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` ~ ~ ~ MEDICAL CERT'1FICATE OF DEATH sQ~i®I~S ~ ; ~•~''~~``=Y 1~7';
M14 ' ^C E::eEA;Ee-;~a.l. ROGERT TEMPLETCN STEIuART $ExMALE DAFEEB1~Ub~tY 22N,NDI•97A5
^ IV~V(M 'L NC:RO AM(A; a1N INDIAN, AGE-V71 N^fR I Y 1R' N r,h ) WVNn STATE OF IllIN01S r
,`f t.U_~Ei~.ll.1'.i' DATE Of BIRTH INOerN,o[r,ruA PUCE Of CEATH y,,,,
' n:.lrrc:'~ ~'I 1 I Dun•, E•,{rAtJ~ N°Y, DAn ~ NDJ+Y NIN, COOY• W
ti. ~ 4, IsaS - ;sb. I ;st, I s, Ul_L` 13 ~1 70, _ ~ COUNTY OF COOK SS Gr
' % ? C~.r, 1J~~N, iM, CN RCAD C:AI7 ~Ci Nt'~IItN IN' CC C~11 I Nyt/tlAt CA OTN{N IIfAiItUfICN•rJM~ I! NOT IN {I[N{A, Dlr( D"NL(t AND MJNIL CITY OF CHICAGO
r i HOLY CROSS HOSPITAL
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µyt~ ~ C A~H~;ACE (LTA+(CA/OA{IJN CIT12FN OF WHAT CUUNTRf MA.RIcD NC4~k•#rw7i+E0. NAME OF SURVIVIN SPOU E (NAIDLNNANI,IIWII[)
x~ I~,~ a°'~'I'ftE LA?YD ~ U ,S ,A , w'~`~iA~Ri~9RF~9 MARGARET BUSBY ~ I, Murray C. Brawn, M+DyLocal
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' I' ~ ' SJGAI StCVEITY NUhIL'ER U$'JAl CCCU?ATIUN ~ t,nD OF 6US~NE53 Or INCJSiRr ~ U,S. WAR VETERAN IWAR OR DATES Of SERVIC! Registror of Vital Statistics of
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,~~i t~;3~ij•3~~- j1 ' t~,,r'Ir'EFITiER ;13b, h;AliUFACTUF~G~G~lst. __~tsd. I the City of Chicogo, do hereby ?7
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cltr, ranN, iwr.cA n°Ao umAl(r No, INvoc arr ~runANO Nwnu
~ LL I ir013 ~ COOK ~ CHICAGO ~`"`°S"~$ ~ 3112 67TH ST ,I certify that I om the keeper of
~C" ;dj. ~ It4t, 'uo, It4d. 'toe, ;I the records of births, stillbirths
''•J•'~ MTHti,-I'VAA'E rlAa N;oou usr MOTHER-MAIDEN NAA!E nnsr Ntuou usr
' JOHN S TE~IART MARGARET TEMPLE 1'ON and deoths of the City of Chicago ~
IMC~htANi 5 SWNAIJR: ~ Ijf~d~~ I ` ~ I MAILING ADCRE55 Din{ct ANO No, oA N, r, o„ arr oN "oNN, star, nr I; by YirtUe of the laws of the Store
l / ~ y 0 I 2701 ~r 68TFI ST CHGO, ILL 60629
of Illinois and the ordinances of ~
A, 1'N VlIIIIrL INi[II IAt I' I
13, CEATH W CAUSED BYI (INTf1 ONLY ON@ GWt RA LWA IDA (1), AND Ee)) AtTNC[N ON{ti Ahr D{ATN
fARf I, INNLDIAr[ CAJ1[ ~ }he Clty of Chicogo; thot the
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lol f~Z-~-~••~C.i~ G~~~ ' o >~~S ~ c.A~-+rs,,/~ w oeeompanyiny certificate on this ~
on ro oA.tJ A nNSC°u(N,i
oron
t!N"•ITiDN,, n,Nr, ~I , sheet is a true copy os o record ~
e,re AIAt ro '~t'~~r L-`'~-' ~o`"'``~~~ ` G "'t ~ ke t b me in ursuona of soid
Irvc.~Art c.nt h) ; ~N q A CJNIICJ[NCL I P y P
A'A"AJ TNC Crt°CA. ~ ~
tr:ND tAVSt us', ~ ,laws and ordinances.
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9A~1 II, OTHER SIGNIFICANT CONDII IONSI coNOlrlow coNTAlwrn.e ro ounl wr Nor A[Nr[o ro eAY{II (IVLN IN ?AAr I p1 AUTOePrSYY , n Y[f. lns nmuA sAN. ~
IrplNT L S i ii Tani sm.NUln ewAA
190 '19b,
DATE OF 01ERATION,IF ANY ~MAIOR FINDINGS OF OPERATION TIrRt C[rEtft[d C0~ VA L!D
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.~,~..,...L2Q~• :Only Whcn Original BLUE n
IATi[AL';DTME 4NChiX,DAr,rNNl I lNONTN,I"f,rMA IANDN{}MA'NiN( LNONIN,DA},rGA INOU OF EAT
CECEASED GUMI TO NuuwtoNl Q +
.S ^ ~ 6~S -Z ~ Ste; .Z ~ ,1/ ~ ) S^ ~ ~ ' 27 ~ S~'AL And BLUE SIGNATURE
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JF'Y TEAT TD TfIF. BEST OF' 1fYFG~'019LEACF 77f;9 DCATFIOCCL'JtFED NOTEI IF AN INJURY WAS INVOIVEO IN THIS DEATH, ,Arc ' A,Bistd. 0 ~
0:. Tfi.~ 1JATE, AT THE TLjfE ATD PLACE, AND FROM TJiE' CAUSE(S) STATED THE CORONER MUST B! NOTIFIED.
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SIGNATURE (DATE SIGNED (NDNtN,DAr,rMA) ,IUINOiS LICENSE NUMBER A
big LING }D(GRES` CERTIfIERC Arun ANO NuN°u oA A, r. D, Dln oA raWN srA/St/ , tlr' ;t ~
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;R~ 'tel.'•l, CREh!ATION, ,CthtEitR'f OA CR 111 RY-NhME IIOCAT10N ~-CI?/roATONN , tTATt IDAt~ (NDNTN,DAr,rGA) ;h,~ ~0~:~ ?N
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• ~ fi,l • . , r.t hwA!t NAME ITr,Ln ANa NVNttA OA A, L Q, CITr OA TOWN ITAtt tlr ,
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FvNEiN: C,EiCtOR'S SIGNhTU~E T" ~ 1iCNERAt DIrECiOi'S I{UN013 LICENSE NUM6ER ''j v ~ ~ ~ ~
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iOCAI RtlJli("K'S S~GNAI~,E• r•-- CHICAGO BOAROOP HEALTH IDATEREC'D,BYIOCAtREGISTRAR(woNrN,wr,rt~AA) I
Y~':~"'~..~•=~ ~;,a .t..,,:'~?~:}~'Ce~~ourt~`Leavel~nChlcor~o b060~~?6b, Y~.'{:~~ ~ ~?"i^; _-v
,r ~ • +wjn.w~wr w~:vANw ^wr.rr A7r.ryAr..r r ~r,r~~IN~i~ Tlr'~~~
VR•.00 (19)R[) Illlnulr Dopartrranr~P,,cllc Hoaltn, OFtlce of VlEel Roaords IlAStO ON 1941 U, S, Sr C i CE111FICA1El
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