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Death Certificate - Barker, Mildred Mary_11/14/1969Certifi� Co�� of a czninncvr CERTIRUTE - EMaoar.nv REGISTRATION � cEanFlUiE DISTRIQ NO. r.u. a. v.,�a �� Y[PMAN[NT INK See a mo.w� m. �a�P.. .� fuMml �uK.vs HwS[m: : n+ST.uQIGriS _______________ , STATE OF ILLINOIS CORONER'S CERTIFICAI DECEASED�IAME finsr �. 1�ildr RACE K'HITE N[GRO. �ME0.1UN INDIAN, AG iLC (WfCIfT� BI0.1 <. klhit2 s�. 9. IiIQ 2 ; sb. 5 � �Irc51pE CITY :��ES/N01 U.S.e�. - --- ----- �Z � It3a. L RESI ENCE 5tert ' ;ccourr '-- -- -- ,.o. Inc.iana . � �<b.Gi FATHER-NAME ,m+n � . . _ j. �= � l�[]..! .15 ._. ` .: _..:: Johri , " INFORMANT'S SIGNATVRE ' - , -- ";-�,'. no.� 3udolph Aarker _. 18. DEATH \VAS CAUSED 1_"_'________'_' PART I. 2 '-- --------- . . _ co.voino�s, �r .:+r. _' __" VIHICN GAVF P6E TO � - �w+[oinT[ uus[ Io1' . � SiAi1NG THE � U40ER- -------'----"' LbnG UUSE USi. .. s'____ -'___"_"__ 5 i�________________ P'_____'____"___ NOSWTGI OR OTXCR �at�ecorc� :� , STAiF fILE r+uMOEz OF DEATH SEX DATE OF DEATH Iw.ew:r+, ���, tuvi z."emale 3. October 'i0. 14�0 OF BIRTH won*�, o..,rnn� PLACE OF E� A - <y�T�' •14-1907 ( �a. ;�:t. C�r-�e1 �i=t=sh NTION-N� W (IF NOT IN EIMER, GrvE SiAEEi AN� 4UM5E0.� iYAiIOPI ; KIND OG BUSIM1ESS OR INDUSTRT �VS. WAR . . . I . ilrES/xol °St.�C !736. ;13a NI , iv. iCN�Y. iY.�P. GP RO�O'JIi:PICi M. ' IUiICECIiY � �YE$/NOI on' ��«.Or�ensville ��aa.Ye uooi[ , un A10THER-MAIDEN NAME_ p�a ;3ChU1tZ - � 76. �� _ � in.'l; ��:�_:-° iRELATIOM1SHIP, �MAILINGADDRES$ 1sm[ Sii[Ei MD NL'.�n°'0. �<e.507 MiooiE � _ . ,,.,. ' ` ;,,hY:usba,nd; „�507 E. C12rk, O�rensvll �e:1[a o.v�� ONE C�us[ c[a uwe [On Io�, �ei. ��o �q) I E� ove ro, oa ns n co zc:+.�e�cc m�. � . . , (b) • . 'Wf i0. G4 t5 n CO'Kf^UL`:Ci Os:' , . • • . . . .. . . . ' 1 �• • . _ � _ _ � .. . . . . ' . (c) =ANT CONDITIOM1k m.w:io�s c�.�.eie�n��e :o ce.�. eu: �:c. r.�....m ro oae ��:m i�: >.cr �:_�, I, � l':�OfiE5H.l\E�IS�lCIF1� ' ' ' ' - ` - - 20a. � 206. : 20c. IVJURYAT�YORK 1PLACEOFIVJURY�:wv.e.�.e,v,sratt: �LOCATI( �vEbr.O� . •-fr.C:OR�, Oi%CE tlU1t�1.�G, FiC 6GfU'vl - , 2OC. � • 2Of. . . ' . .� ZOq. I C(PTIiI TIiAi If! MI OPI:JIO'!. 8PSE0 UVG': M! ILVIS:IGniIG': '�AYO/OR illf IN�JUISITIQ!:, Tilli' DF/�ill C��UF(�C� 0:�� iHE DATE: 21a .' qi, illL PIPCE AuD WE TO TMC UUSC($I FAIID, FnJ.1MTT --- _ CORONER'S SIGNATURfE ' � ��J : - . � � i -..A�:':���. .O'i7��::.r� `'/_��i�IGC� A'/L.iii� � BURI - REM - 24a. FUN � al ��.