Loading...
Death Certificate - Garrett, Paul_1/23/1978�� .. � r q u .L.� � ... . . � 1 :T'n "y4,YY`a t :r . . � '. . � � s �� f �1 �r. > __ . . . � � 4.� ttti 5 � • . ' •� ' ? � r • ` . lh _P � r' , ', y . ' . . , -I. ' , ' ' - . �;�r.ti�-r��' •.,�.��� a� �s .�.+�:���: �sc�e�irc� : � ,..n,,,. � - � DISTRICS,TNO r � .. .. �. .. , . . BTATG OF ILLINOIB � . _. MuMea .� i . _ �' . xy. � REGISTEREQ y 800? i, ,..�� PAEDICAL CERTIFICATE OF DYdATH;. � � �•� �t;�}p �?1* 3�.-�'�3'� .�.": � wi�ranrc- ,r .. ._ t., . . _ . . _ � ,,.� :.i�E.K'�ex.'3�C . � �...�4 +: ,en �:, i. -----.-: � - r..:PAITI; �'. ... : ..NMI ��i RACE wmrc:r�[ao. M�nKwi �rowl AGE-��st � Un �....li4tYt[6r1.' r:.'c:;'. : n•• � ��4TMDAY IY0.11i i ! r;.;•:. ; tthite`w �: :.; ���'- - �. . 63 ;sa � :.t�T'. _TpWK iVII. ql 10A0•WST�KT HUAU4l: ' . �IN4 y � �{Yl: t� ie: "rari'on9�=?t.: . � I�iC ��BIRTHPUCP6urt at roa[K++, CITIZEN OF WHAT ', QLMibI . . • ' . � a.:.:� Indiana :' i q. USA � ., : �. . . . � 4 ,z i�. N,ecl � Rf51DE4CE iiwit • ;couuTr ;.�. �na . ��t.. G. �.A H . . '-nuT -. . ' q.: .. John� � w��a a��n..iuKC . . G� PART I, � DEATH WAS CAUSED BY: � � IB . - i�w[outt Wrsi i: ' _` •ta� Cerebrai �� v:,_ � - . Du� r0 0� �f � ca+s[P �� ccwomws.'ir�u.v . . . �wn�c� wve ncc rd `�� {�j. Coma . �� �MMIDNTL [� US1 t0) '.- Y STnT�NG TNE Un'p[q• . qJ( Tp p4 Iy A Cd13[p IYMG GVSI VST. i , IONS: cwc�*iaa cwmiu �' � {l. , �. ,.. "_ "�' ireterans 10. ' �11t5/�WI . �i3e. Automobile ;i3�. ' Yes� lua. .. ' C�n. lpM�, Ivn. p lWp pfiuR W. ' �M�DCC�TY � STRlR .WD M . ; .�r6�no1 � ;;,,�. Owensville ;i.d. esi�,, ' 21 � ... _ . . usr . MOTMER�ARIDE�/TAA� nur . � CidZTet't 16, ` ' ttd'%2 '� � TIO SHIP � MAILING ADDRESS Rnc[r ar�o na a ' .�iosp�'. ; �i�e.. Fedc_ Ii��. VA Hos�ital, tSarion. : � IV+T[t oNlv ONE uVit rq UM !Oi lol. NI. /�NO kA L:d : ... :.�: ,_ . :1977.� :. � ti. :� ; , � � � �'�'°'-: . �1�1+ ' � i �?J, 'R GY6�MAfCN M�M!>m-�:- sr 'L Si•. I FI r �� _ , ��t, y�,' OF SEAVICfi� - :. �. � .S;u. W. Brumnitt St. . ' :. �; ;. ; `- Y. . " woou .. � - y�sr . .. , r'•: i�.U2ZdLt .`� ,,, -•. r� . . . o, an w mwK sr�is. im - - linois`62 � �-`. _ �r.ROx�Yen urtvvi � � omv�w a+srt wu ouni � ' . � , _ l.� 'xee s .- ivSY � n rn. n,[ ,n+n.o�x ` . ol . �a ouni � o[itwwwc � . . n.J ��a. . . . . DATE OF 07EMTION, IF ANYiA7AlOR FlNOINGS aF OYCRAI1Un ' ' ' � . . . r' - �-._ . � ' . , . _ . : �. , . .:. . . . _ . . . . . " ' ^'_ ' . .. . � . � . : ' '- -'�. . . ;. . 