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HomeMy WebLinkAbout1685~ ~, . ~ OHIO DEPARTMENT OF HEALTH DIVISION OF VITAL STATISTI~S ' co~uMsus 5~51'71 SUPPLEMENTARY.MEDICAL CERTIFICATION . ~i ~:.~c o. occc.sco ~lly Appel on gara ge Roor ~lt :t.cr o~ a.=M __ 2559 IBU~'elhurst Road, University Heighte, Ohio April 7, 1980 -- - - - . -- - - a~c a oE.rM ~~l ~ ~~~~O~fYI( MIIYV4 N~TMY{C11KM~T: f~rv~rlsw~+.Nw~+/~~.t'~l«Ir.l tEi~tEwOuStr uOGt~iN :~ - - - - • ,,,,,,~T. t.w ~ Asphyncia by carbon.monoacide (inhalaNon of auto exhaust). ~ C ..~..~. Y~t i0. OR af ~ f0~il01RKE OI ~ ' .Vd~w~..r w ~wrl~! A! •y~l~~~ _~~_____ ___ "__ _ __ _ .. •.... .... w• ouE to. w~s ~ cw~cau[wc[ as - . kl - •Yi a OTr[~ W~1CY~i COO~T4d C ~ ~~.r.~.n.y ~~.+~.r.a w~wM w<wrr ~ w+.. M•• ~••; •utyf~ ~ is rES «~. ~.N..~....~•h.M •r•.~.~v~ ..4~v...~~~.w~M~~ ~k 110 ; n- yeB '_! UOfTt~YrlO 11Mn4~1 . ~~-•~~.~. ~T '+•~ -- i,p,~•- --1"a, apparentfy coi~as'"~e'cI'fd'ctos'ed - - ~,. acciaent ~~ ti ?, lsso _1,~_ _,o,. ga~ge wtth ~uto e~ogtne nw,ing. ~MJ{A~ 1T 1f~ • . !~a M+~R hn~r.~m W~. ~w H~rfir~ I IOC~i10M r "-- ~ ~~r w~ ~ ~l ' t ; : . ~ f.w r ! ! 0 M. i.ry .. ..tyM. ~.w. n- a.i r ..r ~. no , K! ~~s ~~ e" ~,~. 2559 Laureihurst Road, un~~~raity xei~t~, Ohio ~~~~ ~ ~_-,~ , • 0.. rr u0 I~SY L~ mr ti[• ~ O~O ~O Wt nts ' 1 ~il ~, ~ ~ i~L~ a '~~E ~ODI AiiE! p(1TM ~~rC~A~~•y ED .. r. M•i J.~ w~ ~. ~ a.s- '•- r.+~ pA r... fw~.w.~.w.~.~ oeu.~ee ~~l~~w , . . )t~ ' ~~ ~ ! ~ ` 7e<. 1i~. ~4. . cE~ V~ ---- KrObw- ~7Mf~.Mr.~•... .NI~w -_._ . ' - - -- --~- - -- ~- - ~~ ~ ~ .~ ~ ~ ~r-~ p~ •.f ~ W.. "' G=..s : : "'~ ~:~ 6 ~ E TK ~ ' _ •' -;'; _' : i--- ,1 Apri l _ _ 7 -1980 ? 22 P. ~ . . ~~-S~fiMiUl[ D.~«.. t N. D~~E SK.~ED ,,. S~ ~ ~',.. . ~~; ; t' ,~,~ ~ M.D.,Coraier ~kJuly 3, 1980 ~ . ~~ , , • u•T[ _11~ ~ ` --~ - -- - _ ~8 P4 ~ ~, .... !~ - --___ -- - -- _ - - - _ - < _ `~ THIS S~P. ~ Y CERTIFICATE IS TO BE COMPLETED 8Y THE ATTENDI HYSlCIAN ~S_~a OR`~ b ER ANO FIIED WITH LOCAL REGISTRAR OF VITAL STATISTICS ~ S3?1.06 R~r. 9/61 ~ ~ _~. z. ~ _ - ~ .~ ~~ ~~~~ . - - 3' s~~ 347 PAGE 1679 _ _ _~ ~;: