Document Rj5D8OpZB8L9REa7DQwR0dO0z

% r __ ____________________ WIST V rtO *H it STATE 0 E*Af*5* i: C * li.IT -- 0 *VISOW O f V K * .; V-AT".* -f 1 II * C f r.c b trt ^.erf CcETI.SiCATr Or Dt^T.-ICs4i vlaVWs*We*M*t/ ; .r i r " ! ; T-1 i - _.ih^*. **. .trti.i*: USss s. V.T.lte 1A*'-;*iV 5s. rc- Js-i.o ` ** so! nsri 5c. ev : bat: Of t**- --rr^-Ll , - 7I1|rA,.*A&**i!,i 73- ' . C m V. `* 0 * ^ . OA L O ^ I O ^ c / "dT a T T lM<5i JTi l<* *s CJ:U; 0s 0*Hf* n"S'V .0*---N *<*i .****<. ?! SM titf h i *i as; I * ! 7c. G r . a r l e t c n 7c. y e s 7c. S t . ? r & r . c i s H o s p i t a l J W C O ' t s ( * n ( rvet ia . (.'5 A . s m tt/ m y l C l I l t I K O.* W A T C C V K I5 Y l M 4 f * : 0 . K f v f t ; S u r V iV - h ? H S . i E .i ** . f - w r * i . 1 W iS 0 'A*t2 . O lv s t C fO U M t f * ; 1 ; 1 . i v *A s. U S A -l iio . a a r r l e d j n . V ic a a K i l l e r ssc ia i scc u ^ itr H 'jM ttt USUAL O C C U PA TIO N ifn -* kMC ( w H M - S l v f A | matt ( w i i s g (if*. i :!i M ) AiKO O f tu s iN U o t i o u : ; s v .X 2 5 6 - 0 9 - 2 1 4 3 i^ . P i p e f i t t e r ia . C 'a e E ic e l t v w t r lie.W. Va - /FATHER-NAME ub. P u tn a a ueP oca ftMTHFlACl iu a ii s r r* * L weJlC -ri*" I Ui. R ?D 1 MOTHH-MAIOEN N A '/f ^ tm n r tagnny) is.She 11 A r t h u r -s ! ______________________________ _ _______________I. W .V a . usAana Cot t r i l l c e v rt*,) :sb. n. . **ra* . . f *' m i i M w r in ri*s U J . t m t c rarer!?"' INFOSMAN!- V.GNAIUI !**. a*. a* in<tiwriil >*. f >r s r d eist t f ssrvfcs) C D 5S1S p j - 1 ^ 1?. Yss 1i7h. W orld War 2 . ,its . c 0 -- u s. p o c a V f.V a . CAUSE O f DEATH ( t t w m Iy m s U vm p sr (ins (or Ui. ;*!, r d I f . ? * n I; OCATH W AS CAUSED BY: IMMEDIATE CAUSE (el___________ * V o d e k-*ir1s" C--s^--ii-iw--u -, rf 4tf*rYf,, "I: , - wt *h<ichh (!H* tS t I Uwa TS (bj. * * r * 5** ' r - Ia ; cswtt Is?. J Ows *a {ci. D isease jt j ' mC' j l----- OS*-Stf rtflfw ll ai*i sid dteA f M li< OTHER SIGNIFICANT C O O liiO K S i c s id i** cssniW tiiic is dsstS svt.ACt i i Jsh C -a c s .ts ( s t Wt"s n I 4 AUICrSY I K i r t - * * to s i ? (yss f i to) ! coApdsad M ds*mVTS / aCCIDI V y j i c i a c M fW in n , DATE OF iNJUtY (Am* r / r t s ^ l H0 U3 o t UKOETEtMINEO te M ilr ) HO' INiUiir OCCU&tEO {tm tf M>VI < V I " 9*0 f t p sn U , w 19* sn. Jib . ! Jlc ik ju p y a? w o k ' ' PLACE O f 1NJUIY AT NOME, fA tM . S 'i iL '.. LOCATION w i * r t c w *) FACTOKY. OFFICE BIOS ETC. (ipscify) . M. J i d . "' (strrsi M J 1 K s . c<*r ^ *S--*V. ttsisl - 3 1 * _____ . E lf. __ I hmmM * jusid *-- - 2i t _ _____;______ :_____ ________________________________ :---------------------------- :-------------------- ** ` *>~-7"73 ` -' end Ltum- >h dacMMdstf*s -- - cj . - r5c**\ -- y > - Ci. Css1sttwfd si. *?10 a-. -- ss *hssss ts*dsWsr ii>{ts m bsti t*-r SIGNATURE ADDRESS \ 7 >f r''S*U*aiAl, C*R*S-MAilON^tEssOVAL CEMETEtY 0CMA70*Y-AV4 j LCCA'.iGS Hi t**scswtst v*d. BATE S:ONIO - .1 CUT 02 IOv*c S*A*s , t `J 4* b u r i a l J<bH a v e n c f R e s t H e s - 0A1E (iws-rti. 4*f, yMf) FUNEtACHOM5-NAMAKOADDRESS K cze to w s, rf.V a . ' * c?r at tawA, tii*. :<5| } `| M 5- 25- 1 9 7 3 , _ G a te n s -p o c a , W .V a. 1 FUNIti^mECTOrS SlS>AiK4t pO C* ------ -CATE MwNIO C^TI KECp E? LOCAL CEO. j CESIETANrS SIONATURC ^ J 5- 22-1 573 !* ~ P~" __________1Jto. /TQgA^ * I r* a \ ^ /4 I hereby certify shat the above is a true phctc-r graphic eery c: c reco rd i'.ied v?i:h the Di-.-lsirr* of Vit.