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HomeMy WebLinkAbout06465%~14UU ; . ~, _ .~- ~ , .~ ~ '~ - , ~ j~ ~ \ ~~ ~ ~ .~ , - - =. . -. -; ,, ., ., s .~ c , v~ ~ , lEal •-~ •r.( •' . -• r~ A ~- ~. ~ ~ ~ ~~~ C: i? ' T tMM ~ ~ U ^ ~ .^ j`. ~ ~ ~ .. C- x ~ ; ~ ,R L r , ~~' f cl _ _ ` " g ~ _ ` ~ ~ ~J tq' -Y ~~ ~ ~ L m " .-~ a ~ ,. 1~ r ~ ,_. o _ ~ ~~ ~ =~ a ~ J ~ ,~ ~ r~ . ~~ ~ ,_ . . OH10 DEPARTMENT OF HEALTH p4~~ ~ ~-f ~ OIVISION OF VITAL STATISTICS s~~~~ ~ _ ~~"~-0w "° ~`3~~ CERTIFICATE OF OEATH p..•~.«.~ /rY_Z , F.._. ' Fra YW4 l.u~ SE% D4TEOf OEAM~Ma. Wl. ~n.~ ~-~"i =~` ~1~E~ PASt?UArEI.I.I , 3emaLe , 3e6~ucu~ 24 IoR/ ~1M1 p~wMrw ~Gf-UM {.rlwOq UNDER 1 YEAR UkOEN 1 011~/ DATE Of ~i11TM ~y~,p~, p I COVNTII pf pfATN ~_ ~~~ . lY~I Ya. ~ O~ss e~wn ~ M.w~. - - . ' . y ~ x ' I~ "cuce /7, /9~~ 6. lahe il~'j~ ` ~ TM~i Oi pEATN NOS-ITAL OR OiMER INSTI~UTION-N~ny IlJwt h tipn. ~M ~yr~~ ~y wyaMY ~ ~i H061 3N ~hST ~wOS~p ppA, ,~a ~~vt~e 7uin ,. RS :~., /...o. ~'i.. ~orre~,...a..~.~.~ur..v,~ • ~~'~INj~}YV~xwY.2A..~rr C1T12ENOiYMATCOUN~RY ~~~ -s ` ~- ~~ ORiG~NOROESCEhTUU+rw.W.s~w.G~~ew.Eqt.w.CrWe. SOC~ALSEtuM~TrYU-~~ER -~+~rw R<M „e ~ ISre~~J ~ i~~4-----~ D ~4~ - .~ USA . . r 9 4 Q • ,0 29~-~4-~n~~ wwSQE~EASE0EVE111NU.S.A~tYEOiORtES) /~~1`w~O°"°l (~1NLf~vai~/arnty ~ I~ANN~ED.NEVERMANRIEO. W~DONEO.DIVOACEOI.t~.~cV11 SUIIVIVINGSrOIlSE/f/.1/~r,~f.r..Mh..r.~~ ~~ • ~~ ' r VSYAL OCCU~AT/ON ~G.+ Uw~ eJ .or~ ~t /rAy ~~ y~qraK w~. ~~ yn~yN~ ~ K~NO OF ~USINESS q1 INOIJSTIIr f j~ ~ ~~ 1~~~ e o. pES10fNCE-SiATE COVMTY CITY, VI~~AGE OR IOCAT~OM STAEET ANO MUM/ER ,~NS~DE CITY ~1y1Ts ~.. hi.o ,b LQ/~e ~.: ~a~n~.vi.l.Le Jrun !rs~en/j r.f .. x.~ ~b RS ~aLn~c A~ve 1 FATNfp-A~ME i'~nr MdJ4 . . ,.. , v Lan MQTMEA-MAIOfN NAYE Frst y,yy ~ ~~ „ Li.bv.~i,v 'cuaurueLCi. ~.cnou,..: .,... . _ ,~ ~ ~ 3anni.e (~aGGa~dru __. ' - ^ . •JQJ1It~@ I'Q/1Q[KUCe.CCI. ---•~.~... ~.vv..caa 1SINEET pq N.F.O. ~ip 1 It~TY Qq TQNN~ ~„ RS %aLme~ Rve ?ainersvi,~,Ce O~i,v .-~ .r1 y •wqT ~ DEATH WAS CAUSED BY: (FNTFR ONLY QNf CA!/SF IfA L/NE FOR /~J, /01, AND kl) : U ~ ~~ / •~ r-1 t!1 IMMEWATE CAUSE ~~~ ~ '' ; 2 r' ~ c /~--)-j c {i • ` ! ~ t ~---1 ,~, ~ ~~ - _ .*h ~• ~ .1 H OUE TO OR wS A CONSEOUENCE Of ~ r~s~u. ,/.