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Death Certificate - Powell, Dorotha A_10/25/2001� . -.. �/^ ." OOA'OiNAREN �119G1v CSEF.iDFOPODX oaucoons '� / 2� . -. n�- ��5 _i• � - , . 1 ff O�ATH OC:UFREO w ��sn:uriox. cr :ESIJcNC'c EEFORE �D�SSiM � _� 9 A i - .- �- i �. . 1 q `�ReS.tirtW. /pc _ r . PTarYRr9.0isir:o._ �o�C)� P,�Srsrelseb.� Ohio Departmen� alth VITAL STATISTICS CERTIFICATE OF DEATH S:ateFdeNO. TYPE OR iRINT IN PERMANENi 61ACK INK _ __' _' ____'�.�.......:.... Dorotha A. PO��'ELL Female OCI' ??, ?00] �___-'____- -<.SadalSem�vyHVmoe: - -"-"'-Se.Age-Las�B'vmeaY SD.UnaerUieYea� - 9c.UneerlDav -'-- '6.Daieof9���---"'--]dvc��lece -- - 11'wa1 MQl:lls Ody! __'_.i1Wn J MIt11M1_3 (4Y1WY.Ye+�1 - fL=1stl9+4dFm9+�v=�Yl o U.S. NveC Fwcei?'.9a. Plaw ol DeaL� (GVC: ny�wj .. ._.."- --� --' -' / --___-"_" ____'-'-___--_"_-_" ,- : �FbfP�dl -..__"'-'_"____._.... ._-'_"'_____. __ __ _ _" _ "_" � Otnet �_ Yes : i� No _____ _"""_ _'_-�^Datien___ EFUWye'.KM __ DOA l ALrtvg nax __. ResiOe:.ce _ Other 5 �SC.Pa[iqyNSY!<MbWmGwSenqatlMmeei _- . '. _ _ __._-____"" I G?�?li__"_ . �9c. Gn. VmaOe. TwG.. w Locatiori o( DeaV. 9C. Counry o• DeaN _. � Rid ew�ood �ursio Home and Rehab ----$---... ----?-----,-.- Springfield Clark f0.NartzlSm�s ' '_" '-".. . ' ' -_'" --- � . � u�rnt.l.�.avarec. " -_ ---'----__- "- _ _ __ '_____ _'_ M�6�� :1, uMMb`Sp.)115E�pwh i2d.�lC%IenCSUwaIOIX]Ipd:Cn Gybyy�plpy� �j�j.l,(y�j0(euyj�eSS�IN, fSM�l) WnMaOnfUr.-�) q/r9moYtl�wavpYe.CbmlweFe6Cf ��'idoged, Home �7aker Ow'n Home 13aRaoence-State 13o.COUnry " 13c.CCy.To.vn.Tvp..uLa�ation '-'-- f3G Slree�aM�NUmCer ._______"___ __" ""_'"_ Ohio _ Clark _ Sprin�field _ 1404 Ed ar Avenue -- -- :3e.I;5deCrtyLmRS? 13i.ZIPCoEe-- I<.Wypg��e��ofHqpaevcOn{�?---Yes �_X�o 15.Rattw, ry�yra�g�ay� �1fi.Devr.em'sEC:�.ionlso.yypy�µyn� f0 Yp. S'M�A' CutY4 MiLYt MOf Hvt et[J W IY�. �1c. f5CWY1 Grce CM�lIM) ` \res _ No 45506 "4li:1.2 --•�"P°"rsam�rl�-u� we�eu�«H: Sr-irt r- _ J1orris Stee�art Unl:noN n Ohio 45506 XBUnaI .Gemalon _Re:nwalfrom5ta:e nou..a.el . .. ___'__�_'__.-.�.,.._ -- oo�atio� _ oine. rs�+n Ferndiff Cemeten� S rin ield OH - - -- -------- -------- - ---------'-------- ?OO.DateolDispos4m .2ta.NameolEvWetmer '"---'----P • 210. ticense kuTxf Oct ?5, 2001 Jomes E. Qualls 8090-A na- --... ----'_..._.._...._--------------�------. -;�, . s' --- - - - gna�Lre o! Funval DvoUOr or OtMr Penon 2i0.1.4cense NumDe� Idtcartwe) 23 Name znE�AEEress of Favi i 7591 is. Rsgtz{1s SqnWU� 25. Dm Fi�tl ryorq ar. vrq �. 