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HomeMy WebLinkAbout2219 : ~ . ~ . ~ • I~r9~6Js i n6tA0I! D~ARTl4a1T OF HEAI.18 4p~1~~~ i ~~I636 ~I'~AL STATISTICB DIYISICli ~4=` ~~',~~~4 : 4~.f RK : ~:UIT ~OURT . . RfCt~:~~. yff'•f F9...,.~.,~. ' t w , CERTIFICATE OF DEA.TH 0~ 10 ~ u~ PN'~~I ~ ~~n ~ . w~i... a..s.w.t rw.~ ~+..r~ .«.....•.w.... OECEwSf~-N~+ME r~n~ •ra~ , us~ SEIt OATf Of OEwM ~•a.a, .w ~ , '~n.ed l~,w~. ~ : itc~,t~e , ~ .j_~, i y7~L F tnCE .rwn. wow. w.eMC•M wwM. AGE-a.s~ ~w~a~ ~ n.~ wa~ ~~a. DATE Oi ~MTN ~ ro.w~. ~w~. C011Ht1f Of DEwiN ex. ~ srecr~~ I~.wi~ +o~. ~..s wows ..K ~n.~~,~ lXtl~)'~C: , l~~,i.,t.e ,~"7~. ~ k • r. ITY, Vil , IP OEATH Msre cw~ ws M05MU?t OR OTI~ NS - ~r .w~ w~~ua~, om snea w.~e~ ~ wcr. .es w .a ~s fle,t~o,i,t h~u>~ H. `1ohn, ~~o '~:.C S1ATE Of MRiM ~ r ror M Y.!-~.~ •••~u C1i1ZOi Oi w11Ai COIJNfl11 M~AtlE~.~NEVER MAR~IED. SIOI75E ~r ow. o~re r?ra~ w~re ~ ~ ~ 13~,i.~e1.c e#. S3,t~c~ri.e~4. usu.~ ~[varK! ~ lil• • ' ~(7~U~ » t~llVV{/lJt~t tl. ..ue oeci.~ee SECY~IIY wWE~ YSW?t OCQMw1~ON ~aM a.a a uwa wr owna roa a RND Of MlSNESS OR r~11S1l1f 1CK<WetD w~1 •M ~ 1110t~10 4A. !r!M O~~M~ 1 ~ ~?l.l W 371~-03-1u~ 1b „ ~~ee,~ f _ ' . ~ei on.ce ~ewr rq~w t~r awws ~ SilElT ~ND ,c..~es~o+~ ~~pENCE-SiwT! C01#iir CITY, YiLL/YGE OR TGK'NSHIP ~vaa.+ Ki a ~.o ~)!j~)~),) ~l~~t~iJU~100C~. ~w T~~ich.. ~.11c~r~b ('.C. ~~1uon~. ~w tu~~ ~ _ _ fATMER-NAME ~~i rM~! wt MUit4i~-ru~ri~i iiai~s :~.'s: . f~t~,t. U~thn - Cin~'t~ct 1~t,t~th, t ~s K- ItiOfMAeiT-NAME MAiwG /?ODREii ~sren oa ~.~i. w.. en w w.n. u.R, ir~ ~ ~in,isl.cet l!~,v~.n ~.3.»(~ C~.i~uuoocl C.t-. `~~o~.~s.~.i.rJ~~, y ~~ut DE~n~ wn5 C~uSEC ~r: (EMEt aalr oNE UuSE ?He tr+E Fat (el (e). ~ kl) ~ own •.r a.s q wrewe ! N~ l~'.erti~l..,k- ~u~~.l~ ~$y.,...e.G-~-~` ' , . . ~i COMNt10Mf. 1/ ~M, ~ Q~~~ • ' • ~iG~/`~ • ~ ~~~c¦ a••e nse w (el ~i~-~'7`~' ! ~rrls~~~! c~vft ~e~. NR ro. O~ af ~ COwSlWtK! p: - . f f1~tIM0 ~M! YMOf~- ~ 1~1M6 C~YY I~f* ~ ~ t~, ~ ~wlT OTME! S~GwrKwMT CONWhOnS: ca.awaa cowrwn+a ~o «.m w~ .