Loading...
Death Certificate - Siegert, Herman_4/20/1999_ ��8715 BARi NO. ti Trpe or Pr'ra in PERAINJENT WN See Furral Ooe�rs. Hasp+Al. a Glrysida+a • Ha1dLYUk fp , INSiRUC7ION5 1 -A.. /.�..... REC�ISTHA710N � � DIS7AICT N0: � b 0 REGISTERED � NUMBEri • k'CE0.iED �AMC �! • �Herman :OUNtt OF.DE4li ' . B - . socva � cr.�.mm�� �o........... `E isa 1107 S. Hart St. s,�r zro cooe , 13e. TIIC�=3II? 73f. d`%�J`IO Iumw+. FAi�-NpMc F6i5i MICq.c ,s E,—nest STATE OF LLLQJOIS • STAlE FlLE NUMBEA EDICAL CERTIFICATE Or DEATH Sa L.4Si Sc"(. Sie�ert 2- h!a UNpEi 1 YEAR UNDc�i 1 DAY pAi ryR5) WS OAYS IKKIS wt Sb. 5c. Sd. )R O iliEA P!$i ITU i ION - Nu�E (6 NOi W FffHE�l. 1 �6b. m@gdO�i Ip. NV.9 MPARI�. ik�. DIYOflCED f5a�C6':) Widowed L OCCUPAiION Electrician arr. ia5. 1 . . . . . . . . . . . 460F.�5 NMAE (11'P� OP PPP+n 2 � � - � � � � � � � � ��a. Chester Siegert 3 . . . . . . . . . . . 18. PAAT 1. E ar IDa <aea� a snock a near: 3h�re. ........... Y�.rcemaCause(Fnal f3G85tIXf1Ylf:Cki1 � ........... rtstSqhceatQ �aJ DUE i O, Oit A CANDI�IOD15. R AlJY N?ilqi GIVE Ri5'c TO (b) P1M�IATC GUSc (al p� iO.ORa �A i WG T}E UNOEiLYPlG GUScLAST. r,.i it. Electrical P��n wr. rw� 3. �HO� ia�. Yes i3d. Gibson w on r�� v�. s�co- r asu+. �.oac,w. xaro ac,w..e.� LASi MOi}ic�i-N,L.IE FIHSi MIDCL= QdT1�E1� L1Si Siegsrt I�6. Frances Kuyk2nda11 cV.�lOKSHiP AU0.J�GP1IGFFSSISSf�uOYO.Cw3iD_CfitOFiGYrtlSSA='L:) it it 1 I,��New�hew ,;,-Grawille. IL 62844 yu�ana aw cusec xu ay' arw uuae m'ac� � C jA,-'�/ p I (}"Z- ONS'cOUENCE OF Or 4........... PART II.O�+ r�tr�nE'.iaucmtridrb:CroCeamMrioirawftln s........... /;s P�2�i ioN ?NEU�u„/�Il N......... OAiT OF OPFAAION, F MIY MNOR FUJOWGS OF OPEiAii( P........... 2Ca ZOb. . . . . . . . . . . . I �1 (aD NO7 A� THE OcCu15Eb G�+M Mr. rE.a) PNDLliS1WHWMEe7P1NEON CIF�IGI�I� ........... 21a i0 it1E 9ES� OF MY NNOWL�DGE DE+.iH OCCUFAFD At�i, �iliE i1M .. ,. 2^es SIGNANRE D �'i,iDM C. J'1 "� . �. BISiVl CHc?AAiION, FEM AL IS�C �ea uria�' VP'f.A (Rev. SB9) sicwv � on+w nw+ c�nnF� cna an:nwn EA ICFlAE-Y OF CAFMAiORY� N.1ME lOC zabG:acelar.d Cemete:y Z� tU1.lE `�� M9 MA.Ec—f. C(i PF. ral Home, 221 N First,$.trQet, ��J f j;l /L C 7 1 V l`� � 0inii Ceoar'.n},i et?Sfic FIaJ:'�Divoit� of Vadl P.ecoms iY xvcurovslr.r�s.v.NeFmcxv muu-� cs � <s vra:�n ttrsswoi NO 79b. 6�W1E W/l5 iMEiE � ffF_:.W11CT W PAS: ThPE- MCNiHS� 20c. YESr NOX ION6i OA M�IG.L I HOUR OF OEAIi a t1QTIFItZ7(Y6HC1 Yes zi�. 9:15 a. rA. �USc�S) STA�J. DAiE SIGN� pMTA �.^•AT. K13p zzb. —1— �/9 0.LW06 UCEK'aE M:Mdc.i zzd. vo6-091476 NOiE F M! PLAhiY WA5 PN0.V� W iifl5 o�rn nff c aaon�+cra n,m�cu �,wa� MUSi BE NOTF�. iNN TAC DA�c P�'TA�JAT.TFJAI zad.Jua 25,1997 rn mvm ra � � IL 62844 �=x �ctws uwoa ��xse mw�.a px. 034-007838 L� 3l LOG�L PE66TeVA U<NM.OTY.YENi) � �,M�aS', l�i�i7 i 1 reu�'n u+ �s� us su�o,+m a.r,ir.a-� V � � ----. _.. 1 NER�BY CERTIFY TNA7 rhe JoreBotng fr c rruc and co�rcct copy aJthe dea�h reeord Jor rhe deeedent named at Item 1, and rhat rhlt rccord wat e::eblfaned enC fitcd fn my ojJ(ce In eccordence wRh (h.c provisfonr oJ IF.a !(It,-.o(r Yf(e! Re[orda Act. ,� � I `l �1 � SIG ED DATf�a w Q—.r � ✓ DEPUTY �r Q�vwtJ 11I(no(: OFFICI,4LTITLE iA-+�r � 1.-7.n n/-1 The or(gfne! rero�d of fnls d<a�h Is pe�manen:ly Jiltd wfth the ILLINOIS DEPARTblENT OF iU3LIC HEALTX:cSprfndifelc. Ca��ty detkf and locel regftrrart u[ aJtho�ized to makc cuNJicedonl fiam topiu oj �ht. o�lgtna! �ecora. The fiflnoG siefutc! Pravidt /h-� Lh< eu�lffc:tlon of a dmrh reeord 6y �he D<perrmrn� of Pubi:e NacL•h, loea! r<airtrar or eovnry eluk i'r.all b: p�ima Jaelt tvldtnea.� ��i eovrr� and plaeer o/ lhe Jaeft thuefn a(ared., �