-.i S tc is ti c s , v.".t^ V ircircs *1cr- D*"c r i mcnt.cf Kcaich. '" h arierre:., V'*** V*:rrirca. V.'iiner. = r y har.d sr.d sea- *";3 c?.v c : Jur. 5 Gc9 *-ar7.'- / ! * fr*!. Na___ .vn *i Z Z : 5 ^D-NA/.tf . WEST VIRGINIA STATE DEPARTMENT OF HEALTH--DIVISION OF VITAL STATISTICS CERTIFICATE OF DEATH farti U tl " n s M IC F OEAIH ImaAlh, dry, ftr* | H o w a rd W a lla c e C o ch ra n .M a le x K o ve cb e r 2 8 , 1971 MrOW, AfflKlCM (ie c ify j l;h lt e AGE-LAST SlXiHOAY (yra) Under 1 N N 1Uffdrr 1 day Htwn Min. DATE OF SIXTH (mancH, <Uy.y*r) uP* Sc Q c t . 9 ,1 9 0 7 COUNTY OF.DEATH y ^ u tm m rT.ToW H , OK LOCATION OF DEATH iM IO t CITY LIMITS HOSPITAL OS OTHER INSTITUTION-NAME (Il IMI la trtf^jv* itft <nd number) . . N itro t li C f SIXTH (H mat in 1A, ciMaa eavntry) CiriZEN OF WHAT COUNIRY 9 1 4 Q th S t r e e t R o ad MARRIED. NEVER MARRIEO, SURVIVING S F S y ttS r^ fv tfc * WIDOWED, OIVORCED (ipadfy) mmT ! ''l A t V a . :-A i SECUKI IT NUK3ER t. U . S . A A ita rr ie d M i l t ( afhlnf (fa, va raitrad) . S y l v i a f e r i e / W e s t f a l l KINO OF SUSINCSS OR MQUS1RM :a a S = flft= 0 2 6 3 L_ i?tH C E-Sut County 13, F o r e n a n I n d u s t r i a l City, town. or lauriaa % Va. u tP u tn a m lie N i t r o 13b. M o n s a n t o O i e w i c a l C o . INSIDE CUT LIMITS fiyacify m ar m ) ua Ygs t $ l 4 0 th ;S t. ; Road: tKER-NMC f a lla c e C o c h ra n SwIRT*HnFfLACC (Ut at isb.w* V a . MOTHER-MAIDEN NAME ^ D e b b ie M cCoy RTKFLACI <tUU ,9*wn*y}!- : *. A tegf^Va. W dyt--wdi aMr In UJL rmed la rS If INFORMANf--SIGNA^JRf A M . AT rSiMwnl K lf trtv |W r t r d M i W H rviu ) * - < N O I 17b : N o CF DEATH (nlA AAty aaa M K DEATH WAS CAUSED 11.7 I n U j , P a a . x ii^ .f N lt r e f e lf f V a ; ' 'i ' } any, *** c m Ha ta w CMM w , f*" j d * wacW * *? R wm ItA | I rvA M -* w _______ _________ ______________________________________________________________________________ ' fL P V 4** tifU iin rA w r rn u iiiW M K . f '- ift ** L j r f * t* *H ** r* rrr i 5-- * r**t I (-) '<cnmdarEdFula*d tU tw M a o JObi: T FpW* w w i m * . * r s ; HOUR HOW INJURY OCCURRED (talar afcra af M tury,M >ri f a r p a r f i t ItAtA I I ) ' ' A l WORK ^ m AT AA) n u21b.________ 21. PLACE O f INJAUIRY AT HOME. FARM. STREET, LOCATION FACTOm oOmFFICE SIDO . ETC. (tpAfy) M. 214 * '* ^ L*\vV"*** *** ( t w t l Af R J J 1. M a. By at*awn. aW ).:,;^' ... .. . _ 21f . 1 dUndcd Km A n u t d f n r a - f L-- lit , aad 1..A ama ^ A aua4 altri* V Z W 7 t * g z j s .x M, CREMATION. REMOVAL m ah rt*a d itt FHw bwt and Ia iba barf af <wy fcnawUdQ, f n a lb# a m mi DATE1SSIIOGNNED > ' wM i ir S a I CCCEMMCETCTlECRYYOORRCCRREEMMAATTOORRYY-N-NAAMMEE / | LOLCOACTAITOINON CUT OX TOWN 'STA J B u r ia l (MAAdt, A * y ,y *w ) G u n n in q h a n M e m o r ia l P a r t e E ie .S t A lb a n a W . V a . FUNERAL HOME-NAME ANO ADDRESS UWt * t M M . N a . dty ar Mura, rial, tip) | b v g jd j e r 3 0 . 1 9 7 L . ___,, E o o l c c & P a u l e y F u n e r a l H o n e , 2 0 0 2 2 0 t h S t N l t r o , W . V a . DATE SIGNED DATE RECO SY IOCAL REG. RECISI SIGNATURE -J ,1 1 / 2 8 /7 1 j j * . ^ / c '/ y / M b Tt' f r j f o / i f t "] * D00633 * > 0 W E S T V IR G IN IA S T A T E D E P A R T M E N T OF H E A L T H -- D IV ISIO N O F Y IT A L S T A T IS T IC S CERTIFICATE OF DEATH 'V. n 0 9 8 2 P c : a30 . + Z c VlATH UUNTY M m i) .S to n e w a ll J- P o rle T a Date OF DEATH Im m illi (D j /> . 