�'•+alnut .. ('�ES/�'9) ' --_:, i9o. j�eS �ISb.[� CF SERVICE rk St. 4S: T'. Sin:E. Zlii• • • �� d. „� r. :iSi:: :._ . - . °5 nncJ dv�....ie�c.�.._...: ° ai.::���rz.":?: �' . . '"" __ ._" 1 i . � I-0. : 20d. - ( ICRV. VIL ON :CWN: Ci TN0. CR RJ. DIST. A'O.: CCLti:r: 5:�:(. � . .: . . ' . . 1 CEDEf�T WAS PROYODUCED D�AD OM1' � AT, � ^u:::M J>f '� �ctober- 0 ..I:�l 5 ' "�:;3'J_.?. , 3 9. .9� -::i,<: , ..,'.,�. � DATESIG'`ED, • • INO' .:... ' � - ��22ti:;:::'. � �G_,� ' _- v ': DATESIGf:E. ..r iM]a.n. J r. �Ewa�•-' __� i� ... -. )� y � . ' .� ._ _ :c236: _/ "_'i°J�=� "`CITY 00. TOW4 - __ - S AiE � DATE WJ�"Th. ��Y� YE��� �ort :.rG*�ch� ,Ind...` .Lzaa.l�_�_1���' . � ,�zsa. {iolde"r=vFUneral�`-13ome, 319_::5, l�iain,-:0;•�ens.v.11le:;._.Indiana_� .,_5.55 . n FUNERAL DIRECTOR'S SIGNATURE . � ' ' , � vu�=zr.t owecrcv�s r.:wciz uc[cs[ nuv=[a ' • i 256. � � � - " .ti:.- 7'� ' /Oc.U✓ . . � 25c -1!-%QU : � _ . . -C . . LOCAL REG� AR' �51 �TURE ' - ' , . � DATE'RECD. LOC R GISTnAR •- � _� - _ -. �� � • - �i � 26a. " . " Z6h ' " V �O�L � .• . T f B 1 [/_� P RF� �[S2AILSLGS • • ''� . •.". ��' l H6HF.8}' �C6�RTIF}' TH.I T d�e JoreGOing is n true nnd correct"copr_o� the drnth'rerord jor ";hr'decrden..nem^J c�� ii'am 1, �and�thef;ri_��� i� record u�ns. este%blJi�shed �nd (iled iri mv o((ice�in accordanee�wi[h d�e pravisions oJ Ihe 1(linais Pi 1 jeatistii>',•Ict,� � � ' r UATF. '/ � / /��/ I Y �' � . � -���-" . . . ' �". _ _ . � " _ . ._ 9IG:YED ���� _ l � I , • . - _ ,.. . � ; � . .' ^ � -� '` � �r Mt. Carmel ,�ur�o�s. oFFrcr.qr.rirce -Reei'strar • , .. , ._,_ _ ..•,_,. __ .•'. _. �_ .> : _ _ ; -V 'I : ` � Theodgina! reco:doJ tLis. dea.'h is pennwentlr fi�ed ui!h the fLLLYOlS�D£.PARTAIE�\'T OF PUBLIC HEALTH at-Jpnngfield-.Coun:y.der.':s r.d (os! ' :egis:ra�.c ¢re authon.ed.m mdce rertifications from topies oJ theonginal record The !lliriois s[dtuterpmvide [hat_tne cexijica[ion oj a.death reccrti q b�� the peya.^ment oj Public //ea(th or the locdl regisuar or ihe county clerk sholl be mnsidered as pdma'facie�evidence'oJthe'fac;s:herein s:nted �_j i " _ �- a I i. t ' • i I�5 'IOI B (19681 BUREAU OF �5�'.4TISTICS - ILLI,YOIS DEP-1 R7'AIEA'T OF'PUBLI C HEALT7f = �Y"RI,\'GF/FLD 62i06 �' ; ` �;' ' - ' ' � - . . _ .. .- . _ - - . . . . . -•- ' . l ' . fi