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I~'AM H0. 1IS~12
~w4~•REV.•1-b~ SiAiE i1tING DA1E
STATE OF WIStO!~lSI~:
~~Fy df~ARTMENT OF FfEAl1H ANO SOCI/1l SERVICfS STATE DEAIH NO.
l~ ~ O1VISlON OF HEALiH
IOCAI FIIE NUMBfR ORIGINAL CERTIFICATE OF DEATH
DeCEASED-NAME f~rst M~dAte losl SEX OAiE OF OEA1H Mo~tA OaY Yeor f
I T~ TROAS LEE LUNN i?i ~ a. V r~~.97p
' R~(f- 1AK~~se, Nc~ro, M~trkcntrnl~on,Et~ Aqr Luit B~rlAdor Unde~ O~+e Ysor Undet W:e ~~r OATE I~AOe~h O~Y• Yeor COUNiY Of AiH
I ~ Wnite ~ n 70 ~ o°" ~""`;""'K a a~RT December 18, 1899 ,0.1?iil~vaukce ~
` ~ ~ ~ ~ ; ; ~
o NAAtiE OF C lY, VIIIAGE (11 Ne~tAe~, Nomr Taw shy) 1 s de C ty o NOSPITAL 0~ OiHER INSi1TUilON-NAME
~ W (locoeion of Dc~th) . Villoye l~~ti qf tbe M EifhK G~re S~reee end NumE~r a laolan)
~W ,p Milwaukee ~rK ,d. Sainfi Jose h's Hos ital ~
~ - ----P------~-- ;
! W ~ S~AIE OF BiRTH CITIZFN ot Wbat Countty ~µpr~;~ Never Motritd wRY~Y1NG SPOUSE (If Wift, Give Mo~dM Nome) ~
~o ;;~~w s~?.NanjCovntry) Gertrude nee Prinz
~ 8. Y3`iino~s 9. _ UsA ,o. o w;e~,~~i ? o~~o«~
SOCIAL SECURtTY H0. USUAI ~CCUPATtON Give Kmd ol Kork D~ri~ hbst o! Workiny l~te K~40 OF WSINESS OR INpYSi0.Y I
~ 1z. 34?-0?~ Even ~f Relired . ;
3498 A „o. Salesman ~,a Retas.l Store
RESIOEkCE: S1AiE COUNiY NAME Of CITY, VIIIAGE ~ns~de Gtr a ~ MAItING ADDRESS (Mant Addras ot Time ot pcoth)
i ~ (1( Neith r ff . Town ~p1 V~I{oqe Limili
Wisconsin ,~Aiilwaukee .,k. ~l~~rau~Cee rK nw 3035 North 4~th Street
F~TMER-NA.VIE i~nl lM~OOIe lost MJTMfR-MA~OEN NAME First A1iddlt lost
t
` Unkno~,rn '
~ I' S-_- - ,a _ Unknuwn
t'0C ~;`:FORtAANi -?:A.IAE MAILING ADDRESS Sireet w R.F.O. No. CifY or Yilie~t Stott 2ip 'NAS DFCEASEO EYER 1N U.S. wR`AED FORCES? ~
~~i ~ertrude Lunn ,~035 N. 44th St,,Mi1~v.~~iso53210 17c ~Y,
sr QGWO o~~«~°~~~'~~
I je. PART 1 pEATH WAS CAUSE~ 6Y - Entcr Only One Cause Per line For (l~, ond ) Approaimote Inicr+of
i i /~L ~ ~ 6etr Onset DtotA
Conditions. If My. A. IRmed~e!e Cane: ~ ' ~ C ~-~7 ~
~ f'b'A~ch Gure R~se to p~
to, or os o
ImmeE~~tt Cov:t (~i S. ConsecuMC! O~:
' 5!ctiny the U~Cer- - - '
i q. Ly~r.q Couse last. p~ to. or os o .
