ~ A ~ f ~Q.Ww1:.~R'"~ ~ • Ly 13 1 uaM rrn.~;~. a~e~~ « nwa sw~ ~ eK~.rnar ~ ~ . . ~ . ~ ~~r~7o ~ ' - J ; ~ . _ ' .r, - ~ . . - + ' ~ d00K P11GE ~iv~ ;a _ _ - _