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'Y0'"~~'°~'° ~~r~0.EY STATE OF WISCONSW ~ '
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irt OEFAAiM[NT OF HEAIiM AND SOCIAI SERVICES '
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DIVISION 0~ NEAITH STA1F DEATH N0. 'h
IOCAI NtE NU~dBER ORIGiNAI CERTIFICATE OF DEATH
lorrr~~nu!ao~~+Ade~ DE~[~SED NAME f~nt M~dl~ last SEX DATE OF GfA1M MoM~ DoY 1'~0~ r ~
~o,h~~~Y~.<,~~,, i~ Harvey ~H. Brown F! s, Ati7. 27, 19?? ~ ~ r
ruonoi 0 «~rc~',. ~ . - - - - - -
~ MoMh Day Ytot ~(OUNTY OF DEATH u
ona Mea~vd E~am ^rr'~ aaiE Wmi., N~9ro, Amer,;an i~A~a~,Erc Aq. losf B~rt~dor Undei One Yeor Under One Doy OAjf ~ u : ~
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SOCi~I SEfUp Y ~ 0 USUAI O((UFATION ( ve K~nd ul Work ~cr ng L1oti1 0l Work nq Lle KtND Of BU! '+FSS OA INUUSI0.Y N ~ ~ ,
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w~o, q,,,,~~,. ti~~„ iz 400 44 1011 R`~'H°nrineer ("~lechaniaal) ~~b J.T ..Case Co. ' W o,. , '
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Decwud I•~ea ' i 4 E S i G[~ d f S I A T E ( O UN t Y NaME OF (I1Y, VIIIAGE in+~Cr Gty oi ~ MAiUHG AG~P.ESS iNO~nr Addrrs; m T~me ol D~oinl z ;r
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Wisc Facine `~a°~e~'on~a 433A .leadow Dr. ~
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iAfNEp h4Mt ~~~ro ~ M~ddl~ ' latl ~NOTHER MAiULN rA'dE i~nt ~ Middle lost : j~. ~
~ 'iowsrd Brown Audrey Johnson c,~ ~
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a)o MAIUNf~ ADDPfSS SirMt or R F D No ( tY or Vdlog~ SIOte I~D WAS OE(EaSfD [VER IN U S AR!dE~ FpR(ES~ ;
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~ AtfenedPor ~ ~h~ron Broti~n ~~b~'i39 ~fpadow Dr.-P,aeine~ WiSC. xY~"As`~~~~'~~w~ _ ~ aa; ~ ~ N~ ~
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. OCCUD0Ir0~ Gwtn ~n POrI I iA, ~ ~ IN D(11AMININO CAUSI 01 DIAiN1 ~ ~ ~ x' : ~ ~ ~ ~ j ~ ~ ~ .
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1 A C( I O E N T D A i E 0~ M a n ~ h~ D o y~ 9 l o r Y.~ ~ M O W i N 1 U^~ Y O C( U R A f D ([ntrr Not u~e o~ In ~ury m Oorl I or Vart II~ Item IEI ~ z ~ ~ ; p M, y~ r'
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~ 400, . j~
V ~N1UAT AT WOAI( ~lA(F Of INIUAY ~NOme. Po~m, Slred, feUOrY, Elf.l 10U110N S~~etl o~ A f 0 N0._ ~dY Or Yillp~~J $lolt 2ip i~ ; ~ u~4, ),W r, r+'.,,~, ,
QYn }y~No ~ 7'S~'•`~..._~._..------ISDec~lY) 20q_ ~3~/Q~...1',~~`^!_..^!'--~11~.~:W?~!1ri ~l)~ W W,~; ? a C ;~I:.'~~.I" M~ It,~'
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CERTiilUTiON Nonin ~ DaY Ywr MonIA Da~ Ymr ANO lAS? SaW HiH, HEA AIIVE ON C'0 YpU V'EW iHf DEATN 0(NRRED AI ihe Plou, on~he 0~ ' , DA ,M ~r t„{ ~
VMYSIUAN 1 MOnIA 9oy Yeot B~DY Ai1EA UfA1H ~HOUr! Dote, ond, To T~t Eeei ~ J~, ~ ~,~1, j~ . ~
' I Atfendb The ~a ~~W~ 01 Mr K~owlydQe, Due {7~ r.i ^ ~T
NCeaed lrom I f~Yes No U~M^~`" ~o The Goutieis) Sialed E•y x ~ 0'•, ~ , ~
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p ~fRi f'fA1i0N YE~'(Al E%AM~FlfR OR (OAONLA 0~ 1ne Onti~~, ol Tht HpqR Of DEa1N 'N[ DE'[DINT WAS vkUNOUN(FD DEAD Fy ^~i 4
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~(mm nobOn o~ 1Ae 8adr and or ihr Inr~tt~qot~on, In M~ OD~n~on, Orath O ~ Man~h Doy Year ~~r ~ j,~ Q, ~ 7 "
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,~(ERiI IER NAME 11yDe or i~mq SIGN 1 Rf (I IEA ~ Tillt DA1I 5 GNf D MrmA DoY Ywr
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I~k_I.1~.. l= f IJ L . ~ ~ s~.. $340 .
~ ~ {URMI (FME(ERY OR (AEMAlOR1'-NA.Nf ~i~ ~l0(A110h Gly SIOtt ~
' taol ous~ of W~ ~ E~ O( ~I r r a
:~AE, ~~REMA110N Forest ?~ill Crer~a.tory Oak Cree~~ Wisc. "
9b.~n REMOYAL q/D _ 2/ti--'- - - ' .
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t lUNIA~-OAIE Month OOY~YtOr iUNERM HOMF NAMf hND ADDA(SS ~She~l or R i 0 Na (dr or Vdlo9t S1Ctt i~p ly(~~~ llil'; ~
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~ Au~. 30 L4 77~,~,. ~'aresh-Meredith F.H. ~0 3 .Mafn S~,,~,~ c i n w A 53403 svdi ,.d ~~~~y
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