Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Death Certificate - Green, Charles Henry_3/15/1978
� 1 ��, REGISTERED •' � � 1 NUMBER - • - ' '4 �DECEASE - AMF. � � -.' y �)F �_,- ) : t . ..' .. ��4� /Y31—! a f�H S�b '_'�RACEvmrt� w�cw�u.nuc.w�HOu ,� �,w«��.� : ..: r� � .�{ ' i}pClYl �+ � £ cirv. ,wr� nn. .o,e� - � n;,.,c, : �(�� � i�.7b. � Rt4'LOn . e CERTIFICATE OF DEA '� im[ CIiY �- � rypy�}nl W pTME4 �NSTINTION�-euq( �� � ��IYfS/N01 . fii NpT IN i:u u;" 'i'. 7 . ; t ..*. �, �s. . � 3•. 7 }t : '`'i.: tD �,''-„ . . ! OF-DEATH � WartR.wr.mul :.�'. , � renuary as'�'�`�i979 ` !: uar . OF D[A7M . �qy�'--``- �k '�`� � �. V: " c p�'! iilliarasoa�'�,�� ? ,�. y � �;:� [iiwER,GivE ST�[R µp �yep�' . � F� �� Yeg :,e. Veter,ans Administration `j' "a� ": + --BIRTHDUCE Isr+rt on rwnw � 7c. , r�. «: t cpmrvv� � CITIZEN OF WHqT COUNTRY MARRIkD, NEVE0. MARRIED, NAME OF SVRYIVING SPOUSE �I� WIi �rv� y�ipW � %� °' � �a. ' .. � . WIDOWED. DIVORCED�sr[arn C .�`+�:? � ,. � _': �'? Q � N/w[ �L SECURITX �10. t'IBpj`i@(i �. �NUM6ER: 'USUA�OCCUPATION - ��• �18��8b�'' �..td'�sLF ��`� +�.�� . . : coue.r. . ' 13c. �'13d. � Ej "5i . � . • ar.. ro+«. +w.. p.o.n asrucr ro � u+sioa c�n . snar nHO nu+uu � � ' I�b Q� � .n[SIn'oi � i � � .-:. . - :. R q �I�c. pI'ilIC9tOII � I�d. ' I� .`$i ��g�� SYr+ ,. � rusi- wiooaE j� �-. :�, 1 .r'i;• . tesr MOTHER—MAIDEN AME � ritsr " wDptf � ��i � ' V'I'88ii ... .3', a �['�S r r .-. . .MANTSSIGNANRE � �REUTIONSHIP 16 � � LSEfl18 � :%'������f�.� � • . � •, _. . ; MAILING ADDRESS �STAF[T N1D NO, pq IL g p CRy a ' �. . ; _ {�� TOWN. STAi(, Llry .. � 17b. �� I7 0� 'K18 1�1 N�� `_Y.(H_.-t':"_, r �r -1 "OEATM WA$ UUSED BY. . ��-+�D niy�l � ��' �'j9: � i�� �:�� .�. � IMMFOqTF UVSI �- M _ {�G"ONIY ONE�UUSF I[II lIN[ iW lal. 101. nND I<II ' .VqtOYly,�}� IMp (-_ � � - . . �� : ItTWlW d6R �8D I � f "✓•:i . •,. �0� . ' Wi'Oi i + 1 YifLL��e'. ' � . 1i n�y �� • ' :.� � . � . WL TO 04 �S � COe1SFWlwC[ pF, - . . . � ..G a 1 �Qflf/y : IONS. I/ �NY � . . . ... - . WK PISF-Tdfll � •.. - . , � 'l t A t �.e Cno:E m1. + ro� - . -: r - � . . r ,. G_TnF UwpEq- �' pyt TO M AS A CONSFWLHCI 01: -� .'f t.�.i. ��f.'. GUSE IwST: - • � ' � �. . l �'l�x. f.p r{4:� , . .. . C�"' . . .� . , : ' . ' 11 OTMER SIGNIFICANT CONDITIONS: cwoirmn cy�nisvrv.c ro a.r� ��r Hm �tuno ro c.w cm� w„yr �„� ' � �' *^a''��� u4 i "�'7:� - . . � . � AUTOPSY � � �uee� ut[L wue r �. � . .• � . • .. . . . . IYES/trol �. �i V ouir��� Df OPl,fRlATION IF. ANY�/.wOR FINDINGS OF OPEMTION �� '' 19d•n ,SIF,,, T ��l y l . ,-.' �' �, �Y - . ; , " .' . ' . . . �: ' . � . . � ;, �, � .y f! �. ']Ob. ' .- ,� �.� 4.i:� f�.r� �l rt: i � CERTiFY „TMAT' TO THE BEST �OF MV KNOWLEDGE THIS DEATH OCCURRED p7 � � y �}< <i� �� )N TME. DATE,°AT THE PUCE AND FROM THE {AUSE(S) STATED *' M., NOTE. IF�AN IN1�Jryy,qr���pryQ�y� � . TNIS DEATH .