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HomeMy WebLinkAbout1074 2'75f ~ ~ ~~Q. 'r3 CERTIFICATE OF DEATH • r.:e ~.~~e• M~cDipow D~ao:ts~M a{ P~blec Nw:t~ •.:t ..:~su . :'_C:ai'~-ti~MC •.~s: ~ ~-.e ict ~DA7f Of Cca-n • _ •t.~ . • , ~ ~ ~2 ' ~l• . t ~ 1: RLC ._G~~. ••t~~C• r AG[-~•ft c.C[r rT_RU ~J~-N~_p~~ `J JAT~ Qf 1.i'N . v~~w. J~~, iGOU~iTY ~ 1~•_ • " ~ . ~ \,1:w~~• ..a~l~ ..Of • DerS ~ rJv~ti . r.,~ ~ ~f~~ ~ ~ ~ ~A~Y _ -v• ~ .i:2~4' h / J ~Sl iS~ - ~f - ~ i~• ~ ~ .i _ 17Y 4'11~A~E. CR 7C1N?1SH!? Jr CEA?M ~.~~~a~ e.n ~~r~rs nUSMi~I Ot O:HEi +`SS:TJSr~K-rJa,«i ,.o~ n~~e~. ,~.e va+~ ..o N.w~~• : t.a-.+. .f o¦ ..o ~ '~~~.-l"'?'...'i ~~5 a'.. ~ .':::CSt?'~ _il_.~ ~ I SiwTE Oi ~~~M a0• u f~,*~r!lGTtIfN Of w'.u?i GOUNTRY ~~utRiEO. NEVFR MA1teED. :SURvn~(', S7'OUSE ~w rul. 6~v! w~Jfr wwt ~ cou..~. ~ w100wFQ. DrvORCEO , vee~n ~ ' • :r-.ca 1 3 :1!3 ~.~i. . i!T_z ~ { ~t~ :~i`a''..T.1`S ~i J~?cZLC; ~~.uM SOC~~t SECU~TI ?+VMifR ^i US:i~I OCCI:~~fiON'•w+e awo o~ ~ro~a oo•.t av~~~w .:.u o~~KM3p OF 6U5?+ESS O~ ~HOUSiiY _ .ra . ~ ~.~n •r. t..t. :.n... een~w ~ ~ . .:e ~twN ~t ?~j"~._l,11_.'O'?.i ~U~ t~ -Z 'l ;lA r at~ ; 1 ~ > RESiOEr~CE-Stw~E COUwTr ~17Y, VILUGE OR TOVVYSFi1P ! C~n ~tr~if STiEE~ AN~ N1W~ER ' Ly t t 1~lC~~~ ~H O~ '+O ~ 'T ~4 ::1C~:1_:1:2 ~k :~~ZCi' ~~~ii ~u! ~CS u. ZJI~.~ Jonas fATnEN-t~u.~f ' r.n~ ..~oae us~ MOt:~fR-Mw+Ofn ~.wE r~~sr ,uoae us* ~s (~'n:.:~:=~n? ::uCi~^~ ~ -:~r}• Cu-~~n INfORMIWT-N~Mf ~M1lt?~(', ADDRfSS ~i-~ter~or ~.r.o. wo, c~rr w ~o~~, a*.n. tu~ ai~• ~.liZr?l~J Jiu~lr ..`rf~~, ~_ii SIY.~..ii.i .~`,.^1.L::f1~?l~t -~~.~.1•~ . N~ IA ?wltT pfwTM ww5 GtiSF7 sY (iNIFP ON(Y O`~t C-USf ~Et t:tiE ~O~ (o;. ;b!, wnD ~c,~ ~er~e:r orui •ro ot•rw 1~ .+wo~•rt c...st ~ Evc ~n 2 ~ r N ~<<ti. ~ ~ ~ ~ j u~-~. i , . . ~o.u«,t.~~ , i ~ ~o~o,.,a..~. ~ b i't ~E ~-+Z ~ h T ~zc ~ a s c ~ t-~ ~ s~,s ~ ~1 r S - ~.~~cw e..e ust *o ( S ~ r. i ~rr~DUtt C~uf! .o•. pyf t0. Oe .S ~ COwstOVlK! O~- ' 1*~uMG tw! V~D[~- i I~~MG C~Y3! t~3i ; <<~ c ti G ~sT~o~ ~~-:rn, L~ ~ ~ - ~f d.~:.~ IwRI h. OTMER SK'irtitK/WT tOr+D~TrOrtS: ~~anors ea.enwn.w ro w.m wr .o~ ~a.•ta ro e..tit e~•t.. r.~r ~SO?Sr If YES M(~~ /INOIMGS COM~ ~•tS O~ ti0~ ~'~!