Document gbxyrzY8eRbqdejwrMx3Eo0ee

FILE NAM E: Philip Carey (PC) DATE: 1957-1961 DOC#: PC012 DOCUM ENT DESCRIPTION: Death Certificates io 0 O '3 c D 000120 A . ,* '\ -- iw M" ' * A - J A 4 O H IO d e p a r t m e n t o f h e a l t h N yi :,q *f# .i'.J i* -- i ( ) 1 : l l ^ p iy is iO N v it a u s t a t is t ic s ;.-.V 1 - V I .1 'T T .If? r *. -- * 5 l i t * ' * .:^ * . ' * V . M.T.-V. w j . )Ur= .l/**. r t \ ) > t , . Y / - . E ~ C E R T ! F I C A T S - . O F * '. D E A T H 7 % j;-~ --T **i ~ ,/^V **" . ,-... towsrr . H a m i l t o n - v . c r ' w * ~ ;* -- \ ; i-, 2. U 5U A L RESIDENCE ' <Whr* Wtfiwd u *7 'ii* O h i o ' i - ^ a f l S i l t o n ' '-i iiw cjfr: jriUAoe,^* iOCAiiON rr..UNOTM 01 STAT.TN |fr _ . arr.vuiACt. o* iocaiiok ^.7."- .'-.'v . v ' . 1' C in c in n a ti ~ T; - ""Jv*.*--/* mT (* TL* <4 il- li ;i>*i-iiL iiw s.& t r ^ + - I * ji4r-NAfrr:ot tj .7 (if> alja htip/Lai a*jmtutmi/tm, - t r r r jju n f d 'it t ) -- `.i - J J v T S T B lir A b lts il4 ! > !! ' H 7'*T 5* .1! . 1V*'. ' i / . ^ wosfitai o r . C h r i s t - H o s n i t ^ T * ; -- jHsnititvtion. f* *fr*,A T--n *71 7^ ~ }' jn ^ iw v r ;H7l ^ 2*4,72--V i r--i H" ?P--l i rH. -*- . i^(* : ^ *~%.T, HT *rv1 T *. -- - - ,1 *frf74S KACSOt PIAIH INSlOf COT.tMUTSTo = - ; U z l is U440IMCE iKtlO* o r r ilM I? ^ MSIPIMCS on H U K . *" *. 7 '. **.**-. - f * m ' ! *!.-=* 1** TT :i - - 1-5 * - . 1 . '*Vm f l ' "^no r i * v . < '!*.'.* . . . -- 1* m i - ;. i^tcs Q 1not3* -- f .1 .n .- > O --no 5 ` l,*R A M OF - . --fi. -- .* i, M . U d i U M P , . f - 4.. All,.. _Atgn(A . Di ^ r*4_ - P r r ^ f . S f ? ' H e r b e r t . ~ '.7'.- L e w i s p ' O b o c h v ! 'i'' ; . l ' - A u g , 1 5 - I 9 6 0 - s. sex - . COtOtO* CACf : M a le C o l o r e d . __ - WIQO W f P ' PfW O frCfP o ! ' ' _________. T * *^ " o i / u u w i O CCU PA TIO N V c / i / e i #/ **#** 4*mt l o V k in o Of iu s in c s s o t jN o u s r r r i i ; iiirN H A C i . i > 7 i 1122. . cCiItTuIZi EN O* 5 - L a t f e m M i wwfrHtfhim , arma it emtttm) ^Phillip Carey Co; .TOPHfersrilie':Ky| ' COUNTtt? IS TAlHU'S NAM|. (ttooflng 6 -iug\ri&tion) '"14~. M--OT--HCt'S MAIOEMNAME -- Alex Gooch is. was deceased 4vci in u. s. aimed l o i a s i i . s o c iA i s e c u tirr n o . Susie S w \7. O R M A N T 'S S IG N A T O T * # # . '<* * , t i - w w ^j T i y w i O & ^ * * u ******** 2 7 0 ^ 0 5 - 1 0 2 3 4. C A U S E O F O E A T H { a ttta a it //p1 t* it a / f f r im i, )-j f A lt I. DEATH W AS CAUSED STi *' * i IM M COUTI CAUSE lJ_ V*- v:.v C fd i u a e i. if M9 Ot/I trir/fr f<rr m# f | #2*# tam tt (m i, V tu tta i tk t mad*** I _ _____ i ; M | tarnt tat, ) O U l t O f l ' ^ >77- INKHM IITWil ONSIT ANO 0`AT */ * * C X -Z -tU - . w : . ;/. . LT ,i,. * ',!