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Death Certificate - Gooch, Harry_7/8/1998- • • � - '"`� � � � - � � � Ohio Departmenl ol Health . �Reg. DisL No. �' � . ' . : VITAL STATISTICS � rm�wi � . Primery Reg. DistNo. � ""^��^'�•,��^� r CERTIFICATE GF DEf►iH sce�eF��eNa. u���,;M _3 �s-9-�� '""�'^'"CO^O�� Registrar's No. . TYPE OH PflINT IN PEflMANENT 8 WLK INK °--- I. OECEDENT'S NqME lFinp MitlG�, LASTI n, _ � �_ Y. SE% , �, DATE OF OEATH INOntq Oag Vee�) , _ - Ha r GOOCH Male Nov. 7 1996 4 SOCUL SECUHITY NMBER •' Sa. AGE - lasl BinMa Sp. UNDER 1 YEAq x UNDER t DAY 6. DATE OF BIRiH n � I � ) ' MonNS � Dar� Mours � Mlnulea � � i Mar. 25 1895 Princeton Indiana - B. YlpS DECEDEtIT EVER IN U.S. � 9a. PUCE OF DEATH nRMED CE57 ' (Checkonfypne) � � � HO$PITRL es ❑ No ' OTMER � O Inpatlani 'O ER/Wtpatiml O OOA Nursinq Hpne ❑ Reskmce O Oihm (Spxiry/ �/ 9E. FPGLITY NAME (If nol in51i1�fiOM1 gira sbM �nC nvmDeh g�, �iTy� y��LAGE,TWV„ OR IOCATION Oi OE.1TH 9�, COUNTY OF OEATH 'n`"'" = Veterans Administration Medical Ctr. Brecksville SLUHFIO p� �0. MAflITA� STAiU$ � MlrtllE, N. SURVIVING $POUSE (11 wile. CU aho H iSL�Y11Utl.CIVF Nev��h•arrieC,WiOOwM,Dho m�i0ennama 7^"e' 1?j,OECEDEM'SUSUALOCGUPATION(GNekiMOlworkl2C.KINpOfBV5ME55/WDpSTFY FfiDExpE /Ff00F �gpK�M % Con� Ow4g masl OI�wwAlnp Ws. Oo nol wa refinCJ �4�ssion Widowed Ly None Laborer Shi Producer 1]0. RESIpENCE SiATE IJO GWNTY ._p Crtv iOWN Twv pq �oGiiON .- ' 13Q STREET AND NOMOER . � -. t'..: � -f�. 1'�c.' S1 13:.., ..1�.` f �2� ��l �`-.j�;�e. ,l _. . ---�hi a '�`"` "�""? C eve an u:�`"�� - ' 8908 .Em ire Avenue 1Je.IN5�0EGtY(IMI15 �]I ZIP CODE f�. WAS OECEOENi OF HISPANIC ORIGINI �S.MCE�NnericenlnCiahBlec 16. DEGEDENT'S EOVCATION P'es or NoJ (SOeCI(y NO 0� Y61 � II ye; tplClly CybLR wnila. ak. l3PaciryJ �� - Meaken,PyrbRkeqeleJ "�io pYq Elemenpryi$���ary(042) Cdlpqery��orYi Yes 44108 5�°'r B1ack Sth Grade I). FAiHEH'S NAME (WS( MqEh, UaQ _ 16 MOTMER'S NAME (Firtp M/tltlb, M�IEan Smn�ma) .... .. ._ . . �_e .. ii:,. . ..... R b • - :.��;::}. x -+ I o ert GOOCH � �° ��- �� •-- • � • Catherine COLE tBa INFORMANT'S NAME (typa/Prinp �^ �� 1B0. MAlL1N0 ADDRESS (Sboel en0 Numbar v flurel RouN NumOV, Ctry or TowM1 Slel�. Zip CoEe) Mrs. Vir inia Washin ton �' y.9103 Em"ire Avenue• Cleveland Ohio 44108 70a. MEiH00 OF pSPOS�TiON . 20b. PIACE OF DISCOSItION (Nama oJ cemetery. crsma:prg w 20c. LOCA710N - o�nsr c Gry w Town. Stala ' OBurial ❑Cremalion �emovallromSWle.... pta al.._...__.��"7.: �'. - . OOOnalion ❑ONer(SPecilh ' "'�'}::A � � . Sandhill-=Cemeter ' Gibson Co., Indiana �OE. OATE OF DISPOS�TION � 21e. NAME OF EMBA�AIER . . 21�. �ICENSE NUMBEF � Nov. 12' 1996 .= ' Howard E:` Levine ' 8363R Y1s5�G EAR PERSONFUNERnI O�qECTOR OR � 2ip. IICENSE NUMBEH �•���.[ 2�, NNAE ANO �DOHE55 OF F�GUTY (G Lkaiueel ': --.'. �+.�. . . C�� �. t r•�...,;, STROWDER FUNERAL CHAPEL ��. STW�F'S SIGNANF �'" " 822 East lOSth Street . / . 2S C�T[,Ij�(E�M „h , a�l . P.O. Box �8�i28 �� �� �� • Cleveland Ohio 44108-08428 . 51 NAi qE OF P ON ISSUING PERMIT � --- . 