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Death Certificate - Staley, Cleophas Paul_4/8/1985OPEflMANENT CEHTIFICATE TEMPOHARV CENTIfICATE rrx. o, v.;��;. VFPH�NENTINK u. a w.�w.� �a ce.o,e� .n fuMra� 0i�fm. NsnOEwf br INSTFUCT/ONS A............ Certif rQ� �''o�,z� of a Deat�i�ecorc� ' STATE OF ILLINpS st�r[ rne RfGISTRFTION ' °V°�� otsrR�tt no. 39. �B eea�sreReo CORONER'S CERTIFICATE OF DEATH nu�neErt `Jqd_7R_R Cleophas 1. iwo�� .�Itir ��{• [��C x OPIGIN OR DCSC! ,, '�+Ihite� �erican Carbondale=fp��f ��•�� 5. 'B.. . . . . . I s Indiana . �PANENTS�i . ............... 2 ............. 3 ............. a............. 5 ............. N............. P............. .............. .............. � Paul� Staley � Z MT �'.� ��S IINOER I YE.�R UNDER 1 • C1/� �1 � o•liG u � •• c.. I�2�iemoriaT Hospital �' cember 25, 197 uly 30, 1916 ,yTackson � �",•,,,�" °YfCfg""nln'e"r"�eu'cy 7d.n___ w�oowco. o o �s.a�r.i � 9. U.S.A. ,o. married ,,. rfary Hurt VSV�LOCCV��TION KINOOf9V51NE550flIXOVSTRY US.W�RVETERAN WI1FOflO�TE50F5ERVICE �� ,,, ��-... 'rIaintanance � University "","Y�o ___ 13a. 73b. 13c. 13d. RESIOENCES ot �owr.♦ Ow •oo� ♦• INSIDECITY COUNTY I. Cf." c3g _1.`�n�gi�� Carb�nci�ie � yes Jackson 74a. 14b. 14c. 14d. FATHER - NAME ��ws� ��oo« <u� MOTMER -AIAIOENNAME nwv �mo�c ,5. Eartzrell Staley ,6. Clara INfONM/�NT'S SIGN�TVNE 17a. 18. ��9 Straw s M�ILING I10DRE55 IS(wt(i�wDiao.own.�.0..<��vOwio�n.siw�[.z ; J�,�«� t7��., ,��5 i1. Oakland, Carbondale,I11 TH WAS CAUSED BY: � ja • ONE c use r w �a�. �h�,. o IC11 � •vwceeo.s«.eoi IMMEOIITEC�VSE . ' " �,� t�{yo Cardio_.Infar_c_t COND�TIONS, Ii MIY. �OUETO.OX�S/.CONS[OVEwCEOi � p� a � �� WHICNGRVERISE.o ' �teriosclerotic llP..�b Disease INME�IAiE C4USE 41 ' ST.�TING THE UNOEfl� (b) IVINGC�U5El6ST. _ . , pVETO.OBwS�CONSEOVENCEOI ' �C% OTHER $iGNI FICANT C( zoa� `.......d.9,:«�".:� e o. INJVR'I /�T WOMK >L ��[S.xO� �IT�ONS: Cew�na.a cwrwiwrt�..o m ce�m wrt rror wcunn m c�usc wv[w �w r�wr � 1• 1 o... . ,� Or��ee �v��OrnG.[iC.li�[C�erj i �ow Sudden years_ ♦vio�sv �.�LS.•u��wu.fco� �.. ,.ri o ,.... • 19a. 196. ,..,.....�.. o. �..�......�e. �o „ �C��, v�1.0� �O�n.Ow iv�_ On wO.O�ii. no.� couh��. s��re� 1 CfXT1iY TN1i IY MY OIINION B<$fD UVON MY 1NVESTIGITION 1ND/Ofl �� TME INOUISITIOx. TNK OEPiN OCCUNVED 0.Y TNE D<TE, GT iME VLLCE ' °owr+ o�• 27a. �xoouc t�E�.�E�:��,>r�o..�o,�.r ............�..... a,bpecember 25�1 CORCNEF'S51 NAT�RE � ; �\} 22a. � l7vi � ( / ' � �2= // �� oc�ow n �78 zi�. 8:15 P �TES�GNED I�Oni�,o��.�[�w� ,b_December 26,1978 iTE51GNED I�On�r�.0��.�{��1 BVRI.�L,CNEM�TION, CEMETER�OFCRLMITORY-NAME IOC�TION <�i�owtO�rn fi�t[ OATE I�O��+.o��,r[�s� NEMOV1LIS [<�� 1 za Burial zao?�'?aunee Cemetery aa<�rensville, Indiana �ember 28;197 fvnEwwLNOME N�NC . +��[[i�eoneu�ueww.r.o. <�r.oeie�n si��[ a�� 25,. Walker Funeral Home, 112 S, Poplar, Carbondale Illinois 62901 RC •[w��o�v[C ____ ��C[nl[wu��[w fUMEq�LO1RECTOF551GNATV 1 / / 250. � � �� :`et * i.! � ��Ji�%��LQ IOC�LREGISTR�R"$$�GN/�TVRC � O�TERECV.BYIOC�LREGISTRAPI�ON�w.o��.�[��1 1 ` 26a. � Dr. John B. Ama io ____._., __ _. �bregistrar___ _ z6e. DecemUer 26. 1A78 ! H£REBY CERTIFY T!!AT 7he foregoing G a trve ond corrtet copy oJ the dmth record for the decedrn� nemed at ftem (, and that thtr record wat utabltrhed and f!!ed !n my of/Ice !n aecwdance wl�h the p�ov(aloni oJthe!lltnoft�'}ta Recoti diAc� o ^ December 26, 1978 � � DATE _ SIGNED �--� �� r Carbondale ,nrtnor, oPFrCUGTiT�e Citv Clerk & Subreeistra�_ Thr orfgfnel rcro�d of thls death is p:rmanen;fy Jli:C wfth the f1./.lNOIS DEPARTAIE,VT O� PUBLlC HF.AI.Tlf ar Sprfs,tfirld. Cr.:•aty rinkr and lo[cl rrsiaban a�e cutF.nri:rd m make tt�tlficatfonr f�om topi[t of !hr a�iyins! rcroid. Tht /!1(noia statutr, prori::r �%r.: :4� cerliftcettnn ef a drarh rarorJ b�:l:t Departmtn� of Fublfe f7raf(h, (oca! itgtttror o� county c7e�k sha17 bt piima Jocle tvi1.'nct r� :i! rowu and pienf of the /actr thueln smreJ. � . VR-?OIB(IJOBf OFFICEOFVIT/iLRECORDS•ILlINO15DEVARTM[NTOFVUOLICHEALTH-SPNINGFICLUd27ii �n .