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HomeMy WebLinkAbout0930 ~ ` / ' ~ . ~ 1 l ~ • t~ - 1 ' ~ _ ' ~ { OH10 DEPARTMENT OF HEALTH 69~IZO 5' ` Lh? kUT i~Yi~ITEINMAR(31N ~ Oy DIVISION OF VITAL STATISTICS pESERVEDFOR ~O°"NO f~F,4Ns ODHDATACOOIN~i .,.~..w~o»~.»e. CERTIFICATE OF DEATH ~ i f , ~ DECEOENT-N.W E stim rrrr r..r sex owrc oF oEwn~ pro.. an. rw~ ~ ~ ~LOYD RICKERT ~.HALE ~.AUGUST 12 1984 ~ Rw~E-M~.1Mru.~4es.i~w~rt~ AGE-lw ~rwd~r t v 11 l r w?rE os u~n~ y0..a>. r..~ COUMT/ Oi DEATM tl c.n ~w~w...e_~ ~sr«VY! rr..n/ Ya.. ~ oqn Mo~r~. ~ Yiw.. ' s.. e~. ' x_ ' s Ju 2 4 0 n. CUYAHOGA s ~ CITY. VIIIAGE p1 lOG?71pN OF OEATt1 1100~iTAl OR OTNEII IN{TITUTION-Nwn~ (!/.et r e~An. r.r ~a~r~ W iwMU If NO~.OR fl13T. IM~CN~ DpA. - ONEwrr.l4a.l~wM /J~si~jl ' ~AST CLEVELAND ,.HURON R~AD HOSPITAL NPATIENT STATE OF ~IATN (y~ N U.S~t-. wwt CITIZEN Of YMAT COUNTIIV 0111GIN 011 OEtCENT (NMi~. Y4tiun. GrM~. EMIwN. QlY~. SOCIAI fECURITV IMNE11 ~si1 ?urq 11.an, Ne.l lSMrYyI - 4.~ ~b. f0. ~ ~ ~SU:c~AfS~OfNCE M~l?SOECfASEDEVERWU3.AW1EDSOiKEi1 MARNIED,NEVEIIMAMIED, ANIVIVtN6!?O1J~E~/l~wF.MR~~~I Y~EREOECEA3ED tYq,aqr.+Ww/ l1J7~tl~~+N+~~l '1wDOWE~.pIVd1CE0/!~t'IN'/ ~;veo. iF ocwn~ ~~rj0 ~b. Married Mildred Norris OttclpRED~M URJALOCCU~ATION/~+tMlN•at~a.rlo~~arN.o.tlfl~h.naYI+~YM/ K~NDOf~NtINES5011iNOUSTIIY IHSTiTUT10N.GlVE REYtAEMCE ~Efp1E - A~ ~iSu rvi Construction L~r ~ATE - TI ~ITY. VlllwGE 011 IOCAT1pN STAEET AMG MIJYtE~1 ~ INSIDE CITY IWITs Is~.r~h r., e. M.1 +.D Cu ho a=«. Euc 1 id ~b. 412 7 Greenva le Dr . Y fwTM~l-MIItlE !Mr lt,lsk 4a YOTNEA-Mw~DEM NAYE Frs~ I~YOr 4n s 1 , u ustus Rickert , Blanche Baker - ~ MfOqYANT-NAYE IT~ rhiry MAIIING ApOwEiS 1ST11EET 01~ R.f_O. NsJ IpTY WI TOM~l1 tSTATEI lZM1 bert A. Rickert 8549 Tanalewood Trail Cha rin Falls Oh 44022 2.~---_ ~ I~t7L OEATM wAS CAUSED BY: (EMTER ONL Y ONE CA(/,SF PER L INf FOR (~J. fbl. AND /c/) ~E7~EN waET u+o o ~~T?~ z ~ ~s. z r C~ ~ ' - ~ 11r1E01ATE GMlfE tq 3 / a ~ OVE TO. A QU - ^ c'o.6nw. ywr..ac~Y ~1 = ~ert ~ut M wwtdl~te ~ Z ~x OUE TO, ON AS A COMSEdUEiKE Of: ' ~ !