25 i* f 62 UiUAL RIIIDCMCI (Uin'iwflfMZTtTZTj l i n i . If lnoiittitilMn ibiMMii hK filwU itxutli Itf(|*| Mf< Fnnftwhfl. STATE y/* V n . ; C0UNTV T u f f i A n c. L k kc th .ov Sta y ut "c T a f? . C harleston Cit y o i T own TMw* Banc r o f t ( If m i m h n r iu i, civ m ec mJtnO il. IT A E E T A D D tlEb. IS PLA C E O F D EA TH IN S IOn-eETCrhtITToYVnLMiIaMiaiIiTiSrMi! e m o r' ia l1 H o s b .."IS R ESID EN C E IN S ID E d ir LIM IT O (. J t R c tio trc i On a Fm m l YES J J 7T | i . Le NO ________________________________________________ C olom o * iU c c i y , M m d i i o q t Y c r n M i m i i o q Wh 1 te I W id o w e d g ___________ D t * o * c z o Q JEJ& j a I . D ATE OF IR Y H 9. UAmct|i(I*iUe;w| i A - 1 Q -O Q I < 7 / / - Y ElS: U i 2 & _ Ir U>>m t Y u i Ir Unoim 34 lin i. S in Hnn I Mm. / 1 / IH iu LP c w rA T M N (C Im Ar / I (OS. K in * o r B u io 'in 11. 9ViliiltThNnIl// Cc Ii I|SlmIMu. *wr /m i U M lf/l ' - f i t W r - w fc ? P Al < & ; % ; / + t/ F r y a . ^ ilE R I M M E ~ ^ -- "X :h/>g/es k 'fyOfi/e i**(U icY w tp tviRlH u. S* Am m u Foati? 14. M O n iE R -S MAIDEN HAM T S o c u b S t c u v r r H o . 1 17. INFOXMa h Y n a s.a t 1A Jdrnt M - E CAUSI 09 D ITH (En ter mnlr M n tme f f Km fa r f L (M* nnd<(l] ` FA RT L DEATH WAS CAUSED ICTbW'F lbs . 0 -S.-j'* . I xY ik v a l Ic T w iin O M I AM D U IU / C - * IM M ED IA TE C A U SE (3 C m A lm i, J|f ' % . n o u e t o <*> U flM f (W I. b in s **M lo t s J D U E-TO M -- rA R T 1L O ily it t n U a ir ernditions cvntriW tUc desti* but M '___ -------- ;------------ ffU ie J lo thn terminal dim m m UUm |w m ia F in l( * ) 19. M'* i A cro rr* P u rM N is I YES N O E ---- !0wA dt*2W r' SviClOK OMIC18C 20b. D u ca in t i lo w InjufeY Occunnxo. (Enter M if f * f U jw tr h Ten 1 nr Fan I I i f item lid iP TIM E JLlM ift* Oc/ IW H im OF IN JU R Y . f 04. IN JU RY O CCU R E6 f 20. P u e i o r lJt| n r fr .t ,M N W J h * n f,| 40 . C IT Y . H U LE A T Q N O T W H ILE Q * ` fee*, /W Fr O w l, bd L* F U t , c j 1 * ; n* ` * 1 TO W CORK At WORK ; - - ' ' -- -------------- . - C O U X If ----------------- STATE '-=-- r r ------ rM U n IM lU IlM U /l *iiw w . m on I l f U f H O f i W it; m i l* IW W il o f ; M w l f l f . f o n tbe cevsc* te i. I lk . ADDRESS- 22c. DATE SIGN ED - C h a r le s to n , W. Va. 7 - 2 8 r 62 '' CfM *TlO JI. 21U. D A T E <m . i h h i w S U tn r .In*ct hfiw ''*b, lliltr LLooccaallkAlixr-ee*.y g l2tS-././i1Jtltt.ic7ciim^iTuiuft ''ii fI -3/- M ft i._ _ _ _ _ /P a^ J_su f t ` ...-....'......... II --u Tr'VT --r-r----T--r--r ' -- V --t a w' . o Cbwu/J |M*1 Oerr, O -' M- UFu?nttn* ** Lb^^.l:>aftcCTioO^f ^i AOI^b8d1mh y lVl . T e ca .. tUfr- r* ' :1\ T 5ll -jS a r' < D ia. N*. A p WEST VUOIM I* STATI DEPARTMENT O F H tA lM -D IV IJIO N OF VITAl CAUSTICI IYPI 0 P2INI IH SettiI fi. PERMANENTINK^DECEASED--NAME a0.f. fail M*d* CERTIFICATE OF DEATH Law 1(X 0A*t OFQi*lS***>*JIjj-: _iM0dltXa, LddiEi,i..L,u47n,L7i Z _ H InhiitHfycWileiknifW A C l-V A i , Nh i, K o --ard E Aa m K mi A G -LAST n r l _U_rd_iIiyir|fa| UandtrllI_4_*r__I_DA_T_E,OUf U_H.Mk(mieanti_. feY.iiiT/- W I m , le. (pttiFy) W hite " tIRIHDAV (ye**) Sa. 5 9 r IWi fe. .!<. Yl It. 9 - 1- ID . 197fS c o v ili OF Ta Ih ,,r` > K annwha. u .s .vU*hrrI* ndieUcutntecdi tlMttw*y*iemdni. .kfIifWfIan*ninrneaattlidih** c irr, *> SIATE UJ'^ tov/n. o i lo c a tio n C h a rle s OF RUTH {if m i in .n^a.t*vn,nr) of to death INSIDE CITY LIMITS HOSPITAL C I O IHEI IK L ll1UH0 N-NAY.t (il nel m .