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HomeMy WebLinkAbout0515 14s is A Ce~ti~~ed E~~d Coc Y hi wlw Gty ~tm ~t w Ha asth SUE IEFIER ' w R~r _ ~~253 Ct N ~ i 1A18 OHIO DEPARTMENT OF HEALTH ~ ~301 ~IV1810N OF VITAL STATISTiC3 ~~w~ a ww,.~.?a«.u~- .~.1~,.~,-- ~ CERTIFICATE OF DEATH ~~...r.w. ,?.tSd OECEOENT-MAYE n.e ru~e trr ~x wn os awrn w.,. av~ n..~ lYeGen R 1t ~cl~ 3e?„a,Le Se e~6 /9 8 - ~~.r w+~aw ~ v a?n os a~n+pw,.a.~ n.~ a oEwn~ •"ih ' F ' ~ ' . R o ~ 1. WT/.VI~lA0E011lOCATWNOFOtATN IqWTK0110TMt~INfili11T10M-M~/qwr~!?w~rwr~.f+..My ~fM00.011~NlT.Myrw~00A. - ON6~w /f1wV>I y~Q~~,,' ~ - La~e rv ^°e~v~i.ccl ~/wsni.~Eal a~t. - iTAYE Of ~111~11 Q[ ~N r U.SA.. r~~ C1T12EN Of NHAT OOlMR11Y OIIIGIM OII OEiCENT G~Mir~ W~. Q~wN. EM~M. GiiO~~. tOGAL iEGNUTY MJY1E11 Oh~.o 11SA ; "~'"'~in,~.`~' ~SR-/2-/R~ wA,i OECEASED f V EA W U.t_ ARMED fONCEf) YA11A1E0. MEV EII YAM1E0. 74MYIV INO i~OllSE !b ~R d~ ~rYn a~r~ _ . ~r~ .w e. r.?....u ~ tva.a d•• r«. N,n.4~y MnooNtp. ava~c ~rMqy~ A o t~~atiei.ei~' An#.l~on~c ~i,c~i ' us;u~ oocurw~ an ~u.. w,r,+~a «....+.~.w~.v..•wr w..•.. v~+.•~ Kwo oF wnw+EU oe warsrRr Owiei!-~ Jl „s. ~trC~i ~UJt¢~l 11ES~OENCE-fTATf C01!!(TY CtT/. V KIAOE 011 LOCATION iT1tEET ANO INh1~ER WitOE CtTY lMN1s t~? `l ~tCO t~s. tk .~QfJC /t.t ~aUlDO/l t~s.IS~/ Hlalt .S~• tw.~.~0 wiw~ FATMER-NA4E IMr - 4Y~t Irt Y07ME11-MA/OEM NAYE I~st MMi ~ Lrt ~ , ~ - ~'i,c.~rs~l~ ,~li.GL , :yeicdGa Unf~nouR - - ORY~W1-NAYE llhr wlrb/ ~ YAtLMW A00/1W KTNEET Oq R.FA. Ns.l ICItY 011 TOWqI . KTATE) Qr) . ~ntlSv~e ~'~ch . S43 /l• /e Sf, 3ai~~v~,t ~laabv~ • Ohi.o 441r7~ . . IMi L OEATH WAS CAUSED BY: ~fNTER QMLY QNE GtISE ~ER t JNF iOR /al. /bJ. AND kl) ~T~wEEN pKET~A~IWEpGfI?TM It wwEa~Tf cw~.~ w Natural ' 70.OR A3 A CONtEOUENCE Of: - heart failure ,ws .w a ...~r. ~t. wM~ 14 ~oNs~- OtlE TO.OR AS A COMiEC4F1rGE Oi: ~J'1q crw' 1a+ ~ kl + ~ARTII.OTMERSIfiN1f1CANTCONpi~Oki:elr~rwew~w~ylM/lwtrrr~Yw/»a~rr~h,ww/1w/~y IyITOK1f VII?f~ASE1IEFENAEOTOCONONEII I />ar~o) llN~YY rnrllly a..no es ~cc.. wic~oE, ?aM.. u~+oET., DATE Of tNJURY ~+am Now uuumr ocarnnEU tr.~...... e~r~ r ~.r ~«~+.r n, w. u~ oa rENaaKS wv~.sr. Ry«Ytl r~+s. a, r...~ 20a 70e. Y - lIWRY AT wORK KACE OF INAlRY A~ Mrr.Ir~. wreR ir»?)• ~ IOCAltOf1 - ffw+~trrRfQ w0. dy~?w~ Mli +rJ ~ ~ierr/ WF•ea-IJMewb'1 . . ~ . 20e. 1'0r. IQ~ To a Ca~pkud qr ATTENDING PHYSICtAN O~tl To M CwyirW Ojr CQRONER Oa1y ' . ~:a ro a. wn a.r ~¦o.4or, er4+ «anne.. ur cin.. a.e.ec aao..~e Ay. a un e«.ww o. n. e~rs e+ ~ari..e~ awf;« a. oPL+:.. a..M.~e.wr tl Ma aiM. ~cv ~ aAeoac.ww_ m.cw~.m,nw ~cw~c Iirp~wwrwr tYr/ ~ ' ~01YIry I~t..~ H.D. ' CA c C~ . OwTE S~EO /Xa. An ~~r/ M01N10f OEATN TE flGt1FD Pra. Qq, Iwr/ N6lJ11 Oi OEAiN' - ' ' " ._a\>.~.~ y-~:.~: . 21R Zle. ' Y 7 S /O ~It. ~1~`M;'. ~ EOOEADAM~.4R rr/ fRCMOIMiC - ~ ~ ~ „t t - ~ 8 7 m. ~r- + . NAYE ANO ADORESS Oi Cf11TIf1E11 lMYfIC1Ap OR C0110NER1 f1yN wM.~el /JawtrRAn dy r~ila _ ~ _ Frederick E. Nachter M. D. 124 Libert St. Painesville - Ohio 4k h~' ~ ~ . ~E L.~~I T~ON. pATE NAIrE OF CEYEiERtl OA CREMATONY ' IOCATqM p , r , ~uiciuL ,S,e ~s#. 9 / A ,k. . ! ~ve~u i.de reme~e~ ~a ine~.v i,lle . ' . 0 ~ = ~ ~ursaEwnw~r+ ~~c.N..~ ou~ECr a~c.wi ~ . 'V . n. "ame~s ol~.on ~S A,~. t t~- , fU11EHAl RNM AND ADORESt • tSTREET NQl ICiiYI ~ ISTAT!(, : t:. f- v~ . itr! ' 'z 3 ' r. S cu ~une~a.L f'ome 9nc. ~S'li7 %,~eto~t A ue ~ain~isv' Olci~ ~OJ',? ` _ ~ ~ _ ~ ~i nECO fY REG4T ~fONA1{111E ' DA7E TEiWIi ~fiUfD SIGNA7YRf Oi ?E/1501~11 tt3UY~3/EIr11T • . Nw 4 / 8l ~g •~st~l . . . _ - . _ -~u~;~~ - 4~6253 ~ _ ~3 S pt1 I~ : 40 . . - . I~ ~ . . U k ~ P~t'~E bOC~.~ ; ~ ~ ~ ~ y- ; _ - _ ~ ~*_"An..~:~ . , . ~I I