~w{awutlei ~ . - Ic) ~MTI~.OTMERSIGN~FICANTCON0IT~ONS~CeMtrorcownYwr~nMrs~r~wor.NnMacr=~+~wwM!/~/ AUTO~i~ N~?tCAtfREiER11EDTOCOROMEII k ~ , _ IYa r~el R/+cVY Yn w Nol ~ , ~ J CcJL:~~ ! ~CC.. SU~CiDf. ?~OM.. OATE Oi ~ NOUII MOMI IMJUIIY OCGURAED /l~ur~rw~ olyor M MlrArr ~ l~w /f/ - OR?ENO~NG IMVEST. /l~eih) p1eaA1. Ai~. rr1 ~ „ 70a . 70c. M 1lIJURY AT Y10f1K ?LACE Oi ii1.RJ11V ,1r tiwr. J~~., mrr; J~sn.y. arylre IOCATION /ta~rt e. R.F.4 +a. Nry o~ ~R w~. dIl E ~ l3N~Vl 7n ar wo/ M~. et- /J/er1~y/ ~ , 10~. 20~. ~ _ Te w CoweMe~A M ATTENDINCi PHYSiC1AN ONr Te b~ Caqi~~i b OORONER O~h ~ t 2t.. To eM ba a w~r k . aru~ ~wr r~a o~e~ ~ne eua w iti cwrbl Ow w O~i~ d.an+irnan nWa ~rw~tl~. ~~wr ov+~ 4M aoo..ti w er uw. ~wr ww. .+s ora w ew eo r~. nw.~,~ n,~.a ~s+r..~.~s rr~.~ ~ ~ • • ~s~+.....d nw~ DATE S1GNE0 (?fa. Q,~. Y / Oi OEATN OwTE f~GNEO pla. a~. Ys1 ~OIM~ a` OEATH 710. ~ L ~1c. M 7l+c r V f0 OEAO lite.. Dr~. Y~ri MOHOIiNCED OEwD ~Nov~ . pr Tt~. AT Y ~ MAME wN0 wODRE3i OF GEpT~eIER pNVS~CtAN OR CORONERI /T~/r whrri It~t w R.i.II wu: eyy r~i~r, srK WI ~ 17. V~ V7 ~ Z l WRtAL. CREYATOl1, OATE NAME Of CEYETfRr 0~1 CRHfATOIIr IOCAT{ON f'G14. Ars. er n~ll /f~rl OTMEH IS/ec/h! z.~Cremat' 8 14 84 ,k.Cremation Service I. Cleveland Cu aho a Ohio NAYE OF EWALMEN IL1C. No.l FUME 11ECT011'f t1GMwTU ILIC. Ns.l • ~ , • ntdot Embalmed 7070 _ ~ FUNERAL FIRY AMO A0011Efi !fTREET NO.1 KITYI KTATEf Qr) r~ :~Fi ritto Funeral ~iome 5236 Ma field Rd. L ndhurst 0 io 44124 , ~ = ~ AT RfC'O ~Y 11EGi R'f 31G~iA1 f DATE ~Ej1Y1T ~ 31GMA Of ~ER~01~ I~S1V 1W1T O/~T• IM. I ~ 11EG. • ~ L1 r. / t/ > ~ ~ . ~ . . ` 69'~10 ~ f his is to Certify tt~~h~t +~~t~~ py~ of the record fiileo ~ in the East Cle "dtf.~~~le~Ith•Be~xr~~t. ~ ' " • . WIR 21 P 1 •32 ~ AUG 15 - . ~ -~D~'~- ti ' ~ r', ~se ~~r~ = Qate Issued ~ ; - = ; - , - - ~ ~~I ~ F il ED r: k- . . ' ~ ~ ~ ' ROGER F~G:~i ~ : k~; ' ~ cr? : ' ~ . • : - ~ - ST. LUC~E C?:, , ' '4 ,r cat ke~?istrar~n~ Vitat Statistics ' ~ C;~'•;R~~strat~ao-~istrict" No. l~ ~ ~,~t ~ EM~fetan~:"Ohio c~~ ; ' ~ r. : ~ - = R ~1 ~ P~~E ~ : • . . . - _ ~ ,u , - < s . . ~e: ~ _ _ _