Death Certificate - Robb, Tom_5/18/2004OEGEDENT'S BIRTM N0. REGISTRATION
DISTRICT NO. 61 .
RE61S7ERE�
NUMBER
�ypp�p{��/� OE(:EASED-NAME
PERMANfM/NX
Sss Fuxra/ D/nc(ms, 1.
�TWdGa�Y+�M+ COUNTYOFDEATH
Mm��opk M
u+srnuc�s 4. MARION
STATE OF ILLINOI srnrE Fae
NUMBER
MEDICAL CERTIFICA OF DEATH
�1
ROBB
�FNOT W ERH'R.
n ............. sa. CENTRALIA st. ST. MARY'S HOSPITAL
BIFTHPL4CE �CT'.wDSieieOq MARRIED.NEVEflMARRIED, NAMEOFSURVIVINGSPOUSE �
� � WREicrvCOUrrmv� WIDpVlED.DNORCED Isrcarn
�. GIBSON CO., IN ea.MARRIED gp,KOZETTA WHITE
B SOCVLLSECVRRYNVMBER USUALOCCUPATION KWDOFBUSINESSORWDUSTR
C ............. io.
GfTY, TOWN, TWP, OR ROAD �ISTRIGT
e ............. �sa. 802 E. CENTER isc. HAZLETON
STATE ZIPCADE RACE rymiie,euGK�ERM.a.v OFHISPANICORIGI
INDIANA 47640 W����SPE�WHITE
i z.
�e�ruewin �wrrrn,o.r.rEw�
JANUARY 27, 2003
(uOt+iN.O/.v. vEU�I
�srvo�
e. N
73e. 13f. 14a. t<�. �jNO pYES SPECIFY:
FATMER-NAME FIRST MIDOIE LAST MOTHER-NAME F�RST MIOOLE (MAIDEN) U
�5, ORVILLE ROBB �6. EVELYN ( STILES )
INFORMANI'SNPME (ivvEOAVFwn RELATqNSHIP MAILINGADORE$$ �SmEEiu+DnO.OArtF.D..CrtvORiO.w.Si�iE,�
t ............. i�a. KOZETTA ROBB »b, WIFE »�.802 E.CENTER� HAZLETON.IN 47640
2 ............. 18.PARTI. Emerineaivasas.«m�GrationsthalcaweatneaeaT.DOnaenterinenntleolq'vg.wmesrardiacaresWetaYe�resl aexi.al cru
sfnck a treaN ImMa. Lin aN' wre �ause an eadi We. °
3 .. . . .. . .. . .. . Hm.mm Causo (FVw '� — � C � � � ('���• (�
Eerasa«mna�m � (a) 'C12S��1(/�/�.� 'F-pin„�/v`C , j�J�7�/� . \T V01n� l lA
............... resmiginaaml � �
DUETO,OFA ACANSEOVENCE F
CANDRIONS, IF ANY
wHICH GIVE R�SE TO (b)
IMMEDIATECAUSE�a) DUETO,ORASACONSEOUENCEOF
STATING 7HE UNDERLVING
CAUSE LAST. (�)
4 .............
PARTII. pnw�m�a�wnmmd,n,qmaunm�a�smy'�vevw�ry.qm.�..n�nv�Ari.
5 .............
N DATEOFOPERATION.IFANY MAIORFINDINGSOFOPERATON
P.............
...............
� zsa. ► .�
VR2001Rav. 5�89)
�uor+rN.o�v,rewA�
�°��� �3
C REDATTHETIME,DATEAND
2ao. HAZLETON COMMiJNITY �zac.
NAME /STREEfANDMMBEPOPR.F.0
P.AL HOME / 23!r SOUTH EL*?
nUiOPSY �
(YESNOI m�t
,o, NO ,on
ao.rs.vr,�aEmorm
rvsEOtu��rcsw
8:00 A M.
SIGNED �MONiM,DeKYFAF�
1-�'O�
)ISLICENSENUN.BER
�3G -�G s�i67
�..�.,���„�,�.«.�,�
YUSi BE IqTIF�ED.
fION CrtVpqTONN ST11E DATE (YONiM,OAV.YEAR�
HAZLETON INDIANA zae.JAN.31,2003
pttOPTpxN ST�TE 21P
CE*ITRALZA ILL?n?OIS 62801
FJNEPALqiiECTORSRLdp$LICENSE NUMBEP
M. IRVI zsc.034-010252
DAiE F6EDBVLQ.�I aEG6TRM�MWiN, Oev.YEeq�
zeo. O 1-29 —03
W V�tal R �a.�seoon isasu.s. srnno.woceA*iric..rei
I HEREBY CERTIFY THAT the foregoing is a true and correct copy
and that this record was established and filed in my office in accordance
with the provisions of the Dlinois Statutes relating to the registration of
marriages,.births, stillbirths, apd deaths.
r� ��,� �
DATE JANiTARY�2003 SIGNET�:k�+'�'�
AT Salem, Dlinois
V