**. fi u,l n* (Specify y*i m m ) n _________re. Y e s CITIZEN OF WHAT COUNTRY IMuAR.RIED, NEVICMhBaIlrfpI, f s t onG en e r a U o s n ife SURVIVING SPOUSE (il wil*. fi m O tn . | WIDOWED. DIVOtCED ( ip u il,) ' Mo. M a r rie d 11.I s a b e lle H arriso n wmkr) 1 fuma) SOCIAL SECURITY N U M I USUAL OCCUPATION (tv kind #1 wt>k *na 4 **% KIKD OF SUDNESS OR INDUSTRY ) ir 235-09-0302 T J ......................................... |3fonsanto Chem ical Co RESIDENCE--S u i* u . Vi. Va. Cewtty City, town, e r lecefien ia. Kanawha tfe. N it r o IK S P t. CITY LIMITS I Sltcet *nd nvm ter Mjfc<hr y<* * 1 f r i " Y" 03a I S 5 2 1 5 th S t r e e t FATHER-NAME SIRIHPLACE (tU lt et MOTHlt-MAI.D>E{NN kNAJ.A eiRlHPLACE (Ueu e i ,gerry H u d n all p a ro liniee WWi/egnneer "Ub". V a . ! Wa d N i t u d H t r in ih* U A ind fecce INiFfOo.^ ulnt--signature ( i " . "* , * f unSfwwfO |(ir y et. f ir w tr t M tt mt Mvk) 17. . N I I V _____________________ Vi CAUSE OF DEATH (enter enly ene U n a M f tin* fer (a), (bL end T o j 1. P o i L OSATH WAS CAUSED RYi "J J " A9?5f e - l5th S t , lasN itro W.Va, klAwppmetimrnem)*I nMdiAmaiiS /ZI CendUient H eny, *vWAlmd | Mumriu (mil S frig g i Melinf -Iti* ynorr* J t* ctvif luL causi (W. Dv*H(d. carcinom a STHST ./-* ' S e v e ra l- mos f w t II. OTHER SIGNIFICANT CONDITIONS w e d i l i u i cantaitu tin e H dM lh-W i net rallied n U vt |W w In ft I U) AUTOPSY I If y n t t t W i ^ i (fH f m ) I te n d e rrd -in Attattr * v rc d ii* ___________ T t. * .r ? 20* . _________ / acciden t, SUICIDE. HOMICIOE. DATE OF INJURY (meniti. Uiy. y e a ) HOUR OR UNDETERMINED (ipecify) MOW INJURY OCCURRED (enter m i m i l l w y in pert l_*c peli I If) 21*. . 21b . 21c FA S id . INJURY AT WORK PLACE OF INJURY AT HOME. FARM. St LOCATION lutea er KJ.0. N*^ city i ew*. wMi " 3 21. 21F. 21.(tpitifr>TM nr ne) FACTORY. OFFICE RIDO. ETC (ipectfy) tfid!#d the d f u i t i d *-- S -!^ fl-7 fi k. _^ -- -- end U ii u e the A **--!. **--. - - A -- A ' *t q L ` . Mceutred *_' . ' T .. A22a " U m o URIAL, CSEMAIUN. REMOVAL f M3J. r i e l Da IE (m *nf\ trf, ye*r7 ' p m mn |Ke dele W in d i b i w t end t* <*>e b w l ef my Enewiedp. ( n e tKe r w m P i i (O rfe * *f till*) ADDRESS . DATE SIGNED 23b.l . - ^ ________ CEMETCRY O f CREMATORY-NAME C h a r ls a t o n ,f___W___Vv_#_.___________3_3_.___4__- _7 - 7 0 LOCATION CITY O I TOWN STATE g^ nter P o in t Cenetery ^ L ib e r ty , W.Va. FUNERAL HOME-NAME AND ADDRESS Street e t RJ.D. N e , city m* t#m. UU, lip) ,4 A p ril 7 1970 ajpQolce & P a u le y F u n e ra l Home, 2002 2 0 th St# t -K itro ,-W .V a , FUNERAL DIRECTOR'S SI DATE SIGNED DATE I IC'D 6Y LOCAL REG. REGISTRAR'S SIGNATURE Ferm VSQ02 (l*l-M) * ,4 / 4 /7 0 3*ej hfi iO C H IU Mumm / m cm m m um fW W S T VKOWIASTATf OffAtTMCNT OF HFAITM o rv tsto N o f v n A t statistics ph y sicia n 's cran n cA T E o f death UK W W ttiK w in- 0*1*OfMainimi,fcf. rj IN M OCCUMfOM arsvrvjK ttltUNOMM H H IO M ft COMfUICHO# nsotH canM i I. A CM t*.W M 9+A. *C4--U * U * 4 f . w h i t o - CaMOwHOaiOCMOHOfOUIH U*041T1M OATS rX J 20 UKMMOAT MUH I .M S OAIIO* SfN |M k.0^r#J 6 -2 0 -1 Q S 0 COVMfTOBMAIM t. K p n f w V i o ^"C harleston H M io ia m ( a U fA , COlMO*WKUCOUNISt a W.VaT . P3A tOCIHUCVtfllKlMU <wuono.wCat.om.hovauorm*laemosi(*ut#o,**n* General H os wwoPout(0-u.r* p ita l M a rrie d ,Anna_S*fi dp one irtuA ioccuAic*r< ^ t^ vufrw <>.