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HomeMy WebLinkAbout0428 7 ~ 7 . ~ ' ' . . " . . . . . _ ' . ' . . . _ . _ _ - - - - _ -1 CERTiFf~ATE OF DEATH ~~4 ~oc1~~ ?AkY... D~..+ d /M~t H..r~ ...R .a. ` OEGEASI~-NM~t ~ •'~u ~ OwTE Of DEAiM ~••o~.e¦. nu ~ - : ~ - - - l~ i ~ YYa~m ` - Josetih ~ - - . GORft~+'M - t- ~~al " c~ RwCE wr+~. Mwb. u.eMC.r www. AGE-u~. ~ rw ww~ Of MRM ~.~o~.. w. COUNiY Of OE/?1N ex. ~wcn+~ r~a.a•, ~rtus~ ,w~ ~.n ~s rr.. . . '•Jhite A k Anril~ 20 1 1 ~ , VILLAGE. OR P Of OEA r+sre crr a.MS MOSMfAt O! OT11B NS wr r~ em+~. a~+a s~ ~w.rs ~ ~.inn ns w Mo . Ca~iillac - Yes ~.~D.C.A. ~e v~? it • iwif Oi iiwiii ~ r Moe r~ LiTl...:`~ OF Y+tlt~?T L~A~!!!Y Al.~lt!!~4 !lfY~R !1~P_ 51RV11rNG SlOUSE ~ r.nw. ww ra~w. wrr ~ ~ ~;~nca ~er., woowco.avo.a~~mc..~ ~ ~ - _ • ~ s„_. .f+~«.~. ~h1 O U . S . A a ~fa, r ' ~i. ~ ' ~v e r ..~+e eece.seo ~ u.m o ee.n~ SOCu?l SECW~t1l MN~fER USUi?l OCCLI~ATION iow~ aw a.+wa eoM! w~rus .~o~ p K!O ~F MlSMESS O~ M~IDUSTt1/ 1YQ~YIp ?1~ l1f~M M qtiA ~ \ "r~''°"„~'c"'~ 1-Oq-2 2 ~a ~~T?'ue1` ~1~. S21f-~ts~.D? o~.•ed v ~e~o:~+u woa ~-,ssa+_ RESqEt~CE-St~~E COIN~? CITY, Vll OR TONYNSNIP ""O~ S ~ ~ ~ vawr ses a w IN ~:1~.'~l`-'-~SFI ~q, jIGX1O~ 14 ~j IN. Ti~ IN. C iiZ'but~ t,t~G~ • FATMER-Nrurf nn* rwr~ uaa MOil~!-MA~EM NAMf rrs~ +Mw! , ust „ ~ p;eal Gorham Unice rotts 1w011MANi-NAME w?aNG AOO~ESS ~snar w a.r.s. Mo., on oa w+w s+.l. i'rs. ~1~r3 ~or~3~: ~ 30.3 Arbu~us :ve. Ca3~ ? ~.ac t~ichi~an 4^•5. ~M rw~ i. ofwn~ wws C~usEO ~r: - ( r Gusf r~ trrt roe (el fsl ~r~D k)1 un+.e.. wsn ..s ee ~t. - r.wwn u~s`'-„* / . ~ . ~ y 't C i/, i~"t ,i_i~t ~a~-~r - ^ - / ' , . , ~ ~ , . a . , ~ ~ / ~ ~ ;rw ~ ~~a ve iisi ro (6! l_ l/r % , . _ / ,v ~?-z~__ f/ ~ - ~ ' ~rrtaar~ C~Yit ~a~. M t0. O~ ~3 QOwSlo~EKf O~_ r ~ . i st~nro 7w! nMet~- ~ . ~ lfIMO CAYSE lA1f . . _ . s ~a ~r ~!-J - ~ ' ` " ~ ` " = "l- t" ; ?wti N. OTMEe S~GMIf1GWt COi+Wt10~+5: ca+anoMS co..w.~wo a ew. w..a~ au+e~ +o uwar c~.s. w ~ w. RUiO~Str ~ YES wa r~Mrwea co~ ' ~a ilp O~'MOl LM~lO M ~N~wIMM~Y CJ1Y7! : .i' T q l~qtr_..