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HomeMy WebLinkAbout1846 _ . - _ - - . OH10 DEP!?RTMENT OF HEALTH t31.I,j~~~6 p,~. DIVIliON 01~ VtTA~. fTATIfTtGf ~,y~ tr~..n ~a- ~-:!'1~ ' O. CERTIFICATE Of' DEATH ~•~'~~t~. ~ c0{M+n , . 1 • wh~rtw~: , ~ - AtxiewM : . ~ . _ , s : unn ~ Ohi~ . .K ~il~ cin, rtet~vR,~ ~t~ • _ > I ?EMGTM Or iTA~ IM 1? afr, mtw4c. ~ , . ~ ~ t . ~ ~ Z~ ?3f'i~2 ~~t iJ ' t::;• t~ ° . _ Athe~apt a mo ~ ~~i F •.r. ~ _ ~i • I. MIwE~'(! ~~u psi ihn~ ~J/nul I. fit!!T f . ` 1 • - ~ # - 110lIITAI Ot .t:~.? J" •`~'~.;,:i~s~ nnnrur~a+ A#.he S~ r ~ RoU! _ ;?t~k*ii~e ) ~ ~s nwae w or~?rn i-~oe arr ~u.irn ~ ' ' • !.-N MSIOlMQ ON A MM11 _ ~ _ ; ~ T - ~a - j~,, ; ~ , ft! MO .~...~.~,.d... s.. ~ ~ ~ :'3:w.'~ Y!= NO ~ NAME ' • r Fux idd1~ : i, . 1 . c~t - DECEA'.~iED - ~ ~ - _ . ~nr~ os nu.-~~ . Eli~Bbeth - i~~l ~r':3~{ E~ 6 21 ' iEi GoIOR Ot uU 1~. ~wtlEO M~?2~ ~uutltn' _ : ^ 71` f~ 1~rr M Mrr 1 ~w ~ If MW N M. r": 1.' ~+q1~/~ J1l~~~lt D+)~ H~r~i ALs. FOmale I 1~Ibite w~oowco D avo~ae:±- - '-~~1 ~ ~ ~ i0~. YfVAt OCQ1~A110N fGiH~ n~r! l~~t 10~_ [IMp~~y~ ~p~ If10Yf1~ w~~j• 1~. Ct~lltf! 01 t ~rrL~ Nr ~l .~+f«y lii~, wM N .~?ir+dl Qi~lrl . ~OJ[LS ~ ~ M/MAT tOYNTl7i ~ Z HOUaCxii! ~ • - ~i~`~~~ U S ? : : ~ r~n+eri M~ ~ . _ ~a. _ w wu~ > _ _ _ ,1._- ;a.. _ ; ~ Arthur Ferree - - i4 rear _ - ~ if, wA3 oEawslg evie ~!1 u. s. Aw[C rolast Ii. imp~?t iiCUt~T1r No. t~. 1 AN 's HAME AdAeeu ~ O ~Yti. N~? i~M~ N/ lin rr rr lru ~J ~nrinJ I t ~ ~~S~~• ~ t~. CAUSE DEATFG ( ~trr ~d~-~~~ rNU /et rN Jwr I. (r . tMlE~vl?l ~lTw[tM ~ ~ v~?n outM wrts uuseo ~r. ~L1ir10T4~.it _`~T Y . HWtWATE CA{/f! t~l _ _ - _ - Y .O .c ~ ~ ~ - ~ ~ ~ ~ arE-TO r.? ~an~e$tive Heart Fsilu~e _ j~~•~~ _ ~ ~ : : i'.~.: . ~ . ~ j . . 3 - - r ~ /rt ~Y! ~O -(cl _ I . Z !li ~ r • . _ z ~~~1 11. 117~/ iN~l/KYt CHM/1~/ CNI~INT1q H DlR• •n t~r t~u~~~ rs i~1/I\q ~~tf~{~ CMMfIf~ sttti i~ ~nn Ma) - N_ WA3 AViOSS1 ~i ~ o : 1EtfOi1AE ~ . r Ure:?~ia - - ; t S _ rts D~ +eo t. ~ ~Oa. AtL1DfN1 iYlCIOf lfQMIC1Of ?Oi. OEfQi?[ MOW 1!/!U[Y OGCUtt[0. /Ew~rr ~~rr~ ~J i~j~r~ /at 1 s~ Ps.t ll JO.J ~ { ~ O O U ' ~ ]Oc. TIME Of HNr Al~l . Dq. Y~w • t f INJYfT i. i . ~ - ~ ' ; ~~or. iMxrer ooouea~ - ~o.. r~~a or iMiuer f~. s..•• «.a.r ~o+. cm, v~urwE. o~ ~ou?T~a+ tounn, 3UTE ~ - ~ WMII[ AT 110T w111Lf /ww. ~~cer?~. Nrerr. ~~te X/~.. Nr.j ~ ' i- wPUC ~ AT rI?O~F ~ - ~ ~ 6~t5:66- ~ ' Jl. ! ~tu~/~/ tM /rrr~~1 /rsw_. ~ t~- " ~ ~J l~n i~ ~lirr ° - - • ~ = P~~I ~r~wstl ~t l~•a~ ~s tie ti~ Nar~/ i~ 1: ~J t~ I~ bn ~J wr twNl~lp. 1~~~ K~ ~w~~i ~t~ul . ti.. SIGNATURfE • (D~p~~ w ~Kl.l 1tf. ADOttf3 7)~. OAT[ SIW/EO - ` Ic~~•~,r,~ ~2 ~~„~,6 M.D. I Athena State Hospital ( 6-21-b? ~ ?7~. tiAt. C 27r. DATE 73s. M/wf CtrETE11? W ClEMATOlY 7]~. tOG110M (CHT. 1orn, ot tow»T) lible) Sg TI f~ ( - l _ 3 f G! 1~. Oi /~1e. no./ I3. ~At DItECTO!'f i1G1lATYt[ 1uC. »0.1 _ - ~ 4 ~ y 7,~ , - s'o s ~ ~ ? i (filtlT MO.) _ (ifATE~ ; F ` J~t~~y,~, ~ L ~ ~..i «n~~ - - _ - - ~ ~ _ - - - - ~ 3 y . C u.~ = cr-~-Y C~.- ~ : N ~ic~o ~r - ( eec~siua•s~~ "i~.~-+GI~ { n. - ~ o n ~ so. ~srurt s ~n . . , ~ - t: ~ . _ . • ~ ; - ~ ~ r~ ;~..,r , , - ~ . : . ~ U R - ~4~ PAGE~~~~ Jl;y 1 ~ ~7~ ~ ~ ~OOIt