> * _-BOA. u T n n ffM p n f. w ttH c riitN iM iM a r MMCOfO*CU* (V ^ fw n W > l -- v g f l UW N CI-IW l OOUKTV tu . W . V a . WNU.MM f u r ,^ F u tn e a X saao C . K o o re k oim w i Kwa < rm t^ crr.iowMoa ocaion ts c 'P o c a HUMMWUl WUIMNUMH im. S t a r R o u t e it* no OIMB--MMNAMES' IAH &ir, P o s t l e t h w a l t IHUIMUANO;. erro lawM *i*n u ir IV u JIrs^ A nna Meo re /iWttiCniuiCAttiioriiootii^wW S tar R oute- P o ca. V.V#. g515Q C M K IreiC tuufO n 10CAIQM ctnottow M Stall B u ^ le q ^ y HJMIMM U % V C V *Jl^ ^ J*y t + U + ii *i g. : y l e r K t l e n o r y G a r d e n s * . C h a r l e s t o n , V7. V p . A M O ffiU n 3N itt 0f i c u r C a te n a > .z * - W t W / ^ fVW iM f^wiafiM Fis M w i Miw i* 7S Jg j. NH^iMrTpiO.f--ariUntOuMohWinMcw OAi MCMdI Aliwd Mc :pianifM If * , ; * ^ MWatOMMttOfUUrilifdfwi att w M ' " ii F u n e r a l H g a e r ; Kk. P o c a , W . V a . OAHSC*O|M.0ATrjr;' > M tfO fa t HA n /, y - ? / He. ft V' |B tC ltA , O A t tn c iw O B rt t M t s A ifM ^ .O n ^ i'A i ^ BAM MIO OtMIOUIt ) OUtf SMIMOM IM tAIMO CW U U lf E*>l r i W b < 0 U IIC A U S 1 //v / ' J * _ * ? * m ' * W a T fo n iin t f ib f v m s C*NtqfCW ASACOtaUOttCSO*. M 1 t4 1 fllM lA M fa u lK IM H M tU O M rO M fO U fSIB nv^ O BM M A N O M I 4 H f^ tn rv tn m a o f s o f t t is s u e o r io in . ' 7* V U jL ill.r H - 1 -.rta^BM-. m e t a s t a t i c ______ /1 m ^w Ba i t Q W H w C A H 0 K a O 4 - C i .A i i ,i w l ^ l w A ^ w t b w n N - r w n H w n o riT iw V ' O A iio f H j u i r t M .A .h i M M O fN V R K K iM N O W M M fO C C U tin r" -- lU M H IO tC C tO M I . 0 f 4 ta N B fo w .n t n . * n M M lA lW M lW y ik IM fU t flO B M IW -- A#*". -- (W-W 7tt. He. A M w b l M . rPIflIMAI tu lO G U O N Ms tlM ITO tU JA M O L C ltM IH M I hereby ce rtify that the above*is a true*photos ta tic (photographiij copy o f a record file d v/iffT the Division of Vital S ta tis tic s * West Virginia S tate D ep a rtm en ts Health. Charleston, West Virginia Hitness my hand and seal th i s --ItaQQfiibar _________ -________ I S JUL ^ In ta n f fl Cfafrt .o o e ,j? v t #> M 1C ;= R T I F ! B Y A U f CM LYIP STATE M A I ANO SI O NATO E l *O i : M O U T E A * A * l tM M IH K D HRRtOM : v itK K V ta u t a. - ccLcrceproPTK s . m ssolfecw o 1 ST * \ WI * i S t " ' tO WTHS W *tt9 - Q E '* .orvrtntsT JU w nci II I I I J K L * \ *lt.Y WUCTXS1 4 ooumioiroYHCAuii ! . u o N r o ttn jU A j A T*ri HKMTHM 2 S GS r t t * CERTIFICATS OF DEATH L4234 TCFOAJH . A t MO. _ 2. y SUAL RESIDENCE IWlHf K t i M IhrW. Il U i i j U L u EU*c T H ^ C U O C E H * ._ ***- 3 7 0 2 0 ' V ,I A w Ja W ; C. PLACE OF DEATH > C ltnT C ^W N . 0 kOCAIOH .. in sio s a r r u u n s f - T E > 4 - H O a . 4 STREET ADOREES i r 1f k -tf/jkEIDENCE . | ^ 0 I CITT UWITS? Y ss^ -tio a . ' * A M M I . " w aH sc a G E rw * 1 AU9>fU) :v MARWtyrJ-'KEVUUAtlicj'^T WtDOWSDQ:J ' DIVOlCEDQ| AIOCOJPATIOH f& tn U jf ICb. tttHDO>fFi uiUrSlMEUOS / m*^ ) l * r fcT< | I ( | | su r I C S Q T H E A S MAIDEH NAM 3 0 8 - 1 4v ; a N o a ' j .. OF DEATH " *'7 / . , ^ ,i;, \ " H. r '| ?*S&Iftff IF tlNDER I T tA l 1^ UHCSt aa h S C . < ^ | >| D ri | h * n j K U ...y PLACEIStt*r 12. CITIZEN OFYfHATCODNTRK . Q flf. J b f I tA - S .} .A U * u iuIEt .On eF ScUiitAwYtISYiINeO,cft/acfi itf J L . -n JO EVEINTCiMEaKHC i,irftfa ik |^ n l rt w w j|rM fi l XiW L__________________________________________ 14. SOCIAL SECUtlIT K O .