HomeMy WebLinkAbout1197 SU2594
OHIO DEPARTMENT OF HEALTt~i - ; ~:~+-::.D
iTE INMARa1N ~ ~ DIVISION OF VITAL STATISTICS 7
SERVEOFOR M~~~ ~EM~.-..:~,~
f+DATACOaNO ?r,wlnrRyON.N.. CERTIFICATE OF DEATH R.wl,•rwti.
- ~
~ DECEDENT-NAPE ~,1 pT ~ ~;BER , r ~ , - ~x ~ a?TE OE OEATN /rf„ or, r../
- i. /'1}~AI t~IAtE 3/10/80
` RACE-Ma.,rRrtf,Wc~,A,twb AGE-lW ~rcMiM UN R Y M UNDER 1 OAV GATE OF ~IRTNpiw,Qq.rf/ COUNTr Oi OEATM
cM I frarU Mn. 1 OtM 41wn 1 Mw-
' - ~"i'~r~' S9 6/18/20 CUYAHOGA
V. E1. 1 k. 1
` CITV,VILlAGE011lOWT10N0EOEATM 11pMITAL0110TNERINftITUTION-Newt/1/riMflMn.fhf/er.cw~rrMfl Ii /10r.0111NET.IM~pMOOA.
- oI/Er«.RIw JNflfw /lfMrYl'/
- CLEVELAND Y A N1FD CTR WADE PARK DV INPT
fTATE OF IIRTIT ff/ww U.iA-, Ilwf C1T11EN Of MMAT COUNTRY 0111GIN OR OEfCENT IIWMn, WT1ICN,Gxww. EwfwT. C~Mw, 10C1A1 fECYRIT\I MJY~E11
.r«,. Rlglti elc.l I~f 280 14 666
' w OiiIO E.. USA G R_MAN
s~aiRES10ENCE wAfOECEASEOEVERWYi.ARYEOiORCffi YARRIEp,NEVERYAMIEO, fVRV1VU110fI01gEp/.pkM•efrW+rry
.~fREDECEAEED /ra.AwffwWfwJ Nlrfi N / M11001NEO,OIVORCED/.~ffrJ'/
ED li OEATN „ yes 8 28 43 t0 2 11 4~ MARR1~ i2? MARY TIMAR
-_i.uRREDIN IJfUAIOCCUTATIONfCfrfYt/N..rttNrr'Mfrff/N~RffY.fM,ly,+rtN/ KIND OfKtIflNEffO111NOUfTRV
•s~~T~nON,GrvE
f s~OENCE ~EEORE
_.•~sstoN ij~__L_ATIiE OPEItAT~R _ B N
REfIDENCE-fTATE - COUNTY CITY, VIIt.AGf OR IOCAt10N fTREET ANO NWf[R Illf+Dt CIT1/ LWltf
/Sf.fvy rafrfwl
OHIO t.t, CUYAHOGA 1!. CLEVELAND ir. 4579 W 223rd ST. i«. YES
fATNER-NAME Mr XMrr Lfr MOTHER-WIDEN NAME fM1r YMW E.If
„ CARL WEIIER ,f ANNA GROF
• - NEORMANT-NAME fTYI•olrr+q MAiIING ADDRESS tSTREET OR q.i.0 Ns 1 KI TY OR TOTNII IfTATEI QIII
• tTf Or FICIAL VA RECORDS 10701 E BLVD. , CIEVEIJAtdD, OH 44106
ARmOxwATE 1 ERVwL
~ ~ 1 ?ART 1 DEATH WAS CAUSED BY: (EN1•ER f)Nt r ONE CAUSE IER 1/NE /OR frl, f0/. ANO kfI fETrrEEN oNfET ANO DEATH
tf. - - - - -
• - IMMEDIATE CAUSE ul (t ~ P . , . . , ~ r , - Ly' / , ~
OUE tO.OR wS A CONSEOUEACE OE
' CJI.f17JRt. 1I R1. ~AYfi iDl ~ ~ • / C
T•~tvrf ~ aaJrr- ~ OUE TOOK AS A COHSE OUENCE OE -
?ARTU OTIIEP SIGNIStCANT CONDtTtOhS C.+J„r•wro+rMranfroL+M w, v.r..Y,N rarwrfe.e.a Ra.r/4, -~TAUTOKY eIAS CAfE REf ERRED TO CORONER
T / r.r rsIKV, r., r.vp
ACC.SVICIDE.MOM,UNOET.. OATS OE INJURY ~MOVR~ MDYY INA/RY OGCUHREDfl+reriu,rrf ..l Mlr•rwl+rr /„f IrT U.,Irw ffl
OR ?ENOING INVEST./SIKH?I I,Ya+n?-Da,. ]'f.r/ ' .
