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Death Certificate - Cooper, Bernard R_1/23/1980:� . �� � � Er.�ry na. '�-% idabasa �- -' S. Cp�:(I:S' Q� UiC:J �`t�:J: � c CIiY.VIL ":�t_. e. V:..t1E O Y.OJ21iT.�. WSiliUii 3. NTS4E O : � - - = - - � - - , :.. .__-_ CEATIFIED CO?Y Or A DiATH eZ'cCOx� STATE OF ILLINOIS �MEDICAI CERTIFICATE OF DEATH . .. . _... ��2 USUA� l2`-S�DFNCi O. S1Ai! O.CVUNIT - Ir.@iana Gi3s�tt t. Rasilm<x v.a: . ' �OUiSiDioyfmu.vMH ................ .:.... ...........TOWtiSNIG. , I.VSID2 Kr luav cM 61Se [u/. .TcB•. d b..n nc.W G 1i .__ SiaiE iilE NJMe'3 ilOU('� {� cFG�'_iEiiO NO. 7� �`� ��UM3E? L�� i���t . ._ .. E�ar� 6=n cN �n ............................:.:... TOwNSHIP. cb 6�n� c.M n L5e <h. .Ft3•, v- ned d �a. L1GC O� TOWN d.IENG�H Oi SiN IN ISerl: C�*�nel 2b tlay3 ._tpmmAOYda�•���.S�•�Yrcei �t.IFNGiHOFSiTY afiash Gaaera2 a. �ift5l� .w� �ii�u �" . S R:.C2. a.a-. .' ! Y�DON t#��{A__...I M�iZ �pj;QN lG�e Wdd 7�a KIND( n,� J..a'v � �.le. n a 021N o� !] y�y� urv rnu+. r?.Y .. Z2U u• 'w�i l.ci l.0 YES ❑ n� L c iusn _... 4. DATE OF w.O:�im tG�ri _�rE.�tl ;, DEA7H C (�.e;0A92' i��3��/`% � ---' ., 8. DATE O: flIBiH __ ' 9. AGE �,��r�+ �� w�e, � r� �I..�Ea 1� kn.. '. Oo kVy`S./.!��..a�l upYtxS D,�inS NOIIAS �In. . ���� r�s .��:�'� . !`� I � �i Il. B�RTFIPLICE .(City ond s:o�e orlwe�gn counrry) �. ; I12. O:�zen of..�hal> �.! , _yy;]IryZ . t(gt�9d �g1IIE6T naii�+a� . iu:i.�• , •, •, r o , l7. "TflE3> iU!L ' ' " ' 14. MOTH=2'S FULI . - �. . Z "_ I, NAM? . ,A._ .'�` i^'_CY � MAIDEN NAMc t '••-•1:. Z' � `*h�a9 C000eP '�ay A. =•:cCoy > . li Lvcs dxwsed e.m%n U.S. Anned ForrosZ 16. SOC��1L SECURIiY V. WFOxMANT ' , �' ' '; ' ' _ -;_ _: _ e. ns.. �.e. o. _='�o-.� AI trti p�. -<. w hin d w.i.l � NUM3ER a S�GNATURE �. .��.a COOU@P f . .. ... .- ''__.. .— _-. '_"'—_--__- —._'_'_'___.. u ._ •_�O=y�l :,._i . . "c" .. . b. ADDRES> c. RR�AjTiI�OFN�SHIP TO . I9.C4UScOFDEA7H - ='�-���..���-.;." ���11(3 -�—'.O ' " . '_"'____' "'_'___—'—_-_. "__ _-- _" _" , . ._ ' _" ' "_"--___' _ . _ "_ ' . T AL ° ° W _'"___"" _ ;'. 7.:2T I: DcAiN WAS CAUSED 8Y: [Enter ml one mvse Per Bna fp UI. 131.�and IQ ..y. "' _.. _. ET AND � - '" Y � � ONSRV iDFA'H.� _ ... . ... . , . .. _.....'_.I.MMEDIA7EGUS.:IA1......p.,. ..�y .. .........'...��`.� ♦� ��.},�� _.... __................. - ': � +�� �titi�i%ii8 Wl3L1. . � : lrt9l"it�iil61... .... - .- " •. �- � ..............�...............................�............... ........... ... . .. F lt ii . . I -� � `:� .... -. .... ....�... . • �Ondi�i09z. il am. ' ....... . ..... c _ • .• � •• •• � • „"'�'81 .-�--Carc3no�a of se�o13 colon . .. ,. �cnths-�•- _ Z w.;;�s S�.o .�:. r� - _ . 0 tia abo+el.NM_vIA7i�� ..................................................................................... _ " _ . _ ... .. .. F CPUSE 1?J, s:a�iry : - "'_ __ _ ... . ..- �. � .. Z Qt>UNDSBIYIVG-._ dvetolCl-� .- _ . - . � �,�,���u . . - - := and �etarta�ai carc4n�a• oP=liver = -,� '�- ( y)- .