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HomeMy WebLinkAbout0074 . ~ i .~q~8623 ~ f 4~86;~3 ~9T9 J~':+ 20 PH ~ << ~ Fk~~ L' Rh! "cCUnu: ti ST I,U.^.~F C~.4VTY.f! / . _ J: ~ f; .'z _ . ji . 1;'. :1~; ~ , i , . i'). .~.,-e_~~ ~ 06-23047648/ELLINGTUN ' ~ ~ , ~ - WEST V11tGW1ASTAiE DEPARTMENT OF HEALTH + DN/151pN OF VRAI 5TAi61K5 st~n ~a[ ~aw~tt ~ i«µ ~M~~ ?HYSiC1AN'S GERili1CATE OF O[A1H + oeccocNr_?uu~ ~wst w~oo~ ust wc oNtoroc~rN(w..ar.r.~ . : ~s i G,L ~C E /P i L L c/1 : Fe~.^.le ~farch ? ~ 1~ ~ ' _ 3 fACE'h-~-WVM.recl./Wrc fGE-IWFn~'~ol' IMqlll'(EA~ U!+Oft10At OA1EOfwIH(Ms..Do/.1~J COUNIYOfO(A1M z M.b1MC.~13Moh'~ i7ra) 1~t'1S. CA7S 4~~3 ~ a?Y~S ~ S!. Sc. A ? C Ta. l f M06~. O! MKi. ~6a~M DOA 1' ~ i t:, s~ _ ' p,~....... ~M ~s.«,h1 ' CR'f, idWN OR IOCAI iON Of Of AiM ' M06~wA1 OR OINIt MGT{11f11DN-MSM 1I ~M Ww~ ~+d w?a? - 7~. ~ 4 n- liir'li inr~ 7c ^ w~s t e V i rlj~. CnQEMOfv?Mw1COUN1t'f MAtleO.MEVElMAt~ED. SURYNHG ~/Y.d..~i.~.~s~..rn+l 11tMED/ORCESt SiA1E Of MlM(r.M~ yyppyyEp pqpR(EO(Srel~) .~.rawr>) ~Yd~. T fL~E~IN ~ ~ a 10. !q ~ 1L . ~KCU:tf0111 ~ ~UKOCCVAiIONlfiwl+d~l.~~/~w~~"'y~w~ K~~~~~«~K~ ~.~;rliRYl SOCWSECUlIfYMIM~[~ .~rLi~ib.~•M/,Nw4 ' ~ ~ e ~.~r+oaeoe , ' ~ i ~e~•ev~+e Q u. • asaceariM+as G~r:EiiONOf 1~. c c 5 t~f kCE rtEMS .~ESOf MCE-SiAIE COUMIY . CR1. TOMN Ot IOCAiION S1~EET ANO NtJM~E! I~C S ~ } `ri. Ya. . ~sk Ctibell ~k_ Huntington ~s+. 5282 Ist St. ~s.. MOilE!-•MADENMAME iIKT MOOIE UISI fAt1ER-NAMf fRiT ~E Welch w Roberts ~a ~ 'a~,~ ~4~rar3 :,.rt i• NFOfM/1M-NMAE f~fP M'r) MAI~+G A00lESS SiKEt OA tfD. MO. CA+! O~ iQ"M~~ IM. •1 sa 1~ 1- T . N.~RW.C~fMA1~OK~f/rO~M.01~4~(S~:yl Cb~EiNVOR OtY-NAME IOCAiION CIIYOliOMIN SiAIE Burial Floral Nil? s Frank].in F~nace Ohio ' ~ Off1C~lIY AIJOtESSOFfAC4R'I ~~F.::Ei ' w~.u~rirE?~~:Ea...,~.,~.o~s.~. ]./~17 ~ffnere $t. ~ ~ S ,4 ~y ~ ~ ' . ~ elcher~ -ry_ . ~ < T~,) ~i ~L_ oy ~ r~ y DAIE SK's?~EO 1M?.O~f. hJ W~U! Of~ . ; _T ~ _/t' ~r. \ ~ au. 2k- ~ t ~ a~..R~•rd a~l~/ t NAME Of Al1E~ I~~S i 071ER TMAN Cf~l f Et (flA hiq i ' ~ ~?~v ~~a. ti~81tE2t}1 Yates - S* wr~~+o~na:ssuruetrc~R~r•«r~.y ~ .7aldir Lobo li• D. 127.4 W• v~• Bld . iiuntin ~ton 1'. Va. ?_5701 owtt afcarrt:, cr ac~:su;+~c.. a.~- r.~ ~ - .E'vGliwi ~ ~ ; corlt rq~6 / ~ ~ ~ F ;M . m- ( ..~K~.'sAVE ~-fSYW'N ~ wew~+ww~~Js~A c ~:,c ro ri wr[ou~~E C~uSE t r onE fwusE rEe twi ?+oe f.l.l~l ~ k?1 _ r~""~ i fN~.~£DMiE = r t ~ ti fAtT ,I • `ST iM trrt ~ Iel ` ~ v ,Itia..d~ew+e.~.«~ed~e~w 'r ` ~`~DfRl1MG TQpASACONSfOIlEMCEOf: ~ ; ~.~~.s, ~1 SPa t~~ fS ` a? ~ i'O ~1 ~ ~ 1t /~l S~~ ~ 1 JF ~~~•1 ~L~ e Na c~1 ~ ~~~a.sa.? ~ q!f i0~ Of AS A C01+SEOI:fMCE Ok ~ i. ~ kl WASCASElEiElHOTO?~tOK~I ~ ~ OiIERSr..Mi Cp~DQ10~6-5/~iMw~ ~ ~s~o1~6M^Mrdoudlea~w~P~rlAff iN) /~Ulpi~lsp~al~~ ElUW/4RO~C0td4t • ~ ~~yr««w~ e IAtt J w~ w 2~. ¦ ~ ACC1DfM(S~d/ «W) OAiEOfNIUttIAM..Oti.yr-1 OESCl~E110WN1UfYOCCU~?EO _ . 76c. M )6d- / ~ 76o.iRS.NO1AMfDttJr+vt~ ~6?. STAiE - ~ LOCAtD~'~ SilfE1 OR tf.0. NO. CRII O~ IOWN . NIURY Ai WOfZ (Spolr f~s ?UCE Of It1lIlr-N M.r. ~w~ M~~.1aas7• ~Mst r+liM. t ~ Q2M YS-002 ~ K) ]N. ls1K,i1 ~49 ~ ctv :-7/ 76e. . . oR~iNat i ~ ~ - . _ ..:.r_ - _ _ - - , _ . . ' ~ ~ ~ I f~ereby certify that the above is a true photo- ~ I static (photcgraphic} copy of a record filed with ~ ~ - : : _ ` . . ~ the Division of Vitai S~atistics, ~Jest Virginia ~ ~ - ~ ~ - ~ ~ . . State Department of Health, Charleston, West ~ f ',-r - ~ . ~ - . Virginia ~ x . - ~ c • .7 . - ' . , - ? ~ ~ . I~Sitness r~~y hand and seai this~~ntee„tt, _ ~ F~~ l day of ?iarcl~_ 19_Z~L..•_ ~ _ _ : . - - . - ~ ~ j _ - ~~~o . i ~ . . - : • • a . t . . • ti . Joseph D ney State Reg~s rar f . • . E ~ ~ _