Document dndM35vkVqygwyyO045wNGz19

* LiAHUfN u,>ot* m aCCOCMT IN fi Dili (HOI. GIVI iaaMCE ICfDMt Rcy QisL No ------- ----------------Primary Ht?9 Oist No ---------- VITAL STATISTICS CERTIFICATE OF DEATH I C' , n Sli.te Filt; No Registrar's No -- I OtetOtNT S NAME thut MiOirl*. LjiIi Joseph Robert Succi--_ 4 SOJCIiALl SECURITY NUMBER *M AuL Lett U.lll'day 6U 291-16-1586 b WAS DECEDENT EVER IN U S nAnki<MnLvfi Fr vhnflvn(m?r X Yvfc no 67 MOSPnAL Inpatient t *L ti I /LAM tH'Ouipaiienl 1 2 SEX i DAT( of DEATH {Mo/uti Day v**0 M 5c UNO* H I DAV Hours j Mir)ul*s I 0 OATL OF biRTH j^yfurifh Day fViil) 9/8/1921 9.1, rlacl Of Death iCnet* only unr 01/10/1989 > DiHThPlACE (Gfy and SUt* ut f uiuitjn Cuun/rw Ashtabula, OH QUA v Nunstny Home .4^HetO*n<. , Qftj/ri 'Sput-Jy* yr> I ACUITY NAME Of riut itnl/fu/UMt 1767 Griggs Rd. ttntvi jno ti/uOvii Jc CITY VilLAuE OH LOCATION OF DEATH Jefferson 111 LOurirr OF GfcATn Ashtabula iu MAHiTal STATUS Warned ll 'A/KVI/fNG SPOUSE fit 'fw >_/>* 14. vci Married. WtOuwwO, Ucm.c l2u t)LC.Lj( N T 5 USUAL Oc.0')P& IiON <Givv A>*d ul *uur 120 AiNI> OL HUbiNfab (MluSTRY iA/frc lUminj n<ui.t ul mu/tuinj .//. In riel u>w re/trcdj married i i.. til sifJtNCE - StATt Dorothy Cartner Electrical Maintenance tjti v.Ul/NI i rji, cMy (own ui! u a,aiion >)i ,tMtLl AND NUMbtH General Tire Ohio Ashtabula Jefferson t'Al Zip coot 14 WAS DECEDENT Of rirSPANu: uHitir49 iSpeLity No Of Yeb *1 /i*^ '.pi-udr Cupan 44047 Mi.tii.iii, Puerto H<< m1 u< < w tm t lf\ 1767 Griggs Rd. f'. HAI..L mM -.nr. Ird.un blech N..U- wti. White io OCfcOtNTS tDuCATlON uld. J-rLILh'J J.mHQjLjudl 1 Iruii'ii! n , Si o>(t(J,iir IU \ 2) 12 College h' tAHUHS NAME (fita Middle U MO l Ml H S NAMt Midd/v Mj.iiun Sut/>.in,,. & 5*> John Ssicci- Vi,i INFORMANT'S NAME /Type/Puritr CarmeLa Bucci____________ >90 MAM iNu ADDRESS t',ttt.%l and NunitMi \>t Hm,il floo/e No/nOer Cay yi lu*m Slain Zip CoUvi Docq,thy I - Snr.ci ror MmetTthHoOdOoOfP' lDisposition X burial 0 CramaOOit . . Removal from but* , Donation Cl Other (Specify) 1767 ,Griggs Md.--JgffecfiQtu Qhia___ mtiZ 200 PtACE OF DISPOSbIiTriIQONfN(Nuirfie u1 Ctirfiuier/ taiiiiafu'r Of 20c lOCATiON C<iy uf Tu*n Sure othar pievwr St. Joseph Cemetery Ashtabula, Ohio i(ju date of disposition 1/13/89 2.. NAMt OF tMUALMtt. Thomas T. Fleming 11D UONSf NuMHfcR 7353-A 22a SIGNATURE OF FUNERAL SkHViCF LICENSEE OR RtfjsapN acting as suery y + 24 REGISTRAR'S SIGNATURE 22U LiCtN^t NuMQEH iul L'teusccy 21 NAMl AND ADDRESS OF FACILITY Fleming Funeral Home 6746 49 W. Jefferson St., Jefferson, OH RECEIVED' 25 DATE FttEO iMonth. D*f. f*aii biGNATURE OF PbHbON >bbUiNO i'LHMil F&BW989 (tjU Olbf NO 27 DA It PfcHMlT libUtO 2da CLHTlFlEH /Cfietfc urily iticr -toad's-COMPQ^ftTlUM ym Ll CERTIFYING PHYSICIAN To the rwsl of iny knowledge dcelh occuiicO .M w>e i.uu, unit- .mu pi.ice .mu Uutr lo V'e CtiuitMsi .i<U niun/iL'i stattU C CORONER On th* t?4ts>* ol ttAaimnaiian anu/or inveil*yalion <ri oprn.on ueaih uLcwri^-u n me >>m uule ana place, ano due lo toe cauSw(Si and mannf ai vaKKT Uu T.M6 OF OSATH iltt U ,OAtt PRONOUNCED DEAD iMufllft. j iujn 2nd WAS CASE RtfEHHED TO COHONLH' 9i3Q_A. ___._____1/10/83______________ TUb blGfiMURU F.Nf) TITLE OF CEHUHtR XX TU1 Nu 201 LICENSE NUMBER " /VAt c ^ 29 NAME AND AOORESS Of PERSON WHO COMPLETED CAUSE OF DEATH y/ i iTy^/Pt.nlt Harlan Waid M. D. 125 S. Chestnut St., Jefferson, Ohio 2by k .MuOrn, **0. __________ __ DAI SlUNtU _________ Day. Y /' //- J"7 44047 ShOCA. Of heart failure Lit>> only one cause on each line IMMEDIATE CAUSE (Fmei dise.i^e or condition *-- ifeSuH.ny in dmih) f y 1 i t * ^^ V J ^, DGt TO (OR AS A CONSEQUENCE OF/~ v '/ f ~J Segueni.aily list conditions. M any leading to <mmoi*te uu Enter UNDERLYING CAUSE (Ohmm or injury mui initialed events reSuitmg <n death) LAST Out TO iOR AS A CONS6GuNCfc OF) DUE TO (OH AS A CONSEQUENCE OF) L Un!H and Death C* M_4--4C^.. nsr, tstRucriONS nth SlOi PART ll. Qltigt ^/^ihUC^OI j^fK/mor^i contriOutmg to dealri Out not leauitm^ i* lfij aiiUeriyif.g cauSe ijtven ifl P,il| Jta WAS AN AulQRSt PERFORMED'^ JU- WERE AUTOPSY Fl fNGS available PRI 10 COMPLETION OF cause of death* U MANNER OF DEATH C*>'Nuloi*l At odehl U PendiftQ Investigation i 8u-c>o# . HOlUiLida G Could mqi be Determined U3o OATE Of INJURY 33d liMI Of iMonm Day. Yuan INJURY I Yei yNu 3Jc injury AT WOHn 1 JJd OtSCHlHE HOW INJURY OCCUfiReO . Yes C No M tKiMding etc /Specify) jjt LOCATION iSIrvel aiKi Nurribcr ur hut it) Ihsulv Nuri'lAfr, Ci(y i 5/dleJ GENC 002902