| STATE OF ILLINOIS MEDICAL CERTIFICATE OF DEATH # 66-062173 | |
| NAME OF DECEASED: | Vivian Forsander |
| PLACE OF DEATH: | Little Co. of Mary Hospital Evergreen Park, Illinois |
| LENGTH OF STAY: | DOA |
| SEX: | Female |
| RACE: | White |
| MARITAL STATUS: | Widowed |
| USUAL RESIDENCE: | 2525 W. 99th St. Chicago, Illinois |
| LENGTH OF RESIDENCE: | 54 Years |
| USUAL OCCUPATION: | Housewife |
| KIND OF BUSINESS: | Own Home |
| DATE OF BIRTH: | March 14, 1892 |
| AGE: | 74 Years |
| PLACE OF BIRTH: | Sweden |
| CITIZENSHIP: | USA |
| FATHER'S NAME: | Unknown |
| MOTHER'S MAIDEN NAME: | Unknown |
| INFORMANT: | Mrs. Carson, daughter 2525 W. 99th St. |
| DATE OF DEATH: | November 19, 1966 |
| CAUSE OF DEATH: | Coronary Occlusion |
| INTERVAL FROM ONSET: | Sudden |
| DUE TO: | Generalized Arteriosclerosis |
| INTERVAL FROM ONSET: | Years |
| CERTIFICATION: | I hereby certify that I attended the deceased from -- to Nov. 19, 1966, that I last saw the deceased alive on Nov. 14, 1966, and death occurred at 4:30 PM from the causes and on the date stated above. |
| PHYSICIAN: | Wesley H. Ryd, MD 1832 E. 87th St. Chicago, Illinois |
| PLACE OF BURIAL: | Chapel Hill Gardens West Elmhurst, DuPage Co., Illinois |
| DATE OF BURIAL: | 11-22-66 |
| FUNERAL DIRECTOR: | W. W. Fern & Sons 10001 S. Western Chicago, Illinois |
Comment and discuss