~s~ nuaa eo c.ose e~reN ~...ar ~ a~ wYfOK~ i 1IES rin s~raMOS ca«- ~ . . il!! O~ MOI pifWlwWO G?Yf! /~l,, Iw A[C1CEHf. SUKIOE, nOr~KIDE. ~ rwrw, w., •e•~ ~ MOUR qpw tWURr OCCUR~EC ~ e.ee~ n.wie a uwn ~w rwrr ~ o~ r.n w, rw u~ ~vscr. i ~ f[ M. 7W 1Nltltll A1 wORK rtACE Of R~IURY.r wo+r...e., s~an. ~.cno~r, IOCwT10H ~ siun w~_r.~_ no., em o~ ro.n~, n.n ~ ~ ~anannso~«o~ OMKlMYG.,lK. ~f?KM~~ CER~i1CA110M- .a+*M w• .e.~ .or.o~ w. nu .w w~ s.. w+/re~ u~.e a+ ~ ao/ao w~ ne. ~a o[wtw oeew~eo •s w~e ~ua. a. ~e ~~S~G~u+: TO ~a+m a~r tw w~~ ~nn ee•s~. ~wou~~ w. ~re. ~o K ~eu ~ 1~niNOtO /M! p.~ wO~M1t001. 011E N~ wcewsw ?w. tN -3 j- ~ 7!l ttc l~ 7f tu. 'l th./I.C~J 9w~ ro~e e.ww su*e~. CERTIFKAt10N-MW~CwI Ex~~+ER OR CO~Et a. nu a.s+s w ne wow a oe.r ~w~ oeceoe.n w.s ~wrou.~ceo ow ~a~.wwrwM a we wer u+o/oa r~e r..~srw.no~. w.n o?.wa~. ~ w. Ku Mow eua. ocevuen w~ wr ..•o we ro-~e c.us~~u sr.no. lil t2~ ~ - ~ CEl11FIER-NAME p~~wn IU~RE ~ ~ pGlt! O~ hNR 1r~~IM. M~, ~lY~ tla ~v7» ~~7/Yt .s n it .~h d. l.t~'<,iOswc.s~""l Ir) ' tk. a~ 1 3 ru~t1NG ADO~ESS-CERi~f t u~ea oe e.~.o. ~.o. cns o~ w•+~ x.w tw t7~ /~•~•••6sc~'~` ~~lf /Ji~f»if ~-/i - 9~P1?-6 Wa~l. CRE~u?nOe~. ~EMOVwt f~?EtEtr OR CREev?fOtv-wu~E tOGI~Ot~ CITY, VILL/~GE, TWP. OR COUt~(TY. sun ~ ~~••c~•~ :~t.Ut.Ui.~. r? ~`~'l.t.~ E..' ~E'.C c~1t.Ot T1~'~t~.~('(IYI. ~ ~ OATE ~au ~ H! MOME-NArwE ~yp ~OORESS ~ s t w~~.~.1.0., trtr t ~ n, ~ : ~ ~ 3/.'.).~~'" :,,~c~cr~v~c~o =n~n.~n.c~ `~~o~;ic ~,r~c. ~'-~~1~0 a: ~r~~. u.:;.~ . ~~0~1 • ~ 6-36 pR_y~~ tEC,~sTenR-s+cr+~ruRE . . _ o•a atEn~o ~l ~pcyy ~~nwa 8-68 ~ ~i__. a,ti~ ~'y'• E'. ~ fi ~ 3~JOM ~~'?'r . . - - - - - - - • - ~ - - ~ _ I hereb~ certilr that ths foregoing is s true cop~ o~,_:Lh~,}~cecord oa file in the ~ D~troit Departmeat of Healtb; 4tte6ted by t2~e rai,sred~;;j~~'e~_f~f~-3De Cit~ of DetroiL. ' s . . , ti. ~ . '~~~Si ( ` ~ ; . • ~ . -j ~ .5~~..,,'~ ..~~E~ ' t~ • _ • ~ r - y • 4,-.`.k ~ • - ~ o R 4 ~~2219 4-~~ - ~ ~y= ~ aee~~ . a ~ .S ~ D~ii~ ~ ~Statietica ~IIAR ~ ~ 1y~4 ,~~~~~MX-~` ~ ~ D~?ced . . . , , . . - ~ - ~ ~ ~ _ ~ _ ~ ~ r~ . ~ - ~ . - . W