40a' '�" :20b. . . . ... . �-,•- ��-. � � . �I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THIS DEATM OCCURRFD AT � M„ NOTE: Ii AN INJURV WASINVOlVE91N � ;��-. ON THE DAT AT THE PUCE AND FROM THE UUSEI5) STATED - � _, THIS DEATN TME CORONER MUST. . Z� - E, . P� BE NOTIFIEb. . � '� � �i ATTENDED THE �M • ar • fuR MOr+Th �� wr � rWt �/�NO LAST S�W IyM/ . MCNM ' MY . YU4 � .. ',' DECEASED FROM: . � TO � - , �a wv[ or�: . . , . , _ 9t „e. 11' 29� .7? zin. 12 ' 13 � 77 � �,<. . 12 � .13� 77 � �.._'- =- , y. SIGNATU0.E ' ' ,, , � _ . . � . , DATE SIGNED twoNn�, wv, 'uq , ILlIN015 UCENSE NUMBFA. - - ' ..�. �''? ��an.Dec. 13� 1977 .. �:s�. ,;: . aza.:, K. B. Paland.iian, i•i.D.. ---- - . ' � MAiLING AODRE55--tFRTINER � � m[[r .HO rarea a ti r. a � utv aa mm sr�tt � - zn ; , ,,. - . ..,: , . VA Hospital, 1•larion, Lllinois 62959 ' � =' �uf�RL, �CAEMATION, L �CEMETERY OR CREnUTOBV-NAM' E , aAT10N un ai rown . srwrt ; DA E� ww+*w. w�r, rw� � 1 .> ;REMOVAL �sv[arn ; . � . . . . . • �. '� . ' �� �'�� � i�aRemoval �x.s. Or�ensville �z+�. Okrensville. Ind�� ;��a �c. 14, 1977 �. !� FUNFAAL HOME NAME mm uio miwu w a r. a utt oa rovm surt - _� .. nr ..- ��so ' • Paul Holder �neral Hore Owensville, Tndiana 4 Cl ,_ , � �FUNERAL DIRECTOR'S SIGNATURE � . . •��� oumroas �wnas ucwx nuw � �—�='�'.: � 5 � , Robert A. Hilson ' iss<. z1�E3 ' ` ' . ' IOGI REGISTMR'S SIGNANR � . . - , , . , CATE FEC 0 BY LOCAL REGISTRARw.. wc....� �,+ , . �,,,_;�„ '. , Charles W. Elder, D,D.S, :�bb.Deceruber 14, 197� •� '- / NERE3Y CfiRTlFY THAT the jo�egotng fr a tnie and conect copy of the deatb rcco�d jor the decedent rtamed at ttem I,�and that tkii� � reeo�d war er bffxhed and�fUed !n my oJ/tee in ccco�dance with the provtrfonr o Jhe I!(lnofc Vfm( Recordr Act. � _ _ ... r � �./�D.f�l>�iL - � ,�f%/ � . � � .. ...SICNBD ' /' . - . 7lC��_ ' � • - DAT6 � � r " - � . . AT. � J � Y Aiaz'iOri � ', IlllnoG OFF/CIAL TITL6_ . . � • The oitglnaf rfcord oj th/s death is permanentJy�Jtled wlth the ILLINO/S DEPARTMENT OF PUBLIC NBALTX af Sprlrtdfield. Counry `' clerki�Gnd7oca! ngtanan�are authorfsed ro make cerrlJtoatlonr J�om coyfer oJ fha origfna! �eco�d. T/ie t//lnoG irafueer p�ovtde rhat rhe ��� - ', cartJkCNqn'o/ a death rccord 6y the Depmtment oJPublfe Health, focaf rtgftba� or eounty cic�k tha/l ba yrlma facie evfdente !n a!I tourtt `• =- and ylceu o(the Jaeti thtreln rmted. . � . � � � , � � .. . � - � - ..C.^.-l0: q(IVA3),•' UFFICE Or VITAL RECOHDS - I�LINOIS UE�ti:Ci 7d`c�:.- GF � U�.LIC H=ALTH SFRINGFIELG G27oi ' . . —' . -- . . --__— -__'__ �. .. _-" "' -_.__'- _ .--' �- � �. S � ' .. ,... -. . . . ' , � _ . . � . . ' . ' .. .- .. . .—� --. . . _ ' . ' . . ' ' ' .. . . . _' . '.',.. . ' ' .