'wWna`Pmunl��oc�ad____'_L�'-�SP��� _.. �.�,i� Porter-Qualls Funeral Home Inc. 823 S. ]'ellow Springs StreeL Springfield, Ohio, 45506 ---- ------- - �- - - 26C_ C�st No. �P. Oate Pentit IssueG ln.+byow) `S�GNlyinpPhriiclan To Vro cest ot my knowleEpe, Ceath om�rtetl al itre tme, Ca�e, enC piace; and Eue b Ne muu�s) eM mamer as s1a:eE. Goronar On Ne pasis of exertw�elqn eM/w imesLgation, n my opa�un. Coath oruirteE gt Ne L�n¢. Gate, anE place; a'e: Cue ro nvse�s) arW rrernor as stateE. i90. Tme o/ Orzm - --- � ?BC. D�te " -- - -- WorouncM OeaC I�mn Oy. vaq - '---28C. Wa5 Gase Re`erteC ro Comnerp "_ __'_____'__ ___. 8:40 P. V. ra Oc[ 21. 2001 - Yes X eo 2ie. Sg:s:�re anC rNa of CenCrtr� � ' ' __" " "" "" ___ _--__ _- _28f.litenseAL�Mer _____- __'_ 2dS.DaieS9reElurAD.r.reeq >..�'�C^�h <�1..�-.-�-.1 _ _'S-G�- �4S"0�'� f � -23_ a.,.;� =- I D:. \ajeeb Ahmed. ?l31 K. Limes�one Street. Springfield. Ohio 45503 M1_ .�G. Fart I. Enur uie Eoraxa. vyune�. or arnpbcelpru ihet auseC Vm Cea7f. Do nol en:az Ine moGe oi 0 Wq. surt� as raNiac or resp rmey a:res:, ly�prou a:e �nttrval 5e:ween swcl� w nwn laaurt. Liv one reuse on each Me. Typs w PMt In parmanent Elack Ink. .._ - �^�.__-__'_"__-____. OnxteriCDedID . ___'_"" er a. -___-- __' _ __"_'-- '_ _ .. c. _ IY.h"DIATECAUSE COrL1'IG /� V� J (�malci�eattncwia:^im _�__�'1 � L41J2=',}-L � - rte�eir,ndee�) � p. piem(orasatasseoueMOa �� - -- -' - '- ca�•�nayhtmrai:ons. _��iy��nlivl� "__-_ s._ Eeery.ImMpbimmMUa e Oueb(orewCOn�e�eo ---"" � ' - ""'-- m�.� � ----- - � �:c UMerlytrigGacsalast __"___"_--__"____""___.__..._-"-_.--'_"_ -___'____--_" ___ " ' �JitM1G wbyVry Nef lLIi0fG0 C, n, le b �w d3 0�.OM1SlQUenCC 0� � !VB!'15 RSWT➢19YI ElBL�J _ PARTII.ONeiSlp�:liuntCM6itiOSOtuiW',v�ybCea.h'vu�tqt�esN'JnginNa�nCe�yi1Jtg�ysx��in?artL --"--3fa.\:'aza-.au'=uv- 3i�.N'er=4:o:s�Fi�:uu�s- � � � ?eRO.r..eJ? A�n3.:leP:io:'a:amaetion �' � / " af CauSp ol Dea�h? . "��'�'C�` . - ies "t No - �- Y� - Na � �`�" ``i'` -]2..'AZmu af DPaN "'---- 33a. Da•s oI L-jury 33E-T"vna ot �' � J3c. ir -- -- -- ----- -" �_ uW7 �N�YatWOA? 33a.Jesuioen;,w4yi:ryGCCUrtec"'"_---'_ - - " N'°�y IaNV� Ori. nay ' �� P�MM _ M _- v�a - Ho • • _� Nv� _._._. -_-"____ _ ._. _-__".-_._. ._. _.___'_.__ " .-___ __^r''+ tinzi» "'" s�s. _- 33o.Plecediryury-urane.ivn.50-ntf�eW.o3caa'txq.es. fSCerYrl 33:.LOratmnlA+e�xmmaaw�aon.N'urn..ur>ra.nswel 5:4DSRw ]A] � - Cnq�qte Gler.a�e0 i IPlafi