| 17. INFORMANrS NAME CfAAIUTUUODFEDAlTAHTWHlAtUSlaG?AUUDTl IMMEDIAT* CAM M ISnw T lT w T * t a t- AS * . ym g .g ff* ? INtETYAI. U rw iE N O N S ^ A iV E A TH v^-| lii.J* Dif i*\m 4 MH C*tM*lMta J oue to m. PARI R. OTMS I SISMIHCANT CONDITIONS COHIRJRUTUtC TO DEATH IUT HOT tEVATED TO THE TERMINAL DLSEAU C 0 K9O1ON V E N M PAJtT I U ) -. ,, I f . WAS AUTOPST PiRfORMEOT ____________ _____________ r t s n o o b . DRECRUE HOW IHJURT OCCUUEO. (EaMr w fw * *1 to i * * M ACOOEMT fU IC tO l H O M IO O I a __ o 1* f* rt II ItM I f J . IIHIOP H M H .>L 0 T , t * OilUET 6. 1k ;v * ; h u it oocurreo t f AT K O rW H U * *x O AT WORK g ltk t<carrH * t 23k PLACE OP IN JURY 1 . t ^ U t r t so i. C lW , TOWN. O t LOCATION . U m , #tm , U tH r y , i l n i l , a f f i a l CONTT STATE _ fi tm*th* * f X a h M * ! W W iM < t! i l to > h t f f nf b W W t , Ifr* rt t N C ie iN r i l ! i r>2k . AOOEESS T 7 . . * i \ ^ f c . DATE A IS K -- y ^ >. MvNfy/v^ XXyyfyXJsV^. \ \ V ^ I, \ ^ \ X h ! S! ? <*, , 0 l M Mfc* OATS w I 32c . KAWOFEUITERY OECtSMATOI SK SEAL IUCIOE & nm >i ^ " " s t t S S ------------ -------- L l i . OATS E f. j(T C aON icur,,tQwi, riQ w lyl lio. U , M TS aLr o 'r f & u t \ 2 & ^ 1 1 r WEST V ftG tN U STATE DEPARTMENT OF HEALTH ioc*i rKiNMMV* MW DIVISION OF VITAL STATISTICS PHYStGAN*S Ci'ftTlHCATS OF OgATH uu Ut tUH* M i. Hugo D avid K I - M | i * A r I UNBtl I >1*1 T id q u is t Sr i. Male MMMtIMt |PAUO*ltttW,Of.M COUMirotHAln iK0V. 13.KT. *CtY.J13MWN0i4ftOiC.AliOMO*OWLN 6 9 t~2 i 1? KW 4 I. Aug. 13. 19 0 MOSM/U 01*4 Ilt U T O N -W **w N *W M t * * # *-4 m - H Kanav/ha C%--.I*ty.--- - ,,.N itro MATTO CflKMOPwicrCOuMf U U Cm <SCMcUNCvIQiCUtnMnVUMiMAIOiCOMTTMIHDSCNOKMOi N i t t K I AIMS K a n s a s T " *'' U. SOCIMUCMnummi 512-10-9016 UMMCI-IUK COUMV S. A. )=T> Wgst V irg in lA M lfU -N M i MW Kanav/ha fc-11Q9 P a r k - Ave. " : ^ .^ e a ia g g r ||U w w a ilO u m < .J|,) ,|< M iM m * 4+ U .tM % |e*u, -- tWaOMMMa rDrKiWe dCOMI 1| m.:S--a ra h S a n tro c k T ld. cLu i.:&*">?**T*,,*'",r* No IM9CIMH4UOf NM:i<r .R e tire d Foreman .J'lonsanto Co M T . IOWMO LOCAIION IkN itr o tUM TAN O KUM U l tu. 11Q9 P a rk Ave. MOtM-WNNIM MU.. ASOU U % t(l|V (H R S " Yes' \ltt ;- --g f*f-i s r Ari u. C h ariy mani--nani T id q u ist tr. C lara ; Biooindaht^ mmmouoku uuiro.tfA.Nak.. f - ctroarowH tuft if l i .S arah S. T id q u is t /M ikC M dC M ^V A O lN K Ipm tJ109 P a rk Ave. , NltrpSy Wst V ir g in ia 25145 ICMIUTO.ClUUfOM--WAW ono.town itAtl ,,.B u rial. .Cunningham M em orial Par^ i*St. A lbans , W. Va. QifjiC U / jomctMCur Cooke 6c P a u le y F u n e r a l N itr o , \f. Va. * UNkMdafl |*|2 wMoriiniioMfMiciM#orthancuti I ff tu JaE-n H M M M O titso fc u ru trriN M M S A H K N O (M ,O vtl| ^ ov.13,-1978 ---- . J , ... 1 1 ;4jft /-jp - - HCuaOJOCMM Tic3 :3 0 A.M? luconuI tk M IU aM B nM C IU I|IU .A ||iW , >J1IM|MCJIKAA<UM3tlAMIt CAVHIAU EaO^ Vi3?JJS ; m1>tM1 r DM fCkO lAS r MfCkClNACOWaMlOl) L nn OMI StSMCANTCOMMIOKS. ACCefN f Vm >Naf O M O N M rtM b h tJM AMTACNtrCMCAM! ^ ni A50IIJ * q t e j M C.QL XA W * * ! v r - w - ;< - - . v i : . . : . : ^ HO M O IM M O I.NUIH AMOnTAcM^fW IfwUniAAwMSfVCM*.lN.tOMM.CMN-OuN-Mr-o-NI-OU-W--O-C-A-i M iciuiOM M uifocamo ih m m f k M M ru tio iin M i^ ita PIACI C# rowtM*.t--nntn X # tN | M l. lOCAlOMM r. M m .h i^ M W .IW T ..O WW k f . ' Tk ORIGINAL suimo. uo.no. CHMIO.N U A I| Cl I hereby c e rtify th a t the above is a true photo s ta tic (photographic) copy o f a record file d withthe Division o f'V ital S ta tis tic s , West V irginia S tate Department*.of Health, Charleston, West Virginia Witness n\y hand and seal th is___________________ . day of November_________________ _J 9. 