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HomeMy WebLinkAbout0096 ~ . . ~ ~ ~ ~ . . ~'.1""0. REG~S~IAt10N STAT! OR iLUNO~! ~•n~• ~a ~ ~'S'P~C1 NO ~ ~ ~ ~~c~sta:o ~ MEQ!CAL CERTPF!CATE OF 'JEATH 'i%:5 n+uMetw ~y i/iMIM GCC:A~:D~NA1v~: ~."N •uo~i S:A DA~F O~ DFAr~~ .n~~.~,nu,.t~n ~~~i ~ ~ ~ ~ p,',:~iA JONES ? ~taie ~ :Vovember 2, 1977 a~ s ~ ~ Ip . a • ~ V ~ ~ ~y ip QACE ~MrT~~ MLO}O~ ~M~~~~~M iMDi~M~ - AGE~~~~t yN I Y A ~ Uh~, ~~tE p~ Ilio, H i.owr., w., ran i:ACf Of DF~1M COWT~ ~ti ~ ~Q ~ ~ ~~t urtC,rrl ~(t~I.1. Mp1 . 0~~~ '•OV~1 . MIM, i o ~ ~c ~'~0 W?tite Ju1y 13, 1904 ~ Sangamon ~ a! ~ So. : Sb. ; Sr.. 6. ? ao N ~ N•~ ~ V ~ ' ~ {`Hr, IO*b; tNr, O~ ~0~0 D~IM~Cf »Y~~l~ ~~~4~G1 G~~~ ' wO/Idll O~ O/~I~ '~IIiIY11OyNAMf I~~ MOf iM U~wU O~rI flillt ~~D~ ~y . Q) 0 'I~IfItiJE ~ ~ ~,1 VI + ~ ~ ~ ~ . . , ~ ~ a p S rin field Yes '~emorial Med!ce? CentQr ,c:WU~ V , ~ ~e P B ~ ~c ~ ~e v4+~a , 1 ~ ~ ~ , 9~RTMP~A~E nf.~c o~ wn~ar CI~4EN ~i WMAT ~OUNTR~r MARRiED. NEVFR MARRiEO, ' NAME O~ SUA~!~~NG SPOUSE (MpOIM MIN(, n«nq u~i j~a c ~ ` ~ ~ ~ ~ co~~mi ' W'D WED DW kC:D ~vcurri .1 ~n S ro ~ ~ d ~ . B ?:linois q U.S.A. ,o ~ar~ie~ ~ „ Lela l, Palmer ~ ~M _ M • 7t ro b ~ iQCIA~ SECUbTY NVMBEA USU OCC'JP TION ' ~'Np 0~ luS~Nl55 0~ ~NOUSnr u S. w~a vETERAN w~A pA DA'ES Of SEpviCE j ~ ~ ~ Q) ~U • ~ y ~`eavy ~quip~~r. . ~ irtflerl ~ ~ N ~ ~ ~ ~ ~ ~ 387- 10-9343 ,~o p~~rator : ~~o:Construction ~1~_ ~0 ~ ~~o M Q tM a ~ ~ RfSipENCE I~NI COvMt+ ;~nr, rPwM, ~~r.OM M0~4 O-H~d1 w0 ~w1i0t C~~r ~n~te..o.u+~u ',~~Ifl~UI o a~ ~C b ~ a ~ ,~,I? linois :14p Sangamon ~„s ~pringfield ,+aYes 2501 Yale Blvd~ i~ `Q) i0 ~ei ~ ~ hA'NtR-NAME u~1r »ou.i MU'nER-MA;OfNNAME ~~wu •~oou ~~1+ o~' b m ~ ,s Moses Jones Lydia B11y~:u a a~ ~ ~ ~ ~ ~ N f: :ti~QPMANI'S ~ NAtUqf 4ElAI,QN$M~? , MA~','NL ~~ORESS IIl~fif ~Nd MO v ~ i 0., P~~ w ru«e, tii.ic. prl a w ' o a c, r~ ;,,o t~ ~,11, Wife ~2501 Ya1e blvd, - Springfield, ,IL 62703 ~ F W 0~ v ~ m . . W a N~~ ~ ~ I-~ IM, OFA1M WAS CAVS ' BY („iu u»~~ Gat C.u~~r« ~~+i ~or ui ~oi. .+o I «n„ur „N~n ~~o ou~¦ W; 0~~ H CJ y ~ E "v~ar ~ IYYIOI/11 G ~ , H J 0 ' w~ a~w " ~ ~ a ~o~ ' ~ ~ ~ ~.wws. ~~oa~ M o o > a ~ ~'w~c1,r~..r.n2r~ < o o ~ E~ h • p~ ~ N H . ( o~i w.