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HomeMy WebLinkAbout0486 • w _ ~ :~~ERTI~C~~QpY. CERTIPlCATE OF DEATH ~ =~ou~'WU ww~n µk~loa~ D~ooA~~1 oi Pollk HwY? sr.n rw .w..~e~ ~ ~w~~ r+~ r~oo~t a~u SE1I DATE OP DEAM ~M~NM~ u~~, n~u ~ 1. ~ ' AL I~CE B. St;IT:-i : FEtl~:LE ~~,unust 22 7~• F RACE wa~N, AGE-us~ uwe~ ~ n~t uaoe~ ~ wr DATE OF ~IRiH ~.o..rM, o.r. couNn of oFwn+ $ !K. ~ 1 N~fMp/J 1?t~~l/ Ypf. (N1f MOYH MM. 1 ~ s.. 74 s.. k • r~pr. 17, 19W Oa!ci and C17Y, YI , IP Cf OE/1TH ws~w cm u..as qps?IiAt OR OiHE[ l1SiITUi1QN-NMtf ~u ~p e~Twe~. cne sr~n •.o .wrst~ ~ ' • s.ecu. .es a No ~ n. Pontiac es ».64 Charles Lan~ i ( STATE OF {MiH ~w wot a~ v.f.~.. M~+t UTIZE?i OF WMAT COUNTRII MARIdEO, NEVER N{AR~ED. SURVIVNG SPOUSE ~~-`+ut. ont w~ot=wwt ' ~ Mi ch i gan `°u."" U S ""°$"~c°' ~ . ~es~atrae ' ~ N. 1 VvrCE' 11. ~ee, t oec o:TM SOCIAI SKUR1IY NU~MfR USUAI OCNPATION ~wve cr.o or rrou opa owuq ,.osf or KIND OF btlSlt$SS OR It~USTRY ~ OCi~~flO IM M~OKM4 lU h~M Y\lT~~ I . F ~S~~T~~~~~, ~M „ 376-12-3430 A?af'ron Pr i son ~evoeYce ~tron ,~~~ss~oti. ItE$IDEHCE-SiAiE COUM~ CITY, VILLAGE OR TOWNSHIP ~m ~"'m SitEE~ AND NUMDfR L-~ /tilich. Oakland Pontiac ~s't~"'•~:o.~.o ,N ,k Yes 64 Char I es t.ane iAiHER-NAhtF r~asr .uoae ui~ MOTHER-AU~EN NAMf r~ai +.wae us~ George - - - - - Bracknel 1 Susanne - - - ~~+nison ~f. INFORMANT-NAME MARING AppRE55 ~snee* o~ ~.~_o. ?q., em o~ +o•.M, s.wn, su~ „~Geor e E. Smith ,n 57 S. A;ain Street, Hartford, :':isc~nsin 48017 = aART L pEI?T1f Ww5 (J1(/$ED ~Y: ENiER ONt1/ ONE UUSE PFR LWf fOR o. e 'riw,~... ~M rK ~ I ( 1(bL ~ k); un+~tw o~ser ~we w~n~ f ru.eoun uvs[ - } i _ tai fi.eute eoronary thronbosis ~ ~ v , w w o..s~out..ce o: - ~ NI,~Mi6•~:,; o ro~ 1lrterioscl~rotic heart dise~se ~rrlo~~~t C~YS! col, py! ~O, W ~3 ~ CO~SfOUEMt! O~~ 'I Sf~1tING iMf YMD~!- " ~ ~tINO CwYS[ l~li j k i /ART N. OiMER SIGNtiKANT CONDIT{ONS: ea+wnows to.~n~ur~ao ro o[+n~ s~r ~.ot ~cweo to uust entN i« r.~r ~~71aSr IF YES r~n r~NO~r+os eoN- ~ . ~.es w••o~ oi i e:rw~ areuuMw.o uvse E ih H?. ~ ACCtDENi, SUICIOE, HOAAICIOE. . DAi W1URY ~..o~rn, owr, ~e~n NOUR MOW tNJUR~ OCCURREO ~e.nte wruu o~ ~wwn IN ?~~t ~ Ot ?~tl ~t~ R~M 1{) ; ~srecwr~ Yi. 7N. 7k. M. 741. i 1 WURY AT yVpRK ?IACE Oi Wri1RY „w~e. sreEn, rwc~wr, ~p~ATtON . ~ sraen oa e:.o. ~o., ertr o~ ror.., s~.n ~ ~ g ~ s.eon ~es w.w ~ on~ce aoe., e~c ~ s?eun ~ ~ Tl~. 70~. . ~ ~E1tT~1CwTtpN- ..owm o•r rw .~wm o.. *eu •w usr s.~+ MM/Mf~ ~UK OM ~ owioro ..o. nn+ n.e oEwrn oeeune~ A1 M! IUCf~ w me ?NTSICIAN: T~ ~'~M W~ ~[~U {OOT ~ltt~ DE~M. IMOU~/ O~Ut, wwD, ~O D1! ~tSl 1 ARINOlO M! W Y7 [ND~w~~pw, py~ t?a oeeewseo r~o.. 7t~. tlc 2H. !b. M_ t0 w[ taustw surt0. g66 CERfIFIG1T10N-MEOfUI EXM~YNER OR CORONER: oe. iwe a.s~s u n~e ¦ow or oe.rn IME OKfOfNf W~ IlOM(~yM~~O OI~D ~ [=/wMwtWr~ W 1Mt WO* u~0/O~ tMt wvlSt~G~rfpw, w r~ AIMpv, p rWn1 O~~ ~I~t ti0y~ ~ oe~rN oeew~w a+ Me o~n w.io oue w rne c.ust~si sr.no- U' ~ 0 r1. wt. rn Q 22 1? i~ Q . Iw 7~. . GElTIFIER-NM~f inre w rt~..n ee.t ~ DATE SIG-vED ~..o~+», w•, n.a~ ~ - n.. ~hcrr.~s .f. Pet i nga , FS.I1. r~ ^-22-7~? : ~ MAIUNG AOO~ESS-CE111f1N - ure? o~ e.r.o. ..a un w ia+» a~.n rs i t~.• - ~ ~11. 7() u n s~ O~i ~ 1 C}1 f t:~l1 - , l)" ~ i ~ EURlA~ CREINATlON. RfMOVAI CfMETERT OR CRE.MA70R1I-NAMf LOC/?TtOPI CIiY, VILL/1.riE~ T~YT. ~R COUNTI' sr~*e ~ ~ srecw?? ~ :aRemoval-Burial :o.Rock Falls Cemetery ,~,.Sana Seach Twp.HUron County,~.tichigan ~ DATE ~rwrw o~~ a.~~ FUNERAI MOMF-NA/NE ANp ApORf55 ~ sneti o~ ~.r.o. r.o:, an a or+w, uie, t~r ~ Aug. 24, (9y4 ,~Uonel son-Johns era I Nome, I nc.8~~ 1~:.~iuron,P~nt i ac,i.ii ch. 4E053 ~ ~ :-36 ftR+ OR- REC,~s wrt eemo ~r nnwi 8-68 ~ _ ~ :w C 3 ~ . _ ' " ' _ " ' ~ ~ ~ _ 3+ ~ r P; S 3 B ~i,:iv~lj ~@ q~ ~ aFe~~~ Y~r;ri~q ~ ~ F~0 S I~ ~M'~~~~ ~ ~ ~ ~ 3QU838 ' ~ - ~ ~ - ~ :s - ` ~ BOOK ~6 PAGF 486 ~ ~ ~ ~ ~ - - _ ~ ~ ~ _ - _ _s_. :