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HomeMy WebLinkAbout0970 ~ , ~an~~--~~~. ~ rA~ ~ ~ UMIU UEPARTMENT OF HEALTH .NU~ • t ' R~r~ ~hMAHii1N ~ t ~ OIVISION OF VITAL STATISTIGS _ t3tAVEl~rON H.Y~;.~ N.. :,a.~ .ti, lJ~c~~_ _ W10ATA1:UU1N~; ~..~.«.Nry..~~~~.. ~ CERTIFI~CATE OF DEATH N»~~~~..•~ ~ yWM l~at fkt UAIf G~ UkAIN~.y.. lNI. 1'a+~' VFfFDFHt NAME Iin• ~ FLUYD l,L•'UNARU NAL~ ~~Mal` ~,Uctober 23, 1985 - _ _ _ _ ~~~~F~ t.o W~~u.Biw? ~~w. ~A4E .n+tl.~~wr ~IkOFP f r~~H l'NUt•~ ~ 'U4/t Oi t~A1M~Mn Uhr.P•I ~tWht~ •~t ptAiN av~1 MC I[ :Ip~ I!~'~ou MW . W~~ ~ N.•.q 4.~. i • . '~iil~~` 6t3 !6June 24, . 1917 _ ~uyahoya , ~ CIIr.VtLIA~.ClK1l(lCwll(~h:li DE~lH HOS~~TAIOHI~nfN~wS~IWt~• ti N~i//1w~r~m~r. ~n~.w•~++.l..w?rU 11iM03?OH~tql ~.i-!?~OJ~ 'Of,fnw firw J•wov • •.•rt.~A Clc:veland Clc~v~land Clinic Foundation ~ • IIl d~1C11 _ g1All~»tl~HM,qar.nl'S.~ wn.~lihZFNU~7Y~~AtCJ~~N1R? ~Wl~~ItiUROfY.ININI~~~M.M~~K~wWniyn.f~y'w(+o+~. ~SUCIAISECURITY ~fR .~:~r.~. ' ?JM~p~iKM ~Y.I~.~N~~/~r •~'~?n~y~Yanisa ~m S~ . S..A. ;y Ge rma n _ 2 0 8- 0 3- 21 3~ ~'•t NfS~•:ttiCE WASUkCtASfOEVfq~NU.1 dNGEJ«1N(:[S' ~MAhN~kL Ni ENVANPIFU. ,SVRYIVW4'~DUSI +~J~ •'w~"M'~. w•.•aR ~kt.eASEU -I~~.~...,.wlwtin: dl~ri.dK.br~i~•l~m~r ~W~UTN?f G•'.•.•9l'4.y~:q. ~ I t ~r•,~.~N „ yes 12-~2-44 ta 10-24-4K:. Marriec3 ;,A Mildreci tiim~s , ,ti - - - - - - - - - - • -"W '.Wk USaiAt OCCUYAl10N•4~.rlis~../w..~~J..r.a.rvywarn/.wlrq~/e ~w~~/•tNN •~VI.~.~ YUS~NfiSb~~ ~NiA:o~p- f bE~.~Rt ~ V . ~ . Government ~c~iitr~ct Admi~iistrat~r , . '~w wES~dfN~E-STwTE - - (C6UAT~ ~CIiY.VILIAGf OR' OCAUOY ~SiNtkl ~NO VJM~ER ,tiS~oc ~~rv i~u~~. '~3M~p ?u... Ni. Maryland ',4, Calvert ',k 5t. Leonar~3 ,b Box 200 C:alv~ert Beach .,N ~fo fATMER NAME F4~i VMfJ~ I~~t YGIMfM-MAIDENNAYE rnr y~k ~~n ~:dwarci P. Nale: Eva Lerch ' i _ . _ 1 NiORMANT NAMf iTyr o. Mv~ MA~~~NG ~ODAESS ~SINEET OR R f O No 1 ~C~~'~ OM TQyyq! ~STATE~ 17•• rlildred Nale ` Box 200 Calvert Beach, St. Leonard, Maryland ~i. ~m . AMNOX~YATE 'ti • EMVAt iAHI 1 OEATN WAS CAUSEO BY: (ENTER UNL r OhE C4USE ofR i 1NE FOR l~1. ~n). ANJ k?I sE~wEEN a+sET •ti~~ oF•'~ - ~ ~ 1~ " _ ' _ ' ' . - -1~___~__.` ' ~ {MME~IATE CAUSE s X ~ Q ~ 0 V L ~ V~ ~ 'i t!.l . - I - - U~E iO~pp wS ~ C~YSEOUENiE Of ~ ~'-n~~-~Zp ~~2`2v~C- ~~P~rt T 4t`FKc' ~ (t~t I~Y ?+1~rlftStlt ~L~ _ " ~ ' . ' " " ` ~ " " _ . . .was.. ~raatf~hs~+J.