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HomeMy WebLinkAbout0643 _i~ ~ ' t j. . , , _ ~ , . . ~X 4~03 OH10 DEPARTMENT OF HEALTH ReR. Uia. Ns. ~ ~ DIVISII~N OF' VITAL STATISTICS NO' ( p~~~~ • CERTIFICATE OF DEATH R``~""" N°' ~ DEGEASED-NAME F:.ii JMillle 1+~~ SEX OATE OF OEATH r.N~N~, Qr~, 1'e- LEa'1ARD FOSTER MALE 2 RACE ~'fir~, ~r~.~, ~wtritr~ AGE- L+~i ~t?+DEt 1 rE~~ UfiOE~ 1 OAY OAtE Of ~1/tN l.~rt~. U.rl, COUNTY OF CEATH inlir~, eft. IS1tri11 Li~~bl+s flroil Urn ~rp M~~. )'~01 ~I~lhite • 70 k. Jul 27 1906 . Cuyah a Clit. Y~tLAGE. O! IOCAT1pN W OEATN INLOf CIT~ t1Y11S MOS~~1Al O~ OiNE! INST~TUf~ON_N4YE /f/ +Nf ~w win, ~iee ih~~f ~J ~rrlt?1 Bratenahl ~s""~""""~ 10005 Burton Avenue ~ STATE O~ {tliM /IJ sN i~ US.A.. ~rt CIi1ZEN p~ MI11AT COYNTIf MAflIEO, NEVEt r~~tllO. SU~VIVIHG ypVSE ff/ rili, s%t/ MiI~IfO ~M1f) , ~••r•,~ Ohio w~oow o av u ~s~.~:~,J _ U. S. A. ,o. ~arr~e~ Florence Ka iOC1Al SECtl~~ti HUWE! ' W~S OECEASEO EvER IN y, S. Alr~EC /OtCEST /)'rt. w~. ~r r~liwr~l ~a 7n. prt r~tn e/ serMal USUAL~ESIDENCE 283-05-1745 A ,n. NO w„ERE DECEASEO USUAt OCGY/AiION IG:rt li~l • r~r! I~yr Ir?i• s~il KIt~O ~ WSINESS Ol ~NOUS1Rt I~vED. If DEATM / s OCCUt~EO IN r•sr4i~~ ti/t. trr~ i/ rHirtr/ iNStitut~ON,GrvE Tool Crib Manager „b. Re ublic Steel RESiD[NCE tEIO~E RESIDEMCE-St~~E COYnit CIT~, VItIAGE OR IOCAf10N INS~OE C~ir IIMItS 3tlEEi ANO N1NUEt wpMISS:OH. ISlrr~h n ~r NI Ohio Cu ahoga Bratenahl ~fes 10005 Burton Ave. fAfMEt-J/AME twil Mi/d/e Lnf /rO/NEt-M110EN NAM( 1 u~l ,\Wr//t 4nt Y ~s. John Foster Amalia Ga12 Z INFORMANT-NAME r~iuNG ~oorESS ~3/rr~/ R./.U. ury uIL.R~, ~t~~~, a~?/ F rirs. Florence Foster 10005 Burton Ave. Bratenahl Ohio 4k108 Z DE/lTH WAS CAUSED BV: IENffR ON/t ONf CA{/SE IEf Ilh[ 10~ 1~1, AND Ic11 ~?~Wi~M~~E iN1E~v~1 W 1W N N •1 Z 1~. Q ~ Probable arterlosclerotic heart disease. ~ MIiMEOIATE CAUSE ~ Ce~Jitiswt, i/ WE TO, O~ AS A CONSEOYENCE Oi~ W rbitb ~e~~ riit I• 1?1 I a i~~wtdi~Ie u~u /+1. ~ OUE TO, Ot AS A CONSEOYENCE Of: Z t~i~i~t ~bt r~Jtr• ~ l~iyt uri~ /~rt li ~ F- ?Ati 11. OME! SIGNIi1G1Ni CONOITIpNS<.o~/ili~wi ~sU?ib~i~~ I~ lutb iaf w~t ?d+lt/ b r+r~<<ir~w i~ ?irI //+1 wUtO?S~ ~f ~ES r~r~ N~f.~p ~~~i,d~.. ~ ? 