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HomeMy WebLinkAbout0594 ~ - 73-20y6 r CERTlFICATE OF DEATH ^ ~ ~ ~6~U31 .ocu ~ne Mw.?w MkVM~ D~/o~M oF P~Wfe N~sMY vn rne ,.w.w~ DE EASFO---HW[ ~~ts~ r~Ow~ u~~ $~7[ OATE OF OE~TM ~•~owt~, o~~. ~ ~ Lawrence H. Rose ~:Kale Gctob~r 3, i~.'I3 RACf ~Ml~t, N~f~~y, ~W ~K~N ~MDI~M, AC~F ~ yS~ w+oe~ ~~~u pwpe~ ~ o~• DA1E OF N[1M ~ ro..tw, ~~r, ~p~~Tr Of DEATN i~C ~ SIfCN i ~ N~!»O~~ I 1U~3~ r~-~--WfS ~MII~S W ~l~~ ~ ~ ~ 'r~hite „ k .Mar. 1'~ ,1y18i,,, Kent jITY ~It i A~. pQ TOWN$HIP C1f OEATM ws~e c~n ~wn~ NpS~1?Al OR OT11ER ltSTlt()T10N-N.t1?tf .u .nr e~r..r~. a~.e sr~t~ ..,we~ , ~ u~tu~ ~n w ~o nGrand Ra l.ds Yes Fer uson-DrUSte-Fer u~on H~~ iiai ----p- - - _ STn~E Of {ttTM , u ror ~ t•.~•vt CIl ~ WMAi COIlN1RY MAlbEO. NEVER M~IEO. SURV1vING S~OUSE ~ a r~~t Gne w~w?.. wu+e ~ ----l- couvm . NfIDOwE~. DIVORCED ~ vec,n ~ ~ntcni~sn ii .S.A . N Married yable V, Bunce SOCIN SICIlnTY PN/MlEf' - ' ' ' ~JSUAL OCCl1~ATlOfi ~a.•e a..e ~ w~+e ow~..o .osr or - ~ - - - - ~ - Rwo d wsr+ESS o~ n+ousttr ~.roa.~ un. ne ~r Nn~tD ~ ~~U ~-1~-c~4 AutomotLve Machinist lESIDENCE-SiATF ~QpNi~ ~('ITY, ViIIAGE OR TOWN$NIP w~ an .rn~ .TTTR[Et /WO NUM~E! u~;ichi $l1 ~4 i'tor. tca lm = Trufant ~'s•~u~• +u w.a~I ~ 5~,~ v-, ~ ~u~ Ye.,,~a 1~_(i ~ f~iMFR - N~e~E n~v ..wpe us~ nWiNER MAtpEN NUNf ruf~ r~aeae ut+ ,s Sldr.e • ~o~e A i e H~ im~s INFpRµA1•11-NAIME f MA4tPIG 4ppRESS ~sr~eer o~ ~ r o. c~n p~ ~OV.w. ft~R, /r~ ~?.:~ial~el Vir irila 'os~ wii'e 228 Souti~ ruf• nL t~ls '~tii~•a~ vwRt 1 OEATN W~S CAUSED {y jE?~rER On~r O?+E C~uSE ~E~ ~rvE fO+t ,o~ ~h. •wO ~~I; ,n w - -..re'o~.Te c.us:--------------~- - - _ ~~_.eeu o..x~ ~..o oe.t~ ~~~~_Hemorrtoa~e _ Intra_ :;bdor~ina 1 a_ ~ nours . .¦~c. e..e .•se u sl i ~ °»S ( , Ne ~ast3tic Bronchc.rrer~= ~ c,arcinoma ' 1 ~ear .rrlO~~f![~VS! o~. ~ _ 1__ ' . fr~•.N.. ?w! uti0t~ o~t •G C~ ~f ~ :J~.s[O~.sfw:~ J• . ~\~NG C~YSf \~!t . Bronc.~o enlc _Carcin~ma ' ~ 1 ears - - - - - - 1 _ 1_-Y---- I1t~ ~t piNEi S~GvNKaht C~D~h(NvS~ ccwa~,cws tanaW~,~ ro p~.H wn c~.r ~aune rp c~w~ a~+~ti ~w ..n ~~m ?AUiOISY `!f YES rne nro~«OS Coa~ •!S O~ M7~ I a Of~tw~ ~~IfaIw.MG Cw•J3f - !