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HomeMy WebLinkAbout0451 r~ 5~~ CERTIFICATE OF DEATH r- _ ~ .a. .wr.~. ~k~iPO~ c.pal.w ei P~l~c Fiwr? ,an n,. ..w..a -~iAME wst ++~oou utt SEII OATE Of DEAiN ~ rOwtw, O~r, nu ~ W.i.C.~.~am S. INeCanxeh MaLe , Ju.Cy 1 1, 1969 ~ RwCE wn. Mww. u.encw uwu», AGE-uf~ uwen ~ nu w+w~ ~ wr DATE Of WRTH ~ra~m, e~r. COIRJTY Of OEATM ~ frecvr ~ rnMwr t re,~f ~ ros. a+~n wou~s ..M. ~ ~ Wh.i:t¢ 69 ~ ~ ph. 1900 Wayne . TO~MN. OR lOG?T10N Of DEAM ~as~ c~r iwns 1qSMAl OR OTHER NSTrt 101V- ~v wr w a+n[~, cn~ sraa .,+o Muwe~ i - _ - - - - - _ _ uec+~ .~a o~ .w_ _ ~ ~ Qa Ohn _ _ H. _ _ - - - • _ STATE Oi WiM ~ n~ot w u.~•.. wre dTtZ@~ Of WwtT COUI~IiRY AU?RR1FD. NEYE~ MARbEC. 51lRVINt~IG S1~OUSE ~ r~.w. a~n r~be.~ wuu ~ V.i.~ig.in.ia S. A. „~°°"~'a°~~cP""" Ensa I~~.~.t en socuu sctubrr nu,we~ uwn? oaw~na+ ~ owe ~.w o~ .~o.~ oo». o~,.~+o .ou w~ or ws~u oR wo~nrnr r0~~4 W!, Mw r 1 367-14-8221 $.cbpazchen E. and L. Tnanbpon# Co. RESIDENCE-S/ATE tOUHT~ dtY. TOMM. OR IOCI?TION M~oe cwn u+m SiREET M~O HUµ~fR . =„~M.~ch.~gan ,p Wayne A.~.2en PCihE2 ~~~S~Q6 ~ ,w. 9239 Pank ,fAMER-N~+wE nw rqae usi MOTMER-~uDEN NAME ~rs~ rioae uu • Shadey MeCah~en Ann.ie Seo.tz IH/~RMANT-IiAME MAIt'1(~ AOORE$S IfIHl1 W l.IA. NO.. Mr' O~ ~Ori. 3LR, 2M) ~hMhb . Enaa lUcCah.tex 9239 Pa.nk, A.~.~en Pank, 1~~~,ch~.gan 48101 ?A!T 1. OEA1H WAS CAVSED tY: [fMER OHII' Ot~ GUSE /fR LM~ fOR (cb (bl ~?'b ltN ~mirw a+sn p w~m t~. wreou~e uuu . N, G~c "-f • - t -Z . ~ • • ~ _ , ~ coM~mo~s, ~r ~Nr. rMKM O~r~ ui! w hl j4~" T"'~ J t^ ~w ` uu.iw~n e.use ~w. eue .o. .s • co++uaw~.ce a: ~ s~~n¦o rre u~oeF ~ tn,.o t~ust usr (~l '~A~T L OiHER SIGNIfKANT CONDtT10N5: ~~*~s ~~~~~e w oe.m wi ~+o~ aeutto ro uuse an[.. n. rur ~ q? IF 1?ES rl~! NNYIMOf COM- tfes oa.a~ yeueo ~w oerte.uNaro auu ! w ourn A. 1f~. ' AOCNIEM, SU~C1Df. HO+NKtDE. ~+w*N, w•, •ue ~ HOUR HOW INJURr OCCURRED i eu+n .unn[ w~~ivn ~w rwn ~ o~ r.er N. mr ~ iOR W~DfiERWVEO ~s~cam - 1h- 2~. Z~c. M. IM. .1lWRY AT WOhC ~IACE Oi W1UR~.~ ~o+e. r•a., frwr, r~cro.r, tOCwT10N ~ snEt~ w a.r_s. .ro.. un oa iovn+. u.n ~ ~ ~1fI[41f Rf O~ MOI y//C! MpG..lK. tfIlCVr1 f ~ ~f. •~f~ ~ !.~~~A~~ rOMtM O~t 1F~ y0M11 O~~ '/ll.l ~ND 417 LM MM/11[~ ~lI1~E OM .~ao ~.or nn+ ne ~wn~ occuaco ~t tM! r1AC!• ON AIE - fNtSK1AM: ~~M W7 tEAR ~001 VtH Ot~A1. INOYl1 0~1l. uMO, 10 M[ ~I3t ~ ~ .m.~oee (p T ° l! G CJ ~ 6 :t~. '~'i ro nu uu~se~siu+w ~ th. awuo rror tl?- ttc. ' CERiiKAt t E]fwMWER OR COIONER: oa rre s.s~s o~ a~[ w a.m Mt o~eeoE.a .r.s na+au~ceo a•o (LtMNaflpq QI 111t qOt AlO/0i ill~ INtlST~,~fIpN. {N M~ WMWO~~ . rOM~M Y~ f(I~l NO~/f ; wm oawno a. ~rc wa ..w oue ~o nu e.use~s~ s*•no. rc ?b. tl~. A~ GfRi1HER-NAMf mn o~ rewn ~ a 51GNA o[e DATE S ~..oMw, o.~uu~ ° v ~tJ ~ . ~ ~ l~~. . ~ 7 • y 41AAlNG SS-~ RifFE~,i~ ~ ~p arne~ w u.o. No oe w.rr. suue r t~i L ( / / 'i" r'~W ~ ~'~-~L. / " CR~W?T~ON. REMOvwt Emr O~ C11FAU?TORr- OG110N an w ~ovrn uwn I~ Bun~.a.~ ~ M~.ch~.gan Mem.. Pank F.~a~ Rock, 'M~.ch.igan A~- ~ w~ +w ~ fU Rwl N ?~~E ~r/0 ApORcSS ~ sr~Ea o~ v.o. wo., cm p~ ry, sun, ar ~ Ju.~y )969 ;,~F~lowe Pe~endon, nc. -225 jl1 ~.tg«r, Pean6onre, N.ich~. an # I ilR~~l O~RECtOR-31Gr1A1URE~'~ / REGIS~RAR- tu owr[ e[cento ~r l t tEG?s~ut ' r. ! ~ ~ _ 1 ~1:~~a; ~ r~~.-. i,. z~a. ~,f~``T~ " -=-=---~_~`tt~--~~~DE~•r-F~A-- - r_ - - i ST. l_UC~E ~r~ Z?F~~O a.~. ~ State of Nicht~en) ~$S~~ ~ ~ : . E . .,-..~4 County of ~'~ayne ) ss, 11; 41 -~s= --i - , C i ty of Dea rborn ) g S:-.: ~ : ~ S' i, s; . ~m/ ~ ~ ..6 ~ ~ ~ii I s R. iYi 113 am Ni 11, c ler~; ;o=P~ ~SeT ~~~T of~s Deei~born oo ~hereby certify that t?~is documen~~~aK~t~B~t~ , y oP~ t e;.c~ri~ina3.'"' qr}~ file in this office. ~ . - ~l ~ ' .i i ~ ' ~J . ~ ~UL 1 4 1969 ~ ~ <<~~`' Aif . ~G~' ' _ : - , ate City Clerk ~ aa~K ~~2 ~~~E 449 ~ _ _ _ _ ~