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Death Certificate - Wilson, Pearl_9/26/1969I.'��,�, � - . .: _ '�„ CERTIf1ED COPY OF A DEATH RECORD STGIE'rtE M1VNbE4 � G � /j` STATE OF ILLIN013 � IiF:.� �C. �.� 15iR:.����i / ��. l' I D�SiRICT NO. ,�ecisraeo /(� <� I MEDICAL CERTIFICATE OF DEATH _ : U:'.EEF �ws* SEX DATE OF DEATH �"�'•P' - - \ ncst m��ou .• __- '. i r.EASLD-f:a,Y.E Pearl Wil,o z. '. �1�9-69-=_ : Pn!: 1+ . � !. [ei i�K '' ---- � qGE-usr � VNDER 1 YEAR� UNDER 1 DAY �DATE OF BIRTH iw� ^. �^r,.�.w� PLACE F �EATH Fi.l[v...ii[. �:[viO..�.v.[GIC�ti Iti.".1I.t�. FIR��JI��0.51 M.�.S. • C/.V$ i MC�GS . MIV, l O�1(i�188 i i0. ��'fl' �3C� .�.,H:.-, = „�°``vinite � . s. � � __ ._._. -- � • '": I Sb. : Sc. � CL:'�i 5�' f AOi W[RME0.�GNf Si�E[i " '.: :^.�>. in:_ Ov op�] ::�S::iCt n:'�9(4 ����[5/.`Nli' ��CSVItnL O4 Oin[41tiSLITV90N-/+�M( 1� - Iit C.srmel .,� yes ,,d. Wabash General Hospital - — NAA1E OF SVRVIVING SPOUSE f� "��E. �.�E °"" ..•°� � E�S7 q.P_ACE :s:.:� vv roQ��c�. Ui12EY Of '::HAT COUhTRY vA�IEDD NpV OR EDRRI[cDY' `. --" � Irdia� USa ,o �`atr�e`d ,,. Thom�s 4111son - _ — 9 � "�""'"���� " - 13a. b. '. . '_ ___""'_ - �iS�CENCE 5:.:: - :xr : r . � o:.. rn�v. n.r. ca com nsrocr nc. ;�.�v�[si�o r ' s,n[[: ��o wMefa ➢ Petersburg .,,d ye's;;�_ 802 Maple S�r=et --- - Sr:dlana �,<b.� ike i,.�. —.—,,��.�_-. - �� �-�. usr • MOTHER-MAIOEN NAME n.zr , ....-". i:.iniR-NA,45E ncs: m�DO�F - . -. .. Isaec '=' S. Jones. � ., ' Fanny �orn i = 76: ' � .... �.., . :G ISi0.Efi wn'O yp. 04 4. E 2Ot� 04 :C � � � � � FELATIONSHIP � AM�L�NG ADDRE55 � � , 'I:.FCRMAhT'S 4GNATURE � � � � � _ � i � �nL:,�-„�,,,� .:.� t.��N�.;��hs� � :,�� ��.,�. � f � ,� - - !s ao-'�'�.- . • - .t°`--. _.�: �.-•° - - . �i:,:. .w �n� �x..xa�. r.;�� •�.c -�- _.___----- �fniEa aNtr ONE UuSE v[a I�KF Fov �o�. lel. , — - �;.�� �. D`ATH �'�AS CAUSED BY: . - • i '_"'"'_ i:.. iwmt>i.:[«uY, . . .I " " / 1 ' / C i' .Ct. � � LLC,!: � .(.i_.,i_.!.('� - - � - _ ___ (al �I_�l.-i� i,ti LC,' L': �.ii�i L.l� ' � I ovt ro cv .s n:ensa�•wc[ cr: P �. . �/ , .J J�LC.': ;�.,.• .`.�..�-•�, 1 ' .Gi..-i ---'---- _ _�.�o•a. ,. .v. 1 �✓;.��.,r'`,t_�,...t.,c..�� I` � i.C.4' : !- . - � -- ---- - ::::�.. c.:c au[ �,d . (b� . ' � i •v:m.:[ <.vee �_� � � � + ; 6. . '.1�:� .,+ T.E V':OEn. I.!'[ :[ Ca n5 � CONSEQUENCE LR _ � = _.•:i Vl:[ t�5i . __ . (cl AIJTOPS % . � rES. �. ... . � ' __ . .,.- . '. __'__ :.esinc� . :, _,,._ � FhRT II. OTnEF $IGM1IFICANT CONDRIOVS. co+v*�=`s corv:e�v�:�.+c :a oe.*� e��: nc: enam *o c.es� m'.�.� �• °'�*' ° ' __"'"__" _ 19a. .iGb.— _- ___'"__ p,: OF O�iRAi1CN, IF ANY;StAJOR FluDii�GS OF 07ERATIOV """'-� ,� . 