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Home My WebLink About1082 pCTROIT DEP~RTt1Ef1T PF t~+Ca~T1t ' VITAL STATISTICS DIVISION ~39~748 . ~ ~ STATE OF MICHIGAN • oEPamwrn~r ~ F Pusuc H~TM . c~ - STATE fitE NUMYER ~ 0111 ? ? 4 6 CERTIFICATE 7F DEATH DECEDENT NAME TnliT woou tASt SEx PATE a pEATN )Abp. Gta1r. n/ ~ Ann L. Koen F r t_ 24~ 19'7a RACE-Mi. wire. ir••. AGE-r.r a..rw R 1 V OATE OF 6M1TH /Aba Du1c ri./ ODUNTY OF OEATH •~a.~ wcr I$Pacdyl /Yla/ roa pwri rrpllli errs 4. W s.. 6a 6e. e. 7a. LOCATION OF DEATH. pr urTS ~ De~~~ 1105PI AL 011 OTHER WSTITUTION-rw Irrr. •~.w. r.. r.w w.w..r hl ~ w« vau~ci u.Tf a. 1 - 1 ~ H Hoe 70. Tw?. a. 7c j RATE Oi f1Trr /art • YSA UT12EN OF N111AT ODUNTRY YAAAiEO. rtvElr YAAA[0. SURVMNG SPOUSE /NM'i~. /rM wra~dMr wanNl/ WAf CEOE?rt M ! .rw••w+~M/ wrOW.Eq ON011CE0 rs~•cgl Yt wrr?•EO NrfaC[fr • OEA1N fSpd? TM AYI «~.~o.. a ~u~t. an u.s.A. ,a d T,. u. sooAL. sEd1RIn NUM6ER u6uAL OOCUPATION /Giw.A ~a~ ~d~ dowry rnoa d 1cr1D OF suswESS oR wousTRY I, ~«~^E^~ a 379-18- 3060 f3.to-C ~ W CIIM1E/tT RFSDENQ-STATE OOUFITY LOCALITY arliDE OnV UNrri OF 1)~Jl~~ S711EET ANO NUMlER W Ite tOM'1~O..aoE va,Ar.E u.TS a ~•~•9 a - 11374 faih~.i.trtd FATHER-NAME aeT ~roo1E Iwit MOTHER-MAIDEN NAME NIST ~rooTE twit Ts. • Ro6e)it Mennin 17_ fIF01M1AF1T MARJNG ADDRESS iTrIEET Oa Ri.O. rD CIIY CR TOYMr FATE 71 Ts.- w l W.i,GY,inm J. F. Koen lee. 1)314 Faih. " anocM~AVE T!. wwEDU?TECAI/SE 16V1E1PAKYOIY~CAU~4EPEl4LMY~fQRfd.fbl.AMDfeI.) wr..r~w..r....r.ru.+ •~sE To ' ~,rE PART I~ ~ ~ T/~/ ~ ~rR ~i eel ~/.C•~ r9 Ti a JY i la~R-- . St.,MG THE _ uwr,Err••G Ol1E TO. 011 AS A OF: ( ~ ~ wM~ G415E LAST. I t~ ~ Acs r~ Yo tr3-~ ~~L N~~LTI o ~ 1 DUE TQ 011 AS A OONSEOUENCE OF: ~ 1 •rw.r ar••• •n•r w aw C~evti~-)er I~T~eosc..~.~~PoTir- ~~T 1 Y¢ars PART N OTHER SIGNIFICANT CONDITIONS-cw•.r mrwwi r uw. •r •e..•rr•• r c•.•• i.r . PART i AUTOPSY (Spacily !1q WAS CASE REFERRED TO MEDICAL a Abl fXAiMNERt ( Yles ar AbJ 20- O 21. PLACE OF DEATH ow.. rr.•.i rrwa f IfOSP. OR YYST., trot OOA 4a. ~ Trr rs.. w ur.ra.w rt r w • ..••c.r wr..•r• u•a r•w•a ~ orh.. Rte. l~*hl rCBM 22a. ~.Sf1TiI p- I/V rqT! .~~?T' eo.l o¦ r...r .n.¦.... we..r..w.~ «...oo.... M 25i. T. ar Mr M wT W+r/f•. •eanM M M rr A•r ati•• w I•• r ~ ra r•r w EYC• w r trr e••aM1 •n•r. M Or•ry rww )Sipnatwrand TrdMJ ~ /Synatw+And TwAeJ f? j <<ii DATE SIGNED /Ma.Oa); 17r.1 HOUR Of EATH DATE SIGNED /Ab..Oaf: n.1 HOUR of DEATH 2 ~ / OTTF 2 ~ P ~ ~ IF E T~/ CE~ ~T~ or Printl ~ ~ 2PR~0-NOUNCED DEAD /Aao~. O~aY. 17c1 2PRONOUNCEO DEAD (Flow/ M - 23d. ~ _ • 24d. ON 24a. AT M NAME AID ADDRESS OF CERTWER srrrs~crAN a IIEaw EJtAW41~ )Typo a A~:rK/ ~t T leG/ T AOL. suooc rw.I. wnMU? or?TE a+.Rlm? ~ Day. Y..l HoLa1 oc IN,xItrY oESCroeE DocuRREO DA /ETrDN6 MYEfT. /SveuM - 26s- 26A. 26e. 26d p NJ11RY AT WORK PLACE•Of V'1.11fRY-Ar u••r. rnw~ .r.a rrAarr. •nc• LOCATION fTI1EET OII rr~o. rq. Cnr, vRaAGE. orr rortnasrr iTATE y /SwECilr Yas o? Abl ~++~a •k /SDidl'1 26• 261 26y l~MCREMATION- REMOVAL OTHER CEMETERY OR CREMATORY-NAME IOCATION aTr. vnucE. a TOYYr`SMif fTATE 27a, $ 27A. 27c. • DATE /Ab. Da1c Yi.J NAME OF FACRITY ADDRESS OF FApI'Tlf 4025 27a. 0 27 197 26a- T 2~- t FUNERAL SE NSEE REGISTRAR GATE RECEIVED BY REGIST /Aia, Day, (4/78) ~:arr/ O/ ~ 2Sgnatwy Yrl ~ .9Rti~~~C ~ OCT _2 51918. . r 7. Y ARE©Y CERTIFY .THAT 7NE FOREGOIf~G IS A TRUE COPY 0~` COR~~ ~>vt';fIIE IM THE ~ DETROIT DEP1;RTnENT OF NEAITN: ATTESTED I3Y TffE RAISED ;S'~ l-- ~TNE ~~~TY`. OF DETROIT _ • FILEDAN~ RECORDED-' : ~ - ~t+'.:S. r~T. Lt}C1E ~~?UtV?'Y: FIA:~ _ :y - ~ , . .r ti i f- 439'74 TftcoD~rci~:.~~~n~.ES - . - - '79 APR 4 AM 9:23 DIvlslorr~t ~ - ~ _ V1TLL STAT~~ICS~~ ~ D~TC^ ~T 1 ~ 1~7a-«~ : ~~CUiTiCOURI; ~ ~ ~ .