Document 0q9n2D7O36QpERnGjvq9eEEBJ

-14.- f':- - .. jkmen's Compensation* , - v 1 The Industrial Ct mmission of Ohio ... .. ... '^jgmpinyppr 1 Henry- H. Hoeret 1 .Claim No. O. D_____ DOPUCAit Pr 'Y Street fir.d 10-i^ W&ynO (tVO., 'Woodlawn `______ Date ol Disability------- ________________ Kity,,___ (State) ...1; '. te ..^^Kmriyr " -.Tfae^PMj.lp. Carey.>tfg':Po.'::.:.':. .Manual No.__ _M33_ ____ Risk No,___ M&Street WVSfc'City. C Indiana11__ lSji_Q_hlo ' ~. , (State) 'AWARDS FOB COMPENSATION^MEDICAL, NURSING AND HOSPITAL SERVICES Hi && m y;_. -' SaVy . -v *>, wiSS^Temporary Total to-- Permanent Total. r^^^^Teniporary Partial toy. V- \ ^.^^Permanent Partial for.loss of_ Total Medical Services to date----------r____________________ Amount 'i ' ' : FINDINGS OF FACTS AND MINUTES 74*40 IjsJfrfyf' On this day this claim was before the Commission. Findings and orders were made for the payment of the items listed.below. The Auditor was instructed to issue such warrants as are necessary to pay such Items. .; JjMf*-'V"`7';V ' * MEDICAL SERVICES - v.'. .v- .>; : NAine* i."" < o ,.*{. -: > -- `a ; Address - y * .v - " j . Amount WArrant No. m : '.'Hy ' : Type. COMPENSATION_______ ________Weeks at Rate of $ Period Amount Warrant No. ' 'r v* Kota to Auditor -- In Absence ol Another name. Claimant is Payee. H: Present for Claimant Present for Employer Sy ti ... ^This action based upon the following motion made by Mr.- r__ JEftbia_ iHeard'by'Mx** ; Dickerson," Mr.' Tobin'and. Mr,1 Marshall, w/Mr. Hiokling and ?Mr, 'Brocktnw 'Thit claim coming'on to bo hoard on the employers ^Application'for :Handicapped Reirabursemont filed on January 2$, 1961, it is'tho finding of the Commission that the said application be denied.fo^tho reason that the^ claimant * s disability, diagnosed as `aobeetosia^was*not':caused by a cardiao*condition, nor has any compensation or. medical'benefits been paid for an aggravation of the ' heart .condition by the . said asbestosis. .. Hiy Hy; *^Orv-. - .. *' ' r.r'/'f "" * ' V- '.I-:. i - yY ".............. ' - 'V':-. .'-v PLAINTIFF'S EXHIBIT That any special finding or order written hereon supersedes any printed matter In conflict therewith.^ This motion was seconded by Mr._____________ as follows:. Mr. Tobin, aye; Mr. Dickerson, aye. ^' 7;;: / . ; Dickerson ^l// //! -and was voted upqn 'yf.-['/Hy < oata---J<anch-ll,-19Alj-ig`^a s^uurr-JZ&2L'V'--jj,3* H Va*..r1.w. -L- I M IS' S V;l` Form 0 D 2 (in / / 'h '. V lESTlWCTin.NS. la tccArdtxet >>tb Sc C i on 4121-SS of THP fHTO *':'-WF.VS CrMprvSATIO'* ACT ***ry u^tyir aHall Lee? record -if A! I. muri** r h' ht #^plote* n h en'jie of * *p 1 n n t and re* fort * to The f'lmu of I0N WST DE a'LL> LGJn.CrCD V'[) .C,!C'...0 ap"n for^i rr->uled for :*< |*rpii. THIS tFPLICA.-II ED 11 HI TW. fHl.rAl' pnwm Port I of thi* fnrn BJ.I fc. ococutod by the eaployer by ehea the decccrnt *npl*v*d ehm hie ditibilit* bejn, or h i aeuLhorited feott Fort 1[ of tbit fori bo completed and aigned bv the clamant. Wail thia report in tta coo* plotod fora to Tbo Bureau of torkaoa'o Coapea a a11oa, Claiaa Section, 0>luaou. Ohio. Do not write in this column Ajo VVi FOR OCCUPATIONAL DISEASE ONLY Claim No. STATE OF OHIO O* D,.?