~!D OlitW~wIMG UYS! Q! Ot~IM I: i~~, NL~ ; i ACCIDENT, SUK10f. F~OMIGOE, D~TE INJURY ~ wpar~_ p.r, ~E.~~ HOUR ?1pW IN1liil OLCURREO ~ t.ret w•qre or ~M~u~r r.er i o~ ~•tr r.ir i s?tc~ m . ' 7'0~ tOS A[ M. Y11 INIURY AT WORK ~U1CE Of W lL'RY .r ..o..e. •.e... srn~r, r.RO~r, lOUT10N s'nn o~ a.!.o. ..o . un o~ ~p,n., f~•*t i ~ 1?tOn rl~ O~ ~O~ O+rKe ~G . e'C ~ f~K~n 1 ~ ~<TIf:UT101'~- ..Mtw O~• •ta¦ nOwM O~Y ~E.f ~+~a ui• Yw .r~~la .1~.! OM OWID~~ ~.Ol vM+ Mt i DlAiM OCCURliO •f Mt ?aKt, O., Mt ?MtSK14M: TO ~ rO~.rw G~• ~f~~ ; ~00~ ~lit~ Df~*11. twOY~• y i O~'!. ~~'q. 10 Mt t[SI ~ a77li+OtD iM2 f ) 2 i p~ rt [wpv~tp~, p~ 7ta otce•seo rwr 7~ '7~? ~ j ite 2. '7 tt~ ~G ~ 2t~ ` ro n.e c.use~s~ si.reo. ~ ~ CE1ti~FlCAT10?i-iwEDfUT AMINER Of CORONER O`~ M( l~i•3 W f14 wp~~ ps p~~}~ • T~F OtCFDl~+~ ~..~~5 ~lOMWMLE~ Ol~D 1, t~.rw.no.. p 11.e wa* .wo/o~ rw~ .~..es:.:•r~o... ~e~ . o,...~cv, . rc•~'» o.. .t.~ wor ~ Ol~M p~CY~~lO Or~ o~E WT! .I+O Ou! ~O *r! C~vlE~i~ 1'~*rO ~ - M- M. CERTIflER-wwE mn o~ .~~~r~ SiGr~w • otc.ee o~ u ~TE SIG?rED c.rr+M, o•. re•u :k ~crt : --,.:::n ~s ,t f ,r~ 3 73 MAIIWK' ADORESS-CffTlfifR iiKtt Q~ t ~.D. h0 c~~+ c~ r~~.. sr.-e r o~~ . ~.:~•e*t `r~~~I•~ 1~-_~_z, ' ~L~3 ~UtW, C1tEMAi10N, RE~wOVAL Cf~+E~ERY OR CREM.~.TORY-N~utf ; tJUnO~ ~ITY, VlLLAGE, T1/P. 02 COUNTY si.*e ~ snt~n ~ ~ 7M. Ji:r1.t1 tn ~~OJ:~':CPC~ '<<< ;~'':~,T. ~:2Ct:i•~:.:1 ~ DATt ~..o~.,~, w.. .e.~ ~ f1inL[Al MCMf-'lAME AND I~OO+~f55 i u~eer o~ ~ r o. .o . c~ o. ro~.... s•.rr. t~? ~ ~w. '.•:ot-c:~~•~. ??,~?i t'o:ar= ru:icral :_o::~ 5~ . ::.I .':I'.=~ : a-?=, :•"=c':i_~ar_ ~SI:I ,.~3 FuiERAI SlGN~T~AE REGISfRARr$iG7JSiURE , ^ DA1E tsGf~vED t IOCAI tEG~SitA! ;-,;!w n* .-rr-i• ~ l~.i~ l.~u~-~ i~ 3 . . . . - - CERTIFICATION OF DEATH`, ~ +t . 4 ~ STATE OF MICHIGAN) SS. COUNTY OF OA,KLAND) Y , I, Patrick G. Flannery, City Clerk for the City of Southfield, Michigan, do hereby certify that the foregoing i.s-,a ~opy:of ~ the true Death Record now on file in my office..%-~:."-~1-'~,;j`'.;=:;=- f ~ tc.~ . . _ ~'fr'~.'~~;~~; " ` ` ~ ~ ~ In testimony whereof, I have hereunto set'~3i~,~~d~,a~d''~aftixed the seal of said City. c,~ ` - - DATE : IIOv 13 '~'3 , . - Pat Flatuieie~r~,,-_,~ity Clerk t~~:~ 2~4 PACEIO~ , _ - ~ ~