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HomeMy WebLinkAbout2007 ~ ~ ; ~ CER~! .._-:~i ~ OF DEATH ~ . , ~ - s ~oC~t ~a! ..:•?ee AtkSi~,on Deoodn~r? a! Po~t~c FkoGS ~ ~v.rt r:u ...~.r~t/~rCJC.xr W OKEASED-NANf ~~~it raal ~~s~ SE1I DAiE Oi OEA1M ' ~Oti». O~r, ~ ~ COitRIN~ POLF..1K , fera ~ l , Nov. , 2'l ,].971 _ ~ Rw~f rMli(~ h1GW, ~~(~~C~M eMD~~ wGE-us~ ~'e.~ ~•~~u ~ o.. OATE OF ~fa7H ~+O.uM, Owi, ~QVpITY Qf pEATM r'_' tE~~ ~ .,.t~b.~~..,,.~ ..o~. a.s ~,.s .w i-29-1909 h'ashtenaw C;;.~~ - , ~ white ~s, A + ~ITY VIIL~GE. OR TCW1vSHIY pF DFA7H M~oe em iw:rt MG~riSAl OR OINER IN:TITUf1pN-NIN~F ~u wr ~N en~u, e~ve s~ue~ .~o w,..~ea ~ ~ VK~ ?IS O~ N4 Ann Ar'r~or yes- University Hospital _ ~ STATE Of ScR1H ~N r~0~ v.f +~r! CITIZEN OF WHA1 COIK~~Y INARRtE~, N.~"f2 MARRIEP, SURVivA1G SPOUSE rirt, Gn! r~~Dlw ~urt ~ ~ , ~""DO marx ied'"`#~~ ~ James L. Pollak .s.,.:.~,~~~..« , Michig~n , U.S.A. _ _ _ .~.e aece•seo ~j~ SECUR~T11 NU~fR USUAI OCCUPAT~O?: ~u~e awo o~ ~ro~a ooue ov~~~~ rps~ or ~K{Np p~ WSWESS OR INDUSi~Y ~,.•o ~ ot~fw o:;~•..E~ Education ~,~..~T,~.. ~,K unknown '~'eacher .~s:~..:t.~w.t ~t .a~ ss.o~ R~S~DENCE-SI.ttE COUnir ~ITY, VILLAGf OR TOWNS~~~P ~"'m STREET ANG ?~7UMlER' ~ LKU? qf M NO ~ L"'p" Michigan Oakland ,k Southfield yes ,w 20664 Kno:~ ~~ood~ Driv MTNFR-Nwn~f r~~s~ r~oae us~ MOTMER-AUIDfM NA.Nf rusr r~oou w* Harry N,. Greenbery Sylvia Singer ~s ~ WpqMANi-N,~MF MAIING wDORESS ~sntt~ o~ ~.~.o. ro., cm w ra...., sr.n, :u~ d ~ RonaZu L. Greer_berg 26071 Salem, Hun~ington k•oods, N,ichic~an ~?~~Ol~ 1 i tnTl~~~: 1~Ri 1. pE~TN W~S UUSf~ 6Y (EniER O+rtY ONE UUSE ?i' lwE F01t ~o). (E). .wD (c~j a~:~.ie.. owur .Ma w.rM „ uirliu7t C~Lf! ~e~ Recent myocardial infarct. ' ~ ~ ? MS~ t ! co..a~w..s. •M. ~ .M,~~ c.•e ~~se ro I iel Coronary arteriosclerosis. _ Irr~outt C~YS! ~o~, pye t0, W~s ~ CowSeOVeKt O~- ~i~tING ~M! VNpl~- ~?IMp C~VS! l~3* , "Systemic lupus erythematosus.. _ ~ ~ART N. OIHER SK,NI?ICwNt COr~W1110?rS: co»ano..s co«rn~v*~rw ro oe.r.~ wr ~o~ n..ne ro c~uu e~ve.. n. rur ~ a~ ~~r ~ ~ES re~t n~o~MGS CC~s- s yes ` yes,r~~MG UYS! ~ ACC~DEM, wK~DE. MO~~pE. DA E 1 rp+n~. pr~. tt~~ ~ MOW INIURV OCCURRFO /~NR~ M~N~f O~ IMJV~7 IN ~A~1 I~ I~~1 1~, R(~ ~ ~ 1 f/lCM~ 1 7A. ~ M. ~ ~ i IN1lIRY AT WOcIC ?U~CE Of wA/RY .r ror[. r.w, sran, r.cr~r, lpunpN ~ snur oa ~_r.o. .w., c~n o~ ro~+M, u.n ~ ~ ~s?ta~+nso~..o~ ONKf~IOG..lK. ~WC1I?1 ~ I ~ ~p M! ` LERTWC/?T~ON- ..o..n. s.. nu rw~ wr rw .HO us~ s~.. w~..iwc~ u~a on ~ ao/ow .