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HomeMy WebLinkAbout0828 ~~6 OH10 DEPARTMENT OF HEALTH 4;~6438 , ~`R- u"`. D1V1510N OF VITAL STATISTICS Fil~ No V\ Primsry R~s. n~u. No. CERTIFICATE OF DEATH R••~N~~•• ~ECEASED-NAME lin~ .Mi/d~ Lr~l !tx DATt O~ O[A7N ~.~t~rib, p~y, Y~,n) ~ V dlberL ~i~~el t. SI ~ ~.ov c~~ IiA6~ N"~wt~?~, ~wrri~~~ AGE- ~+t U?~DEf 1 fEwR UwDE! 1 DA~ O~TE O~ ~~tTN ~.4~rib, D~~. COUNTY OF D[ATN l~d..~. ar~SI~~ri171 i»~ ~tn~l q~ ~nr . i~. 1'an ~ .tE11LE 3~. A. Sc. ~r.. '3 1906 7e V~~rp., C~11, Vt?~AGE. O! IOCAt1pN Oi OEATM INSIDE Cli~ tIMITS 1105~I~Al Ot OTME! INSTIIUTIOM-NAM[ 111 ~M wb~r. j~~r ~I.~rf ~rd rr~`f?1~ /SNti/f ) i ~1 ~s ~,^.~Ciel~+ it~ - ~e ~a. ~arymeu:it i!o~pi_t91 - 36" 1 ~r~th :;t. i - - ~ S~AfE Oi ~1fTH I/I ~~I n1 U:S~A~~ ~r~f di1ZEN Of WMAT COYN1fT MAl~tEb, HEvE! ruRR~tD. Su~vrviNG S?OUS~ 'h r~~~ n~r r~~J~r w,IrN e~s~l~~l WIpO O. OIY D/51t~i()/ ~ ~{ungary l?3A ~o ~arr~ Ann~ L~. r~~~ SOC~aI SEGUl~lt1 NU~f1ER WAS OECEASEO EvER IN U. S. ARMEO IOKES? . ~!'a, ~r rs~orsJ yes, p~e datrs oJ senaRl ' ~SU~I RESIDE?+CE ~~o. ~~5~~3-5237 ~~y_ I~tA wnERE OEGEASED USWI OCCU?Atip~l /Gitt 4i~1 rer~ 1~~~ Jr.i~ ~off • ~~NO O~ WlINEl1 O~ ~MDWt~• ` .~~ED ii DEAiM i I ~ UC!:lREO IN fr t~~tt r~hr~/1 ..sT~,~~.qH o,. `1~+~~ti~fl ~vner-Ret~red - : ~fS~GcV~E ~EtA~~ lES~DEnCE-f1AiE COUNit Gi~, VILUGE O! IOGi~ON INSIOE CITY l~MliS STlEEt Aw0 Hu~tEi + l S •4r.:~i9!! (s~errh • w! L L . • ~i t Ut~io (iUyIAhJ~6 ~errieid ~~r,s t~~ s. ~ . . ? ,.o. ~.s. iAiNEt-~IAME f nit ~ .Hi1/!t Lut ~ wOiMER-+MAIDfN Nw~tE ! ni: ~I+I«°!~~ _ 11r~ ~ Y •s ..~D^ZDh c.i ; ~:,~di ~s. Yf Y' T: !+C ` Z INFORM~NT-NAMrt MAIUNG AODtESS ~Sht~i RJ. . ro.. ul) Or ti!l~~e. u.n. u~~ 3 ~ Ar.ne Krionel ~~e. 36'J 1 4t 5~. G^r i e t~'~ ~ ' t IAlT pEATH WA8 CAUSED 8Y: (ENiE• ONIY ONE CAUSE IEf UNE ~Of 1d, 16/, AND Id! A?/f0~1MAIE ~ Y~i . EfwFEn~r. t AN ~ Q 1~. , ~ ~P /f~L • i. i~~ L~k/ ~.~r _ ~ , . . . ~ i~ca~rE c~usE ~ - _ _ S Co~Jrii~~r. i/ CUE i0. Ot 1~~, ;~Y~IEf . ------r-- i r ) 2 u~irb Savt riit re , 101 ~~f J L- ~ fwwr/iae tw,e I•1. p~E i0. OR AS A CONSEQUENCE Oi: ~ !l~ti~t.tbe rrJer- ~ ' _ l~i~~ s~r~e l.sr kl c- ?ART I1. OTMER S~GNIfIGWt COf~10l;lONS l.~~lU~ ~[~~!?i~Wiss N/ ~r! rdilt/ to c~au< <i~r~ i~ ~~rJ /!~1 AUiOISY if ~tS r nr J~~J~r~. .~r~?.Irr~J ~ ~ ~j ~ I Yn er ~s Ji~n~..~~• a~r~~ u~ ~..,I~ ~ - ~y.'si~ y~\` ~Lr",~.