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HomeMy WebLinkAbout0923 3i~ ~ CERTIFICATE OF DEATH r- 4 ? ioui r~u «ur~~~ D~poiliaU ol PrOGt Hw}tY s~.n .~u .w..W~ ::i~~EO-a.uwE n~si rawt ~~s~ SEX OATE Of OfATN ~ roMtw, o.*, n~~ ~ ~ ~~f'~ ~ p : !ra le , . .cc~r 4, / j6c5 ~6~~rrJ~ - a:E w.:r~. ~iaw. ••e~K... ~aou.., wGE-~w~~ v..a~ ~•e•r uwea ~ w• OATE Oi NRM ~rw~w, w~. COUNT1f OF OEwtH e srturr ~ ~ a~ao~~ n~~~s~ rOS. wrf ~OU~s rM. ~ ~ ; ~'`tL.fe ir w H ~ ,~z~c / D ;'~tcv~:rJ ~ "-r. ,'OwW, OR lOCwt10N Of DE~TM N+s~a ca. ~r~n „pSMtAI Ot OTNER NStIiUTIW~- ~u w~ ~M ~mK~. cne suet~ uo .ar.~u ~ • ~ snc~n .es o~ .a ; ' ~~iC::l?Jli.l ~l~l r~ ) f. ~U~J2/~jt f~O~JnI_~Z1 ~ ~ S'~TE OF l~RM ~ u No~ ~M u a~.. M~r~ CIi4EN Of MIMAT COUNiR7 MAltlEO. NEVER MARRIED, StlRVIVNG S~OUSE ~w we. 6~re w?oeu wrR ~ • ~ i-'r cow+m ~ / 1 i WIOOWED. WNORCfD ~ srecrr ~ /j~}/}n I1~ ~ '~IVI. i~il~~ ~1.~1 ~ IIV~.~t~ ~ . 7 7 ; S J_,~. -SECUinttr NuM6ER uwM OCCU?wi~ON ~crve awo or wn oa.e ou~ua ••os~ a KWO Oi WS~NESS O~ tNDUSier ; ' l. wu ua. re~ ~r ~emto ~ - - N~-J~'t GJU)'U1.tP./L SP~if f~It7~~'~'1~ ; . ~ ; 5..~. ENCE-Si~TE 4COUNtY Cttr, TOwN. OR IOGiWN M~ ~wm STtEET ~wD ~+u~ER : ~ ~vaH..~~ w ~o ~ ~ ~~~_c~. r~';rccvnr~ (~.l,in-Lv~ ;~o ~,.44'2~57 ~iru.ti.v# ~ive ~~rn{~-rv~uE ~~~sr rwae v.st r?OiNER-~u10ENHAME ~ns~ r~oa~ w* ~:cc~~~ii~ S~2c»'~~iit Iaul.in~z Sci~iir~~ niO~hUNT-llM~f M~?RN~G AOOtESS isnetr w t.r.e. »o., cm o~ w.~N. ~r~a, tr~ . i ,t ~ 'Uw G~ J:2P~(!t ~~~If=j~ .Srr,ne ~ ~~bvve ~'.,zi i DfATN WAS GUSEO tNitf lJ/+li a7iif 'v~JS£ FI2 t£'~ f~ arrn e••• 1 x. 1l unretN o«u, •MO oe.m 1 ~ ~ ~rrtOUR UuS! • { to~ s /D / 1 • .3. . C F~vDIfIOw1. •li~. / ~ T ~ ~~CM G.r~ ust to' ~ (b! ~ i v G ~ ...eo~.a uuse a~, ( ~ ~o. o~ u• ta+s~aue~+et d: s~.r~..e ~+e uwDtf- ~ ..~~e e•use ..ar Icl , o~q; n OTKER SIGNYK/u~T CONdTWnS: co.~aews eanww~we ro a•m ~w ~+o~ nu~to ro uxse ae.t.. •u~ ~ a~ :.::..'W:' ~ ~se .,...