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Death Certificate - Taylor, Henry J_4/13/1982• CERTIFIED COPY OF A DEATH RE�D MEDICAL CERTIFICATE OF DEATH FILEN0. OECEOEXT'S I STATE OF ILLIN015 DIST. REQ ' I 61RTH �o.: No� �941 ■o. 267 1. PUCE OF OE�TM II L USUAL RESI�EHCE iwn.�+ a.o..oa n+.e. u i�.uwuo�: mia�a e.r... � COUNTY � �. ST�TE 0. COUXTY � � Wvlulon). on . au�ois A CITY (11 WbW H�ppn4 Ilmlb. nlb RUML uC O�H � LEN6TH Of OR lv � o� Oi�lJ STAY (in IM� Ol�p T0`�" Narion-Rura1P' �-�i° 8 days a. GULL N�ME OF (11 rol in Go�piltl ei inrti Wtlon, O�n �lral aGAnp or Iwtba) MOSPITIL OR i�sr�rurion l. NANE OF �. (fintl' � 0. IMiGGis) DELUSEO (Tre� er Ptlnq Henrv a7. � Indiana Gibson c CITY pf euUlE� wmonl�Jlmib, �db RUML .�d o�.. e��.nin o..�o.a ai.�.� TON'" Princeton E. STflEET (II rvnl, pM1� leeailon) ' AUORE69 RR #2 Twp.unknown c (Wp I l DATE (vonN) (Dq) . (Ywl OF 41n» DuTN' Ton l9 l'04�fJ f. SE% t. COLOP OR RACE 1. MANRIED, NEVER 1.fARR�EO. I. D�TE OP BIRTH � �• ��t WIDOWEO, DIVORCEO (SOmif'i) �+��� _m�le white married 11/15/1895 I 57 IA. USU�L OCCUPATION (Giv� tlnC al xort 1i4. KINO OF BIISINE55 OR IN- Il. 81PTHPLACE �St�b oi 1are10� ���/Y) Ou� auriny mert ol rortino ��b, am It nOnE� OUSTftT Farmer Aariculture IIuff Indiana 31. iAtHEH'S HAYE 1t. M TNER'S NAIDEN NANE � . Samuel Tavior Debbie Cato " 1S_ W�5 O[CEASED EVEP IN U. & �NMEO iOHCESi IL SOCIAL SECURIiY p, �pFOflN�NT (HOVCiW� Ia11oM 6MNtl Intlrvc0em On tOb i!�) �� IYO. ne. a ueYnorn) (11 Yu.01.�.ar a 4b� el urvip) N0. 9 I ��J {'% 1 unknown `S�o"'�un Records 1/�i FOSDStaI. ' 1& CAUSE OF DEATM e. eaer.0 I o, fl�1�llenNin b m. as....a uI.OISEASE OP CONUITION DIRECTLY LFADINp TO DEATN• ��jd1+SOi1 111 • •TM� Gw� not mun IA� moG� ol EfInO. �vN u �ur� I��Im�. u1��ni�. �lc. II msam N� aluaw, In)u�v er aomolluUee .e�ce caus�0 AuN. ENTER ONLY ONE CAUSE PEN LINE fOR (q. (C), �n0 (cJ. J z` Dira�cawe(o) Ayoertensive csrdiov>sdular disease� � � z ( o� wereie e.�amon.. u.a � a ,,,, o�.��„��. e�..,�..'�xeu�caam�c Chronic Glomerul y W � uYU Iq. �I�UaO {�� � u ��a.nri�a ..w. wt . < < Esst �o (cl . . � II. OTHEfl SIGNIfIC�NT CONDITIONS V Con]rtiae� conbiWUnO b tAa Ouln. bul nel t �J�1�0 l0 Ipa Ciwq OI oon011nn umin0 GNN . II UnGa I YNf II UKn II M!4 Nen�n.l o.r. Nwn I w�n. I 11 C�T12En OF WHAT COUNTPYt USA d tL. ��TE OF OPEMTtON I 00. YAJOR fIN�INGS OF OPEMTION tls with La. ACCIDENT (o�cif�) lle, PLRCE OF INJUHY (�.p., In or �Leul =1a: (CITY, iOWN, OR TOWHSHIP) 6VICIDE �am�. lum. (�cbq. �trul. ofliceCtaO..�lw�l HONICIOE ua. ur.e {qeeu) {wy) (TUq (Mauq q�, iNJURY OCCURNED I1II. HOW OID INJURY OCCURi OF WAiI� �l Nal W�ile iH,uAr VA .o,t ❑ .� wo.t �: 9. I IneLY « ili/� f1c1 I�ttr�daJ iR� dee�vW ili SIQX�TUNE W C.mtla� u I J LCG{i01�_ O d m a �¢ Firm H N �O p ¢� ACOrut iW �� _ 4p � Jnmes A.Frick /V—� (Dspn� er lill�) I=Jb. AOOflE55 �ND PHONE NO. /C��7 ��_ FECErvEO r -�-•• %Ofl FILIHO ON: � Sipn<d: ' '— �r LOCAL REGISTflAA: nJJnu: 7477 / HEREBY CERTIFY THAT �he foregoing is a true nnd rorrect ropy o/ 71ee � thar ihis reco�d x•as urnblished and Jiled in my o)fice in accordmrce with the reFis�.ation of hirths, stiUhirtlu and deo7hs. / UA"fP. �� ��— �'7 O� �' _ SIGNEI]L AT � �-�—<T Y\l , Illinois. OFFICIAL 7Te orlyln�l mmN ol Nh EeaN h pe`msnentry (Ikd nIN �Ee ILLINOIS DHPARTMEAT OP PUBLIC awEwur.] w ma�e cmil���m Ivm mpka af tpe or13mJ rtwrd. lM Illlm4 uauKa D�wMe ttat � Nea1N or �Ee bul rt�ivru m me cv�q ck[k Wa� Ce pr�a tazk evi0m¢ Iv �11 ceufu ab v�+ \'�R Lt DPpAHTMBM OP NELC NIIALTtl—Bartsn a! StitLib 5'IC�'_-!!'N:—?l,}I� . y`�, i unknown unknown', � , ]L �UTOP51'T YES ❑ HO ❑ (COUNTI'� (STATE) �0—, fr Rultd aLart. 11e. DATE SIGHED ion,Tl . 1?���; 12 12�52 � .� . . SUB REOISTP�R 7art ��(1� flEUISTRAR ltarion F�umd Far bta4 041u Jor the detedent named at irem 3 and J� thej{linais stalures relating to thei plie�ry [le(ka avC Iocll RQ1Wan �R • rcmN E> Ne Departmevt o( Public Rl�ed Of ine AvWekT ef ine. S1a1e of [:ISmb