~ ~ WET0.4NAS~~I~N~tWfkCEUf - ,,~:~u~., <<,t C~-b~(,~~~~J~ f1.~~T r-~~~,~_ _ ?ART11 UMERS~Ghi~~CANiCOhD~t.tN~S io+~~n~z. ..wrntrayrou.~etiM.~+~ •wrNw.wrp•..M?.nl~s. ~AU~O?Sr TwASC~SEREFFRpfC~,•.,-wCM~.•. !,s,..~n r. w,~. (1~~r ~~rP~? ~ K` ~P.,a...r~c~c~~~.~,tiv+~ vc C ~ r~Nr-H _ a o - ACC SUiC~OEMUM.~autt. ;oatkv~~AA~.•+v ' •,~0~.-' ~~~:M.Hr.H~1%i,liNNf ~+a...ti~...1~W-~w1s.r~whnlL~rnwlf• - ON~tND~NG•~+vES~ ~ ~ ' ' . . 7~. ~lOt~ `M w T~la . _ _ . . _ _ . . INJUN~ AT WpRK ~YIaCE Ji IN:IiN• ~ wr a m ~~~rr~- r~ ~.fJ~r• i .~!~l~h rSr.rr~ or k I U+.. IIr w.RY(~ rtlfr. ~~0. ~ ' - " ISOf~If~ tf1. • wvr ~.IJ~ fM .S~filf) 2~! M~ To er C«r~paiw br ATTENDING PHYSiCIAN r To t~ Canp4ad by COAONER Only 21~ lo wn o/ m~ ' Q~a• ocw ~w,. ~w~ r.~.~ i~ Ww• Auf 1~. IY tNfltJ 7ts i:n ~ra W~f of ~.p+. ~~.o~ M Lp ~nrwf~~~. r. mr ~iw~ Op1~ occurr~d N ~~r trm. un~ fua0 ~ 1 rO W~c~ M~d Ou~ ~u ~M c~fs ~1 ~~~lW ~~VIYriJiYl /~fb. •_~a? /N . ~ ~Y..~.,...,~ r•ri.~ - - - t ' - DwfE 5~4NED i.y.. ~,n ni - IyUUR Jr EAiH DATE S~GMEO ra/~ U+.. 1"t~sr iNOUR OF OEATM i ` 13 f . _ r• M :m - ;n~ : ~,o~ j- I-- - - _ . - - - - ~ . F VHONWNCt~ OEAD l4~ Or) i"w: ,?ROMOUNCED OEAO /Hw.~ ~ 770 (1N t72~ A1 M NAMEwNUA00iIES50FCEPiIiiEp~~NV51Ctt QNl'tlPONEN~rl~ptu.In+r. lSvttru•R~~D+.• rr..»..urr.,ure.+ql ~ -r C~J M. R A 1 ttiv E v<< ~ o A-f ~ C<<-yFt.I~o ~r1 ~ u 44 BURIA~ ~:REMAiION, PATE NA4E OF CEME tER~/ ORCHEM~7UHV LOCATION KYy. ~~'t. e~rwsT !SNN/ OTHER ~ 1 U- 2 8- 8 5 ~rc ~ Washin on c.c~ete Aciel ~tu Prince Geor e laiw~ z., Burial ~~w • l ~ ~~C__~-_ - • - - - ~ - ~ • - - - - NAME O~ E~tBALMEH a~t N.. ~ ~~t~NER~L ECTOR SS~GNAIURE '~~C n, Robert G. Hennis 6524-A i,~ ~~..J` 4986 • ~ . _ - - - - - - - - - iU~kHw~ ~IRM wWQESS ~S~FtE7Np~ (G1Y1 ~ST~TEI - I (2V1 /~~'p 1 1~ _d-r-~ ~?M A N~ i..~ 1.~r~ i.~..cc_t I C: ~/~1 ~ h~V iH ~~8ue ~~t.~.t~ . ~ A?ER[CDBY '~•iGIS1Aa! 1 • iE' _ - ''=%~~~EAM:i~SSUFC .HltUREOFVfRSOMISSU1Nu?ERMIi ~ - At NC4 / 1 • ~ ~ ~ ~~1~T . - ~ ` ~ ^ - ' I~Y t~II'IrY ZfAT T9~ J~ONE IS l1N F.~cJtit.T C1;~'Y ~ 1~E t~'1[O Ii~IC~! IS ~i !'II1: lIJ Z!~ LSP~' at ~LTd~ QEV~~ OHIO. IrI1i+~ 1l11 ~a1lD 11t~ b`fi1i. 116 1LlC.Ai. t~G2B7.3tAR ~ Y1TJ1t. . 0 CT 2 51985 82898~6 ~ '87 ,~1N -9 A11:00 ~FILED r,::~, ft_..~t~rDED DOUG~,~. ~ ~1X :N CIERK ~ ST. IU~~E C~lJNTY. Fl. 600K ~5 PAGE ~U9 - ~o4fii~~ar_ . . - - - _ , . _