~-~__ . _ i _ ; ~~'j~ - ~ : - 1 q? i: ~.onrw. w~, rw ~ MOw u~lUt OCCURREO ~ w~n w~we or wwa. a iwar ~ a r.a ~ wr ~ t ACC~ . StAC10E. MOWC~DE. - _~s+~e+rr - j' 2~. ~ 3 ~N ~ ~c. M 2Y ~ E INJURY Af WO~1C Of NJURY wore. ~.s+. snee?. r.nw.. tOCAiIOH ~ s~.eeryt je~+a. ua.oawwy a.~e ~ ~ ~ s~wn ns w ..o~ op~a Msa.. eu. ~ sncr~ r ~ - - . " - ta. ~ iy CERiWCAT10N- ra.~w w• ,re.a .wrw e.r .e.a usi s~vr ~ u.rEw ~ wlao.~or +a~r re otiuM OCauMto se w~n. o~ ar ra++M ~ war uts eeut ~waA ~ H~l. ~u+~. 1D M~eF IN~SiCuM: / i0 ~ ' /7~ 1 xr .f ~ • M r~ O~pOLlYOl, OY! a«:~. ~ y~s ~ ,,t. ~y- ~ , ~ y.s :w ~ - ~-.~s ,o.,. CERTIFIGTION-MEOI[J?t E7U?MY~ER OR CORO?~R: o.+ ~.e w.a w .ow w oa.w ~ v.ws no.wwcs ow ~w ww ea~.w.•~. w ne we...o/o~ ~e .rrts.c.*~o... w~.~w. n A• , Ot~M OCGtfOl~ P~ M! O~R ~~N NR f0 1M! 4YSN31 S~~t10. . _ y 4 G~ ~-7 /G ..r~ 7 ~ ~f r ~ ai CElTiiER-wwE ~mt w n..n SIGNA . / o~ nwe ~ oy~ s' ~ ` ~ ' . / . L r 21~. mY' rr 2~. / ~ w?KwG w00lfS5-GF?rts~t uaar w u , cm w a.w ~ r R.u ~ n? 20 Cobb St. C~~i ~ lac ?~Iicni~*an 4~0~1 " itNnwl. CtEMwnpa. frfMOvnt OR atE~w?tOlnt-~uME lOCwt~On C1TY, VILLNCsE, 71NR OR GdIA~ITY sr.n ~urial ~ ~ ic~_~n~ Carmel Ca^?~ llac, :iichigan_ DAiE ~.~o.ar, w~, n~a~ WNER~?t FfWME-rtM~E M~O ADD~ESS ~ smer w~.~.n. «o., urr oe row.., si~n~m ~ :«?~ov.l 1c7~+ ~.reter~~ n`r'un~ral ~'o~:e nc. 20~ C=s~ ,St. C: d~ 1' ac, a-6a ?u?+ t o o~s+c~w~E n ~EG+s iK''H"r 7 ~w ~•~ow acurua f't 1 fi. i 300M CI ~ - - - - - - - - - - - - - - - ! ?7iti~.~ li= tLLVL1~tJt11`i) . ~ Coua:~~r s+lexford) I, l:z~ th G. Finudsen, Cou~C~r Cleri; ; ~f zi~~ Cir~uit Cou_ru oi sai~. Ccur~~y, ao 'r~erebf Ce~ti;~ ;:=ia ~ Or@oOZIl~ a trus a~rd correct copy o° :?_e _ nri~inal.. S~.~ne~, a~~d s at the Cit o d ac .,.~~-i °f`',;r,~:~~~~ r_ d f o~ - - # - - - ~j ~ _I, : - . S. • ~ : = v . ~ , -rs; _ i ' ~ x~~i K~caa , " • : ~ ~ - - ~~~~a~?. :,aU1~ L . ~M~ - ~ . , fiv~czri i •sli8~ ~ _~~i~ ' _ ~ c-~ L ~I1T GOUiIf . ~ ~ ~ ~ "s v 1. ~ ~~t7 < < _ - ~ ~r i Bfe F~ :c ,i:-£c~~~.~ !`r~~ r•,'-i t' ~~~w7.'"_~.~i ~~~:~~,Y IiZF'i K -s - . r. '.r J: s~. ro ~s ~z~ 3v ~ . > . .t~e~;z~? ~~e~ f ~ 296294 : o Rx~ ~ 4 BOQ ~ _ ~ r - , :~.z~ ~ . , „ .k _