~~. .w~ l nK R+e iu rw~+e.f~re ~~ cart, runk dr r~M- DUE TO, Op I-f A CONSEOUENCE OF f jw~ cerv Lit Icl -ART !I. aTNER StGNIF1~ANT CONCITIQNS Co+O~nwa co~rMy~ qd„q w,r ~~~yrp ~o ~r,~ r~ ~ titi ~l~I AUTQ-S1/ ' N4S CASf MEiERRED TO (Yll M ~0I /S/If1/y Yf1 W V0~ ~_~ ~. ~ ACC . SUICIOE. NpY , UNDET , OATE OF INJVAY - ° ~ ~ ` ~ ~'" T ~ ~~ OR-ENO~NG~NVEST.(S~eeyr: Wwr~.p~-YwJ ~~p ~N~~NJUNV(~WRREDlEwu.yw~/.r.v~rl.n/whn/l~r..J1/ ~ ~~ lfl[. M 1700 ~'~+rh+w~wvN~l ~'IACEOfINJVNV.~r~o~r.lM+.+~I+~t/~rtery.o//fc~ IOCAT1Oh lSrrNrorR.f.D.~s.rif ~r lS~ecy~ ri o. wol ~.. rr. !1-rel/y/ 7 '~M~. +4~r, ay~ ]0~ ip1 ~ To b~ Coa~pMt~d w ATTENOING PHYSICfAN Qdy 2t~. ro N~~ ew~ o~ ~w~ t'wwMpM. a~au oeevRM ~ur ~+.y. m~~ s.~e p«~ w ar w~~rww'.~~ t4b0 ~ ~ To b~ Cor~pNtW bY CoRONER ONy ??~ On uv e«.~ o~ ~.a~w..re.on Ns~w ~n ~~~M~~ ~t ~~ OM111 OGN/AO N M . , + : \ i - /] iW+~ti..wrn+ei --t- . ~ L : /~ ' ! L'- , r --) '- . ~ ~ :'y: ~ . t t~IM. M~ «w w~. ow w. w~. c.~,.~o n«w ,sr..... w nd.~ OATf SI(~NEO /N0. a). Ytr/ NOyR Of O iM ~ - I OwiE S~GNEO ~xa, a.~. rrr~ MOVR Of OEATM ` 710 ~ •. - ~• - - f ' ~S ~ ~lc. Y 1A m y MONOUNCEO'J£AO (M~._ Q~y, -wI -pOWOUNCEO OEAO /Nwr~ r.uc.~n.r..-.e«~..~.-~..~. J?A ON _ YH AT y _ _ . __'_ _.' __' __-'..."' r s.~ ..- . .i lS~~~r a R. F 4 +~. ~Ir) o+'.t1~~. s4u. ~VI _ _ ~, John R. 2lur~hy, M.D. 2(174 Abinf~ton ;oad Cle~~eland Ohio 44106 {Uf~~a~, CREM4TIOh, OATE NALE Oi CEMETERV OR CREMATOqY L«ATI~ ~~ry ~~• M~~ry/ /~w/ OTH A ~S~enl/1 Z..:~u~cuL ~,eb. / R/ ,k ~~ve~t.ale remefeit :b ~aine~vi.LCe ~L~/ze1 Ohi,v N~uitE OF EMeAIMER ILIC No 1 FUNERAL Dt11ECTOq S S~GMATURE ~~M.'p ~ '/`~~~~ [~ ~ S~~ 11 ~ i " ~\ ~ ~ ~ ~ ~ FUNERAI FINM AND AOOR ~ SC/iL je~ 7~. . ,~~'vl`~ .r 1 / .~ - ~ ~I . ~ ~" ; , ~ R~ tSTpEET Np.~ i ~ ~ . KITYI /~~ ISTqTEi • i Qbl r E , :~ Sr,ea~ 3une~rc~ Hvme Snc. ~i~ lrentv~ /4venue `~ ?aine~vi~G~e nhi,o 44m ATE REt'O !v REGISTRAR'S 51(',NATURE OwTE ~ERYIT IfSUEO fIGMATVRE Of ~ERSOh IS51l/NG -ERMIT pST tp_ OC~t REG ~..~8-s ~i~ ~ ~~..~ CAJ~ ~ ~-~~~ ?/~~r ~, ~~~.,.,~ o _ ~~~ 521400 1961 ~lN~ 24 t~'. ~ 32 SiF L~ fR F'Ci t`t ~'~.~ ~L" ^~CkiK ['• ..' ~ ~ ~"~ ~ .. _. ," Cl- tSTATEI ~I~-1 4407~ 9x+wTE ~RTEpv~~ iN OASET AND DEnTM j~ - c ~a'~~5~ F~~f 645