# fr. , * . . . - , v - ^ :' '* ^ `x i r . -V- i *? t f`; . V * fi *j v - i. \ . % > JO* A C O M N T S U tC iO l .ii `n ^ r u a J ^ / ^ l r t U ^ Z u T i . Day, Y tm tMjUtY a. m. p. m. 204, IN iUKT O G C U M IO W H IIC wot* AT * NOT W N IU AT W O tS -, U SI*. I amaada A* Q * w A atemaaad W -- ^ ^ jjS l N A T U R E - ) JO*. PIACI O# INJUtV (a, t ,, m at akaatim u, farm, fattati,, tttatt,- af u U g * a u ,) ' 20t. O T T . T i lU f i C . O VOCATION - - COMMIT. M W * a * am m STATI 4 *< r I ^ - j --------- / t+m t . i S - ia ..u . *mA Im, um* * Mtmm mm ^ ^ V m mm t&a data ttatad Sa 4 ; aad ta tia tat a f my kam riady. /m m tK tarnt ta ttd . C C tl (P arta at tuiti SIS. ADOM|S S3. D A T I S t C N l / I I M . C liM A . 32fr. OATS 23. k a m o f c u a r t t v o cxsm aio ct 234. IOCa iO N rCT C *i j. /7 / m ( w m > I S t e l -B n rj.a J Sa. m a n * O l (Ma i m i i O s c a r 3 . 0/1 9 /1 9 6 0 _ Lee H y - f U ^ lu n it M ANO AOOMSS O scar S . Lee k ~ S o n tU0 0 F a m ily C em etery * i r & NlVyne Avenue, T u r n e r a v l l l e , K y . _________ z r r j& j - 2e^ Loc W a n d Cincinnati' 15^ Ohio 2T. O A t t M C O t f f n . C IS ftA rS StO M AtVU / jmiymzys' 2t. JU fr-aiCU tTAfr S H CN ATU frl l: 000123. M-5*V s' g *V, ? *<* y `V v ^ ' r t d u | | a 7 * 0 , 0 ? c N a ______l J J . , 1 / 1 . u&r O r Hfc.AL.TH 0 5 0 5 0 2 V* ' D IV IS IO N O r* V IT A L S T A T IS T IC S - ^ r . L a>. > " -- `V ; - "` * - :; r m m * * ..!> .- N . .J ----------------- .-- <; C E R T I F I C A T E . O F D E A T H - ': > .p .w . - W . , - . , - i ' P L^ A C W D E A T H " " " 1 / ' -- , i i .J . : ------- T7 "r l .1 U S U A L * H E S I D E N C E . . .( W ie n 4 t o <4 iir*d. - . - :%L t i ? i ; ; H b 3L L l t O S 9 - J - ; ; r - | l ~ j=. ` , C A a t T --V IltA O l, O liO C A Y lO N .. . -w .,l(NOTN o r SlAT IN 1 i .i ^ - , W( w w d w * . * / C S n c d L n h i i t i " . i ` vT.i;-' ^ i ' Z - .; = i i : ~ * ' 4. MANI OT V f i/ N l * 09t$ tn i 09 MJHlIUa*, | W Hrttf~mJ*4iJf. / J ^ :*;..-Nosm4r o t * 5;.* ~ J i l r r r l p c k l a n i , = ', 1! ^ ^ if; ^ n iH 'jr .-tj/ K .- -J - i r i i i - i t:i 1* t u a o t - o iA n c jN S iO l a r t i u m u f 's : v r *5! - r - i ' 5 0 0 ; W y o a i f t J T * A v e n n a ; i i ' ~ * -- m ` - _ . ( . . - ` m ,:.-! j j : ; . . ; j9^ u io t t * c i 4N>ipt d a ij N i > ii' n j -- f l V i, " '0.fN ^I >o.7 i d o fT " v " '- v * ' -*-* * ^ wb 1 -- *-^4 ` - ?V IS G . n o B -- - - - - .* #%. _ . * * * , . . .V, *,w ;-. _ - # f..* ^ v _w < ^ ,SN v; .* *.*t - *w1^/.,* - 7* -in '' `v ^ > / V *v-rA ;'-V^. .* :-or . fFTM O t MINI) J. MX . COIOI O l (ACS H a lo W h ite 1C. USUAL OCCUPATION (C w t hmd *) w**k 4 . aAarM.gr mn9 W vtrtiag IA awa d iw N 4| ' L a b o re r 7 . MABftICD WlOOWtO 10. KINO o r P h iX lD X jQ NrVH MAMII0 Q OtVOtOTD SUSINE** O l IN0USTTT I n o n la t io a a r e v CJonm anv 1. 0A f t . o r IITH 9 . . 