Document KJk4qKN1DnRJ4QER1LaozvJer

FILE NAME: Philip Carey (PC) DATE: 1957-1962 DOC#: PC028 DOCUMENT DESCRIPTION: Death Claims Paid with Cover Letter from 1963 Apr 16 Xr J. R. L Y N c H S u ^ e R v is o * M etropolitan L iee In su r a n c e Company A p r il 16, 1963 915 Carew Tower Cincinnati 2.Ohio Mr. K a rl K rie g , Employee R e la tio n s Manager The P h ilip Carey M anufacturing Company 320 South Wayne Avenue C in c in n a ti 15, Ohio Dear Mr. Krieg: Supplementing our le t t e r of A p ril 6, attached i s a lis t in g receiv ed from the Horae O f fic e o f death claim s th a t were paid between 1957 and 1962 due to re s p ira to ry causes. Vie hope th a t t h is inform ation w i l l be o f some use to you. Very tru ly yours, tf. R . LXNCH Group Supervisor jr l/ d s enclosure cc: Mr. E. J . Fasold, Secretary ,k. ' ( , , ' Death c la ia a d uring the p-ericu vo IS.C2 ln c.Lu siv e have bean ' ' R e vie w e d la order to ta semble d ata to comply w ith t h is p o lic y h o ld e r 's r e q u e s t. The I d e n t if y in g In fo rm a tio n la shown below s e p a ra te d by g e n e ra l cause o f death. M alig nan t neoplasm (cancer) o f the r e s p ir a to r y disease n i *- V .-'s \ --- 1*fk11 /'-fWt> c - Gf' f"' , - ^ c , .vSV f " , wHaynie, Jo e. ^ ^ , \i/W .lle r, G e o ..: ?'f,,' -tAshbridge, Alfred-- ' r~.'Ellis, Benjamin ( 64-- Lesaard, Va. -'M a rtin , Edward -- - -M.Betancourt, E u fino - ' ' S a n t e l, E a ir y " >. ! - * S ta ll, Arthur - - S c o tt, Young - ' . / -- Enixevaki, Vincenty W hitley, Doney ' woods, Alenao Sarisky, Stephen Diseases o f the R e sp ira to ry System: Vance, Howard Ja ck so n , E s s ie i *~--~i H u le tte , Clarence Gooch, H erbert E a rly , Richard P a tte rs o n , Wm. -- Raymond, le w is Jfcardle, Chaa. ; r 1 i tv, 1 ' - 2 4 54 r 66 * 73 * 77 67 43 65 56 58 77 58 56 * 47 76 62* 64* 63 * 57 70 - 54 * 71 S / > y O H IO DEPARTM ENT O F HEALTH . ^W*DiVx N.p-- U 1 I I i ~ ll-.-OlVISION fOF VITAL STATISTICS ' V 'SSiii F.le N ^ Z ^ , - r " *** - V"- r* ^ l l ' V f . 1 r'z r . i i f ir - i; i if m m .n . v .v . i{> -/ -- . ^ tfimwy. R **.-9 .e. I .-V - E R T I F 1C A T E O F D E A T H Vy j> ~ lU r l^ r . T o - ^ V . t l r. ti * VIT* s X _ a t m r , *w > esi^ . -/i; ' _ L . r . ; - . 1 * , . .4. .T z _ L T . Vrr-S PIACE O f DEATH INSIDdEe aCIjTtYa;iMMMiInT?O;;,. N f f t ' ; f .. _ _ ' ...-"T * .**"' * ." y ****. i - -- >* - - i i *.-v .: VI \ r. * i .RESIDENCE NStO*.CITr.ll4MU?. x1 * jfk RESIDENCE OH * PARt " ~ V *;~ \ ' i \ r j ; r r u *,-- -K i i ~ j; - = r t ; -- Y E S O IM /v S m -- i U ~ L *' ti Z . : ' -.' -- n o f i 1.' 3, N A M E O F * - . * .' - Fi r t t . . Middle-?.. ,,* . n Last -- ... -- ~S!SF5mS h8' H erbert. r.' .-\7`.-L w is^ `` p- G och;' ' A . DATE.