�E CARONER M NDED� THE � MoMn� , onr . �r[.0 : -�.,wpriH , o�r � y[/�� � /�MD IAST $.�W �IIM/ Mp�.rw . p,�yp • BE NOTIFIEd -�, N ,y- ..; -t ED FROA1 � . .. T� � M[R etrv[ pN: . tt.Vl � - �'�..a � 2 +"*r�5° URE �% 21D. � % ']IC. :-5 i •,29 .�'%3 ..•1 � �;v :'��'rrr'.',y �1 � �' ' .. � � �. , , DI,TE SIGNED pnpvrH, owr, ruq � , �lLIN015 �UCENSE NUMBFA +f1 , :� t Q.B..9a,1'ues HeDe, , . : ' p� , t,: � ? G ADDAE55=.CFR7IFIER ' ' Z=b. d�w3iy Z�%• �7/3 .' Y2c ��< s i�.: STR[[T �NO NUMp@ p� �.I. 4 . CITV pp TOWN' + P. � ' l� ♦ . • .STeTF �• " vii t�oe iti8i . �oIl . r, ', , y�,b, �RFAUT�ON. C ETERY ORY0.EMr�TORV--NAME ! I�1�S8. '�' �'b�8 �L Ivttrrn.:. !��� - .�. � �CATION un oa iwm � - sT�r[ D T I�iH, wr � ' 4�z•�' Pa ka , - :z.< Patoka Zndiana ; • � ; • . �l HOME ; NMAE F sra � o H [R M A r 2rd. JHAe �4 �'', ^R J _ J _ C tt W TOW11 _ � STAT[ � • ��8�i,�1DA . . . � �,, p.� .�..� � ,'.h�z"g���.�. ar.� �� �71RfLTOR5�51GNA1U�2E• •:•&1 HOi'(1 . S• �ip .Pi'1[SCetOfl . Tu�auyp f . }�_:'y(7(�T�ti� s? f �� ti � � ' . . � . � � , ,' ' _ f ... - � NHU.0 wa�crcr: �wMns �KV+s� wuwa SsnL 8: Toolo ., i� �{ �,';1 REGISTqAp'S S�GNATURE - � � 25c. . Z�a �9� � i�ln,��(.�( � ky ��jif� � DATE REC'D BY�LOCAL• (�ST� b,-� ' �°.T19H:1�- }''�d6I'� lI.(�i�a9• . � t� ''.�:� q �{ry� �'M�^5p�i`t' r� * ' ... �26b d� J00�#+�in'�)li A9. �Y C&RTIFY THqT.the fwegoing !t a rrue and conect copy o%the death record fw the deatdent namtd of��r 7,�k��},�„�. �f ejtablfthed ond J71ed tn my offlee in aecordance with �he p�ovliiona oj he f(lfnok Vlml Recordf Act: ;" i��.n'�R��� f � `�in.�'r ``�'� " - . .✓ P„ -=�a.�.,> d'tmyw'°r�R.a�s._197 a ' �. : _ �,�t; < < � � " �a;t�.f i 1 � SICNED .- i ' t }�` � �. b ro�'x : riiAlalM :c ' n�t' p.�.�.o� ..,, f�� ig���rvl\ �W- � � - , �./fltnote OFFlCIALTlTLE � ��`��+�+'d�%.� �v� ja���",: �""r-�CD� �'f.T-. : . , . . ,. . . , . , . i t ylev# ��-� »s. r� j.a6�`��T ` �w[`y���,rtf(OfptJtN death ti permcnenNy f!(ed wlth the ILL/NO/S D6PARTM&NT OF PUBL/G1dBALTBSnt�� ` J�r Coitn �� �xgitJtmr aie aufhorized�ro make ee�tfjicattoni jrom cop/ubjrhe o�t;tnal rec'o�d. .Thel11le01{°itatufei�proPl�►e4�jdj:�i �+Ql+�tjmth iteord by the Departmm! oJPublle Health, local reglttmr o� tounty. eleik ihafl be pt�rit0'jatfa ed(d�eacq(rs�a!!�'tom � ol �hG fa�ti thutfn tfaJed �. � . . . . �J�968)j�� eOFFICBOFVlTALR&CORDS.-ILLINOlSD6PAR,T.4IENTOFPUBLY6jf `ir��� t�1�� �� ������1 � �� ,� �}�; ' �t"9�, l�) � �� y,tinp ,� �+ , , BQALT,�N FSPRINGFIBLD 4?�06 "�{ i. � w vn:. : ` 5 S `a- 1 � . " ' . ' .7� . .+ � ;�ir���Lk* 4ts�, a�C �t��1.YN13r � . �t � �� '�y� 4� "I � .� .. . .._ ,.. _.�. _ . . �_ �-±.�. u _sr..�- __ ."' ' ' . }� -��m �'�'^'. . t4�. �a. 1 {�l ' R♦ i�y; w;� 'ii�-., �.h,�, r.� 9 t� , � a ; -a JN7�` � � j, � ,i,;�, .� ` U �J'�f z> i4Gcc� 'r�7 di F : 1