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Death Certificate - Henson, Phyllis L_8/23/1994�� (j�6 2 31994 �iyr.na� ,d', d�{'u�.y-s A.UDITOR ueceoenrs eiqrn no. I q[GISTRAT16}J DISTRICT NO, � REGISTERED / NUMBEF iYM or Pdnl In ut YERMANENi /NI( Sa Fun�r�l0/r�cfon. 1. No�ptt�(a0��dc4n� C( N�nJOOOk lor INSTflUClIONS Q cr A ............. 6a a............. STATE OF ILLINOIS STAI[ FILE HuMUGn MEDICAL CERTIFICATE OF DEATH FIRSI MIDOLG UST SE% ORTEOfOEATH IM�Nni YLL[S L. FIENSON z. Femalea Aueust ]I tlIR11NAY (VHi� MJS D1Y5 Iq1185 MIN ion ea. 74 so. so, se. March ] iRO�D015TRICTNUMOER IIOSPITALOROTMERINSTITUTION�HUnc.p�'p�y�flnRn.Grv[SinFEiu�oHUMO[al ield 6� Memorial Medical Center �uSUn:q� MAl1RIF.ONBVf:RMAliRIED, N�MCOFSUl1VIVMUSPOUSE�ue�o[nxeuP:,ifwni;� ......,....�., .....,..._�._ ._.._--_ c ............. io. (SIflEEfANDNUMOEPI e ............. i�a. 401 Sycamore STATE ZIPLOO@ RAC INUI� " ��. Illinois �ai.62839 ia, °z_ FATIIER-NAME FIRSI MIppLE = ,�. , is. Nathaniel � � INFOflIMNPSNAME (rvpEOnvniuq . F ............. 17a. L.V. Ilenson ' ✓� . 1B.PARTL EnlmlhaJimuws.acomplu ' W 2"""""' �MCk, a Aon� luilwv. Liet a � ' 3 . .. . ... . . . .. . MmeeN Cww IFwI ' t� LL � d]uASp U CpMLIM I / (M � � ' • r • • •t• • • • • • • • • • • IbfU4Yg Yl lbi�ll) J�� ••• � I �'. :' ' DUETO,ORASACON � .,. �� .............. CONORIONS.IF�NY F I M1EDIA ECAIUSE(e) OU'ETO,ORASACON SQ STATING THE UNDERLVING Y , , � _ CAUSE LAS7. ��) � NSI. INDIC�iG D O ♦ A WP��I(N�ISI'I.CIIY) iaaticnt ; i�o. Pbod Service ,Z. ]��'� " �" ��' ' QTY, TOWN, 7WP, OR ROAU DISTRICT NO, INSIDECITV COUNTV �rE4fl0 �3�. Flora ix. �'es i3a. Clay NIIIIF,OIACN,AIALBIC�N OFIIISPANICOIIIGIN� �$IYCYYNOONYP.cJI'VIS,S1'LCIIYCVIUN.MIiMICµ,W1111011N:AN.tlt� r IISPLCIf Vl . W�L�C 14b. I%�NO 1=1YES cpECIPV: UST MOTMCR-NAME fIR$T MIDDI.B (MAIOLN) V�SL Mbsbey is, 13eulah Carrigan REUTIONSFIIP AINLING/�OnflESS �Sin[CMrv�XOanPFO.L�rvO11iOwN,51A�E,]iP� ��b I-lusband ��4'.01'=Sycamore Flora, IL 62839 ms ihu�causo� Oiu Jwll�. po nol onlw ilwmpla olOyinp, vmlias coialaca mspimlary urmst. ono cnuso on ouch lina _ m 4 PARTII. plr�nlur� qucn��pMrWrybb�NWrpinw�YpnMUi�InMpt�uwqnnMP�RiI. O............. � 5 ............. • Q N DATEOFOPEM71pN,IF�NV MAIORFINDINGSOfOPERATION a P ........... . 200. 20b. ID (DIDNOT�ATTENDTME�E EASED �MONTII,O Y,YE�P� . •.•............ SISAWMI,Wl1EPALIVEO . •.., ,. , �, ! . , i ' . .: �� :,:.,� 2tn. 1 TOTME9ESTOfMYKNOYA.EDGE, E�THOCCUR 'D�TT ETIME.DATEANDPUCEANI 22a. SIGNATURE ► , , NAMEANDADORE$$OFCERTIFIE(1 (iYVEORPflIN�� ,.... . .. ....... ......: .. :........ . :..:.�. . 22c. Kreigh P. Moulton, MD 301 N. Eighth, S . NAM[OF�TTENDINOPMYSICINIIFOTIIERTNANC[RTIFIER (rvPEd1PRiNij ringfield, IL �,[15NOf �O I(%WtIS/iOGU6ttlu�1�..�rIS�U1 N J❑ 4:] 5 P. M. woum oev,vF.ni �I.f-�/ Q�-- n�vn�,neMw�tinx-rvwMt L(%:�TION prvONIOwH 6��iF DATE �uOVb��ev,vGN� KI�+('L fY� � ' �una� zao. Glmwood Cemetery 2a� Flora fllinois zaa. Au 13, ]9 KIIOME NNAE, GIP[EI/�NDNUMOEBOOqFO. CIIVORiOWN Si�1L IIP FRANK & DRIGI-IT �UNERAL I�IOME 500 N. Main St. �lora, Illinois 62839 4LDIRECTOR'S�SIG 'RE // jj (UNEIULDIPECIORSIIIINOI$LILENSENUMBEP � 1�0i�. !✓• /S.G� �t,. 034-07 7 288 _�-.. �+�,.a.