760. OISi. No. p), pyE yEpyij,�Sj�p�� � � irvV 1�� �° ZEa. GERtIFlER . (CeecF mN S�CENTIFYING PXYSICIAN - � : i +.' , e^�I To t�e Eeal ol my knowleEge. CenN occurted et Ne Yme, �tlats. end ploce, enE Eu� lo Ne ceuw�a) en0 manner m�ta�eE. ' � _ _ _ _ _ _ _ _ _ _ ' _ _ _ _ _ _ _ _ ' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ O CONONEP � � � On Ne batla d e.amination anE/or invpppa4on. in my o0��bn. d'aN occurre0 a1 Ne lime. Eale, �nE pace. and tl�e b Iha umNs) enE menzr ef slalea � �BD. TIME OF �rN -� ae� �ATE PRONOVNGED OEAD (MOn(h,�O�y,�y��h.... • - 294 W�S GASE PEFERqED TO GORONERi y�' 'z. . 'S'A`S y�. t 7� 7S MY.. s a,,,KOS.'=: ,� M,. .;1' Fc,�t. I'„��:��.io'�S : . �n`d-',� y o vti�.eNe y-x�t� .�..✓. _, ., ., �_ .. . � . . ' _. ..,�r. � `. '. . _. . 2'. SIGNATUH ANO TLE OF CEHTI q . �r. _ �.;i����,Y � z81 UCENSE NVMBEP � 28g. DATE SIGNED (MOnlh �ay, Yeaq . Q�`-'� ^' � ���r;.:: �:�35-o1-'J1�3 O�-�to 11-7-�(� 2B. NAME ANO ADUHES$ OF PEHSON N7f0 MP ETE CAUS Of DEATN..�; (Typ1/Prinp � M�� ��?,�-'riT :: r,.�.];:.:_...�::°�%� ���,rll� a�„� -�z:K��rll� o�,ro J0. iAqT L Enle. Ne E�eeae�, in�unn. w wmpliceuana Nal uuwtl Ne deeN. Do nol enttt.Ne moEe ol pra� arrea A ��k w �earl IaiNrn Ust only one causa on eech Yne..MEORIPoMWIqM0.NFM(gUp(4y[ ,_ �0• W� ea wrtlie< or m yy I, � poro.imeie Imenal Between .- . .._ .. I ONl1 !� DCiN IMMEOIATE CAUSE �Final - . j��;.�„ j,:�.., ' ; , Z I�, � Elaeme w cmOillon �► s � ��•S 1 S ,'.J;,nri:;',-�:: , . . . � `� �,� ��salung M EnN� . . OUE TO �OP AS A CONS�OUENCE OFp. . � sewe�uauy �a cw�e�uom. e. UT I'� . .. � .. 1 Z w�: �i il �ny, IeaCi�g to Immadiate DUE i0 (OR n5 A CONSEOUENCE OFp •--� �-'!+� �-� ° � uusG Enitt UNOEHL�ING ,. ` .. •... . . : ..: -• �..: •.....:, �:•:.go-s'-.. : �- . . . - .. C�U9E (Dixex ar Inlury � • � . .'�.:�v.''�.•"^;+ `... � . IA81 InWe1e0 evenb DVE TO �OR AS A CONSEOUENGE OF, �� reeNYrp In 0eeN1 u9T . . _ . � Y •.� .5�,)• • . . I . :i ._ . _ T:'Cki;: ,- - . e. . .�;:,:,,::;- , ...�: � �� I �ANT Ii. Ol�e� EqNli[�nl co}nCilio�n�s tontrlpuflnq �p deeN pu1 ne� ttsW����q I�n Ne�unEerlylnq Uuse plven in Pert L 9fa. WAS AN �U70PSV 31p. WERE AUTOPSY FIND- � ��-V.L'�I'U-� ULC.G�LS "':: :�..�_MCLS7 ��--� : . . . PERFOPMEDt W�$ AVAIUBLE PRtOR ': . • TOCOMGIETIONOF INSixVGt10x5 "'`� ' I 1 T J^� , ��E OF OEAiM . OtNFR SIO� 1 � ��`•�L -�� � ' ' ❑ Yes 3�N0 O Yn O No � J2. MANNER OF DEATH 3,ta DATE OF IWURY 330. TIME OF�. (MOnIM1 Oay, Yur) IWVflY ��x' �w�qY AT WpRN. 33E. DESCHIBE NOW INJURY pL�VRRED �1� YyNaNrel ❑p¢rqing � � InveaYga4on � M .. ❑�Yea O No PD �ccwenl . ; � '' : .•;.� . �,� �Jl. FUGE OF IWUqY • A1 �ome. lerm, tVMI 4cbry, plfice 331. LpCqT10N fSlrnl aM NumW. o� Rvial poVle NvmDer. Gly or iow'rt .: � O$uicid! O GWIE nol DB WIIEIng. em. (SpecllyJ � �� Sbie) � O Homi�iae Oeierminee . . � . ' ' i . a - . ' - .�r' ..�.. �.... . .. . _ � . . . . ._ .; y. . : _ ..:. _ . . . . . . � � .. - - _ - . . . . .. . . yr . _ . � FT�.�:� -- : ._... �, :� ,:�� � ;.;:'':;��; :-�. ` JUL 8 1998 NOV 12 t996'' •:�:�::;,. .. u:.f{..:.. . C E R T I F I E�D �-". � �PC�'N OV T� AlI01TOR , , � r�rmw ewm mn i:t n � ; �w cxne� eaw.c• nc : e�'' -- ' . � u w r�e a nc cee:a`�.:::� ci • � ME/.M CIEVFLrJq O'wJ . . � ' � ' ' � .i.J` �� /�i ��/ / . i? �' - i� w,.nss .w,o �o rn� ,^ ' 1^^�l lr.NP� 1+�`x�y� _ NrnL : fL.ry;�� .