~ ~ c~,uo~,~ci~c , p a Hy~ oa ~ ~ OOMOIIIOM?. II ~Mt~ , _ r 4 a W~~ W ~ ~ M~ ~ ~ ~ ~rn" ~~r~M G~r{ ~~Il'10 ~ ibi ~wC~t•.u,rc'~'~1 +~J~''.~~ / L'~?1~DS . ~ ~ ~ yj U~ ~ ~ b Q H ~y '«~~p'~~t C~WI UI out ~o u~ N~ Co~IWutMcl o~ ~ . I? 0; . E 0 n ri O v,n.o r.ou. . ,w o 0~ p x ~ a b u o ~ ~,~s~ , ~ ~kad~ H a'ro ~ d 4t!' 1-I . MRI il, OTMER S~GN~FICANi CONDiT~QNS, ~p,p~nan eo~t~uur~r~e io w~~. w, ~.o~ n~~no eo t.vu a~Mw ~w rue ~~u AU1CiSY 1'!S, ~,n~u~ u. ~ H~ ~ /'1 . ~ IrHl~0) ~ bN.,' ~w ~~u~.~~i.~ aNl 6 ~ . . Q Q V rl N ~ ~ Sa,~p(G4r,5~•,,~4.'~A~, !9n ~0 19h Y ~ F r1 U'~I ? O?ER~,; N, AhY MA)Oa HntOINCS O~ ~ A*~ON ~ N N A ~ ' ~ 0 . ~ ~L • 700 ~ 7 ~ ~ob. ' w C xi ~ ~ 'N ~ ~t ?ip 1 ¦yywrw,tur,rU~ i.0~~,~,u r ru+i .wUUSIH'rn~.l ~u~r~.nu.ruu ~MQ~'R Q~ ~f11~M ~ VW ~ ~ 1b ~ ~ 1~." r~ ~/J 1 ',+1~•~lnlOM ~ . ~ °t p~ 3:25 P. e"'I ~ • k ~ ~ ~~~;~~e:~:~~~~~~i~j , n~I~p_dr. 41b ~~~I~'21~' ~ ~ ~ 11tf M j 'Cl N ' ' / CA'KTlFY 1'H ' TO TH& BRBT OP AfY NNOWLEOCE TfflS DEATlf UCCURNtiU NU'6 AN iN;UQr W~S iNVO;vED ~N fnR ~EA~- ~ ~ ~ 3%~ I `~t-,? , ON T!!L' L T6, AT tH6 T1NF.' ANA PLACA, AN~ FRON Tllli CAUJA'(5) ST~ITNU iNE COpO'vE4 M~~ST Bt Np'~~~ED , ~ ~ ~ I I IYOhi~~ II.~IIY~ I I l ~ ` f.; ~~~NATU~E . ~DA~E $'GNED .u ,'IINU'S l' ,'vJ N~'MB A ~ 0 ~ d f~ ~ " ~ ~ lC ~1 d ~ ~ ~ : , G' - . ~?1b ~ /~_Sni ~ ~ ?1c ~ n,;y, O ~ ~L' ~ A + ! ~ ~ AODRFSS-CE~TIfIER ~t ~so ~u~u~ a I ` ' ~ o-'~ cnr o~ roww - ~uu t~i i ~ +u1 ? a a++ ~ ~o , . ' ' , ~ , a~ ~ ~ , a,/. r .a.~.(~ ~'L o Z, ~ ~ y BURIAI,CREMAIION, ,CEME1ERr OA CA',~tA~ORr-NAMf OCA' ~N ouo~~o«, ~nn ~GAif ~•ue~.,a+a~un {3'~~, '~r ~ ~ .1',•~ ~f vAl u. a~rn ~ ~ ~ ~ ~ ~ ~ of~ w ~t' , a~~urial ~ ;~~e Roselawn ;~,~Clearlace Twp. Illinois .a~d t~'ov, S, 1917 ~ ~Il~' ~ ~ ~ ~U4ERAl MOME NAME 1~~{I1 ~NO My~~~~ 0~ ~ C, C~II O~ IOFM u~n tu ~ a ~ ~ " ~ ~ ~ ~ Boardm ~ Smith 800 So. Grand, W. ~pringf.ield Illinois 62104 x~~ ~ !9 ~ NNfRAI 0~ f01~' ~GNATU~E ,~UNtf~l D~ftCrO~S ~uikO~S ~~Cttis~ NuMe~~ C'^~ , . d v ~ ~ ase ~ • ; as 7189 ~ ° w u o • ~ C~ U J Ry U CJ~ :i.7~Al Vf ;S~' N) S'~~'vh~' k~ ~ A P i ~ N~ .C~U'~ RlGi;`IAR~+u~~.,o~~.~u~i H ~ ~ ~ ~ ?An~ ~ ~ ~h4~b~ 4w• ?6fi ~r~']~l. ~ ~ ' ~ ~ ^ ~ Q V~~ ~~~G U97:r; „ ~~o'ti;?eDa~~•na^. , 'u'~',. ~ea' ~ ~ . .;i . ~ . . ~ ~ , , . ~ ~