- '_Mofttta ./ D a y Vear ,OV7! "-Aug,1 5 :1 9 6 0 5. X Male 4 .C O IO R O R RACE Colored 7. ' MARRIED'~J0 NEVER MARRIED WIDOWED Q _V DIVORCED 2 / 2 & / 1 & 9 U" . DATE O f IIKTH E.- AGE (In yeort If JMer 1 Ytw I II Under 14 I Motetbt| D#; -I- j Homn I Ai/ P h i l l i p C a re y Co W H ' e r s v i l i e ;Kyi 10. USUAI OCCUPATION (Creo kind of work dom Fb. KINO OP BUSINESS OK INOUSTRY ' 11.;* feIlKKTHPlAOCE .(Stuatet o r-foreign - *.j| 12. CITIZEN OP wwtini tifo, tvm it ito) WHAT COUNTRY* 19 FATHERS NAME/ ( g o o f i n g A I n s u l a t i o n ) 14. MOTHER S MAIDEN NAME Alex Gooch S u s ie Geeefr f, .& 15. WAS DECEASED EVER IN U. S. ARMEO FORCES? 1. SOCIA l SECURITY NO. 17. K p O R M A N T ' S S I G N A T U R E ^ S i t y D , * ^iti of terrice) 270^05-1023 Y j J . y ^ r-^ JC f 14. C A U S E O F D E A T H [Enter only, r f rf utt per im t for (a). ik T r o n ;d--*i f ) ) PART I. DEATH WAS CAUSEO BY, INTERNAI setween ONSET ANO DEATH IMMEDIATE CAUSE foJ^ t / / J*_ / - c Condition}, tf n m y DUE TO (bi. w hich gore rue to kor conte (a ), X sitting ike under, ly in g come lo ti. DUE TO (cl. past m. oth 9inir<cANt coneiTfent^CMTiieeTiii to outh ei V l i ' x-^c 20o. ACCtOENT SUICIDE HOMICIDE 20b. OESCRIEE HOW INJURY b &, n. 20c. INAIRY o. m. P- 20d. INJURY OCCURRED W H fll AT f- NOT W H IIE f-r WORK L -J' AT W ORK *-J D *J. Yif 30*. PIA C E O f INJURY ( f . g ., f or okomt home, form , foeforj, tteeet, o j u f k ld g .r o ft.) N----' 'W * A ll if l l A t l CONOUtOH^VlVll<^^AT/> i n ! n/ IP. W AS AUTOPSY PERFORMED? YES NO Q Y d C f t f j t f r m f j y p c r F * " U * t ***** h > if f i[ h ^ v Y 't j r f ______ 20f. CITY. VtUAOE. OR IOCATION f - COUNTY. STATE 21. I Attended the decetcd^rot_.-- '~f--+---- ------------ i------- **-------- %-- -- /- -S * n d tott tow ~ Mere ) Oeoth occurred At pt op Mr Vo/r //o// /4; 4^ie /Ac Ar>r of my knowledge, from /A. r*<rj T 7 6 G N A T U R 6 r-, e / SUURR IA l. CREMA* TI9 N. <S5pecify ) Burial '.S te r Y c Z o * ^ 23b. DATE d /19 /19 6 0 rO/Rf * *" **> 2b. ADDRESS <Y > * . -*//). 23c. NAME O f CEMETERY OR CREMATORY I Family Cemetery CC>t^r **V 23<f. LO CA TIO N ((.tty^ 'lr'n n '. T urnersville, r </ , . i j U j 22c DATE SIGNE > /r o r Coantv (S ta tai Ky. - - T M S jc r r . Le 396W "& T 2 sts9 " ' M s c a r " S .ANi.ee*^; S o n ,400 NiVayne Avenue, Locland C in c in n a ti1 15^ Ohio 27. 0TE CO RY T 'W . REGISTRAR S SIGNATURE / w> > t m 7 5 s 7 > - C, J, ,, oA * L o ------- 29. SUB-REGISTRAR'S SICNT ur* _ & j p D . *N o Priaant R**..X>tr No. . P L A C E O F. D EA T H _ rS "?., m a llfa OHIO DEPARTMENT O F HEALTH DIVISION O F VITAL ST A T IST IC S ' ' ............................ . i - ( CERTIFICATE-OF..DEATH : w .yii,W n .Regutrtr* "No. 050502 , . \ \ l . ,r ,, : ^ ,~ . - 2. U S U A L * R E S I D E N C E deteuedlfiwd li institution- r V l \ --".** ~~ ^ rt t^ttoc* M off,idm m iQ fl) - . *.