+or .uw nn o[~rn o:.cvuEO .r mE r..t!. o.. r+~ f /NTSK:~M: c ~p~M O~r ~l ~OOt ~/iEt Ol~f11. IMOV~1 O~~l. ~.0. R) ~ME ~lS~ ]1~ oe e.uo~ o.~. l~~~J"1 7/ 1 TOI? ~1~2 I~ I 1 tic 11~2 I~/ 1 tt~eS !1~ :~oAM. ~o a~i u~seiiii:no ~ CERTIf1GTiON-ME~1CAl ExAwuNER OR CQRONER: o.~ rwe us~f or oe w~~ o. a.m TMt OKfOlr,t rV ~qNOueKfD OL~D fL~rV~t~Or~ O~ ~M! WOr ~p0/M rwt n~v[stK.~~k}+, ~r~ rr WwWw. oe~m oct~mo w ou wn .,.o ow ro r..e utst~u s*•no. ~ m N V.~ 27 ~ 197 1 • 8: 30a.M ~ ~ - CERt~f~E~-rfAMF ~rnt o~ rn~r. SIGNAIURE wutt O~ nne ATE SfGNEO ~~wd, w•, rt.t~ John C. Shoemaker M.D, ,~12-3-197Z ~ ~ , c~7 MARING wDORESS-CEtnf~F4 sr~[e~,o~ .a. em w a..+ , u•n O 104 ~ Universit Hosoita~, Ann Arbor, I~iichi an, ~ WRlµ, ptEaMTqN, REMOVAI fMETERr OR CRf+MA10RY-NMrF IOCAT~O+~ CITY, VILUGE, TWP. OR CC1iN7Y s~•*! i vtan ~ ~ N. Burial :u Beth E1 Memorial Par Livonia, Michiaan . _ OATf ~..o~+rw, e.r, n.~~ fUNERAI HOME-NA+ME AND ADDlfSS ~ uun o~ ..r.o. ~o., un w*o..H, s*•n. :u ~ ~ e~ 11-28-1971 ,,.Tne Ira Kaufman Cha el, Inc. , 18325 t~1. 9:~iile Rd Southfie? ~ i1~1ERAl DtRfCTOR-51GNAiURf RfG15TRAR-SfGNAiURE OwfE ~ Cf~vEO tACwi ~EG~SiI~t ~-~8 Herbert ~:auf?:?an ~ Ecicaard J. Connors ~\ov. , 27, 1971 300M ~ _ _ " ~ _ _ ~ ~ ~ ~ ~ ~ '"-r'.s'r't~t ' _ _ T .iYi.'.~.~ __'Z~i~?.SITY ~O~PIT~?L ) I, ~_:~~~re J. C~n~:~~_-s, :~yistrar ef ~lit~.2 Sta~i~,ics oi tr.~ Uni~~~r~itl Y,osFi~.a~, ?nn Arbor, Nic~zigan, do he~ab~ ~ertii_~ that th~ annex~ci is a true and cor.,p~:r~d co~y zhe ~:~atn ~ certificate n~w on reco:_d ~ n this o~iic~; that i:~ave cc:~,- ~ ~ par~d t'r.e sa:: e:•~ith tne ori-~ ir.a 1 rer~ru and s~:z~ is G ~ ~ true transcrip~ th.ere~-rc:.: an3 the wi:ole o~ 5i1C(1 oiiginal. ~ ~ record. ~ ~ ~ f~lEO a~" "=~O~cDEO ~ . ~ ST ~U~~~, ~IUMTY fl~• _ . ~S ~ RG':'t f ~ . , ~ Ct EF K ~ . ;,;i COURt . . ~ ~ RErt~- • ~ ~ ED:•7ARD J. CO*~O?.~, Reais•`_Yar `,~`r ~ . ",L~Ql~•e;~ 6, 1971 ~ Z~ 3 3g PM 1 Z . . t ;s~r:' ~ . t • \ ~ ~ ;~3212~ . ~ E~ 800K~VJ PACE~~V~ --?~:tv it~~i fit.rar - z j;~.~ ~ ~ ~ ~ °~.`s ' R N F Y : ~~"t~i. - - ' - - - -