Death Certificate - Wright, Russell M_7/12/1957y
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� �CERTIFIED'�COPY'OF A�•DEATH'RECOR�� �� �
D[C[DEN7'S .
NIiM NO.
1. PLACE OF DEAiM
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I�OUtSIDF �R� �.�ti►
I le. NAME OF
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3. NAME Of
DECEnSED
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13. FATHER'S fUll
NAME
� I5. Was deceased
nu. no. o� a�.�o.d
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�� • STATE OF IILINOIS ' Nw.ieu
� MEDICAL CERTIFICATE OF DEATN a°on
COUNTY, ILLINOIS
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RUSSELL
:harles B. Nri€
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q INSIDE ��r An�b Md n Mr til�. �i�4 r w 1wn A.w�� �IT/ _ :I .I
C. CIIY, VILIAGE, OR TOWN � °'�i �[�oi ja���OENCE ;� _��
23 yeaz's ,; �
I�. STREETADDRE55 . � �g.G'ddeceeiuuie� i -j
_� . �YE� tJ0 ❑ �:I
c. IIA511 1, DATE OF �MO�'11M1 ID�tI IYEAII - -
p7RIC�iT DEnTM July 12, 1957 ;;
B. DATE OF BIRTH 9. bCi'Gnnde i� �°nde� I,ro� d�de.1� sn. � i.
il/21/17 � 39 ' �o...� o.,. �o�.� .�.. i.
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I1. BIRTHPLnCE (Cdv and 4a�e a(weipn cwary) 12. �Cnyi�zepn o/ wAat .
B�i'd88y6� II1�3T18 UJti� V '
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le. MOTHER'S Nll Z� -
MAIDEN NAME �' ' '
dnna Ingle z �
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17. WFORMANT . . � .�
o. SIGNAiURE "' -
� . ADDRESS ASSt. Registr DECEAS DSHIP TO �
IB. UUSE OF DEATM �3PipT1 IZZ�ilOj.9 O
PARTI,DEAiM WASCAUSEDBY: [Enieronlrona<ou�epwlinafwW,181.ondIC1.] iNTERVAIBETWEEN F
• ONSET AND DFAIH -
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' IMMFOIAif CAUSE. IA1 ' ' 3
......................... Iaenn,ec�s„Cirrhoais..of Liver xith Abdaminal Asci s IInlmrnm 4
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Q Iha a6ove IMMEDIATE ....... - ---;
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r ..�..Sc i:.i. >:c:ing
Q Ihe UNDERfY1NG ldve io ICI � ' ' ?
V :uuse lail. - . � .
� PART 11. O1HER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT Npi RELATED TO TME TEQMINAI CONDITION GIVEN IN PART IW. �
�,,,,,,,,,,Chronic.pasaive,.congestion.of lunga.... .. : •
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� � ' 19. AUiOP$Y7
(aj . .. .... . � YES� NO❑ .
p Z(1. DFSCRIBE CiRCUMSTANCES OF INIURY, If AN7, WHOSE NATURE IS MENTIONED IN PART 1 pR PART 11 ABOVE. . �
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� i1.Ih�nbY�K�ilylAv�%ot�nd�dlhrdecmiadlrun�7J.4V.L.19_71.b 7���.19JJ�
ond d�ath xcvnd al ��� i�OM.. (ran !h� <omn ond m Ih� do1� �la4d obo.�.
DATE SiGNED . ' ADDRESS PMONF ��
7��57 M.D. Q Hoa ital Marion Illinoie 121 �
n' /�,� r �' Gibbons Flmeral ftone
DISPOSITION� BO�dREMOVAR��OAtE�.....T/.'�..�77... ,� FIRM NAME ........................................................ �.
u CEMETE¢Y.......NCH..Ndl'�ORy..ClP.Q@tiP.T�C ................. .=,a,� ADORESS...........�M.�B.tT�.e7..I1�.iT10S3 � ',
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S IOCATION......N.27Y..�dLQfORj!�..ZA111&Ati ................. �� ...................................................... ..... �
, I `� SIGNATURE Q s uCtr+SE 2� .
71. Rxnvtd lor (Sipn�d) •1 �
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_ �7,.],v 1� _ l OKT T_. C._Nu�QIl. - _- ' !OUl ¢EG�gTP�F '
�� +� V5.8 R 200-•BUREAU OF STATISTICS-•ILLINOIS DEPARTMENT OF PUBLIC HEAITM--SPRINGFIELD
� 1//EREBY CERTIFY TOAT eAe Jwegoing ia a uue and rorrect copy o/ the death record /or tAe decedrnt rwmed at item 3 and �Mt ia rccad
_ waa ataLlished and (�le in mr office in acco�dence with the p�ovisiona o/ the lllinois statutei « latins to tAe ry�sp¢iion o/ butlu, a' birtha ond
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AT ' V���l-�h/v" - • Illinou OFFICIAL TITL `�'�' �i - '� '
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T!� orl�leJ rewrd el �h4 de.�b 4 pnm�eecJ� ,61ed d�6 �A� ILLIH019 DEPARTKENT Of PUOIJC HEALTII u 6 dyleld. Guu� eb.b �nd bad m�6�r.n w
�mborized b m�k� cn�i6n�lam Imm sople� al �6a sd�ivl rerord. Tbe Ilifnau �nmu� p�o.id� �hu �6a au�ifinJdO oi . a..w ...om e� �s. u.vu��.� a� Publi<
Iie.I�Y or W� Ixd rst���u e. �M swery ekrk Shc ba prim� fula nideon iv dl eoun� �al pl�aa ol �6� fu� �6erde .�nsi
YS�R 201.1 DHA0.TMENT OF PUOUC MEALTH-�vruu el St�fbtle� � prlvted � tL AutLodV of t8� S!W ol Illlml�
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