7a D00656 tZ . / / / s S 9 * r-i in * ' a. N*. .2 br/'gl N i. U ID -N AM E WEST VIRGINIA STATE DEPARTMENT OP HEALTH--DIVISION OF VITAL STATISTICS CERTIFICATE OF DEATH Fwtt U d s u DAIS' OP D lA U f j J i i Q - O r ^ ' S 8 " | ------ KflcPAl KJMT U g x rA * <- l M a c c . a. f a y / r 7o -VHwN. N w , AiMfiC* . t t ( t f t o l y ) ACE--IA S I Ofldn 1 y tir IIRTHDAY (y**li) I N i, Osys U j K *t c ________________ 3-y sb. ~) n IM f 1 d iy DATE Of ftIRIH Hwr* Min. A ^JD M r) Sc. *. v k `w COUNTY OP DEATH /f r* * * I 7a '/ * A /A M TOWN. OR LOCATION OP DEATH -- . ------ W*M */<d M ir***! AJ >TX.O (Stwify t m v a 4 * c A&2 7A.2 Z& L *&2. . / j U i y a . wJ U 1' t OP H IM ( If M l 1 CHI2EN OP WHAT COUNTRY I MARRIED. NEVER-MARRIED. SURVIVING SPOUSE ( if (], f ir m m u m ) WIDOWED. OIVORCCD (OMlfy) O T ^' A SICURIIY NUMtIR 3 2 --)l> -O Z lC * V lU iV I to .' A USUAL* On Ci iCvUrPATION f tlv t kin d 1 M r t Hmm d w tin f T f jn n A in f IU*. h m U m M ) IS. V lf f e P f T T / A . ll. A / / !o M ^ KIND OP tUSINESS OR INDUSTRY 1 . C bfsilLAl _______ emce- s u m i o wjr City. MOT*. w k tu lM IKS'DE CUT lim its uPO ^ 12-K A M t i--r h t_.'i tvu /t As l . 2 v *M T A iA M Ufc rrfco' E*e<Hr r v w "* ) u i M o - -... r'"1:`v* BIRTHPLACE ( It o t, MOTHER-MAIDEN NAME . tUOJ g i V T F ^ K b . --^ H s b - ' ______I_N____ I A .^ T^ T C SPM . /.M P t SIR1HPLACE (U*N f r^ u 4 Wm < n t i i ( j n r in U A - W M i l m f . | IKPO&AMNT-SIGNATURt y y f a w w )~`KTPy c i iw w if Ri-jRi, (n w k d l - .v _ '-A/ o l in.IT fc. -. - iT Ia T / fL U l 7 ltL 6 * > * tL E OP DEATH IfMr M iy ,M u m p t r l m h r M D L * " f M J 1 e l L.DEATH WAS CAUSED IT* \ . d- i - bJ, * l A cU ^ " t.V v ji Apo tm w m i M w v| wmI M diiiA , f f t e i i t > r _ ; * y r f r * H f > r . _____________ ' / U 7 a 'ih v ih T h l ,T m cmiw .M , \ J W DM W) Oww ItaL *. i t `< C i - o f l i n t ] S .y*i t i i * . c t o s t o s i s P .; : * Oh m i d U. 01HER SIGNIFICANT UlONSi'MnHiiiM) MntrWwtina.M AcMh W no* n l i M f M ( w m < In N 1.4*1 AUTOPSY It v** M t i I M b j l . (H I M m ). c n w iJ n N .li dcNnnlnlng U ut* nf Hwlh . a. CENT. SUICIDE, HOMICIDE. DATE OP .INJURY (im m *. Hay. ytar) HOUR DETERMINED (ip*4 *r) HOW INJURY OCCURRED (h *u m V I *1 iniOTY *n P*d I * p*t H. Hm I t) ..i'- J aib. aic. AT WORK PLACE OP INJURY AT HOME. FARM. STREET. LOCATION J r T M N m ) PACTORT, OFFICE BLOG* ( I C ( t * " U r i M. a n . . '________________ . ' v C (iW M t Of U A NS, Mr V l* M ^ .iu ( t | a i t . ____________ __________ an. MmM At A ciiw f Inm . T/:/7r>_________________2__*____C___' ___________ m E Us* MOT A t Am.*m^ 'aDw.. Wi. NaibWWW*! tSt Emtttff tbm; mi f iNbctf >1mrLnowlodo^triwnJwaiimi iNNd. ^ SIGNA1U U /\ . j (0* r * * w *t aodress 10 3 Z -B w a s n u i g t o n > t. DATE SIGNED 33b. C h a r l e s t o n , VT. ^ 2- 26-70 CREMATION, REMOVAL * CEMETERY OR CRE^AtORY-NAMt LOCATION - ClIT.OR TOWN STATE (fntnlK . f i f a ytM ) 2 -2 8 -7 0 SAVCIRECTOR'S SIGNATURI ^VtODl (1-1-SR) V C i* ____ ___________A__S_S__IS__T__. _f_r_f_f*MA yf A y 7UNHAL NOME--NAME AND AODRETS as. & A T a s *> DATE SIGNED asc,J / J S / 7 0 24c. C ./h ffA T C .ft> K / (u:c ot R^2>. N. city * M-n. '{JL'P) , DATE I ECO IT LOCAL REG. 2AP. S . a / 7 o REGISTRAR'S SIGNATURE ttb Jffrfj O itl. N * ._ X U lA - W IST V IR G IN IA STATE DEPARTMENT OF H EA LTH -D IV IS IO N CF V ITA L STATISTICS JAM,! O * M IN T !N V .A N IM IN< r:* t'*->dbook for Serial N o. DECEASED-NAM E /Ml '*i'*g C i n J o 'i .r . M idd'e I/ G V 7 S CERTIFICATE OF DEATH lati SEX ti'o r k r a r i i. L e l e R A C E --W h iia . N * - - o , A m erica n A G E-LA ST 1 U re a * * ? : y * c r 11 d i . DATE O f STH Ind.en, a l t (ip a o fy j l e i AMO N* 4. V anite BIRTH D AY (yean) M ai. Sa. 5 0 5b. D avi I Hour Sc. Mtmm7. ! *** r * v j 11 . q / 2 g / L q 2 0 IhD A TI O f C IA , ..