~...na .e~r. 1 h! d MOI 4Ol~[O ~M Olt1~r~~t~MG fJWft I ~ / W Ot~~M _ Ih ~V 1A i - i n~C~DENT. SUKWE. ?~OWCIOE. ~ E 1N ~ rp.rw. y~, rt.~ ~ F10UR MpW tH1(/tr OCCURRED ~ t~~ wlu~e d~wrvn ~M ~ut ~ M ruf u, ~r ~ . . I C~ ut~DFiERtiuIVED~sncn.~ ~ ::c ~ I0~ M- 7M !.:•,iRY AT WORK ?uCf Of wNMt~.r.w.e.••u. sr~n, r.era•, tOCADOn ~ fnta w~.r.o. wo., e~n o~ tOrw, s~~n ~ ~ srtU~~ ~tl O~ NQ~ OnK! MDG.,lK. ~SMC~n~ ~ _ ~ ~ ~ ~7i~;UT~ON- .~wRM w. au +a+w~ o?. rw ~10 41t ~~I MW/MN ~~IyE OM ~ ao/oa w~ we.~ me o[~M OCwetEO n.t wte, w Me ~ ; rNrg~C~~N: ~ ro.~m o~~ rut aoOr arf[t ot~a. ~NpN~ owR, u.o, q e~t Nar ~~TTfnOlD ME T~ O~ nt [MpM{Ep(~. pR oecuseo rror tt~ ti~ !U. tA hl ~o ~w uusus~ sr~~eo. ! C:: %~siUirON-IrEDICAI Ex/u~wER OR CORONER o.. rMe s~s~s w na ~ow w a•m ~Me oeceoer~ .~ws nor~w.~cts oe•s ~ F..- w.rw.. a n.e ~oor ...o~o~ rwe w.es:~e.~a... n. r~ w.«o.., rw~r • n~~ wov~ : occunw w Me o•n ..ro oa w n.e uusen~ suno ~'.7D rn / S':rG M. ~ Cc~iififR-N~ n oe .~u.r~ S~GNAi~tE o~ nne DwTE SIGP1fD ~~a+n., o+?, •w~ ' a IA tk ~ y ~ n.,~i.;nG AODRF55-CfATti~Fs Srtllt O~ ~.I.O. MO CI o~ wrM r t~r _ 7 .5+- r / ~ / o,,,,wt, C.RE~MT , REMOVwt CEMEiEn OR CREM~TORT-nuME l T~ON u~ w io~.~+ s~•n i .~o.`"~.,3cvci.cr,C H. e~i~e~ne (~emef~~ t~e.tiu~' ilii.alti,e ~ ~ JATF ~..OMM. o~t.-!e~u~ WNERrI jfOME-~iM~f ANO A~~SS ~ ettt M~.r- C O~ ~OrM, ar~tt, iN ~ ~ , ~nci#,i.~f . - ~ Detiu~ ' ;i ~C~?.cfl.a~r. ~ ,'~c / .'v.`i n. e f~e~uc~c i~n. . rce. =-3=-= • ~ . Fi:r: ou~eCT e ttr+~ , 1tEG?st t o~a ~ece~vto ~r iow ~e~srua :s, ;1 . ~ i~; ~c- a ~q4 . . . - - _ - - - _ . . . . • ~ I hereby certify that ~the above:~s a~true and correct copy of a ~ Certificate of Death'as;recor~ded at the office of the City C1erk ~ and Regi trar of.the~-Ci:ty of=Mc~int Clemens, Michigan. ~ i ~ <~~-; • ~w; ~ Jbhn H., a n, City Clerk and Registrar. Dated ~o ~(Gli. IQ~~~ cu t ~YD REn orROE~ ~ . sT.t_"c.r ~ ~~~s i CL=c : i.:i;i •".(~URT l~l/ ~~Gf"~7 ~ ~ ~ • . - : j" " . . _ .r.~..~rc.- ` OcT 30 9 so AN'~3 2b`7250 ~.`;Y~~~~ ~?4