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
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Jnmes A.Frick
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(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
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unknown
unknown',
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]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