+•I1i:J ,_w ACCIDENt SI~K~. fh?MK~DE. ~b~T[af-p~IUpY ..p.~~r y. re~i~ TF1~l~1R` NOW INJURY OCGURfEU e'^«'~+~~ ~~«iuer ru: e e~ r.n u. r4~ , yr~.r. • ~ ~ ~ I M )1M _~'a'__,_ ~ iNIUlY AT WOMC t?IACE AF W1lJlY ~r +O«!. •~r. ~[Mb, •.i/W~ IOCATION ~ fuUt oe ~ r o ~u . cm or ~owr, svn , r~~tC~~• •~l O~ a0' OM.(f ~.D„ .ltC ytC~~~ ~ t~ ~ 7M hl ~EQTIfIGt~01d-- r7Mir [f~• 11~• ~MO~+M C~~ •fl.~ •NO l?3~ L1~ .~W/w!~ 41~1 OM ~ pO/MD MOl ~:~nr IM! •M~SlCI~M. i ~pr~~w p~~ OlA~M OCCIiI~[D ?t M! ~4(! pr ~we ~ 10 nu ~oo, ..a~ a.n~ ~.n. u+o. ro me ~ev . .rtwreo ~w~ ~ OFU~SfD qJr 12/ ~ b/ i l- `_?/~'_~/7.i ~~25/? ~ ,~.'Jia :1CiF "w --i-- .c mt c.vata s~.na CEYlY1~Ai1~N--MEDKAI E7U.qNER t7R iO~ONER ~yt ~v~f M ~rf „pot O. Of•m 7 twt OKlO[w+ r~f »0..O6.KlO Ot•.~ - - ~ t4r11~~~1()M p M! qQ~ ~NO'G~'NI .~~fl•~:~~~pN. ~ .n~OM. 1 YQNiM p~~ •t~~ w~.• 0[~rw pCCVff[C OM ~N O~'F aw[. i~W 'wt i~i3l~y .•.•!D ,r CERi1FIfR-NM~f rot o+»•..~ M'1?„.__ _ T- 1 SIGNATUtE ot4~ee w'~ae ---TDAtE SKNiO w~rw. a.~ qu~ }i;.~~.er't ti. c?~?~(es ;r~ Robert E_ HSyP.si M. U. , ~U/3/73 r?wRWG /?fiDRESS --~fRq~~ER ~ eine~ w o «o - - -tin w +a+r sr•n -i • t~ lt ~ ~ h " ~ " ~ ~ WRUI. C~E~:qN, HMpv~t ~CEMEtEii~ OR CRfMATORt--H~Mf IOCAi1pN CITY, VIIIAC,[ TWP pR COJNTY s..n ~ s.?t n, ~ ~ ~ f 1 t~~ 4 fiti~iai - -~r,. ~ru•~r~~, ~~~t~t4l'~- -1~.. Trufant t~ OATf ~..o~.r~ D•• ~ fUNiRAI HOM[-w,~.af ,trlp ~f)pitSS ~~ntt~ c+~ ~ r o ~o . un o~ ~o.n, si.re i~r ~ I'~~ a t: t C- 1~~ ` 7~itC t i - C'~ -~=~1 % - - '"y~]DCI:- . . ~ o ~ ~ t ~ ftNEt~i D1RFCtOC- SeGnt~~uRF RfGISTRAR -p~N~T~IRE O~• RECE~~FD ~Y IOC~I ~tG!Sf~Af " ~a~:,z~ :ti . Lt~:~ar. Jacic tirunKerr~~ ~N t~ ~ STATF. CF lQCiiIG~N ) I~ JtiCK f;HCtlf;~:,t, Clerk o~ tt~e Circuit Ceurt ) of Kent County du hereby certify Lt~at the " COUI~iTY (k x:~IT copry c: t!.is doc~ar,ent is a trus copy of the ~ record nu~r on file in tl~e ollice o; the C1erY ~ '•of said CountJ and Court. i ~ -TH T.:STI2IGNY ::ti~'COF, I have hereunLo seti rtqr ' ca.. hand and official seal at the City of Grand - ~ Rapids said Co.inty t?iis d~ o~f - ..v . t t~,~.~ ~ AD 19 ' 3 ~ . . ~ : _ . - . ~ ~ ~ _ . . . , t f-~ ~ , - ,.o ~ , : . i ` ~ , /Xont C :uk „y Clerl~ ~ ~ 26: 031 - ~~r"? z~ ~nc~ 5~~! - ~ , - _ ~