I ' M 2tb Q1
_ :~w i2oD. - _ t~
INJURY AT NtJi1K h ACE OE INJURY wr ?o+v. J•..,- wwfr /x Mn. eIJL-f ~EOCATION /Slrffr a k F D +a. tMf ar .Wyf. IrN, ryJ
JSIfc,/J ,fra+nJ (t:Jf.. flf. /Slfflbl t
_ _ _ _ 70? - 201
To a Corrlpetfd lr ATTENDING PHYSICIAN Odr _ _ Te M CotgMaA MI CORONER Oliy ~
21• To TM Dfa or ~f LnOw4Or.Ofr~ O[NnW .t IM rnr.MU MO p~,[f ,MO Qa,• TO IM C.url.l J2. Ow tM My W •.InNi.M, MdfW InMt~T.O,,, r n,p EO+YO,Idrtl, aCQN,'fd fl W rM.
Wr0 ~ ~ 1 ~ •1 r fW Wc. ~w0 dw w W cfurlTt sTpN .
/ r
/SIf+,1Y,f W toll. ~ / , `
! •~l.>ti1 I ~ - ~ y V S t • + : r ~ ~ ~ • , S,f+e+w.rf w tIrUJ
DATE SIGNED fffa. D.,. YfrJ HOUR pi pEA 1 GATE SIGNED Me, dr. rfK/ IIOEIR OI OEATM -
~ ! Y
2t0 3 ~ ~ ~ _ tic. / _ r~ ~ M 220 RONOLNCEO DEAD fiffvJ
?RONOVNCED DEAD /Ms. f]q, rw./
r
N J.J}'~'~ ' - L , ~ ' r' f' - . , f r r; 22A ON 22. AT M
NAME AND ADDRESS Of CERTIFIER pNYSKIAN CR CORONERI fIJN a?~++4 ISa+frwRFp wn. tfr, a,iMf. ,rr. tr/
' fURU~.CREYAT1pN.DATE -NAMEOiCEMETEPVORCREMATORV EOCATION fClitt.•elr+.nfnw+7/I
OTHER fSMII~I ~ O
2.8URIAL 3-13-80 :,k. SUNSET MEMORIAL PA 2fa NORTH QLMSTED,r~IVAN(X;A.ol~.to
hAME OI EME/fIMER tlK Wp 1 EUNEwAE DIRfDIRECTOR'S SIGNATURE - /IIC. Ns 1 rj
~ ~f
_ I 1 1 2S. _
iUNERAI FIRM ANO ADDRESf iSTRE Ei NO 1 KITYI IfTATEI ' ~W
- • .coRRIGAN >T.JNERAL HoI~ 14750 IARAIrI RD cIEVELAtID, ^H 4_4111
- A E peY REIiISTRAR'S Si URE a FDA/E IEHMIT ISSVEO SIGNATURl Of ?f RSDN IfSVING IERMITi
~ tREG (,l ,1 tic i,o. S/1~/a~ _ % . ~ - , , .}.Sol c,4
• _ _ GSM LeW s
t r
~ -p j-- I • HI:REIiZ . CI:RZ'1 E'1 'i ilA'1' I'lll: At1UV1' 1 S Att I;XAC'P -
Jp D C ~F2 0"r' TILE RECORD t•:I17 t'II 1 S uti I'T I,I: T 1} '"HI:
~ D:.PFiRTI'art~T OI' HEAL': H Ll:~'ta,~+NU, OH IO.
T rn
I'ITNESS 1•iY HAND At3p SFJ1I, J1S LOCAI, Rl(;IS?I2/1P.
OF ~?ITAL STAi ISTIC`.i .
~ ~'2-'~
~ 219 0 - rl:c;LS~I•RAR
sc~zs9~
I?0 i -8 P'' 2~ ~ 2
ROGER PGITRAS -
'CLERK CtriC+AT C:`U i
i,
~~340 P~119~ -