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HomeMy WebLinkAbout2828i ~ li~ ~ ~+ 'N ~OCy ~~~1 MVr~ti K fOtCEASEC-N/wf KANSAS STAiE OEiARTMENT OF HEAITM~~ ~ Diriuon of Vi~al Stotistics J 8~'T ~ 1 i9~3ERTIFtCATE OF DEAT Ir~lt r.:.L:~ ~.at SE1 515859 s~~11 111~ MII~~l~ DAIE OF OEAM ~ rowt«, o~~, q~~ ~ 7~ ~ I~ILLIl~~i N'llSQO :~+Sale ~ October 25' 1972 R~CE ~.m. ~~c.o. ..~u;... wo:.r., AGE-u~~ ~p^ ~.e•• ' u.+oi~ ~ wr DwiF OF ~tRTM ~..o.+rw, p~r. ~COUNiY Of OEAIH nc ~ s.rcu. ~ ~~~...o.. ~.t.•s~ .+os~ w.s~ w:~~s «. •tu, ) ~ lt~ite s. 48 ,. ~li,, -j~ ~_ ~ . 7-13-1924 {~. Johnson CIT`r, 1pwN. OR :OCw1:ON Of OfwTH w.s~w cm ~w~rs NpS~ITAt OR OTMER MSTII~JTION-ntlunf ~u ..oi ~.+ enw~, cne s~~t~r aw ..~wi~ ~ a~~ar~ .es o~ .~o ~ h i~erriaua ,, yes „ Shawnee rlission I-Sedical Center _. SiATE Of ~IiM . u wG~ a. u s.., M~rt G1SIZfN Of MRU1T COl1N1RY'~ iMARRlfO, HEVER MARbfD, SURVIVNG S~OUSE ~a owl, ont ruot.. wre ~ cww~n ~ YVIppW[D. OIVORCED ~ srttrt ~ , Pennsylt-ania • USA ,. ~~ied ~~ F.thel AYY~rie DXe--~_ soC~wz setumir Nv:~,E:rt ='" usuwt otou-wTq~ ,un ^r.a o. w.a oo..~ w.~+w ..os. w KIND OF WSINESS OR INOUSTRT - rOY[14 lU[. MM M Qil~lD / '• „ 195-18-0050 ,,, Senior 12ate Analyist „ Fann Land Industries - RESIDEhCE-Silt~f COUNi1f CRY, 10MM, OR IOCAfION w1~oe trt~ ir~ts STRfEi ANO NUM~fR ~ Kansas Johnson "~"~, •eS w ~ ~ - ,,, ,u ,., Overland Park ,~. yes ,~ 9217 W. 100th terr. ~MTMER-I~uME ~~~ar .wae ust MOT11ft~MllqfN NAME ~~rs~ .uoae usr „ Ivicholas H'asco ,. Laura Hastin~s tnfO~iMw-+l-kr,~f - - w-lWG ADDRfSS ~sne~~ o~ ~.~ o. «o . cmr o~ •w.., s-.v. tr~ ,., Airs. E`hel ~2~rie Wasco ,,. 9217 W. IOOth terr. Overland ParY.t I:s. 66212 ~ i~`i ~~ DFAiK W/y ~AUSEO ~Y. fNl[C 01`i 1' ONf UUSE IER /f'If fOR o. b.~wD ~ •nwi.ran ~r~nvu i t 1 1) f 11 ~~er~+ee« w.sn .w~ wni u ~..uo~.u e.use ~ ' ~Oj ~ ! /~c- ~ - ~j,'~ j"~1-!/. .. ~•' /!~ Jf-)=~~ =/-..' C/_ ~ii ~~'/, //_~'~_ -.~ - Yu~ .U. il~ r> l lVMfeVRMCa (ir // ` ~ V C4~D~1~7aS. ~• •~n, '7 // ~ ~w~C« a•vt us~ .c I fb1 ~ : _n ~~:~_'~: ! ~ : ~` - ./? f . 