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~ MEDICAL CERTIFICATE OF DEATH
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n~`RT~` Milliam Kenneth Kidwell le ~.Februar 18 19?9
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.l+l ite merican s.. 8 s~. ~ 6 1 00 Coles
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AN NNny a»~araw. wr r•aa•T MasrT~
A ~ ~ . ~ ~ ~ ~ ~ ~ ~ ~ ~dafa ette Sarah Bush Lincoln Health Center ~aln tient
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u.a.A. AracwwT T/ •IOOTI[O. OIYORC[O IITac+Tl
B ~ ~ - e.Illinois s. U.S.A. ,o~larried „Irma Wet$el
[OCTAL [[CVRITT NVYR[R VWAI OCCWATION BIRO OI WOIN[Ol OR /NOV!{fRT ~a!MMNAR V[T[RAN MAR OR OAT[f 0/ f[RVIC[
~z. 335-09-3108 »..Attorne ~ .Le al No sae.
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• _ _ _ ~••-208 Hi kor Lane ,.e.Mattoon ,.Yes ,.e. Coles ~.~llinois
FATHER - IVAYE 'HI~a usT MOTHER -YA/OENNAYE ?/wsT rlar.a ?AST
is John Kidwell ~e. Luella 1rlc Hearn
INTORYANT'O tt ATVR[ . R[I.ATIONfM1/ YAILINO AOOR[tf gTwaaT Awo wO-ON.. O.. CITT OwT +1
,~[ife ,208 Hieker Lane Mattoon.Il.
~S. DEATH AS CAUS[O 1V: ~ (twTaw ow~T ONE c•uaa Tew a.wt /N (.I. (bI. IC) ~ T~i~owwiiiiwviii~Tw
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• • • . O[C[A R T'O raw Aura ew.
z,.. z~b. Feb. 18 ,G Feb. 18 i z~e10t4 A. u.
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MAMt ANO AOORpi Of C[RTI/1[R ITTTa OR nrwTl ILLINO\O I.ICa/t![ MO[R
zzr~,Jose h Mellor MD.1710 Wabash Mattoon I. nd.2862
NAY[ 0/ ATT[NOINa INTOKtAN IF OTN[R THAN C[RTIII[R ITTTa Ow nnwTl I,pTE; Ii AN MUURT wAf INVOlVEO tN THIS OEATN -
TIIE COIIONER taust OE NOTIFIEQ
WRtAL.CR[YATN)N, t[Y[T[RT OR CR[YATORT- LOCATION t~TT Ow TOww fTATa OAT[ IrowTw-OwT.TUaI
R[YOV Al Ivad/Tt r
~•Burial 2.e. Dod a Grove ~flattoon Illinois z.Feb. - 21 1 9
?UN[Rwt MOM[ NAY[ ajOatT Aw0 wvrK1 ON O.I.0. t~TT Ow TOww fTATa av
chi i Funeral Home Ltd. 1 01 Charleston Ave. Mattoon I1. 61 8
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I HEREBY CERTIFY THAT the foregoing is a true and correct photostatic copy of
the death record for the decedent named in Item 1 and that this-yc~eeord was
g established and filed in accordance Mith the provisions of. Y-12l~ ~_tatutes
~ relating, to the registration of births, stillbirths and deat~lsrr:~
DATE ~---L.1,1-~-~~, a 7 ~ 7 SIGNED . f•-~y .
AT Mattoon, Illinois OFFICIAL TITLE ~e,,yy~~ ~ _ Hj
T.~ED ~.NF~ K~COR t T ~ ' ~
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