The URL can be used to link to this page

Death Certificate - Burbank, Elizabeth_5/22/1972IY(GISTNATION �� - f _ �,�;Tk��T No. 3 IM.F.GIST[RED � 92 e ni^na ert ILLC� NAM[ i. � � 6TATE OF ILLINOIS �iN�iO[q � CORONER'S CERTIFICAI"E OF DEATH , � - asr mioo�e �r SE% � DAT! OF DEAThI Unor+n�, onr, vua� ,r,.- �i �,e �a.,,�(" z F'emale � Diarch 14r � 972 Y.AIF. W111tf. N(CqO, /�MC0.1UI�"�t1Ul/�N, nl�G—L �m. R��arri aiaiHO�r �; Ylhil;e 5�, h CIIY� fOWN, iWV. 00. RO.�O �ISIRICI NVMOLµ �y Chicago Heights BIRTHPLACE Itrert oa ronnoi CITIZEN O COUnT0.Y1 dD[R I YEAR• UNDER I�AY DnIE OF �IRTH w.a�n�.onr,ruw 7LACE OF DFAThI' wuHrr MOS. � O�YS � MO00.$ � MIN. . . . _. . : ; s�. • 6. Ayril t, t 925 ,a. Coo1: �10(Clt♦ �NOSPIL/.L00.01tl[0.1NSIIfUIION—NAMf (IfNOiM[IiNCR,LIVE51qLCfM1ONVMYEN� sina� , yes :�d D.O.A. St. Ja�aes Hospii;al -: �_. COUNTRV MARRIED, NEVE0. MARRIED, NAME OF SVRVIVING SPOVSE qu.ioEHHe.e6itwirn WI WED, DIVORCEDIS>ttirq . . 8, t•iinneaota 9. U.S.A. �o, inrried ��; t•lorthley Burbank SOCIAL SECURITY NUMBER USUAL OCCUPATION { KIND OF BUSwESS ON INDUSTaY ' U.S. W�R VETERAN � WAR OR DATES OF SERVICE ��Y{S/NOI ` 12. ��a Aou�evrife ;�3b At Aome ; i�c No ;��a. RESIDENCE nwrc ; cou�rtr . �on, rowN, r«r. oe wno oisramr �o. � wsmeu.r � smc[r er.o r+uMO�a Indiona .... Gibson Orrensville . '"`�yes ; 202 Diill St r �e. Clyde DEATH w S CAUSED BV: MFDiAiE UU1F •l�c. � l.ld. I�c. ✓sr MOTHER—MA/DEN NAME �iasr wioou .� us� ��' Culhoun Pearl - �° � 16. ;_;,�� ElAT10NSHIP � MAILING ApDRE$5 lnn[n wr�o Ho. ox a. r. o.. arr on rowH, s*nr[, ziv� �',r,�,iusband �� 202 i•lill St, Otirensville, Indiana 470'6' �Mi(A ONLY ONE GUSC YlN Llrvf iOR lal. IDL GND (ql �srnOnm�ie irvn vu UM't[rv Onili wrvOpMwi�� /LC,<�o!✓.iz�a.� �n'�`c.siL�n' .. . WE TO.OR AS.� CON$[Q�'N�E Of: � // . ' �/ coNOiiioNS, ir �Hv w111CN GAVE FISE id (b) IMMEDI�iE CAUSE ( I STA�ING LME UNDE0.- OVE i0, OR AS A IY�NG UOSE LAST. I�c<mc�r smuoc, �oM�uoc. ou unonlu.nwFO nn�arr� � / ' .. _ . .. _ . . ... t�rr.�-aG/zr� �e �i�et�h �}�� • V[NCE OF. . . . . . . . . . .. � . . : � . .' . .. coNOrtmr+s cor+rxiemi.m ro our� em wr nn..w m uus� cnw irv r.a± i„� AUTOPSV '!o n s'. weiin`.� o�res co�• IYES/N0) ; o� o�y�. �� 4uvr ...._........_.... . .___....._..... ._ _. ._ . ryL5/rv0� ' • {/d�00.V.OfRCF BWLOIN4 [LC. I50[biV� 70c. � 70f. : 20g. ' 1 Cf0.TIFY THAi IN MV OPINION, BASED U�ON MY INVESiIGT10N M � 9 .. ' 19a. NO �I96. ' OCCURRED rt��u nnrvx[ or wrvn..wno�+eo i� r,�r i' IN; 00. TVP. OR PD, pST. NO.; CWNiv; STAi[� ANO/O0. TNE INQUISILION, THI$ OEGiN OCCUR0.E0 ON iHE DA?E. R1e �T tNE VUCE AND'DUE 40 TnE Ut15E(51 STniED; ArvD r»„r ___ ; Z„ rcaT�ii ��4�� 972 � ;�21�, 5:3o r M CO QNER'S IZ GNATUR �b� - ; DATE SIGNED (u�ant„, onr. rua� . �'r w rti..,..,-+,., . �x�� . � ' ; s�n. bTarch 15 � � 972 CORONER'S PHYSIUA SIGN(�TURE _ . DATE SIGNED (morvrH, onv, rua� �va.D ��il�� a-e«�"� . - � ' � - � f �3n. ��`�� /5��_- rBURIAL, CREM,�pON, ` ;CEMETERY OR CREMAT00.V—NAME ; LOUTION Urv oa rowN nwrz ; DATE tMOnrn, nwr, v[wei' REMO�AL 1sr�arv� ' pit. Emblec� Elmhurst Illinois � riarch 1% 197_ sia. Burial '��a �x.�. � :s,a. . FUNERAL HOME NhNE . sra[n er+o vuMern oa a r. o. uTV oa rowH . nnrt nr z5a, John I•I. Pedersen & Sons,Inc 4338 Flillerton Ave, Chicago,Illinois �. 60639 FUNE�RAL �C� pR'S SIG��.�T '. �/ . .ruH[an� o�atC*an�s uiwon 4CEN5[ NUMOFR . ,.� P'�/ /�'oC ".- � �"/%�� P_ ./c%C��,�J./// � ��. F-603 ' YS 702—(1959) Oi VUOLIC HULiN — OUPUU Of STAi15iICS (BASFD ON 106E U. 5. STANDA0.D CFRlIfIUT! x� . i� .TJ Ol � N ' Q ro'•� o � �-< H '�� G�1 ; � .0 A�� N I � r-� �'��p.: r c� O U7 ~ .-i �� 1 a ��T �I .0 +�'� r�, � �V 0 3 � N O U W '0 � � ,..1 U 0 ul � `' ��''. N U C N f�i'� ' N a� o .r` N N •.i +� j� , � � � � � U� ul •�-I N � � •�+>v ro .c o � Y a' � � � Qf }� Q •• 11 +' +� �ri z .a N C � W � N - �a •� o � � ��1 � C � � r'� 0� • V •� �-i 'ri � �a �d p rnero� � Iv N O Ul (n. N �' U •.i H O H U O� O w � � � �'. }1 � •�, � i� t�. ;'�� J: H ` G� Q� +'� �.,� . I +a. N' U �► ,a,v•��o��a� '��n� > .[ry�w�,�,5��.m F,�, � �'w,,.-'.o ? N O O� N x ' �j..bi.�-�� ( H� H �NtiE �+�' � W i, � � Z H F�.'�. �Q � �. �I a �V C .-� W' ' •.i� �N � � U 0 ,� .N ' ' U'I �.wvm � wro�°1 u w owy w I H N N(n Ca Q