's ~rrto~ar~ c•usl .o~, S '~~= -f~- :.--a _ - ~ . .... ------~--~---- ___ % " ---~~---' ~i~~trG iN! ywD1~- I ~ 10. M~S 4 lOMi~p•Cf d i 111MG C~Y~f l~~i ~ (~~ ~ iAR: p O1nER SM.;sv~~Kl.*sT GOt~[~siK~fcS: eo.ro•na•.s ecr.~nw,.~a .o ew.rr wr «o~ nu•~o .o cso~~ ;,~re.. .,, ••n ~.o~ ;AUiO-ST ~!f ~ES wt•r ~~«e~wCS eo~. ' ~!S O~ '~O~ ~'D~~/D 1w Oftf/~~wING UVH ~ ; Of Of~lq ;,k yes ;,,; yes ACCIDENT, SU~Ct~t. tKw.!UDf. 1GATE Of ~NJURY ~.y.•». o.•, nu~ "MUUR ~NOW {N)UtT OC~UR~ED +~~t~t wrue~ or v.iu~~ ~-~ n~r ~ p~ ~~~t ~~, atr ~~~ OR UNDEiFiMM~EO ~v~cNi ~ ~ . 700 ~:H 76~ M iNd • fN1J~r A7 WQ?~C ~iIACE C.` 1NPFY ~~ ~'.+f. rw.+, !'~en rap~~, ~ IOCA:1pN ~ sntet o~ ~ r D r0 . e~~r p~ ~orw, u~~t ~ ~!~lC~1r r~1 O~ wp! ipN:_i lt+(i , t7C /YK'~r 1 a 7!'e !?0' ~ ~~f ~CERTMKwirON- .~.nw o•. n.• i '~rN o.e .e.. ~•..e us. y,.. wo.,.n~ ur.~ a. f ~ uo~ow.+oi rrt.. wlDt~iM OCCU~~fD ws rK ~uet. o.. rr rqrlKUN: 1O ! ..o~.•w e.. vt.~ r~oo. .~+t~ o~.rw ~wu~~ _` j o.r[, ~«o, q we 4s* ~ art~wDeD 1+f _ ~/~ p~~ e~~p~. pyt lI• olLf~i~D ~~On 11- (llt ~ t[! .~// // 71~ , ~i M~o •«e e.YS+a~ wno. tERiNI(/~t~nl-MtELr.J~I ExA~+lt+ER OR CORONti~ p. r«t us~s o+ :~+ wou. e+.ee.r~ i~+e oteea~• ..s no+.iu..uo w•o .......io~. a ~~e w~. .--_ IOf iM ~....~,.:.• s.~. ~« .. aw~w.. ~ ra.rti w. ~.• „u~L-~ ~ i . t! oe.r« oaw~w w w.c o.n ..m oue +o ~;w c.~se.s~ s..»o -'4/- i October ZS} 1972 ~ ~ - .Ta ~ G M')7f ~ 64 CERiN~E~-N~f mn w.•~..•~ SK,rt~ti " ~~ aeae p ur.~ OwTE S~GNED ~.ww~. wr, reu~ ~3.Dr. Bruce_~3arrick ~1.D. ~~i~i~~ ~,,~~i~~~ t~#~p ~n: 1n-?~-7~a~ ~/att1NG ADDRElS RAfKR vMlt W~ r O*.o tm o~ rew.+ sr••e l~- , r,_H ~`nak~ee l~iission RSedi~al Center ShaM~ee Tlission. Y~sas ~s~tl4 ~~URUI. CtEMPT1~n1. REMpvwl ~CE~+FtEar OR CREw-TGRr-Hw~nE lOUtiOe~ e~n o. w.,» •..:e 1 S~fCpt I JM Rem~val ,!, Dfem~rial Park Cemetery ~~t Kansas City~ Missouri . ~,,tE 10- ~ 17~p~ '~.~~~ F„-+~kAt NOrv~ami~y~fiiui al ~..... «•.1~OJc lR~'}vison~lir. Sha~•nee, }:s. 66203 ;;.~ - _~~~~ ~ - .~~s.~„ ~ o.R~~;. ~6~yz ~ ~ 1 - . ~ . / , ~~ ~ a~34? PA~2821 ; _ ~ ~ #~ ~~: ~ :: _ -~:~:~ _..~~ :~_ ,r. _