~.i t gw state - w w / ^ t* ircpuw tY": . y n a a i l t o n 7 .^ /r - *v N^*r -< - w ? f? -` ! ziO fV S r' < < ' *-% - 0. COLOR 0 RACE 7. MARRIED X I NEVER MARRIED t . DATE..OF RIRTH 9 .. AO i,(fn ;y *o rt 11 User ! Ym 1f teWr 4 Hn loti ktnbdoy) Months Doyt j Mm. White WIDOWED 0IVORCED 7 - 7 - 1 8 ' L -- d Ite. USUAI OCCUPATION ( G h o kind o f work domo A Ok. KINO OF BUSINESS OR INDUSTRY 11. ftICTHFlACE (Stoto or lotot%n 12. CITIZEN OF . dmoinn m**0 mi Ufo* mot* if omttrmd) \ p p i ! & & , & I & a u l & t l o n J Comotry) WHAT COUNTRY? Laborer \T. FATHER'S NAME r h iliD ^ a r e y Com nanr K e n tu ck y U . MOTHER'S MAIDEN NAME : USA - T pA A fi pyi la t .t . 15. WAS OEOASEO EVE* IN U. S. AIMED FORCES? ( Y tt , no, 0* nnktown)\ f l f jot. poo wot or doitt of ton ic*) ite___________ L 18. C A U S E O F D E A T H [Enter only 9) f ART t. DEATH W A S CAUSED RY: IMMEDIATE CAUSE iaK Tubila Taab. u . SOCIAL SECURITY NO. tT IN F O R M A N T S S IG N A T U R E Addrci lT, . 4.4. 9515 Crestbrook 2 7 0 -0 ^ ^ 8 0 `I t o S .Httl tttAs---- Oi neinnat ^ t a L flwEEN ONSET AND DEATH - .-v >1 v *S..?L UC/okmtcdbtUgomnoto, riiftoo ntoy i DUE TO lb) okoto conto (oi , StoJtng tko undor- l}i* Z conto lost. J DUE TO fc) Cj* y *<*-ir.CAar ceni.,,,, to Ou 20m. ACCIDENT 0~\ SUICIDE 1 < U L u .0 HOMICIDE 20c TIME OF INJURY Horn* o. m. p. m. Month, D or, Yeor 2Od. INJURY OC'CUttED i WHILE AT WORK NOT WHILE r--1 AT WORK U . ^ iZ - I to. g >tn or Atout c form. Joctory. ttroot, offito k U p .M C .i 2 1 . I Attended tko decerned from ___ Dfmth occurred o t -----I t 9 * T2*. SIGNATURE' z r r - e - j& 0# fbc doto ft tu J m 4 ; /u /A/ kost of m. I 22b. ADDRESS^ f f COUNTY. STATE 22c. OATE SIGNED 22 |U*lW...CUM A*r ` *** DATE TION. (Specify) B u rial 24. NAME Of EM8ALMER Thontas P Watson 'TfNEAI firm and ADDRESS Vorhis Funeral Homes, Inc* \f o u j ~ + - i ( ( lx NAME OF CEMETERY 0 "CCREMMAATTOORR!/ ^ 23d. LOCATION ________ \ V s 3 l4 0 (City, town, of county) (S ta iti Oak Hill Gemete - ______ Glendale IWIC. N O .) 25. FUNERAL OltECTO** SIGNATURE nM* - 5229A (STREET NO .) 310 Dunn St* (CITY) Ibckland 79. S U I 'REGISTRAR'S SIGNATURE (STATt) Ohio >*1. ,,ThiV is>o v*rtify cbac this is a true copy of the record which is on file m the Pennsylvania Division of Vital Statistics * ki accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953 < ' (Fee for this certificate, S3.00) WARNING: It is illegal to duplicate this copy by photostat or photograph. NOV 1 31981 Date m i i No. C & JL f/cu J- Charles Hardester State Registrar MVS-20143-- 525M-- 9-55 DiL*No. ..U62-h3Q jm s s s m w m m w . DEPARTMENT OF HEALTH OIVISION O F V IT A L STATISTICS CERTIFICATE OF DEATH 15680 Ft! No. ^Oisiertd No. 58 1. P L A C E Or D EATH t. County M o w b sem e-p yb. City. Borouoh crt ticofwwnftsshbip * c. Length of stay In l b !. U S U A