~ ~ ~ ~ _ j Y .-,G o . iae ~vs ' j G ACCIOf?~{T, SUICiDE_ NOM~UCE OAfE Of ~N1Ut~ , MOU MOW ~NJUt1 OCCUlREO fE~nr ~~rrr eJ ~~~r.~ p.•i 1 d~ p...t i,~~ !M) ! OR UNDEIE4~~NE0 lS~tti/~) LMo~fb, Ury, 1"~sI ~ C 2°° ~os. w~. Za. _ ~ INIUtt At WO![ ?LACE Of INIU~t A/ bowt. /n~, ihnf. /+~f~ry. IOCATION ISh~tt ~r K.f.U. r~., till ~~1/~Ia fi~rr. r~~1 . _ - W ISD~~iI) )n or N/ o,diie Wl~., na A)tsi11l : a ra : } ~ : ~ r' CERIIfIUT~ON- Mo i W~ Y~w .M~+YIr D.q l~t.~r D IASi SAW MIM/Mfi t YI~yp10 fa~T 0{AtN OfCy~~fO li th? Pl~~t. ~ ?M~SICIAN .r ~ / AlivE pN viEw tME ~t IN6U1~ ./.+r.. r.I. : 1 ATiENOEO TME ~`J ~~TO ~G• M~~ ib Qr~ Ym AFTE! OEATM. I`~ b.,r •f i ~ • ~ /Q 7 ~w~lY/11/tf. Ouf 71~. OECEASED FROM ?l~. 71c. ?td. 71e. A. M ~b~ ~.trii~~1 +~ri~/. CE~T~fICAt~pa-COtONEf: Uw tbe i~dir ibt ria~iwr~i~~ How e/ e~.ub Tb~ Itcdau w~~ powor~ttl dt~J 4 ol tb~ ~el~ r~dier rbt in eiri~+fiew. i~ w) ~?i~~e~. /rwtb Afoiub ll+? Ym . Horr f enrr.r/ ow fb Jrft rRf rrt b tIK rwantNl u.ud. ~ . j 220. M. ~ZY. ' M, x CEfilf R--NAME /T~~t or 0~~!/ SIG T~J - ~ " at~rs~ ~t u~tt 3:G~+[D / ? ~'~isr ' S ~c ~ ~x..- =~•L--~ y.~ . /?'1` ~ ~ , ; ~ - ~ ~ f y 77e. ~I I 1)f i ~wAtl~nG A00 E Ef?If1ER ~ SitEET Ot R•f.O. Np. C~ir O~ v~ll~~E 5~~*~ ~~d ` - ~ 3 ~ .~f. y ~ E::s~ - CJ,~c .~c E.:,,./ G~. v(. ~ ~ . - At, Cf TE NIUN f EMEiE~ •O! 6tE 10 l /(~h, ul/~tt, ~er~t~l IS?~tN S ? ~01 . 7~1 u. ~ ~ ~ . L~ ~ ~ -ey . aw. ~lX ~s f ~ 6i . ~ ' H/u~ Qf EMtAtMER 1 ~UC. HO.~ fUn~ DItE !'S S~GNAi E lut ?+OI r t p ~ / ~ . 7s. ~ . ` ~ .-~.l .s / E.~~ ~A ' --C-LC~~ i : ~ li- / 3 ° fUNE~ ? i1W ADOfE55 ISTREET NO. . . 1 r (Crtt~ ISTAiEi (j~~~ ; ~ _ c_•1 -...~r~-.c. ~ ~1 ~c _ ~~ayu_ ~ 3 ~ 4-- lC~~ /~1 ~ r N , j% _ ~ ~ DAiE RE O ~T , REG RA~'S SIGNAiYtE OA ?Et i EO S~GNATY~E Oi ?ElSpN ISSU~HG ? ~i OIST. NO. • ~ 2i. ?9 ~0. JI 3 ~ ~ _ ~ - _ . L;..s~; r ~ _ . .r - • ' ' - - - ~ . .i E~`^}_`'_~'~~.~~roby certil~ thAt thia is a trne aad ezact ooD~ '~EC~r ~ Er . ~ ~~;s~i:; ~ , ~ ~ . ~ , t T . _ • s. ,:.~i~tiiiic4t~ ot ~~t~ aa tilei ia bhis eltic~. ~ ~ _ .~i~ , . . . - : r lrl:- ~ } i.~~~'y~~ ; r:~t~- `lIG/V~~7v : ==~l't • ~ € ~ i;~ f;~~ F_;t, <<.. , . ~ 6~~~1 ~ ~ ~ 57 ` 1 ~t {4~ ~ ' ~ ls~i~fnr ' ~ ~ ` ~ ~ ~ ~ ~ ° F ~ ~ ' . ~ j; D R ~ : f!~ ~ r ~ ~ ~ • ~ ~ y ~'4.~,` " ~i/l9~ ~ ~ ~ • • - . ' ' . , . i..;;w+~~%.• ~7 i~ ~ - . . • i; R . , _ ~ . . ~G>:~-M-~ ,..A'a , ~'j"~*~~ ~.xs~ F ~ -