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Death Certificate - Madison, George_4/9/1969� � • Cs'RYiFiE� CO�:' e� � o�a�ca �cc6�� � FiLL i!: :vlTH ?rPch'i.;TcR v7 !EG13if %dl,Yi!N6 � i_ . �. '__._'__�'_��_ ` _ -. . . . ' � . � . ' . � . } � '_" ' sinriun� � .. 4 0.EGIS�rtT110N ' 6T�TE OF ILLIMOIS �'; ; . DIST0.ICT N0. . O � . , I.tEGISTERED MEDICAL CERTIFICATE OF DEATH �. ; ; Nwneca I. �� �� JFCEASiD-NAME . �°ur ""°°`� �T SE% DATE OF OiATM �\,_" �"a"'TM; a`r. rw� ` i I i. EO G_�_,_ MA�I�ON____ �x.ID&18 '. L4, 79F.A ' � xACE W��rc rrtua. r�w�+c.w inau�. AGE-wr UNDF0. I VFwR• UrvDEri I DnY IDATi. GF BI0.TH ww�n u�.vwi VUCE 0 EAiM �°"^^ • � .ru iv¢�r.i �unm+. mui� .�py . wn : rwcs . wH. -�� �.r � sd TS 'm � 's • �a ^Bb�Q'1� 189j �o L9at�aah • ' i Clf�. iOMN. ��U �OW p5T4Ci WYtN �In � T' � MOS�li.4 P1 OTM[� IMi1TJl14N-M�N Yf IqT IM lliM[II�UV[ )i�f(! IND NVM�W i I� �s_1�E.`C?iID-E' . �'�a y- ��e. '��SDe.Si:-CLF.� LdLHQS.�?if.1� � ' � � � _ � BIRTnPUCE ot•*t o+ rvuw CITIZEN OF�WHAT G UNTRY MnRRiED NEVER MA0.n�FD, NAME OF SU0. �V�MG SPOUSE a� �'�2 uv� +u�xw �+�u� �- ii W�,r�ri . . � � WiDOWEB. DIVOnCiD�vcoM � . �' ��lgng 9, _A �o. Afars]� �� SP� ,,�2� ?�1sd1 aon � . �: $ ,cwwrv i u�� �gt0¢Kfi E�"'O1 � (` •• I ',. rrtrrp :,.n _�,.� Rural Route d� 1 � Znd�ana �e ibeor � �FATMEN-N ri�si woou ( N>i MOTMER-A1 1 F N . . : 15. Jes er Madison � I;e. Nancv Hnrdiman � �NiO0.MANT'S SIGNATU0.E /J (� REUTIONSMIV ' MAILING ADD0.ESS nnur ulo w. w t r. o. an p toW�, siwn. nn �' � I„� �%�,.'.� ��� ti . �rrra.os�<;r, . wiPe i„�.R.R.;r t Patoka Indiana � � ..�.,,..,. �..�,.. , vw0.T I. DEATH WAS UUSED BY: R�T�+ �� On'E c.vi� ru urv� ro� pt nt wo �q1 ' I�n+�w ow« +wo c� � ; �- IY. �h.uo-wi�uw . . •� .� . o : Urenls .. 7 . . ( WI TO dl .V � Cp�S�WtKI Y. • . . . ' CWJIi1MM1. 1� � , i . �� �K :E';s ) �,� Chronic Car@lo-vascular renal disease ,.�o�,« <.�,� 1� Si�il�'L TME U O[�- } WlTOO�/�=wCOMHWIM�WI . - . LrIHG GYS( Wi. � . (<) AUTOPSY '*�i� � � � >MT II.OTrIER SIWIFIUNT CONDITIONS:wueancen.uv*+nm + �++w'vuno�ewvcm ur.��i . ����. _ � u.�..w(.