-.1?.?.?.!?. Bureau of Workmen's Compensation First Notice of Death and Preliminary Application PART I EMPLOYER'S REPORT EMPLOYER 1. Name Of employer:. The Phlli;T CorcvJ'f.nufin,;:...Corine.riy.................. (Name aa shown on Insurance Certificate) 2. Office Address: . ;':"n.........S.,J^yno Avo. Hiirilton......... Cinti,.............Ohio (Number) (Street) (County) (City) (State) 3. Nature of business:..!Mann iii': t` ir: r.r Type of Organization : ^ .?? tr~ HH [Farming. Coal Miner. Mach. M (f . e'e ) _________________ (i'3r'n>r<.i:p, Corp. or Individual o*ner) DECEASED EMPLOYE 4. Name: .......... Henry (Ftrat) (Middlc Initial) 5. Home Address: ...r ` iP..?...A '^P..\ Cincinnati (Number) (Sireet) ..................... (City) (State) 6. Aai.(.'..Ti^?-.,FMeailne*lei.-1MT,fli*,.?.... SDiinvgolrec.eMd,arWriedidowedHarried ..S.oSciall y No.?VO.-07-0405 Location (Geo.) Elait Report Filed Date of Death Report Lac Hear.r.g Lag Tayment Laf Occupation 7. Number and relationship of dependents:.... One . 1 r. o 8. Was deceased a partner, member of ftrm or owner of business? NO .------ OCCUPATIONAL DISEASE (TIME) ^ ^ i/% , 9. Where was disease contracted:.........^'7.^....r.P.Q.Q.rP:.. (City) (Cmm*y) F .. SZTa..... (State) \ 10. Date quit work:.. 11-17-60 Date of death:. ..1.0 -1 / - c5.`_. *\, ' . [ 11. What was deceased's occupation? ........................... ............................................ Agency (Unease) Typnof Disease 12. Explain fully the kind of work deceased was doing when disability began: . d .. . . ^ / / 1 ->33 /' \ \ / .......... /*>; :h * ............ V ? V 1 -----`r - >1 .............. I L i . - / ' ? .i.W't i ~T- KcA 13. How long had deceased been doing this work?.............. j ..................... ^ ...'-tVoL. .. f ; >1 14. Experience of deceased employe in this type of work <1 ftr inft 15. When did the last period of employment with this cmploycrl>cgin?. . . (/ y/ 3if .. y^-4 16. Name the employers for whom deceased Juft worked'during the three years preceding the beginning of // the disability, and give theiV. addresses and fcusine.s^: ................................. . ' ./T . Y- Natuto of Liiiab. f'.Ut ol Hod/ A\ uaie Wag* Coirpiicatiom Deere* o( Injury 17- Decedent'* earning* were reported on payroll reports of Risk No Under Manual No................. ... ................................................................... By signing below, I do hereby certify that I have authority to execute thia employer's Report and that the answers to the questions given in said report are correct to the best of my information and belief; that the deceased herein named was, on the date shown herein, an employe of the undersigned and at the `inte c* (did ) entering into the employment from which the disease is claimed to have resulted (did not) represent himself as not having previously suffered from such disease. Date report sent to claimant t::z r;:r.ip c.'-ey r.:ro. c*j. For Date received from claimant.. y:.' ) supv n. /lOfTiCial til]9/of per`Vi'i.smnf ind hi| dep\f imni)/ / Date mailed to Bureau .... ( Name of employer aa j^.virn on Insurance Cer'.ificait)