L n t S '3 t C (w here deceased fvd. foro admission) | j In s titu tio n : rc*onco i - s u t * P a . ____________b. County - , c. City. Borough or Township N o r r is t o w n 5 Hrs. d. F U L L NAME (If NOT in hospital, give street address) Mins. ______________N n r r i s i c M i d. Street .Address or Location 2 /. ", r^ n r u T io N S a c r e d H e a r t e. it Place of Death Inside Municipality Limit? Y e iS No H o s p it a l 3 M a in & B a r b a d o e s e. Is Residence inside Municipality Limits? Ye f i No O U Is Retidenea on a Farm Yes No * y / NAME OF DECEASED (Type or print) a. (First) Raymond b. (Middle) 5. SEX 6. COLOR OR RACE 7. MARRIED N EVER MARRIEOX1 Male W h i t e WIDOWED Q DIVORCED iO . FU L L NAME OF SPOUSE c. (Last) L e w is 4. OATE OF (Month) (Day) (Year S. DATE O F BIRTH 9 A G E (in years If under 1 year If under 24 hr* last birthday) Months Pays Hours Min. J u ly 1 1 , 1903 -- 53-- 11. BIR TH PLACE (Also givo state or foreign 12. CITIZEN O F WH> 13. FATHER'S NAME George Lewis ^"^^neybrook Twp. Pa 14. MOTHER'S MAIDEN NAME _____ Edith Brooks 15. U SUAL OCCUPATION (even If retired) S h ip p in g c le r k Philip Uarey riagnesia Go 18. CAU SE OF DEATH [Enter only one caui se PART 1. Death was caused by; IMMEDIATE C A U SE (a) IE. Social Security No. 17. INFORMANT Kary Thompson MEDICAL CER TIFIC A TIO N per line for (a), (b) A ( c ) j 1 3 L W a sh H g ftfe ..s.b.e^t.osis_,^ener_ali.ze.cl^-.p.uljnQnary. A ve. INTERVAL BETWEEN ONSET AND DEATH Conditions. If any, which gave rise to above cause (a) slating the underly ing cause last. DUE TO (b) O U E TO (c) Cor Pulmonale ,,Duodena1 ,,U lcer with_Hemorrhage_ PART II. OTHER SIGNIFICANT CONDITIONS [contributing to death but not related to the terminal disease given In Petri I (a )J * , J * f/ C 19. W A S AUTOPS*. PERFORMED? 20a. ACCIDENT a SUICIOE HOMI CIDE 20b. DESCRIBE HOW INJURY OCCURRED. 20c. Time of lojtny Hour, Month, Day, Yo m. E.S.T. 20d.-INJURY OCCURREO 20e. P LA C E OF INJURY (e.g., While at Not while home. (arm. factory, street, etc.) work O at work Q 20f. CITY. OOROUGH. TOWNSHIP I COUNTY STATE 21. / /ierby certify that l attended tlie alive on 1 / 23/ 5 7 p i......... 22a. SIGNA deceased from 1 / 2 3 / 5 .7 . 19---- - to . - r t m i f l r . : , that I last saw the deceased and that death o ccu rred at 5 S 5 9 . . X E s .7*,, from the causes a n d o n th e date stated above. 23c. NAME 22b. A 0 0 RESSL0 3 9 D e K a l b M o r r i s t o w n --- B e n n a OF^CtMKTfefttuy On nR A 213.&. . LAOA C. A. TI IAOUN S t. 22c. D ATE SIGNEO 1/29/57 (City, Boro.. Twp. *. County) (State) 1957 ^oney&rook Methodist , Koneybrook. Choater CouxjrPa 24. OATE REC'D BY flEG- 1-25-57 25. REGISTRAR'S SIGNATURE J u l i a M* Kennedv 26. SIGNATURE O F FUN ERAL DIRECTOR ADORESS D* Rae Boyd, Norristow n, Pa* a it m m i ' . . *, ( ili z- s. lex. Oitt. No 'v * J n n u i f . Xcg. H a m ilto n i. PLACE OF DEATH O. COUNTY *1 . . * O H IO DEPARTM EN T O F H EALTH DIVISION -OF VITAL STATISITI, CCSS -. Frk N o . t C E R T I F I C A T E Co e D E A T H I L 'V **!'"