~ v C_ ConsMucr+cz oh '
i E PRAT II OiHER StGNIFICANT C0401T101:5: Conddipns ContriCuting to DeoM buf n~f Rtlated to Couse AUTO?SY (Specify) WERE FIItO~KGS C~NStDEREO IN
G~ren in Fert 1 ~Ay O rK DETERIL1~HthG U7SE OF DEATH?
t4o. 19e. O res p No
~ ~ ACCIOENT DATE Of MontA Day Yeer ~Ieur HOW INIURY O:tURREO (Eeter lioture oI In~ury in Pat t or Port 11, Item 1~)
?-I n SU%UDE INIURY
Z i A~l
pl ~p~_ Q NQ1.IC~DE ~py. ~QQ.
i'~;L'RY AT WORK PLACE Of INIURY ;Hane, Form, Street, fatory, EtcJ IOCAT1aN S~~:et o~ R.F.O. No. Cifti ot Viltogt Stote 2p
I Q~~ ? Yes Q No 20F. (~~~I) ~Og.
~CkRT1FICAT10ti-Mor~h Dcr Yenr A'on7A poy Ytor AND t~ST SAYP HIM HER ALlYE 0'1 DIO YOU VIfW THE OEATH OCCUARE~ At iht Plxe, on ihe
~ PHYSIC!AN ~ Ma~tA Oo~ Yeer l~OY AF1ER DEATN (MOUry Dote, ond, To TAe &s~
i ~ At~ended The ~ Tu ~~~Q~ ' ~ O n o( My Kno.leC9e. Dn
~ Deceased From To 1Ae Couu(s) StmM.
Z Ylo. t ~ I2ID_ 21t. v 21d. Y~ ~ 11a M.
-p; ~ERi'F:C1~T~0li-~l.EDiCAI EXxbt'~:ER OR CORanER: Or Tne Bm~s of TAe NOUR OF pEATN ?HE Df:FCENT WAS PRONOUH(EO DfAO
E•cn. notqn Of Tht Bod~ e^d or The letrest~qobOn, In fAy Optr.~on, pea?h N.onlh Cop Ymr I{aur
! C~ ^~curred on The Dole ond Ovt To TM Coute;s) Stated.
~ ~ ~ :?a. M. ?2b. M.
CfRTtF~ER-NAME tiY~e or vr.nt) SIGNA - T~F R Titte OATE S~G`~ED Albnth Doy Yscr
2,, Robert F. bfadden MD ~_~,~,t Nov. 2'/,1970 ~
, ; V~'UNG A~9RESS CERTIf1ER S~net or R.F.D. tb. GIy or Viliage Srote Z~a
8430 tY Ca i t ol Drive •
; ~ 23d. ~ p Milwaukee Wisconsi_n 532?~
~ ~ X-7 6URIAl CE?AETERY OR CREVIl.TCRY-t1AME IOCATIO~ City Stofe ~
~ I ? CREMATION • ,
~ i; titlisconsin biemorial Fark Brookfield Wisconsin
~ I~ i: ta. ~ RfMOVAL 41b. 41c. ~
i :~?jEUt~AI-DATE Ycr.!b pay Yeo~ FU':ERAL H~J.`~!E -NAA.E AN~ ADDRESS STrett or R ED. No. Citr ar Ylla~e SfoTt 2~p
~ Novo 28 1970 ~Crause Auneral Home 9020 W.Ca itol Dr. ~ il~v.tivis
j :mi z.a. + _ z • yl' S3222
~
I FUN RAL OtREtiCR-fiGyA1URE REGISTRAR-SIGNATUBE DRiE RECE!YEC dt tocol Rtu~stror 3
~ ; ~ ( //~~,J~( j17o . • ~ -,~.,,q~ ~ Y«. ~
e I ( ~7I V . 4b0. ' • ` . f i : i' ' ~y~~ #
y .r.~.. i j
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~ This is to ccrtify that this is a true and correct R~n:~e~u~t~_;`;_'~~t ~rd ~
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~ filed in the Vital Statistics of the !~i?ti:aal;ee }fealth $8t~2~;~_ ;~:y~~' }
I2~ted at ttilti:~ukee this 3 v day~~ Y" . ~ 170 4
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~ . ` Coc.rissioner of l~e ~~f~'a~~~`..,~'~ 1
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FlLED ~H~ n~COnDEO •
~ ST. LUCIE CJ:IHTY FLA.
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CLERK CI~~CIlIY COURT
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