Death Certificate - Stewart, Minnie A_6/11/1965_ � : ORIGIl7AL
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�� FI;L IN WITN lY?EN/.41TE2 OR LEG19CE P°'VIIN6
STATE OF IIUNOIS � 5'^�"�"
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—� MEDICAL CERTIFICATE OF DEATH (=.�a:a.,,
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COUNiT
iN11DE m:po.c�e Gn;n end in Ci;y, v;!'ege. o.
Peoria, City
OUTSIDE corpoiate �;mBs ond i�
io�r.sh;p r,cme.........
Road D'n.:ritr l:o .......................
St. Francis Hospital �
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c. H To�nnhip nome..........
�CaTS Road Disrr;ci No ..................
tN G��. RcSIDEhCE �.DD'F55 (Sr.e�r 5:lo. or 2.!
e. e• Inco�00re:eC io�i
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15 years
and Pm� 06<e)
N. 3tate St: Peoria� I11.
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Minnie A� SteWBi'� DEATH
t�f $
ept. 23,1963
. E 5. 1;[ b. 4nCE 7. MAP4IED. NcVER MAFRIEG. e. DAT[ OF EIRTHd 9. AGE l�n.evn •o�.dei i �eo, ac�dmNnn
— = WID v �n, DIVORCED (spenly) ,2 � 1�7� /^.• �;,meo,) ° ^� I ^.^ .•e�.. �'•.
_ _� Female_ _Negr.o- .-_—�j�d�wed - - Aug. 9 4_ 79 - - <
� w �Oe.USU�.LOCCUPATION IOb.KINDOFfU5RJE550RWDU$TRY�I.81�7N.PUGE(C+:yoncira:eor?oidgn:ov�:ry) �LG::zenoeW'r.o+
F � Houae-mife pwn Hmme Princeton, Ind. 1T:5:Y}1�.
�' -� 13. FAiHE?'S FULL ' • � ia, rnOTHER'S FU!l. -
j "�.��E �d.��DE;I NnMf
� Un-kn ►vn Ua-known �
H— LL I S�'/m atteased e.er fn V. 5. Aimed Foices? 16. SOCIAI $ECURITY 1]. L"7FORVAh'i'` +
0 (rn,.o. a unino-n) IG�.e-m o. aa�m ar u�•rre) NU`A6eR e. S16NAiU2E )_�� / `
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o+use w y. �pDRESi J �. eeu�ior. Hir ro
o�o=n;r. � Peoriar„ I11. �Fce�sep ,
� 1E, MEDICAI CAUSE OF DiniH • �/ � } ��`( �;+ . j CLU� ,�_
I � =1i1 I.OEAiH wAS CAUS[D EY.IEnta onl� oce mme erv fine Im �AI.IP) �nd ICI.I INiENAI BEIwEFN
� IbfuEDl!SE CAUSE �n) ONSEi ANp DEAIH
� --Cerebrel Acaideat...�cA:th Rt..Semiplegia........_--... _ ...............3_d8yg.-.
i _____ � Cor.dinws. !i vnv.
Z .hk� gv.e rne ro y�T �o Iel •
� :SeaSo-+eIMMEDinTE �.....�.{�rioselerosis... ....-..-......._.. ..._?.........._.
� UUSE �A�. srating ..........................
, ....................
� rne UNDERLYING ►C�e :a IU
Viceuseles:.
. F °AYi II. OiY.E�. SIGVIiI�ANi CONDIilOKS CONi�15UiING IO OEAI�1 BUI NOi FEIAIED i0 iM1E iEGM1YAL CONOIiIOti Q, /�UTOPSYJ
y� GN"rN I`1 OAPi 1�A�.
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5 N 19a. o�.e or oven�tio�. �r �wr 1 . �• o o� w� �On �O
LL YES � NO �
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,. � I NOTE: If an injury wati �n.ol.ed in fhn deatM, 1he Coroner musf be r.otified.
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¢ 2I. 1he�eby cenAyfhorl o:rended rM1e de<eazed Lon_ 19 ; re
� �ug�29�. 63- —sapt.-23, .19�—, �hal l los� sa•. �he ecemed oL.e
� m o�._lusi_'�f� , 19� v�d dea�h ac�rrcd o�_6__�_ >.1_ fm� rEt mmes ond m Me Jo�e �ro4d abo.e.
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C . N $igna:ure�.� ��L. -G�-.vG�l+� ...........:...M.D. Pdumbe......�7./5............ ..Date..S9Pt..
M: A. S�nders _ ��9�-
-- � - - - - - - - .. - - --- - - -- - ' - -
' Address.. ......... . _ .....Phone....
q m 407 S. S. Adams Street; Peorie, b 2. ........
� 73. FUNERP.I OIRE T IDOII$ O lii �
> I�2. DISPOSIiION: BURI.SL-REw!6w�i{�a:ws+�Ea o�:e.9-27-63. S-
� SeAdhill " � sGr:n�u�= a '
5 — CEMEiERY . ...... ...... .. ...................... -. �. . ..... .
Priaeeton Ind. _..... �.00�ess 9.......... n......�!e.�_...u�e„e
ioe�rioN.......__..... �. � P6eTi6 Il�. ..............._ri„T.6e5036......
'D BY TNE A.UiHOP,IlY .... ................. /� �..
:f 5T.47: O' !!CINOI$
RSM-7-61 � 355
(Ag�ed)
Peoria,Ill, Dep.Reqis;
.
1 HEREB]' CERTIFT T}iAT the foregoing is a true and correct copy of the death recnrd for the decedent named at i[em 3
and ihat this record was established and filed in my ofTice in accordance with the provisions of the Iltinois s[atutes rels[ing W
the registration of-births, stillbirths end deaihs.
DATE -%-24'b3' S[GNED- _ ,�C�
qT P¢Oi�H , Illinois OFFICIAL TIT�F Denuty ReQistrar
The original record of this Jeath is permanently filed with the ILLINOIS DEPART1tE\T OF PUBLIC HEALTH at Springfield.
County clerk_ and local registrars are authorized to make certifications from copies of the original record. The Illinois statutes
provide that the certifica[ion of u death record by the Department of Public Heallh or the' local reK�s:rar or the county derk
shall 6e prima facie evidence in a11 courts and places of the tacts therein sta[ed. �_
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