Death Certificate - Wampler, Lawrence_5/27/2005. _
_..
� Ohio Departm�Health
Rep. WL No. t VITAL STA � CS
o� wT�,,.,+�w Pn�„eryR�.owcNa. CERTIFICATE OF DEATH sbbr-u�Na. .
r�sExvEO Foa OoM Repl�uete No. R� TYPE OR PR1HT IN PERANNENT BLACK INK � '
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. encs ame IF.+t Mema, usn . . are amtwn c.,. r,e
'� Lawrence Wayne WAMPLER Male Harch z�, 1997
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, , �j Yes p No OSa� �❑ ��pebent dER/O��aSentpDOA °f � Nursinq Home p Reskena p ONer �sreory�
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Cuyahoga Falls General hospital Cuyahoga Falls Su;rnit
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n55wETCEBffoaE M�.a:owraa (Sp.ory) GiwMaiaenNar.,e) Cur»pmmtdwa'�eny6b. !b notuuRaGieC)
AO'"'ss1ON -.� Married ary C. xeed Plant Employment Mgr. Goodyear
77a, esiaence- U;e t7o: ounry Uc. iry, pwn, yr�.,ofLaaLOn 734. Veetana urcer
Ohio Sum�it Cuyahoga Falls 2359 16th Street
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77. Fa;nefs Name (First, L�ioFx, t.ex) 78. MoUWS Name fF"ur, Atq.b. Widen Sumer.ie)
Ralph Wampler Theresa westfall
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' Mary C. Wampler 2359 16Ch SCreeC Nyahoga Falls OH 44223
20a.lA2NW Of DiSPO5iJ0l1 0. IdCC 0 15P05�.011(f:ame 0! Gen, cvcy, Gema.by t lOm�O(1 Crty p Town, Sa,t
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p e„w �{ uama�, p Removaltrom5ta:e Northlawn Cremato Cu ah a Falls OFi
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204. Date of Disposition 27a. Name ol Embalmer . 27C. License NumCer
�' ' March 26, 1997 None . � �
' SgnaNre o( Fune2' r or O;ner Person 22E. License Num�er (Nticensee) . ame ara aeress ct ao�,y
� .- �� � 649B Du.*ui-QuigZey Ciriello � Carr flare-al�
a s, olC Portage Tr�il.
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� 1�1�.R L 0 177( Cuya4oga Falls, Ohio 44221
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s� 28a. Certifier
, fCneckoNyOne)d CerUyingPhyslclan
_ To IFS Dert N ny Wk,wbE�e, Cea;1 omaraE et Ne I'vi:e_Ga:e, aM plue_mG Ne to Itq wuse(s) enC mvner u s:a:eC. _____
�" ❑ Comner
� On ihe Easis o! a.am'vution enC�a nveslipaLan, n my oC��'l Cea•.n ocvraC at Nw tne, E�te, ar�C plam; enC Cx to Va cause(s) ar�C r..amer ss sa:e[
�+ 29D. ime o eaN 28c, ale pronouncee eatl (MOnm, oay, Year) 2. as a5e e.erteo lo orone
W 2:27 p M March 23, 1997 ❑Yes �fNo
O a 2ee. igna; e Md iue o em� er / � / , 29. Kenx umGer 2Bg. a;e iS��6MOnct,Oay,YearJ
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3 25 97
� 29. Name Ma AtlOress o( Person who Completed Cause o( DeaN (iype?nnq
^ Bashar Mubashir, M.D. �44 A*. Main Street Akron, Onio 45310
� W jQ. aR. EnlarL'IeEiseases,vyutq�,MtLrn�liCaliJnt4^atCdufeEVleaealRDONtef.larVMmOCa01CyY'�.�VCIaaCaCiaepns;ra'r^ryar:es� �NV'a.+�eLYem�2e-.ee+
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N � nw:✓qinCeeln) � Cardiopulmonary arrest '
��° � S.tven:uui esi wnd;uone, . ue �or as a onseGuence o �: �
! a�+y, Isaciq to L�s'vmneaute
-a �, � v�,. hletastatic lung cancer � 3 months
�'� ErmrUnd.nylnp Gu.• I.�.t G Due to or as a Conse uence o: I
\ (�iseaee w 4qury Vut iMietoa ( 4 �
v everb ret�np vf CeeN)
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ca d. ue to (or as a onsequence o: �
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~ Part II. ONe� SI n�ncant ConaFtlons conm�u6n to CeaN but nol resulGn in Ihe unde
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CwaRFAiE S�DE Q YG! �{ No : p Yes � K�
J2. Alanner 01 DeaN JJa. Date ol lnjury 73G. Time ol Injury 33c Injury at YJorkO 33E. DescriGe Hew Injury Oaur.M
ParW ('�^N• �K Yeu)
(� Nam�l O�veftlpeUOn M ❑ Yo ❑ No
O�en C� N� � JJO. Place 01 Injury .,u nwn.. f.�n w..� r.a
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