0G t.n * y * 0ti lit* 0tftk4*yi 7 - 7 - 1 S 9 II. llm PLACI (St**9 09 f 9t**t* . ' K e n tu ck y " II I M w i Tw If I N w 14 1 *ar<*| >7/ Hamtt I Mj \ i). an tcN or WHA COVHTCVt - t!3 A . ! T w A a g H n ln t.t.a 1$. WAS OCCEASCO CVCI IN g. 1. AtMTO fO tO S t ( Y n . 90. 99 90 90trmf\ ( t f 999. f $00 w it 09 A tm t f stratte) Ua ll. C A U S E O F D E A T H -- ( r W#jr7 w r t/4 fA C f l . OCATH W AS GAOStO I t . iMNfOIATC CAUSE l L 1. SOCIAL S I C U lin N O . S7Q-Q*ir6QQ Ar /; /r u j . U ) . 1 W insila Tah " "u . R ^ R M A N T S S I G N A T U R E A44m HftTti HulfltttCI -- <9 5K1n5r 4ChwraeHs t b r o o k U ONSET ANO fflNi OtATN' *-*41 '* + 5 * f* < * ' ,': V a* 4 * r #: # . I V .* Ci9dtt0mt, OUI TO <I. w0tt0 t* 9t atrt t u zn t ttsnm$ I N DUE TO W , I p 9f ***** II. Tal* a tM lM M t4 W rt> N( luu<w l e i t a l'iU A m t i ES 30. A c a o f N i 1 SUICIDI HOMI01 90. OESCStfti NOW INTUIT 30. TiMC o r INATIT H009 a m. #. . 20 . INAIIT OCCUItfD WHILE AT r i WO K Q * r W H Ilt n AT W Q K u D ir. Ytat /1 " _ /1wi4.#r/#4NM*T*. *JL#w w i w a*"* . >-- j -- 1 91. I +-- d *4 1&0 d t t t w t d ft* * 0 O r l 0( t 09t t d * :. S IG N A T U R E ^ J / A /* w iw ^ * 5 f tO * 900 d s tt ttiU J tm 0 ! 0*d U *09 09tt ** ***** I " fc* aoM M ^ '7 / iT ) . *, 2 d> It. WAS AUlO nT niTOiNco? t t s A wo STAI I . 32. O A K JtC N G " |t4i , -e-i-e--/---*-' ' -`---?->--A--.--B A H 4./ 9293. NAAMMIf 0O7T QO NMf titUf tfTY O l attUtMUATfOO*lV w f J J A lOVTiON 7 //3 t0 O ' (City, tn , wMyl (Suit fia ria J .7 I ^ ily 12 1 9 6Q 34. N ANS OT ( A N I M I Oak w ill C an stsrT Olcndala U IC , W0 .| 25. #UNftlA4 o i u a o r * S4CNAJVA4 m * . Thonas P. Wataen. S. TUNCAi f llM ANO APOItSS VerMs Funer&l Hoaes, In c. f t . CtO lStlAl S StCNAfUU S77_q_i_ U T K t r NQ.| >>'?"7, ^ r\ y t g io n i 3 10 Dunn S t. Lockland I Jt. W L U C l lT u n SlCNATUtl = < = ^ 2_ (SfATf| Ohio 3 ^ 1 9 8 0 ^ -. UJ,. **T J J - t 225. ------- ...ot ,, on .lit. in nit f L in u y iv a iu j U tvtsion o f V it a l S t a n r .ic 3 k't a cco rd a n ce w ith A c t 6 6 , P .L . 3 0 4 , a p p ro v e d by th e G e n e ra l A s s e m b ly , Ju n e 2 9 ,1 9 5 3 vW (Fee for this certificate, $3.00) * . * v U Vf ,# O .W A RN IN G : It is illegal to duplicate this copy by photostat or photograph. NOV. 131981 | D ate M i i No. Q&oJL. //a*^cfc\_ Charles H u d w c i Scare Registrar HV&.20143-- 325M~9.5> -to f f ls s m . department o r health OIVISION or VfTAL STATISTICS nt 5680 Oi!*K. .1 * 6 2 4 i3 0 . C E R T IFIC A T E O F D E A T H Rotlttared N. SB 1.PLACE Or DEATH a. County ~ * - 2* USUAL REStOENCC (Mrt mmwm4 Hv4. 