- 'u s e 50 I* 71 ";T5v?v cr cia*h I I < r r v .ia 9 6- j C ITY . TOWN. OR LO C A TIO N O f O lATH IN S ID E C IT Y O M :T S i O SP IT A . C R O TH ER IN S T IT U T E - . - r . * i ; i f .->01 m e lm '. g .v a tree- and num b er) I raaidaoca) (Sooc-f^ yat or no' j ____ :' d. If death | 7b. S o C h a r l e s t o n 7t 7d. T nonas L e n o r i a l H o s p i t a l .n e d in n ifi* I STATE O F BIRTH |<f n o i n C IT IZ EN OF WHAT COUNTRY I V.ARRlEO . NEVER M ARRIED . i S U R V IV IN G S*O U S (if w ife . give Iran ia n name) : n . g iv a r*i- U S.A.. nema cou ntry) j W IDOW EO. D IVO RCED (lo a t fy ) j a before ad- , i|,V E f i. USA-------- i io. Karr ledi v.--------- --- -------- | n. B e v e r l y A r t e r b u m SO CIA L s e c u r it y n u m b e r . 3 3 -3 2 -4 5 7 8 U SU A L O C C U P A TIO N .g iv e Rind o f w ork d o r* dur.ng moa e f w o rk m g S f * . * v ^ - i# re tira d ) l3r C h e n i c a l O p e r a t o r j KIND C F BUSINESS C R iNOUSTRY ! ijb. U n io n C a rb id e R E S ID E N C E --S ta i* 14. a V a . County u b . K e r .a w h a C ity , le a n , o' toce'-on l4 t S c . A l b a n s N S IC C i TY L-.V ITS- S -ee t and number ! (tp+ oftf V or no; ^ ,,. ! tu. ' To , .,,.260 th rJy sid e Rd, FATHER-NAM E 'm5aEd g a r \7 o rk n an BIRTH PLACE .**!* or country) isb. 7.V a. M O TH ER-M A ID EN NAME r ta*. Vada L 'o r r f s W at dec* atad aver m Ih * U .S. am a d fo rc a li IN FO R M A N T-SIG N A TU R E fY *a. no , or unkno w n) |( lf m . give w a r or dala # ta rv k e ) 17a.______ -^ 6 3 I ) 7b. \ T 2 _______________________ CA U SE O F DEATH [enter only on* caute par tin* for (a), (b ). and id ) I . Part I. DEATH W A S CAUSED BY . ADDRESS BIRTHPLACE (let* oe country) * 7, Va* 1Ttb-Sane a s 1 4 c & 14-e Approaimete niervo) between one* and dealt fjF . J aI rH r 1W 2IM M E D IA T E C A U S E (e l_ / C o n d ifo n t . H arry, -\ , ! *r t ri* V ? above caua* (a). V B Ialino the undef- I I lying caute leaf. J Du* to (b)_ Due IQ Id - tPart I I . OTHER SIG N IFIC A N T CO N D ITIO N S: condition contributing to dealt but not relatad io cavta given in part I la) AUTOPSY (r* " ) JO *. If ye w a r* f.ndmg conaidered in determining cauta of death 29b. ^AACCCIDENT, S U IC ID E. H O M IC ID E. DATE OF IN JURY (m onih. d ay. year) HOUR OR UNDETERMINED (pefify) HOW IN JU RY OCCURRED .enter nature o f intvry in port 1 or part I I . it*m 19) --------/ 21*. INJURY AT WORK (pefify yet or no) 21*. 21b. 21c PLACE OF INJURY AT HOME. FARM. STREET, LOCATION FACTORY. OFFICE BLDG.. ETC. (pefify) 21#. 719 M. 21 d. (trae or R .F.D . N o ,, City or tow n, date) C 04369 I attended the defeated from ~ J L 7 Z j 2 -w . / ^ ^ ^ a n d leaf le w the defeated alNa on. 22. Death o c cu r ad at C/ i f * / -- I _____ m on The dale tiatao above; and to t*e b elt of my n o w o d g o . From the c a v m Hated._______________________________ 3a*. B u r i a l DATE (month, day. year) ^S ep tem b er 1 ,7 1 24b.Cunninghan I le a . Park; 24. S t . A lc a n a * 7.V a. FUNERAL HOME--N AM E AND ADDRESS (ttiaet or R.F.D. No., city or own, tat*, tip i ,,..C asdorph & C u rry P.H . S t. A lb a r.s. 7 . 7 a . 25177