Death Certificate - Sloan, Charles Newton_1/24/1974� ' - , �''ertif�c� C''o�r,� of a Dea�I�I2ecorc�
neue. wrwun iHOi
eTATE OF ILLINOIB - Hwweca�
MEDICAL CERTIFICATE OF DEATH
riur M��el-F �sT SEX D,
G. ,
b{pRI.FyS NE'if['ON S1.GAii z Kale 3.
,w, AGE—usr • UNDER 1 YEAR� UNDER 1 DAY DATE OF BIRTH no+n�. o+r, rw� pl
LIATMUwY �nISJ� �� � y�yi ; IqV0.5 � MIH.
�. 73 I Sb. ' � Sc '' 6. ��v 13. 19� ,,
NOU![t �Irv510[ CITY � WYIL.I OF OTMEM INSTINTIOItiN�Mf �1f 11[
�IY[S/MOI
; � . Ygg ; 7e Vete�E.rts Adalnlstzslion
CITIZEN OF WHAT COUNTRY MARRIED, NEVER M.�RRIED, NAME OF $URVIVI.
U S�A� WIDOWED, DIVORCEDisoccirn -'
9. � 10. p`$it�Cd 11. F'8�.`6� Ci•
USUAL OCCUPATION ; KiND OF BUSINESS 00. INDUST0.Y �U.S. WAA VFTEfiM
IYF$/HOI
.`'?�
,
$5[ D6C@L1bOT 3i� i7I/
CE OF DEATH murnr
�illiaaeon
�
� CWNTY • Oiq TOwH. M�. d�Mp pSiuCi M. � INSIDECITY i ST0.EET �NO HVMlfR ••
' � .(YES/
�. Ltd1&t�.1 � un. GibBOn : u�. °Atoisa : Ue �o I„� . R. F.De r'i 1' • . ,
r.. o�..�u r r 'n�en.. . - � - -"
— . �ns . . u,. ,.,G�HFf.—M..�uc� mc .iasr . .uou[. un+_ �
Issau � lt@1(ton .. . .�-.lcSil Niiilnie � ' PriLctlOtt.
JATVRE �
F.op L. Rich
PART I. DEATH WAS CAUSED Bv:
CONDITIONS, li /�M'
WMICH WV1 NIS[ TE
IMMfDIwTE CAII$f (a1
STATING TME UHCEN�
VING CAUS[ IAiT.
16.
DNSMIP � MAILING ADDRE55 ISTiEEt.WD N0. dl L i. D.C�TY dl TOWI, fTATl, ilq '
---- �„�_ va Hos➢itai� rarion� iliinois 62959
�MTF4 pNIY ONE �AUSF YFX LIN{ fdl �aL �pl. AND Q�� ' '���0%IMAII INTDV/.l
sanrtw wnn µo ov.n� .
Corebral sclerosie
Wf TO W �S A CONS[WfNC{ Of:
WL TO dl AS A CONSfp1FNC[ OR
Bra�chopaet�ania. tlndisylaaed aubcapit$1 iYaoture ri�t.re�ur
I CERTIFY THAT TO THE BEST OF MV KNOWLEDGE THIS DEATH OCCURRED AT
ON THE DATE, AT THE PUCE AND FROM THE CAVSE(5) STATED'
�NDED TME �+oNrn . osr • rmr� wwrtw . o�r r[.ruy� � �
SEO FROM: � � lI�'' � �JT�276. � ' �� 'J�21c. I
Ann_ �. Cituice. �.D.
f—L[NIIHLK ST0.FFT �V10 NUMlOI W II. L D.
VA rospital-
ON; �CEMETERY UR CREMATO
;Z� . DBC}[eT
NAME STPF[T /
Co1Vii1 I'tinerol Horilao
X
Robert A. ailson
t!ontdfe
AUTOPSY .�n �tl. wmr�rw �
(run+oi 'a°�a..mri�ort�uuwm"�uw
ivc. t7o ,�oa .
M,� NOTE: IF AN INIURY WA$ INVOLVED IN
TMIS DEATH, THE CORONER MUST
BE NOTIFIED.
; UAIt SWN[U - I�HTM. Dnr. ttwal { I�LINOIS IICENS
? zro. �• 31. 1973 � ss�.
CIT� O0. TOWN ST�TE
i'BTSQII� . Zii�IlOSH �
C�TYOIl1JWN ]Iwlt �VI�IC ��aT
.'�710Et.QII� I!la±8I1B J6II�
� 2rd.
Cltt 00. TONN
i� Jtr1 � P�nC�i�i=�
�
LOCAL REGISTRM'S SIGNA7URE � DATE EC'D B L EGI
2�.� Charles if. F1der� D.D.3. �.zsc. ea er ��l��l��
7 NEREBY CERTIFY THAT the %regotng it c t,ue and �onect copy of the eath �eco� d fo� the deetdent named tltem and that th4
record waa atabliahed and �led fn my ojjice in aecordante with the p�ovision of thej}�Viml Reeordt A� V �
�- . January 1�, 1974 �
DATE ' SIGNED / � i"�� "P'�� �
" " Parion Cltq C1erk
AT `� , Dlinoie OFFICIAL TITLE
The or(gtna/ record�oj thlt death G permanmtly jiled wtth the ILL/NOlS DEPARTM6NT OF PUBLIC HEALTHat Sprfn;fie(d. County
derki and (oaal regtrnars are aurho�ized to make certtficatlont from copiee oj the odgtnal reeo�d. The !1!lnoG rtafufu provtde thaJ the
co7ificaNOn of a dea�h reco�d by the Department ojPublic Hea(th, local registra� m county clerk cha!l be prtma faele evidence fn a!! tourtt
and platet oJ the jactr theretn ftoted. �
�VR,201 B(! 968/ OFFICE OF VITAL RECORDS - 1LLIN0/S DEPARTMENT OF PUBLIC HBALTH • SPRINGF/ELD 62706
' (25M 4/71 r) � .
.. . � _� . . _ . . . . . . : . .. , ..