- ., F Fnti 11. OTH:2 S:G� 11RCANT CONDIiIONS CONTRIBUTNG 70 D.ATH BUi NOT RELA7ED TO THE TE2MINAL COIVDITION G��EN IN PAR71W. W _ ' ' " ' ""__ _ " . ____ . _ . _ "_ _ _—__"--'_"_._--'_"."' _"_ "'" '__ . _ ' ' _. . . w - -�'--,—�=� �+jocardis7.::insnfYic3�nc}r ;wit�;:...-.-` :..::............... `.`..:: -' - . �......... ...........: ...... .... .. - _ J . . .. . ... . .L�y_ ........ ......... ._ _ y� 19 AUTOhYZ v� �' - i[�SI.�IISSOI� . .. . .. . . YES� NOyJ ".. p 27. Di5CRl3c CiSCUM>TAtJCES OF IWURY, IF ANY, WHOSE NATU2E IS MENTIONcD IN PART I OR PART 11 ABOVE __ . _ LL1.- .... .. _ .. .•_ .. _ _ _.i� . ., r... _. .. . , . .. .... ._. .._.. . . . .. _ < ;..i.: . .' . _-...... .. . � .. 21. 1 hwsc cMfh' Inc^�tmded 15• deceased (rm ��'^� 19_.l0 �C • 3� _,19L. +hor l lost sa.+ Y e deceesed olhe o„ �`9C• c j`7,-...:.,. . :.. .... bSOrJ A .r,.�_ .. . ...... - , 19_, ond death occvrted o1 M., ron lhe W vses or.d on 1ne dole stated obo+e. �AT; SIGNED � ADDRE55 . �PHONE 1?-31�5'J !T3rgi1 :�SC CaTty' _' M.D. -.. . _ ' . � p r, n - O ,: . . - � DIiPOiITION: dUR1Al-R&uOVA4C �W11�ON IDa�fl.���.,�.,,,,.,., � FRM NAME..:.i..:.0 3Y�I GC SCII � �� � w S• L� �• i • "_'" ' ��ADD2ESS...........�.�.PJ�..���......... .� ..�.:.:...:. U CEMEi:RY ........... ......... .................................... . . .. < PP�2iC9�GII TS1d�3Ii8 -_ . z W .... PT�11CBtOII.s.. �IId.?.3II$... -. . - �oca��oN .......................9................................ �� ..... . ........ ......,..: i` _ _-.. .-�s�c.,,r��e 3ack C:. Colvig _���"5`z 3Z96 , �'1a. r.�cen�a �o. l .�•a_�_, - _: � �;���9�^ �fz�5a x���� ?. :�earheile� -- IOUt REGISTRAi . �•:VS"3"R'200--BUREAU OESTATISTICS--ILIINOIS DEPARTMcNi _OP PUBLIC HEALTH--5PR1NGrIELO . - �•:"- b�..�:. -. ' -- � �- - - - - - -- - - I . 1 HEPE6!'� CERTIFY THAT tF.t /oregoing�is a:rru and conect eopr o/ tF.e deeth retord /or the detedent rt¢n, ed a: item� 3 and d`at tdis rerord icw �sto�li.s/:ed e{�1-f�%� in n�y' o[M1ce in accordance mith the provuio+u o( the /Ilinois statutea refating eo the re3istretion of birthc, stillbir[hs ar.d decn5s. ' � i;t� `lir . . . . .. . . . _- . . i\ A� �� DAY � � ` � - � �-•T321T.EI°',y' �� � Z9 J�+ - SIG\ k:tl��a�+�����`� • _ � .. �. . .�� . •. atr,� Ca�i� r�eoistrag9 Dist. 93 •OI .;T_; _ IIlinois OFFICI:IL TITLF The o''ad .-ee.d•.ol �Si� 1ruS�i� �Kr�vmd� fiIN wivS v6e ILLIyOG �Ei.1RT>IE\T OF PUBI.IC HEALTII e� Spri=i5etd. Gmry- d<rk.�.ud Ixal�resi+v.n .:d u�horc.d =ak< -linva:iom Ge eoTU al the oridvl eco.d. T6e Ill:e . :ete i'aride :Sa[ �Se enliu�ion oi � duu� v_ro:d h1 -e Depuum� el Pu1:ic H<ald or Se �:h,:.0 •�Ee coam� clerk �lill be pri ��(ane e.iLmw u.Il�cau.0 .ad pl�a<. at �hs [�cu ohe�dn .uud. . YSER LI.I D"c7ARTNcNT�OF'tU3LIC MEALTH—BUnav cl 5latisticc . ' = PrivW b� tLe Authoritr.of the State of illinoia Y i i\ -�- r . � � ,�..�� � �. y' 4P �.'.: J ._� nh )�Fi: a 3 -r'.�.1 . ..� Z.1't`1'3.'�i s Y ' •2� . 1�� � . _ . i.. .. v.'� � . 7?. ' � � ♦ . � _: . . . . . . � � . -. ' . . ' t � '� - � . .