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Death Certificate - Camp, Cecil_1/22/1976� �. � ��r -��:�� ���� �j c� .�:ec�,.�a aecor� 'P�-�-�. TION —� £TAT= OF ILLINOIB N�'JMCE4�� no. 800 j �o � :4tE71CA� C�.�-'.TiFiCAT� OF ^EATi' CFrZ;, :Ew��rcN[ao..w[uw.u+oieN. AGE—�ws= •t tvtcoq e�ai:wr (nsJ— x'hite i s�. 01 /, tOWN, TW>, 01 4vAD pSi4Ci NUMOU h� �1 •r:arzon �; "lNiUCE �s*.rr o4 roancr r�?;_cry ns �NMP. rvrtri nlir.ois ir. U.S.a. �� Sndtanz yi"C::•r`::i-r:� � \ � $:�� �t.tiFUR.iV.r:T'S Sic ! v,� i �. P C,•,:.:� !2 i�ale i�. D�ce:�ber ?_2, 1 )ATE OF 91RiH ���'�. wr, �aq � VUCE OF DEA'fH a MJn. r)' �s_ Feb. _ "ITY � Np'IItAL W OiNI4 INSTI'ViIOH�'/�Mf �IS NOT IH I . �-'°s re. ;'eta�r_s P.dr_.^._st�ti.on �H•oy ,vror,�=_0. .ierea, �•.'?f:IEC, •�n1AE CS UR�I!'14G TI�JOVlED,`DIVOACcDtso[�in� RO$� itn '':p7']"P� I71. n0—'l.f:'ATI_'! La�. ?az-F: .:y, Fa ; covurv • o-+. rowu. iC4 UZt7J�-Z :jF�, _.. ii�.ii=Z� TUi:c ?,. nj,rh UcATH WA$ CAUS`_O OY: MOUO1ilON5. I/ A4Y �M:[M WV! V.IS� TQ IY4�.'ilA:[ l'AII$E (C) ST/.TIVG �M( OHp[9� IvING UV$[ LAST. , ���:,ho, F�°� ti+a. �.r.r ,�,1 . � i�+uo=c�n � sr�:n .s�o r+ur.a:a . : .P'U/wol '. :;,, y..� �„_ ?26 �_st 3rcac 0 LASt � N.O(}:iJ—J/�AIDCN h'AM2 R43T IAI]J C V.+. -� . � �f!1�'14 .�l.ri tTC� � . L. i. �, ),VSHI? ' MAILiNG A7DRES� IST0.:C ANO HO.IXI IL i. J.CITY UA TONN.:lAT[. ll:l��—r� ---- ;,��. VA 'r.o��it�+.l, �r.ior., =�1_nois 629,9 Itat[a oH:r CVE uvs� v[n u_.• w: la�. i•nvc ;ql ��wx��<:r:�:�u~.''.•.:n'' P mnw¢. c. :�i uc. ;.:..: �,�.JP.cut� myccz±tiial ir.frac�ion W! TO O: Af A CwVSIW��« �%+ . ,�, /fS�i.2='iOSC� 2r'Oii.'iC t:!'d"_``� !j'15e3SC n'l �tl CO^ �°S.ive hea±''� i87.1- ♦ COMIpCMC[ Cf: co.oino`s cur.�eun+c *o u�rn 1 Ie1 I CEBTFY THA' TO T4E °EiT OF MY XNOV/IEDG`_ THI$ DEATH OCCURRED AT 1��,� D�� M., �� UN THE DATE, AT TME PU.CE A�D FRO/A TH� CAl'SE(5) STATED i/.TTEt�'DEO 7�E w.eH:N . Dnr . rWt wCe.rH . wr . ruJi rle� �r 5/W Wi WiMi r/ .,«�.«„ «,,.,. . . -o , . /rv��'?":�Fy I'i i //i i /'/ •�l`/� /'f1"/ II:w ure. iCcT� IF AN I4JUfiY'h'A. i.\":G_%"- : 'HIS CEnTH, TY.0 _ORSVE'i b?CS` BE D:OTIFIEC��Y��r ��,.�,.,��r ._..._ _._..__ . _ . _ . _ . — - -- -- �so.: � Na*� :.ne * '�i D � zzb. Der . 7_2 � '.975 � �zc. • MAIJNG AD7RES5—{ERTIREF ST4CCT /.ND AV.4]C4 Ml R. & D. UTY 0% TOWN srntt = o �l1 .�"�.757_ ��_ � 1'�..i �P � 11= 1Y-�; $ �Z��v/ �'.URIR!. CREA4AT10Y. �C�ME7EitY Ok CREAtATORY—�1AME ; LOCATION Ciir 00. ii�^v srere ; vaie n.+..... ��,., ��.:.. t� ..�. - n.-K . dcN.OVAI N[ahl �, d ; idd. DPC..!'vt i/� ?io. ;�U_^jd� ',246 u@c. � . •2AC. �-^•Ci5^_O� .�Tffi_.3^� _ : �fVNEAAL HOME NAME STS[ET Aup NVM^u[R OR R. !. D. C:TY 03 TOWN STATC _ h �� � �j. _. ._ ,r n �-- �. ` ^��?�� �:.� Y..,��DALI. �r:. c�ton, Ind`�n� r.,, _ 1 f Vnl:�nl D�i!1i;70Y•; '.i'�NAivYC - . funeM: oacaCx's iurvor, i�av:E vuMeu� `;.n �° . . P.qbc7.-`e-.A. ':;''.;o.^. lzsS`"ll %��i� ��.._.._ `.,`,,,;.Y" �. Charles 'd =._:_'dr,r� D.D.S. i�ec. Dece�!ber 23r 197: 4r' .c.! :YCRrBY CER?!FY THAT rhe !oregofng fs a true and correct copy oJ r'r.e dearii secord fm ti�e deceder.: ,-,cm,cd c: ::.r: 1,-cr:� e::at:;:.': �_; �ecord.waa ertcb(lshed c�id jiled !n my ofjtcc fn acrortiance v�lth the prov:t;ont ef tbc I?Ifno!s Vltel Reco�d. t. � , - .s ' . ��i. � l ' � � � . . , '� D.2TE '! .��/ %' i ..?< - �. ��� " SIGNeD !/ -��ii�'.ti:; � . • Z�'%�PIzC>t� _. . % sd •fP !^/^ ",��'ri�'' - .Il7tr.ots-OFFlCiALTlTLE �r�Y Cl�"_'S � ''; r - . The o�fgine! reco�d of this death. :s permcncn:tyfileC wtt?: the IGLINOlS DEPAP.Th1ENT OF PUBWC!lEAL?Nnt Sp:La�.fic7d. Co:�n:v cic�kt anC loccl regtetrara are au:l:orizeQ to mai:c rett:ilcr.t(or.s;rom cop[es.o,� Ute orig(nef �ecotd. Tke Illtnot: statutes �rovirr�rlra� r?:� ccr!iftcetion of e deeth !rtorZ 6y t5e Depertme,^: ojPuu7le i�ea7tn, locat : egtrf�ar o� county cle�:: shall be prima larte etidde.are in eP ro:i,-ts and placrc oJ the fac7s the�e!n nateJ. � . — � .z . . -- --- -- - - . , :' � i . '-� ---� -T-- _ . _—. .—. ---- .� � _ . e.. _