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HomeMy WebLinkAbout0047 . , . ~ . ~ c - ~ . . _ ~tn~t ur w~awNaiN ,~~4 p /309 ~ ~EPARTMENI OF HEAIiN AND SOCIAI SERVICES ~')'f ~N~%If CI DIVISION Of HEAITH STATE OEA/H NO. ~ocn~ r~~E Hw?+~?eR ORIGINAL CERTIFICATE OF DEATH d / 1 M l L AS( 0 NAM[ f~41 MrMM1 lql s[ 7I OAiE Oi O[AIH MMN pp rpr ~ IDA E"- KINSLER ~male ~bruarY 3.. 1976 rAtl vm~~~. Rey~~. MK~Kw~1~.~1~n.(u Iye l~sl Oi~lAhti 1lwrr~ O~e Yea Ihrkr t7n~ Dq OAIt M~nM Doy eN COUNIY Oi pEA~H YeMf Minf~ O~ri 1 Ir4aulef Oi NRTM White ~s,K.+.~ s0. 8~__ s.. I__ _ x. . December 17. 1890 Dane (p NA.Mt W 1111. Yi1lAG[ _w - jil Ne4hH. Naw! l~Nyl Ietilt Cil~ N NOSr11Al OR OiNIR INSi11U110N-NAME c~ ~N ilxb~w.~• 01 pee~Al Vil liMilt tll !Nt iw E~~Ae~ Cive StreN oM r M l~cNia~I iW -rlydison rM o~. MediROn Conva~escent Center _ - ~W SIAII O~ t~tRIM - (ITIlEN 01 WAet COW~tn ~~f~ n~~~ wRV1Ylq~i Sr011S[ (If W~1l. G~rt IYbdM Nen~t) - o u~ ~+o~ 1u.s A.No~e tou~tr~~ ° n. ~a w~e.d o~.acN • ~_._Ili~9 9. . SOCIAI SECURIIY N0. USUAI OCCIIIAT101i Gir! Kid o1 wNt OVfin~ AIOiI N Workiiy lift Kllq Oi W 1 1 OUSI~Y Evtw if Rt1iM Housewi t+e ~~60-18-Q658 ~ a0. Domestic RES~OEN(E: 'SUiE CWNTY NMAE Oi fITY, VIIIAGE t~s~de Cih a /w?IUNG AOOtESS (~*e Addras et Tuee ol Oeetla (11 Ne~fAer Nwt TwMSAp) Vill LhiN Wisconsi~ D~ne Madison ,w.~ r~ ow 501 3. Midvale Blvd. ~ fA1N[R NMII[ finl I 1N~d6~e L~St A?OiMER-MAIO(N NAME F~nt M,~OIe loft ,Z JoaepN Saloman Raehel Rosenthel ~Q~ INfO4MnNi-NAAAE MA~liU6 AOORfiS SUeN w 1.f.0. ~M. Ci~~ a V~I~a~e Ste/e 2io wAi OECEAS50 EvER IN tT.S. !?w[0 i0R[E54 ~ °~,,.Mr. Phili Kinsler , 29 To stad Glen ~ Madison. Wis v~. o Yn o u~? S"'`"' . 1~. PARt 1 OiATX WAS CAUSED EMer Only C~utt ~N 4nt iN (Iq, (~l. Md K) ~ DuliliOn tme~~ans. 11 My, Il InrnMale tan~: t'( I ' r/ t~ N'AKb Gove R~u 1o py~ b, 01 O! O t W ~~ea.on eouse cN ee~s~v~xK~ o~: S `l~t.,t~7 v~ G:-t- ce~--~ j Slolmg IAt undtr• . ~ s 1r~~9 Ceuse lal. ~ ~ ( v~ Cue te. a a e / ~ C. Conseouew[e el: ~~W "v`-' V l PARt tl OTNf R S~GNIi1CANT CONOIIIONS~ COediliens COMr:buliny le OeatA Ouf nW Rllofld f0 C~Vfe AUTO?SY (Spec' 1ME~E AV?Orf9 fYlOWG1 CONfOE~O vs ` G~m+ ~n ta1 1(~U ~ O r~ ~ w Otltw~wMlO CAYfi a OGtlfl 19e. . 