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Death Certificate - Beuligmann, Frances_5/5/1971VSGR 200.1 Bwd ee !e� lNl Rnnion e! u� u. s s�...a.m Grtifiub ol DuN 1 COUNTY RECORO DECE�ENi'S BIRTN NO.: 1. PL�CE OF, 4 COUHTY � MEDICAL CERTIFICATE�:�EATH � STATE OF ILLINOIS IIi USU�L FESIDENCE (w'��n Esn �. STFTE t :.5..�..!� . ilunois E. CITT 111 ouWEe roroonl� Iimil�, .db RUR�L �nd oin a LExGTH Of OR /� � lo�n��lol STAY Iin I.�h pbc< TO'.vN 1']:.1 . Vu_��:�� .1 � �-! _']"•v d. FULL NAME OF �II nol in �moild e� imlllvlion, Cin �4u1 �ddem er leu4en) MOSPITeL ON in�sriT�riorv t':a[X3^:�.2 _C�3a1'.�.^"� S!�:�i'�+l !. A�NE OF �. (flnl) �•(MiEJIe) �ECE�SED �y ^_ (T�v� er PtlnU ?.F'+.i� Fi":�CiQ.�a �-c:� COUM1TY FILE N0. � ..m r+.a. u E. COUNTY c. CITT 01 oul�iE� camouh limil�. wrib RVRAI �nE on TO'.vN Il, i:.. yi.r'Lr G. STREET �. Cin Ixation) u (laaq " 1. OPiE OF ���1 DEATX f. SE% L COLOR OH R�CE l. M�RRIEO. KEVEN M�FFIED. 1. DATE OF BIRTH " f. AGE WIDOWED.p IVOfiCED (SOeeili) ����� i'TC`1:�0 � t:'.3'�..4 L:l..r'�C:2 ��u :�� t%� r �i 14. USUK OCNY�iION �Gb� Yin! ot ed 110. KIRD OF BVSINE55 OR IN� 11. BIRTNPL�CE �SI�N e� 1onlOn eeuntry) aen. a.r�no mm� al —eru�� ilh. v�n u ntlna� �USTRY i,pr� �.�L^fl^ G'ii� }l�i.:i S�': i�i�'::n'1 _ i 3lti"ni �t 10. F�TMEH'S N�ME� 11. mOTHEA'S MAIOEti NPME" v __ _____ R_e__� S�_'!!_ 4L_�`�' •. - IS. WAS DECE�SED EVER IN U. 5. �RMED fOHLESi 1L SOCI�lStOVm� ♦ ��, �gpORMANT ' IYO. ne. er mtnown) Ilf p�.0in w.r or Edn al unieq N0• •. S�en.Wn _±�o_ ra:a '"' '�— � 18. CAUSE OF DEATH . e.eaamu 1. OISE�SE OR COti�ITIOH �IRECTLY LE�OINO TO �E�TH• W r,,,.:: :-.-; - �TM. ae<. �,� m..� ��. m,a. ., a����. ,��� .. �..rt ,uN,.. u�M��.. .��. t Il mum l�� Cpuu. In1�rY er cemolic�lian �Aie� uuuJ 0u1�. ENTER ONLY ONE GU . J . J � . • • � C��.cra� o�' ry-�,_�3.ol.addor , ' � Direct cautc (e) � F . � °z wm Mn.em conawoe., v.�y. . � o °w� o��i�o ��•• �o tn..ee.. duc fo (D) w u< • d1..LUna u. F � V unEOlrinp uuu IuL , < i duc to (cl ' . < II. OTNEH SIGNIiICANT CONDITIONS . V CenG�liem conlriDutinO lo l�e 0ut4 Eul nol \ � '� n1�4E 10 ln� Eituu ar COnJillOn Crv�inO <aIn _ } i IL. �ATE OP OPER�T�Oti Ife. M�JOR GINOIAGS OF OPERATION ���� e (U65�1}/9) r.m�N e. �n� .mm�sa ]b./.CCIDENT SU�C�DE HOMIC�OE (�aaifY) I nom� iarTE 1�aclor>� i4ul'�aflic<�Gle:.. � / HEO. F,, NO. l.. �ulEmu Delon �Eml�danl. IO.n11+ID) (MOnl�) (Dq) •{TUp I/ Untv 