�n. _ � . . • i9d. n� :190." . DATE Oi OGEMTION, IF ANY.MA100. firvDINGS OF OVLRATION . � � • ' ' ; � � ]Ga. � 40b. ' ' ' i CERTIFY TNAT TO THE BEST Of MY KNOWLEDGE THIS DEATH OCCVnRED AT � 2: � 5 �i, M., NOTE: TMR DEATH T E CORONEB MUST �� 2� ON TME TE, AT THE iIACE AND F0.0M TME UUSE�51 ST/�TED . - BE NOTIFlED. ' ; ' I ATTENDED H in . u� . rIM wu�w � O+� . vu� �w i.sr vw ww wwrr� � w� : w+ , ��� _ DFCFASED F 1 �"��� �� • • ' . zia 8' 11 `68 i�ne. 8. :14 ' 68:zi�. ' SIGNATU0.E � � . � DATE SIGNED 1�*+ ar, vw� � ILL1N0�5 LKENSE NUMBFR � G�C / ,/ � ' S �' ' a3 2.; ! Z���� �'✓C.�� . • 22b. ' ]2c. 71a.� nni� rn � � ' MAILING D RFS�CERTIFI R �nen uro wu��ti a ��� o. un w*own , � 21. -� (� NesT/U U I /�� ���/Lefr �r LLLZ/UOZ 5 ,�.�QC � I � _ . , � : r�EMOV� � NMwTnION. �CfMETE0.Y OR CREAUTORY�:AMf , LOCATIO,�I cin ort m+w a*�rc , DATE ��'�/LO�� ' . Surial �,,,. 3and Hill Cen. :,.� Princeton Indlana ' tz,a. �u ' ].w. � ,...c �n � i FUM1ERAL YWME NMtE sn�ci wu �.w.u�� a� ti r. o. . un u raw�+ ; • , • j 15a Sendall Funeral Aome•- 5� South 2�?air. St. ?rinceton, Indiana 47570 { , , .,�.�...� a.«,n., �..,�. ,K..� �,.... ; . ; ,o.�w,�laK�/.O¢ S SIGNA.T[URE /. / ' Indiana 173k ' . �._! o,�,.D�7i�- �f-. /' � • . izsc : � - IOCI�L 0.EG�STM LGN 0.E . . i-DAiE' -� 0. BY-LOCAL 0.EGISi0.A4�-�•.w•.^+� � 1�-- �--+� � � ' f ' 766 � �, �. . l^_ ` % v5 200--l19 ) ... wr.a urwwr w r�wt �wT� -�u�uu o� srwn3ncs .. � ' Iw iss� u �n.wwo_u�nnurn �, �• � . .. ! .� . � . .'��" •i; -i. } � , . : . . . . .. . . 1 � " ' �`...___ _�_ , � . . . . ' � . _ _'___"- • .., M'.. 1 HEREBY CERTIFI',THAT �he loreqoin� �.+ o�/�o ond co�rotr cepy of tho death retord lor rha-°dez.de�rl�QmaJ e����,em 3;•_ �' ` and that this recor wv eswblished end (iled !n my oilice in accor ir he pm siens- oi the„1��1�s tcwtez? ' �. �9 �� sic.� _ _. :�-''� f^ , ; . o.arE��� . - � / ; i"'�'„ _ ,i � ! ' � ' ' ;;i. l.a_:'*!Fl , Iilinois. OFFICIALTiTLF. } �ri_g��:^$I' '- ' .•;`o `� �� A, � AT -_-.-__-__ . . � ._.. __.� ,., : '� . The or.Pn�l recmd o[ thia deeN b perm� enJS Rled uieh �Aa ILLt1pi5 PF.FARTY.C\T OF PURLIC HF.ALTK c SpriopfidA. Couner eler'ri arvi Ix�i'� �1 Denartmsntral�Public Ae��lih or�@u�tla�ltiun`inrn or�eh<�� �n[v�cler:�sLW Le pnmul'.�ci� ntadsnm�in �1� o�-�v����a vi titio! tAe �na�x�d�.uted� f� � i � `!S 2G1A {1961 revision)" 6UREaU OF STA715TIC- - ILLIN015^DEPARTMENT OF PUBLIC NEALTH - SPRIKGP�E�� . . � . � _ . . - �- � . � ,.. . . _ . � � _�._.�__��� .`w_----"-- - '-- ---"--'-_--°-------_-` � . .