*1,N ^ l l i L l| t V 1- .*- '.-.V* . . V* t J< v l r :T AME OF DECEASED J7YP OR PRINT) -M iddle^ ., # V- - '- 'i'^ a c k S O T iy ~ r X 0Af6> M onths. P ly - . Yen .r / f f A 8 / - \ '1 S 6 tesie Q 5. SEX . 6. COLOR .OR RACE 7, MARRIED m ale C o lo r e d 1 0 ; 2 ; 9 9 j i 6 1 -. 10. u sual OCCUPATION ( G it e kind of work domo r NW d vrin f mart cim orklna UH , noon it eotirodf L a t o z m ^ / s r a a s ____________________ w iD o w eo Q S n EVSR MARRIED O divo R ao S. DATE O f WITH ACE T/ ;#ri Il Uflvr l w If Unfcf * *l` -- // birthday) M onthiY D a ji I iiom ti -w ffc II. BIRTHPLACE (S fste or foreign *- 13. CITIZEN OF RY* _ a r a y f f i j)';. r - -- ~ i r o r g g * ! n , A i i : . w m g x : U . FATHER'S NAME ( X o o l g <* Insulaeioii7>4- mother s m a id en n a m e * U Hn M in C y ru s J a c k s o n . :Amanda* ? IS. WASrODEEOCEAASSEEOD EVER IN U. S. ARMED FORCES? I f Y t f . noi, dar#mnkno' >l! /14 k w o f d W n #/ St r o i a ) SOCIAL SECURITY NO ^ Q g ^1 4 4 0 17, INFORMANT'S SIGNATURE Vf D ora J a c k s o n . 3 4 2 $ B e v i s A v e . IB C' AUS~E ~OF" DEATH (n/#r mu- pe-r iio a - b--r U- )i Uh Uh} PARTI. DEATH WAS CAUSED BY, ^ _ D r r ^ C U C f " ^ * i- Addins INTERVAL BETWEEN ONSET AND DEATH IMMEDIATE CAUSE la i U O R P U L M V S A L E j -. Co n d itio n s, i f any ' DUE TO t h . w hich gaw enje to 1 short came (a), Staling the mndtr lying c s n it last. 4 DUE TO /c)_ r ? ' V M l. A s b e s t o ^ s \ ,.&Jc r ~ <r;; i ** [ h {SAL. i .^ r : --/ r - e 3-" J L j L P*if It. OTMtt fimre*r Coannoai comtcuot to OCMif. A bt NOr'Ttvui to 1ACE3jVXW 'u Wu*<c/Co*ioiTu|rt'PH 3* * / / / A rs / / I t 20o. ACCIDENT SUICIDE HOMICIDE 20b. DESCRIBE^^rJURY 19 WAS AUTOPSY performed? YES DNClO* 20c. TIME OF INJURY Hoot s . m. p. m. M onth, Day, Year 20rf. INJURY OCCURRED WHILE AT r-- WORK L-l NOT WHILE AT WORK form, fortory, Street, o fu e b ld g ., tte .) I LOCATION COUNTY. ..STATE 21. / attended the deceased from _ _jind att tau aine on_ D eath oecmrred at -- -- m on the date ttated en 4 .*an d to the best of m i know ledge, from the cantei itated. I 22c. DATE SIGNED n i L T O N C o . Oh i o iR - 1 7 - 6 1 21o BURIAL. CREMA- 23b. DATE ^ * M r i 8; 24. NAME OF IMBALMER 1 2 ;;6 1 . 23. NAME OF CEMETERY OR CREMATORY (L IC . N O .) 25 mI OfaikWlevs AOitii,o .. county i (S u te ) E .P . S te g a ll 5151a 7b. FUNERAL FIRM AND ADORCSS (STREET NO.) - ^ (CITY) ' ~ * |ST> P ierce cl People' s Funeral 27. DATE RECO BY ! 2. REGISTRAR S SIGNATURE ? V-j IQCAI REG. _ ^ /* >A s . jL<A^t^r Home 1504^/ohn S t C in c in n a ti, u Ohio* n sub-registrar s sig n a t u r e