Loading...
Death Certificate - Taylor, David M_1/10/1990RELISiRATION OISTNICTfq, RCQST[RED NUMBER nFfFLC£fl _NI - .--_—_.__[E�TIFIE�_.[�PY__OF_Q_DEATH_I�ECORD � � STATE Of ILLINd3 � ' trnr� n�� MEDICAL CERTIFICATE OF DEATH wVY•`^ i. llavid ��-� "•o`-�..�.... 5 �n . .Il�racr��� a.�C i 'a.. k�11tC � ,. �o. N,t. Carmel i �t:�:°.<°�a1;.s.:,.o,,, -" T '= - wu�i sccvnrt� nuuscn .. .�., ,�..... . ,<,.Rt. 4 EMBREE F�TV1EF - NAME ��•ar � ,s. Jacob � i�a. �,�''. -� ,. ' IB. � DEATM WNS.CAU�ED BY: �c � ONE C�va� � • IOI.IbI. � o ICI I ! PARTI. wumi�rcc�vc� �... � CONp111O1�$. If I.NV� i n'HI<X GIVF PISF i0 � � � � � IMN(OIAiE L1USF I�1 - Tini1.VG IME UwDEP� j" LYIn'GGUSClASi' � Paaru. or„cAy�N�r� ti � � i o.,� o, o.�.,, ... �. . �... i 20a. � .rrznomr..c i�= �� DCLCASCO IROM: � ?o .. a � a--�E � 22a.sicr+.mwc�^ // ' �•�c nna �ooncss9. [ zZ�.Dr. C. L� Martin Ta lor �Mal 3. Au ust 1, 1979 IGINONp[K[N •.E-• • VNDERI�C�I� VNDCNID�♦ O�TCOI�IPTNI�o..o��.����ICpUNT�OIOC�'v • ..o..�I��Y Amer. se. 72 sn.�� �� k.��� �' e.Ma 31 1907 �aWabash nuu�[• nOY1T1lOMOTw[MINfTITVTIOX-w� al�• � a�v��t���♦ �qi • .. .o ..,. ... o.,....,� ,,.,....;��..:°::., �<. [dabash General Hos Vital �a. Iny atient CITIS[NOlWMFTCOVXTR♦ wqqICO.F[VfPw��NNICD. ♦hCOI3VRVIVIMGS�OYfCI���n�rvn� •�r r�l wioowco, o�voncm u•.u..i � " 9. U. S. A. �o. Married �i. Mildred Kofoidy vson�occurwnon n�wooremirvcseon�nouarnr v.a.w.nvcr�w.� nnononrceoracwvic� i..u.m �3=.Em lo ee iae. Steel Mill u<. No �3a. --- ..,o.,....o..o.00,...,<„ ,�o<<�,. �o�,... .,. 1"..,.a� ,<e. Princeton o„�_ Yes „d, Gibson „e. Indiana ..mo.. u.r �:O:nE6-,:tA:JF.�;:aMC •�... .�oo�. .-.. Ta lor ie. Laura Hi bie �� R[LATIOH]MI� r�ILIHG 100�1[�) I���a��nnonO.o��.r.0..(i1�O�iOnn.�r�i� ��r� �ii�./,� nn.[dife nRt.4 Embree Princeton IN 47670 � •5 • 206. or ��n � r- / � roe�..�..m.we.a.rzoro�.u..oi��.,...�..�oi .vro.s. n..,.oi ,9,.No .��» ., - - �.... �hns,� 114 id. Fifth St .�„o,��w,�.�«A,�.,�w ,....o...,,.. i I�ar.r .O� .r[nwl o..i.i... . o�roe 19b. - - '�I IILI�'Olf I�ICPNSC;tiVMBER Mt. Carme�I86�L. Zzd �20684 NOiF: IF �N INNA� n'�S ItiVOLV FD IN tNli OE4TM TNE COXONEX MUST 0E HOi1FIEO. o I.CN[u�ilON, C[YETlR�ORCR[v1TON�-h'AME �OCATIOrv eit�o�ro�n •r.e• O�([ ��onl�,o..,.�..1 PCMOV �L I�raC�rrl zaa.Burial zab.0ak Hill Cem. aa<. Patoka Indiana ddd.All .3 1979 � � 1 I • i' 1 1 IVNCP�IMOUC Xn4C •���[i�w0 +Onn.r.0. C�irOnronn •e�i[ •�r zsa. Kendall Funeral Home 520 S.�Main Street Princeton Indiana 47670 • ir�rvcnn�D�o¢rnn��vcrv � . � .�.....�oi..c.o..uu.on�mi....�..... : ; _ � ; , , r°�,1 �, ; � ase. : ;'� ,�u_ �. _� �7. � is<. 2 i � wu�nccis• x�svice�rowc r-�/ o�rcncco.e��oc��accutwnnr.w�..o...-...� � f.� � ?6a. „ - � � I6b. � ^ � � VHIOO�qEV.A/I91 IllinoiiDepartmento ublicHedl4h-O iceoWitalRemrd� i.•.� a.unv.s.sr..o..oca �u.�i I � . � 1 HEREBY CERTIFI' THAT the foregoing 1s o true ond <orrecr copy o( ihe death record (or �he decedent named at I�em 3, ond ihat fhts �emrd was eztablished and (iled !n my o/(Ice In occordance wlth the provizlons o/ the llllnols s�a�utes. DATE��L" �— ��7� _ SIGNED,CI tyz ��� (�Q��y�/ U _ A.t.� �iL, i+3.,e1 , Illinois. .OFFICIAiy,TITLE— He� St'e �%� 7Te ori¢ind evcord a( NI� de�t7� 1� DermavnqY flled wlth tA� ILLINOIS DEPAAT�7 T�a� EAL7' �i Sn ��Y . ��� � •�d «� <e���nn �r� � tf.o:tied.lo m�k� certlticetlon� (rom ooD��� o( Ne oricinnl recerd. Th� Illinob rts D�ovld� th�t �A� c rtl�c�Uon ot ��oth rd �y DeNnmen[ of Public Fieaith or th� ixal n¢I�tr�r or ttw counlY tlerk �hsll G prlm� (�cl� evl ne� In dl cwrt� �nd vlas� o( N� (�cb Uurdn �a VS 201A (1961 reviaion) BUREAU OF STATISTICS — ILlIN015 DEPARTMENT OF �PUBLIC HEALTH — SPRINGFIEID � �