1?iMUWUtAt immw *r y. , rM-AdmhitM) .sut. pa ^ k.CM.tr .... w S. CUy. Strtah tr fowmntp * c.LtftQth9t Uy lt11- City, ttrttfft r TvmM v* N o rrlsto v m 5 Hrs. 1x5 Kins. ___________ H orristow n______ 7- d.FULL NAME (N NOT InholpfUl. oJvtritt44mu) 4.SlrMt Adtitu tr LtttU-- wsViwian S acrad H eart H o s p it a l e. U Plt 1 Dtatii (Aftidt Mwaitlpallly Limita? Main & Barbadoes c.IW--itMo Im U MualdMlitr UmlUV U h Itmldttttaaft Ylb No a ' * NAME o r deceased (Tt m tr M t) crioi) Raymond fc. <MU4M 9. S I X 6, COLOR OR RACE 7. M A ftftltO Q M EVEftttARAIClgQ Male W hite IO. rULL NANEjOF SPOUSE WIOOWCOQ DIVORCED Q Ynfi Nt Q Ym O * C <U*t> 4.OATC COM) O u r Lewis or y OCATH i 23 OATEOF.SIRP gW R On Rn If a iir 1 r*f 11va M 24 1 Mm IM Onyt M j i n V i o ; ------- 5 3 ------- lI R T H A A C f i ( A id ( U U i r fc*tlt 12. CITIZEN o r W1 **" >n)H Q nevbrook I V p .. Pa . a a s r 17. FATHER* RAWS George Levis 14 M OTHER' S MAIOCM R A M S _______ Edith B r o o k s 19. U S U A L OCCUPATION (tart* W r*ttrad>> - - rI S M i l I w;rtty Shipping* c le rk ' 27. INFORMANT Karjr T hom son t h i p C a r e r i - i A g o e s i a u o - m e d i c a l . c c i r n r i c A T w ~ IS. CAU SI o r OCATH (EnU Mv t a t PART 1. O dUl WM w i n C U t . M T44). (I) 4 ()] 13li V a sh 6 B B v & i Ave. Dgyniflgfrgvn JPa tUTtlIVAl tcrw ci OM1CT AMO OCAH uttteotA T C A u se ~ A s h f e s f c n a ig , ; g e n i> r a 1 iy . a d , p u lm o n a r y CtftdiU tt. W crr> wMtSP |IT r it i t t i W d M t U> Uli*# Ult k luw lu t, , OUEJO M __ *." O OS TO Co) - Cor PulmonaleZ ^ o e a lJ U c r iiilth J ^ o ia ih a g e . PART U. OTHCR SfONiriCART COROlUONSiEtoMflbttt t t .(<1 0 f*X Wt t kFA m m Not I* Part t < t) l > * r/ t \ 19.WAS AUTO*: PCRFORMCO Yt No n Wlwl SO ACCIOSMT llHClOC KOMI. 2 0 , OESCRiOC n o w IN JU R Y O C C U R R ED ,C tO E SOt. Tim t f (Mur, tttnMt, Oar. Y m. - Q Q ____ Q l C.S.T. 204.` INJURY OCCUR REO 20. P L A C E O f IN JU RY { 4 201. C i t y * q o r o u g k . t o w n s h i p COUNTY STATE votilo al Ntt wftltt htm, lrm, fa ttv y , itr*L (#.) . * . t . - wo/> Q t lw t r a Q 21. / htttby ccrttjy that / otU ntti Iht dtciuid /rom 21... to tA4t I lall am thm tt u n all on l / 2 3 / 5 7 - ^ . . , ........ 22a. SIGMA 23. 6URIAI/ 2` CRC3fcxUTlOMQ 'M V. 0/.TE (Nat tfaalJ occurred a l3 . SQ.J? /rom fta raws awtf on tho data $tated ab00* M.p. or 0 ,0. j2t,.7 oD*Esj_Q3 9 DeKalb S t . n g..,. J tt o n r ^ to x n .... P e n n a . ------- 22. ATE SIGNCO 1 /2 9 /5 7 23c. name o r w e T ^ R r or 23 location <c*ty, **, t. 4 cm ) (s u t* REMOVAL g 24. DATE REC O SY e0-1- 25-57 j f if c . 2 6 , 1 9 5 7 ^SneSrook Methodist . Eonqybrook Choator Courir 23. REGISTRAR S SIGNATURE Julia 1 Konnedv 12. SIGNATURE o r 'f u n e r a l d i r e c t o r aooress D* Rae Boydf Norristown, Pa 000123 1 J (0^ ;o 0 1 * * . u! . vfc!*-* * M* , ' * `V : ^ -t .* . _ * j* . * .c ir r # v iu A G i, o a io c a iio h *. . *. * . . v - O IN .C .T N K T T - - -- 4., k > | o * . ili n< -ip r 'e.