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<br /> �� SC�L]Lt��T���JS �3�C0�.� �
<br /> --------- ______ ___________ _ _ -------_-------__._._____ _-------___-------__ __ _ _ _ _
<br /> rxe�uc usr�NC co.-7606
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<br /> � 2. FULL NA�E James Edgar Lyle _ �{
<br /> (a) Residence: No. 722 N. Gr. Bay Rd.---- S�. , -------- k�ard. ---_______�._�--------_---.�--- i)
<br /> (Usual pl�.ce of abode) ( If non-resident give city or toE�m and State) l;
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<br /> PERSONAL AND STATISTICAL PARTICULARS. ;i
<br /> ' 3 SEX �-. COLOR 0� RACE. 5. Single, �ar�ied,"�idowed, !;
<br /> � o `r Divo�ced �write tr�e �rord) ''
<br /> � q�. :�azri ed - —- i;
<br /> ',� 5a. Ii married, widowed, or divorced ��
<br /> HUSBAND of Effie Alfreda Lyle �'
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<br /> �'�; (or) T�if e of �
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<br /> �a
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<br /> 'i 6. DATE OF B IRTH !�
<br /> ! (month, dav and year) Jan. 10- 1�70 �`
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<br /> 7. AGE YbA�� I�ONT"rIS D26S IF LES� THAN 1 day ----- hrs. or ---- min, i,
<br /> 3 3 _ ''
<br /> ��
<br /> �;
<br /> . �;
<br /> OCCUPATTON '`
<br /> �. Trade, profession, or particular kind of work done, as spinner , sawyer,bookkeeper , et�. -- ii
<br /> Bookkeeper ��
<br /> ' 9 , Indus�ry or business in ��ich work was done, as silk mill, s�v� mill, bank, etG. -East Park Bo�rd.
<br /> ; 14. Da�e deceased las� �orked at this occupation (month and year) RIIa.y 5, 1.933. '�
<br /> � I1. Total time (years) spent in �his oecupation. �.�. ��
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<br /> ' 12. BIRTHPLACE ( city ox to��n� Clam� 3?Qint , �i
<br /> n ��
<br /> ( State or eoun�try) I11. - � ;I
<br /> ;,
<br /> —-- ��
<br /> ��
<br /> 'i' FATHER. !'
<br /> ' 13. NAME Not knov�n. ��
<br /> �:4. HIRTHPLACE ( city or tov�n) Not kno�en I�
<br /> (sta�e of coun-�r� ) i,
<br /> ��
<br /> ji
<br /> MO TH�R.. �'
<br /> < 1 . �`AIDEN NAME Not knotivn li
<br /> '� l�. BIn�'HPLACr+. (city or towaa) Not kno�en. ;;
<br /> (State or country) -ii
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<br /> ' 17. INFORMANT A7.b er t E.Lyl e '�
<br /> (personal signature with pen and ink) �:
<br /> P 0.Addr e s s 7�2 No Gr e en Bay Rd. _ �� �
<br /> 1�. PLACE OF BURIAL, Cremation or Removal 19. DATE ��
<br /> i�
<br /> Cemetery--North Shore May �� 1933- ''
<br /> Location -North Chzcago . �'
<br /> �Towns�i�, Ro;�.a Dist. Village or City) � ii
<br /> " Count Lak e Stat e Ill. �:
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<br /> ADDRESS
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<br /> `; 20. UIJDERTAKER '�'
<br /> �;
<br /> � H.F.Kellep �'
<br /> ' (personal signature with pen and ink) Highland Park ,`;
<br /> i;
<br /> firm name, if a.ny ''
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<br /> MEDICAL CERTIFICATE OF DEATH ;;
<br /> '� 21 . DATE OF DEATH (month,day, and year) May 6, 1933. i;
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<br /> 22. I HEREBY CERTIFY, Th�t I actended deeeased from May 5, 1933 to �ay 6, 1.933, I last saw `;�
<br /> hir�. alive on D�,y 6, 1933; death is said to have occurred on the c1�.te stated above, at 2;30 A�;.I�.
<br /> The principal cause of death and related caus.es of im�ortance were as follows: �'
<br /> Apople�cy t Date of Onset 5--5-33 ''
<br /> ,:
<br /> Other contributory causes mf im.portance ( ��
<br /> ; Hypertension � �9�� ��
<br /> 23. �9as a.n operation performed 1Vo. Date of ----- !'
<br /> � �
<br /> a 'j
<br /> For what disease or injury -------------- ��
<br /> � �(as there an autopsy No• I;
<br /> ! V�hat test confirmed diagnosis Gli.nical ;;
<br /> 24. If a communicable disease; where contracted ----------- i!
<br /> �as disease in aLL�y �r�.y rel�ted� to occu�ation of deceased ----No. ��
<br /> (Signed) J.H.Lundstro� Pd.D. j;
<br /> Address Highland Paxk �!
<br /> Date May 6, 1933. Telephone 174. '
<br /> N.B. S��.te the disease causin� death. Al1 cases of death from "violence, casualty, or any !;
<br /> undue means�� m.ust be referred to the coroner. See 9ection 10 Coroner� s Act. i�
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<br /> 25. Filed b�.y �, 1933 v.C.�usser Registrar - �
<br /> P.0.Adc}s es s H?ghl�„nd Park. �!
<br /> Has decedent ever served in milit�.ry or naval s ervices of U.s. ;�
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<br /> '' Filed for record this 1� day of July, 193�+� at �:40 o�eloek P.�l. � i
<br /> ,. ��o„� �. ;;
<br /> Re�;i st er of Dee s ,:�
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