1%. O Y~ Q ~10 ~ ACUOENi OAiE Of Mon1A Oop Yea MOW IN1UR1f OCCURlEO (E~1N NO~Ott OI InjYfr ie ?x~ 1 0? ?o~~ 11, Ilen~ Iq i2 ~1 S1lICIpE INJURY ~ ~0 40e. `.J MOMtC10E ~pp• 40t. 70d. _~J~ tNiURY AT wORK PtACE Oi INIURY (Hane, fann, Streel, ix~o~~, EtcJ IOCATI9N Sfrett or RF.O. Ib. Gt~ a v~lioqe Lme - Zq I~ 20t. n Yes Q No (SOK~f1I 40q. CERTIFI(A710N-MOm\ poy Yeo~ Monlh p~ ~ror A?rC t~?ST SAW H~M/XER ~lt O~ C~D YOiI ~tEW THE DEATN OCLUR4:D A` T!u C~at. on ihe PNYSICIAN ,I Month~ Ooy.~~ Yeo:~(~ tDDYAfTFlt QEA7H (HOU•) Date. c~d. ;o i~t Brst f 1 An~ndsd TAe Z~ To ~ S_. .N ef Mr KnowledSt. Due ! Deceosed Fron 0 "~1~Y f7 Ya ~!b ' ~ r io ~4r tous~i? Sbscd la. 21e. 21c 21e. Z=e. ~l ?p CERi'F'CATION-MEO~UI ExANI~!1ER OR COROt~Et: On TAe 6osK of TAe HOUR OF OF~TH TtiE OE:EDENT wAS PRONOUNCEO DEAD E.aw"na~~on ot T1x lodr ab~a lhr imresnqo~~a+. In ~Ilr Op:ean. QeetA _ ~ulo.,fh OoY Yeor M~c. i~ \ a acu-rM on iAe Dote oW Due Te TAe eevse(sl sroted. ~Z ~ i ~ na ' rr~. ~ ~ ~ ~ I:.~ CERi1FIER-NMItE (Tpoea irinl) ATURE-CERTIFIER Titlt DATE SiGN'a MontA Do~r Year . WIRVIN 11i. ZOLOT. M.D. Si,~./GLO'LLt.t~.. ~n~ ~4'~~ ~}7 S 7~ MA:iIKG ADD2ESS-CEQ~~ • ~T . or R.i.D. No_ C~sr or +1:~e 5•r.• Z~p 4A~I.SWd. W~$ .S3~t~ ~ae. . . lURIAI CEkE1ERt ~ QEMA10xY-NAME ' IOCATtO.Y :~:r ' S}ces =.:r c~ ~ ~ CREMA:iO~I '4 ~RE„~o"~ ~ Lakeside Memorial Park Miami, 3orida 1., YIo. 21e. 4~t. 9UKIAl-pATE Men1A Don reor cU!IERAt MOME-NMAf I4Y0 AODlESS S~reee r l.i.0. No. C~fy r Yi~o4e S!o!E Z~ . ' 'o ~.e. ~b. 9 ~ 1976~ ~~.I~auts . , Madisen, wi s . . j iUYERRI DS TOR- IGWI RE REGIS'RAR-SIGNA Q ~ , JAZf• tEC~t11ED Er to:ol leo~stro~ . ; . ~ ~ ' d ' ~z-~~ ' ~ 91~6~ ~ ns. - ~ ~ . ~ ~ - . ~ STATE OF WISCONSIN) Ss • - E COUNTrY OF DANE ) • ~ ~ ~ I . _ _ ' - ~ TO ALL TO [dHOM THESE PRESENTS SHALL COME : r~~.. ~ . , ~ I, Harold Kr Hill, Register of Deeds of the County of Dane, ~ in the State of Wisconsin, do hereby certify that the above is , - ~ a true, full and~ correct copy of the whole of the original record~ . . ' on file, as app~s ~c~~ie records in my office, as of this g date ~HT ~y~~' . 3 . . _ . - ~ County Recor er ~ t . - ~ . ~ n ~ ' ! _ } _ . ' _ ~ - _ . ' _ _ . i i ~ - :.~~f: '.C:C~I~ti~~ ' . _ . ;j:~ ; . ; . . - , . , ~ ~ ~09'74 ~ ~ ; ~ '79 ~ ~ a~1 ~ 32 ; ~ r . ~oo~ 307 '47 . , = : . - - ~ - } ~ # ~ ~ ~ ,,5 ~ : ~ ~ F , ~ ~~~wr ~ : ~