1 Tur 11 UnE�r il Nn. MenIM D+P Neun NIM � ti. CITIZEN OF WNAT COUM1TRY} O lello� So�cial In�lrvel�an� an Inl� ibm) ' I's,1.:r,:�-:.t � - c. P.i+4en�nio te-tM ea....a —^ . �r7 =%i� l :-:+-�ri7 E FOF (U. <e). �ne (c). �'�OASET �ND DEATH� ? / � ]IC. (CITY. TOWN. OR TOWNSMIP) L.AUTOP�3YjT YES Ly M (COUNTYI fST�iE) � Sld. TIME (Nenl�) (Day) (YUr) (Heuq Ile. IVJU0.Y OCWAREO ( SII. HOW DID INJUFY OLCUR? OG Wnil� 1 Aot \Ynid W INJURY � D' �1 \•/oii � � • .. U � . .. +�(` ��.-.•� i..._� .1r_ IrC'7 �Aa� I(v� ma 6� duwrd �Ln < y. / Arr.Ly m�i/Y Uwt 1 afhnJrvllAe J<nerrd /'on_1i�f-4i_� ./9—.(e—s'��?7—���.�9�. V f� � p ��'1'-h ��e i��s�? .ie—... a.A.lLn� .lmrA .v n.�f n� �[y_.�i ./ruw rtr ud..� tir datt tln�•d cMrt. . � . � � a—m. �anvr f`.Ja.�51GFATUHi ���.{. [(Deyee er Ii11s) ll�. NDOFE55 AND PNONE^�N�O. Il�e'. �D�A!T�E SIGHED .� 1�1LG.rV �.)��1I��1�LJ�_1 . .. ir� I �LCy • .•ji�..� �.1�.• �'� Uf'�.J ti4J� ��J� RECEIVEO JT"��—� 4—.��.�'� •.a—I fOF FlLIRG OV: .. • •• w V � JQ iirm N�mr� ¢O V �GErtp ~�• �� ^ yO ��V. Q �,,. .�� s::�.: ..__; C{j = :;. i.7 11. iCj. — — " " SUB REd�5T0.�R OE]UTY REG�STR�F IOC�I flEGISTRAF: " � PdEroc h,��.^��, . • ILLIN015 p( {ye $nte ol Ilhnou y56q Y'I.t DEPAFTMENT OF PUBLIC HEALTH—Di.i�ien pl Vibl 546�uc� �na moem� �^ <o'"" IWprn� " " -- . .ILLIB015 I . i. o �.�aa— � �w � Pe�w�C For Sut� Olflp 1 U jC LLp LiC4�f� . � SiM+��� NvmEer 1 i! IJF.Rc'B}' CF_RTlF}' T/I:dT rhr fortgaing i� a�s+.r nnd rorrrc: :opy of 1F.r dratb nao�d for tF.e dtrtdrnt nemtd et ittm 3 cnd �Fat thii irtord � � •ret rtteb:iti.rd nnd �ltd in m+ offitr rn 6r�orJcnu _ith tht pro:irioni o/ 1he Illinoi+ .rratr�trt rJc:ir.A fo �ht rrgittration of bi�t61, itil(birthi artd I drarhl. ��.�7E- April 28, 1971 -- — s:G�ED��_ � � . , � . .,11� ___�[�__Cg�G� , Illinois. OFFICIAL "I'ITI.E COLnty l'l�rk b�Rncord�r � Th<od¢iaal rcwrd�oftTia death i� permanently fled xith the ILLI�OIS DzFARTME\T OF PliBLIC HEALTH ai Sprinpfidd. County derta and loeal re0�tnre arc amhoriud to au[c ttnitieatione trom cople� of the orieinal recerd. T�e Illinoia etamtee nmvide that thc certitication o( a death record Dy the Deparcment of Public . Hea:tL or c6e iml reciatnr or the couvty dtri �ha17 be arima fad<o'(dente in all rnurU and phrn of the (acee thvtiv auted. � � VSGR 207. DEPARTMENT OF PUBLIC HEALTH—BUreau of StatieUc�. 7'rinted by .\uthoriq� of the Stnte of Il11noU � . • • �. —