HomeMy WebLinkAbout0157 CERTIFICATE OF DEATH ~ .`Y ~
ocru~ruorc oF w~u~ ~
BIRTH No. nw R.a.ti. ~w. uw ~n. N. .
~~PIACE OF DEA {wMa MewW L~M. A twtlwtk~: rwtdwe~ Mt~r~ ~laN~.l
couMn Bay . aT"rE MiCh3.g8ri L~Y •HtiY`pl~
~ ClTr llt oab1M eoc9enq 11~14. ~tiM SIIYIJ. ~0 dr~ C. !Elt6TM Of R?ONfNSMI~~ INu~ dl i~ Aa/Ora ~1W1~ 11~14 ~f
oR ~...w•i sT~Y w. w~.: v~E Sebeirait~ ``'v `.w.~.t
~ vuu~E Bay City , g
~ 0. Nll NIUIE OF (I[ eot N LaolW ~r LultotN~. ttr~ ~tnK Wdcu~ n leutN~) STNEET r~ knt )
Z t~ttSTTUiqN Bay City General Hospital "0D1~ 819 East Ma~n`~`~~ree'~
Z -~NAOE OF Otra) tHWdM) a ll.wtl 4. (~UoW lDar) l ar)
~ o`«:«~~? Frank A• Koch I o
TM JUrte 19th, 1967
pw, S.
SEX i. COIOR OR NACE 7. MARNIEO, MEYEt MIlRQ1E0. DATE d11liY A
C E (I~ nut It ~neer o~~~
d A~
a Male I White ~'"f0°~'Married ~ J~Y 22s1900 66 ' Y~`~'~
~ ~ ~ lOs. USUAt OCCUPAiION (o1h tlsd d ~xk 10~. KMD Of WSWESS OR INDUSTtT il. WTNPIACE ~~M K Nf~1O QONq) 1L piREll OF wItAT COUNTRY?
l y Sm~ d' ic[ t ut u1[ llfwws If nllydl
a x ~e~''~re~ 1Farmer- Re~ired I Sebexaing, Michig n U. S. A.
p 1~. FAiHFA'i MAYE 1~. YOTMEY'S MAI001 NAYE • 15. MAYE OF WSMNO OR MfIFE OF DECEASED
~ ~e John M. Roch I. Anna Nitz I~ella M. Koch
p ~ lt. WAS DECEASEO EYER IN U.i. ARYEO FORCEST 17. SOCIAL tEWRITY N0. 1~. YIFORY~Ni'i NAYE ~q~t. o
'.i~ Y fYn. «~otnwn) tlf dh nr u dN~ K ut~la) •
Q g`~ ~o ~ None I 381-38M6835~~rs. Della M. Koch Sebewaing,
m ~ 19. CAYSE OF DEATN / ~A~/' 'l . L~~
~«L"~
~ z E,«~ ~....r DIQEC~TLY
lRFJ1~ oT
~?ntK.~~1~,aT/ n l`tPA2~ ~ISE'.ASP 'fi~Q~A~ S tn~pP_
ua~ tar 1a1. Ip). ad te) ~T . . •
~ W ,u~rcc~crt ews~s F: 6 a ~<<R~~e,r1 .r ~'jy~ f, pfc ~,yr ~ ~
~ °iC • n?: a..: wc m.a. w M•,we ~osamo.s. n sa. t~s auc ro t~)
i~., ood~ of hr1e~, wd u Msrt ~ to W s1ow aus~ (a) wW~s
u Q faurre. uWw. ste. It ~ y~,
~ ,Z m~ass tM~ dlf~as~. l~ ~r
~ N~ W~ ~ud arsN euE Tp (C)
~ p. OTNER SIGMiFICANT COMDRIOIK
d iila~tid
teW
dp
~e~
i~
awidlWi
a~st~t ONtY.
V ~i 19/. OATE OF OPERATION tt~. YAWR FlNWNCS OF OrEYATqM 20. A4i0KY7
yxj ~ I Ta~ N~?-
F" I'"21a. ACCIDENT ~saee~ts) 21~. PIACE OF UIIURT Iwr.. m or .ean 21e. (C1iY. YWCE.OR T0INNSMIr) (COYMriI ( AT~
oG Ii0WCi0E I~• t~r~. t~et~s.~uMt. MOe~ lld[..Ne.ll
d
~ i 21d. TWE ~uowni IDV) IYwrt IHovl 21~. NWIRY OCCURRED 21f. NOMI DID IN11iRY OCCYRT
0 i OF Ww4 N.~ a'uN
ItUi1RY I wxt ? u w.rt ?
W {
r~~- Zt. i e.nrr a rr e ~.n..a.a u. a.~.,s. ow ~+-27 ,~9~. a 6-19- , u~. wt ~ asc s~r u. e.c.,~~ w..
on ,19~. ~N tbat NstL ue~rtN at 9~ 15 A. troa~ tM auas aad o~ ta~ ~at~ sta d ab~r~.
• ~ 23a. S~ NE ~iHCra ~r t1~a1 23Y. ADDiIESS • 23e. OATE CNED
1 , ~ / L(i - ~ ~ a , ~ ~
2~ ~R~. 2 ATE 240. NAYE CEMETERY OQ CY TORY 24~. IOCATION lpq. ?IU[w t.o. or aaeui t8uu?
~'~a~s"`"'' I 6-22-67 I Silverlatirn ( SebeKain Michi an
B3~ OATE YEC'D !r IOCAI REC. ii RAR'S SICNATY ti. fi{NEAAL pIRECTp~'t i1CMATiIRE /I ~
~ ~ „ ~ ~ u1tZ aT81~~iome ebewain
_ . - - - ~ - ~ - - - -
STaTE OF MiCHIGAN' ) _
COUNTY OF BAY ) SS CERTIFIED COPY OF RECORD ~
CITY OF BaY CITY ) , f
,
. ~ = ~
I, James H. Gates, Registrar oi Vita1~-,St~tits'~~'~s 'and ; ~
,~b .•ce.'r~3 h`a"t ttiis
, City Clerk of the City of Bay C.~.ty, Michigan, do her, `
is a true and correct copy of the Certificate oa Yi ley~n~•tti~" f
3~y
t~?~i. C ler`
k~s
Office, Division ~of Vital Statistics. ' ~
. t s . . . ~ ~f
- :i
- ~i~ i..~~ . .'W-s`. ~'e
Dated ~UN 2 6 196T ' StLf~IU/C~
E D RE D D ~ e~~~`rAr
T-~~1 r- ~ . . ' '\~f .y+.i ' ;i;:. 1
- t ;~s
yA~
.f. j
' " i~''tY~~i ;Y`t.~-'~ •
~ _=yt;~.s.:~ ~ •
,f:~ ~;K,~~t ;
~ '68 OCT Z I PM !2 : Z I _ , 2- ~
1'71454 ' . . - ~ f
~
• • HOGCR ~OiTRaS • ~
CLERK CIRCUIT COUR7 d~~'~~ p~ 157 {
. ~ • ~
-