'iCb. - VOTE: IF P;: IV1!'�T '__ _r- - c " .... : . ° �_`. />� M.• THIS OcAT^.. i..c ;_ _ . _ .. ..:. . - _""'"_' "" .� I CEFT�FY Ti�+AT TO ���= 6EST OF MY KNOWLEDGE THIS DEATH OCNRRED A ` BE NOTIFiED. �� :_____.-__ i n` 7h; DATE, AT ���= P��= F`�`� FROM TME CAUSE(5) STATED � . O�Y . YEeR •tiD USi S�"/ M1IM/ NONiM '�^� �E�� � - ' �.=yln . J�+ • �`^4 MGnTN . RF 06. .. _________ I Ai i"c::D"[D TMc� . � . ER �l ' ' % . �iCESSED FnO:+.:. , � �. '�"- � / ' / ,�� _" 'TO .,� .: ; � . , �r. ' . ° ^ %-' 21b.. ' r . L'i i �21c .' c" 710. II / � ; DATE 9GnED �/�yon':�. = /r. ve�:� . ILU�'Ci5 LIC2�iE '' .. '� , `' � ' - . -- �I'v::�TIRE ' ' � . .�,'• , ���t.� . .'. : , • lr.: 1' � / '� / ' i '. ' � i : � ' � i .1.� i ./ 1... : ' 226. ' 22c � . r • '.'LG...��.� ... . _ . . � . u,rc.. . - ��_.� ••'•.•—. � /41LY 00. }ONY . , ,. � . ' .t{a.i! ��G �=-DRESS�Eai/F1:R " ; s*ea: �+�.+:�me[a ca•a. r. o. �/ �, � � , .: _ .. . � -, � ;. �,� L�,C�:.� l._, ��1' i •�rl.( r � ' _ � , . I• CITY 04 :OwN Sinif .� �A i G • • - ��, i. �;,, [, nATlO'd. :CEn•'_7EFY OR CREM1IATORY NAME , LOCATION a � _ _ `- � S}:Sloh Hale]ton Indiana :z<A 7-1J=�:-`_— ;:... �g`u'i`isl �i<c. � �z«. �:..E . � ti��E ]i4[!i /.VO l�L!M9[0. OP 0.. i. D. CIiY 04 IONN � . fl�K nAL rOA1E � . . . Co�vin & �or. 425 N� M»ln --- 'Princeton Indians y777�, . NN[4�: DIR[RON'S I:LInG15 tK!>Si n_'�.- i�;^'c�4L DIRECT� 9G;:ATL'RE . �; � /' . . i \^� . .. r> , . 'z5 h l ,r 'i': �� �, �� DATE REC D Y L R I . � Co0-OSSeI � /�/ '��� �� LL:�`�GS �-c+qi.+tE�i Ci GUBLK FE�ITtl - BU9E�U Ci Si�JLKS . �<�. '/�7�% _ J�: tOt9 C. 5. S'a�.].:_ :. ---. a_—.— • .. -.- . 1 HEREBY CERTIFY THAT the (oregoing is a �rue and correct copy of the deoth record;fo\`the decedent'named at item 3. +�� ond that thi�ec rd was e toblished rnd liled �in m o(fice in accordance with ihe��pmvlsions .ef �he'�Illinois statures. .S. Y • � �l � •.� • . J DATE I�' "' / — SIGNED _ ` ^ - - - _ • : ,'j _ i:�. Cn�~!el -; o°'�,trar �� _ AT _ , Illinois. OFFICIAL TITLE_ _^ ., . _ _ The ori¢inJ reeord o! tAi� deeN ie oerme tnUy filed with tAe ILLINOIS DEPARTb1ENT OF PUBLIC }{EALTH �t Sn���¢field. CeuntY t•lerb .na I«el eci�vere ve euthoriaed to mske ertificr hom coo{�� of the original record. The Illinaie etnwtee de thei the <enificevian of s deach rern!d �y :he • Dep�nment of Public AedtA or"Ne loc�iauer ar the county elerk �Aall be N�me fseie evidenro�� murte endb��cee o! t�e faea thermn euW. °� �'' ' V$ 201A (1961 revision) BUREAU OF STATISTICS - ILlIN015 DEPARTMEnT OF PUBLIC HEACTH:= SPRINGFIELD � . � , - i.._$_ , . ' . . - ' ' _ " . - -.