11'ti ~r ~e d~u~.u~i~t ~r.ir ~l J~..U. ~ ~ iv..110 . a ACCiOEHT, SU~C~DE, MOM~CIOE, DATE Of ~H1Ut~ Mp11f MOw In/U!t OCCU~~fO /E~~~r w~rrt ~~~rry ir rw?I 1~s ~.n! a~r /11J ~ OR UNDEtEWtNEO fS?~ti/J) I.4~w~b, p~r, )'~er) ~ Q 70e. ?00 Mi _ 700. ~ , IN?YtT Ai WO~r ?I~GE Of tKJyl~ Ar ~a~~. I,nar. Jbtf1, /+tleq.. LOCAi~OH ISIrrll ~r K.F.U. ~0.. ti!) ~r ~ilbjt. rfN~. ti'/ ~ ~ IS~r~ill )~i er re1 .di~~ N/s.. nc. /S~i~i/~J ~ a io. ~a CEtTIftU110H- ,M~~rb l71r~ 1't1r ,N~~rb U.r~ 1~a ANp lAST SAW NIM/ME! ~ o~oi~~o ~+or OE~Iti O(CYtlEO .1~ ih? '/irr. •w tNT11UAN~ AIIVE ON v1EW TME ~OOT IMOYR) ~br d+4. r~l, rr 1 Al1EN0E0 iXE i0 .No~Ih Dr~ )"trr AiiEt OEAtN. ih~ a~i~ Ir~rl~ll~. /~r n. ]le. OKEASEO ?tOir 71?. Jlt. 71d. ll~. M. ~btt~r~N~l la~J. ~ - - CERTIf1UiIWt-COfONER- Uw fb~ ~.ni~ s/ lht ~x~~iufio~ Il~w Jtr~b Tb~ r~tNarl ~u pro~~r~nl 1t+1 II I~t ~ol~ rw//or fbt i~rnfi~~fi~~. i,~ ~Ii~~o~. Ie4i .H~w~b U~~ )'~~r JI~N ~crmtJ tir rNi ~~J /re q fb~ r~rielt/ nutA. _ t June 28 1977 1;10 A. CEti1f1ER--NAMf /T~~t or On~~1 S~G?~~tU~ i~.rr ~r ~ii/~ O~TE SiGwEO „a S. R. Gerber, M. D. Coroner „ , • Y!/M, D. Cornner Jul 8, 1977 MAItIHG AOO~ESS-Cf~~ll/Ef ST~EEI O~ t.i.0. Np. ~ITY OR VlllwpE sTwTE l11 2 2 ~ 1 3vcl~ttd (lhin 4410r w.~•,. c.Ew?r~a+ o.rE June 30 ~ N~E Of CEMEtE~T OR Ctfw~t ~ IOCAhUM f( u~, u//rt~, ~i ~er~~~I ~1foN ~ cp...h ? ° Burial 1977 7.~. Acacia Park Cemete Ha field Hts. Ohio o . NAME pf EW~(ME¦ ~11C. MO.) f tAl OIfE OCS S A1Y (~I~. trp ~ ` m ~s. David Brickman 6658-A ~ . ~lltc ~ „ , 4263 ~ iUNERAt i1fM AHD AOOfESi ~ST~EET NO.) ((,ITt) (SII?IE) (jl?~ ~ n. BRICIUTAN ~ SON I . 21900 Euclid Ave. Euclid Ohio 44117 OAiE REC'0 ~t tfG1St~At'S G ATU OAiE ?ERKtf ISSUEO S~GN~IYe OI ?E~SON ~SSUING ?E~wyT OISi. NO ~ - ~/L. ~ ~ _ - ; - i~ : ,~i7, - , - ~ ~ . ' - - ' S ~ s._ .~+Js _ ti ~ 1 'i't~` _ : : ~~Et.=_8Y C[R~TY THAT TilfS K A!/ ~ w~ ,F: ~ E%'~ :J ~OTY CF 1!t: C.C~.TL~ ~:'1+~^, i';, : ` : 45U603 - ~ 4J ..;?ii IZ+• . _ r ~ 'r'~• VJJ : . ~ } ~ r 19T9 JUI_. -9 A!~ II~ S2 ~ ~`i#' .~,1.201977 , _ . ~ : ~ ; -s, ~ w ~ . FILEO AhD PECOitUEO - ~ - ` :y~ .~~A ST. LUCIE COJY~Y. FIA. a.~~; ROGER P017RAS . CLERK CIRCUIT COUR ~ X ;>,r , _ ~ ~i.~~~RTf.5Tr7AN. I/~~%~. . g,~ ` f~5 . RfCCRQYERI~ICD_~s~!~~~3t~~ , • J •:~,i~_,i~ btif HAi~D ANO5f/11/15 ~ :OCAI RfGtSTRAR OP VITI'.L SiAA~ ' sa~t ~ - ~ • _ ~iw~ ..r~--,~,~:~SZ.t~r.~,~ ~ - . . . - - -