*.iinvo:t;m*oi:r hva :n*r)*. ^ .o n ,,viu * ci. o lo c u lo * , _ --- Mv - C n e i n n a t i ' : ivn.tJttu) . _ . y h r - . u t . - s o w n if o '7 ? r -`^ r n t w > r ' T 4** JNHin/iiO*- ti& O I De* r r C is t ,* *; j n *fi -- -- * ** ~ ~~ i ~*-----1~~-- **I -- * - i .'** a i a q o r,W A P i n i i o i <O V L " * * TM - . h s ^ u ' ^ L W u 7 )u3 io *m c i i n i i i n l w * i t v . l , - * \ i . ` *l i , . n - '. : : . m io w q o * .a / aim i - s< : - r * ' V* IT n X m E O ? DECEASED - " r - ' ^ ! ; . t n a ,- * w o * ^ r n r r ^ A, . v n O ' o n - * , im i ' i , - f * W l4 k * ,, . -- , iin . ..,.M n r i i . O A IL . ` i , tio ntA ' * 0 * r - V*i i . . . . .* .` V - . - . - . *\ V v r J.`;; n t.*J t -l V - '. - fy va o a n i n i } * S s s d .6 * " *- }. ^ y ffi j S O T ) t ~~ o K in ... *. coioB oa baci tT ju l u iid ! G ^ m a m a m i i o Q . .* X)a , 09 i ,ff7H Il U + t I Tw Il ** f< **, , male Colored * * v rio o w to divo t e i o 1 0 ; 2 ^ J i 6 1 m .*- 1 U*0fi M/m Ob. USUA OCCUPATION (G ** tmd / v i r i 4t * t >w ? M r t l M I L ab or& g'/N ^m iWl l l, p p Carey C 9 ia. o n ic M gror/^t`tr gj a" ," A; lv aj t- - ru' .pj .w A. . il. A n al i nams ( i c o o i i n ^ o I a a u i ^ t i o 7 ^ m o tm $ u m n n m i Cyrus Jackson. u . w Ai o tcA iio m a in u. $. aamio ro tc u r i ia . aociaa u c u tirr n o . Am anda' ? I?: I N F O R M A N T 'S S I G N A T lJ '. A i.m i ,y"v 0 k **<`,<*" '| ** ` f "nbo f 7 0 0 5 .1 4 4 0 Dora Jackson ,342r Bevis Ave. I ^ C A U S O F O C A T H ( t o w <1; n i n w p*t ita+4*r |j | , ( I ) , < N <<).) - r * PA*t I. OfATM WAS CAUSfO BY. A m -- IMKOVAl K fW iiN . ONU* AMO OIAIN NtoiAt c a u si * l / Q fl l l v L y f y f f i4 L & i. _ _ _ ^ . *> J- :A#< * ^ CtW M N i. M *V9* ItM M f ip m g VO I I I .* A ft /..V. * %,. ? -*-w e' -*. Sir- ; .v ^ ^ <8^ rf ft ^U . .. 4 r a y, i io*. iM Ju ar o c c u a ta o w u i at r mot WMttl n wo** U f AT w o r e u jo * . m a or imjuvt /#. g.. m ** */ mnt. / . / W 7 , n k k # A r l ^ l - r J a o r T T .io S i COVHTT. * ..ITATI IT* t sr*d*4 tk* d*t*** f*mm. * I n i n J J j j A i m w . O tt 0*t--**4 <l -- ./S IG N A T U R m * l r 40*9*4* 0* mt*t .. ti. D. i i a M A. W m M# i n i / * I m . A a o iu s C o p p n s n , Ha m i l t o n <4* i m m i i r W . II ai,. o a ii iio mn C o. Oh i o P - 7.61 ST. A U IIA I. C ftlM A . STA. O A II 'M T l 8; 12;;61. U . M A N I O# U A A U U I E.P. Stegall SA. lU M llA ) ) I M AMO A O O t lU U t. NAMt o r CIM4IICV O l CUMAlOtr C o lo red Amerigfen 4U 6 . MO.) 5151a UTI1TT NO.| ^ Y 'liX y t8 % A f l * ' **T[3?/yt ,*,,ir# ISuMI ' O aiaey . . _____ ie . wo. 3 ioni ^ " un Pierce People's Funeral TV. 0 * 11*ICO IV IQ AIO tO . ^ tfG U T tA l l TIOMAlV| i ft^^tT 1 S *,Gf s r A . ' V L l . J L 4 J L K + Horae 1 / *\ - r. ' bhn St Cincinnati,u Ohio. St. S U A -tlC lSU A A S AlCM ATU tl 0 0 0 .