HomeMy WebLinkAbout2353 CERTIFICATE OF DEATH r 4'72560
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DECEASED-NAME /tffl /IIOOfe Lu SEX GATE OF OEATN 1 rOMer, wf, nu 1
t A Edward Hathis :.Hale >'.•1an 1 1
RACE ./wle, reoq, •.uae•w welw, wGE-usl 1 .e•s Ytps 1 wr DATE Of NR1N I IIO/n0, Hr, COUMY Of OEAM
~ eee. /sMtrrl Hhite «elr0~#..•.u rof. 1O1'~s eJune 14, 1903 Honroe -
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1 Vll , 1 OF TH wsw en urns IgSMTAI OR OTlegt RVS - Ia Iloe w elAlee, one urn .w w11rfN I
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~ Frenchtown Twp No DOA Memorial Hospital
STATE 01 WIN 1 N Iql w Y.f.•., /ur! dnze+ Of WHAT COUrITRr MARRIED. NEVER MARMEO, SuRVNNG SOUSE Ir vnr, one r•lees r11W 1
fM l DIrORCEO I srecrf l y Ka th r
bloat. Y g arr7.ed „Hat yn Groves
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1i.eo. a ee•fY SOCUI MIMIIEZl4 USUAL OCCWATIOa IOM awe w r+ou OO/M elwro rpft o. KND OF NISINESS Ot MOIATRr
otc~¦.w w IL '3713 513 " tr0¦[W up, Mw r ¦enM 1
t~I~t~~,ta.l. owe - Owner-0 erator: Partnersh Lee-Mathis Retail Lumber Co.
/litoe.re! ogee
.o.tlftOM. ~~~-STALE COUNTr CITY, VIIUKaE OR TOWNSHIP wsw crr urrs SMET
Hichi an Honroe 1fn`~io `O` S6?~ Lakeview Dr.
IM 6 Ik Frenchtown le/. I.f.
TATNER-NAME f/eft flleeee lace MOTHER-MAIDEN HAMS heft .Iteou uu ,
IT John Hathis u. Katie T. Beazle
Irt~+~~!?tT_r?~ MAIIenIG AT)DOESS Ismelos ur. 11Q, eal+a qrw ur, nrl Hiahi3aII
Maas Kathryn I~athiy, wife ui5673 Laks~iew Ure Stony Pointe., Newport,
?ART t OEATN WAS CAUSED Rr: [ENTER Drat ONE GUSE rElt u+E IOR hL (bl ArID (ell ffevne.I o.a..:
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?ART 01. OTHER SIGNefKANT CONDITIONS: cot.o/not.s cawwtmlq q ealr wr .loi feI•ne q CAYff OnlVI w ?•r 1101 AUTO/SY R/ YES wefe Hnawos cOr- -
las oe MOI o~oe~•tr Oeeefrlrllq tCAYfe
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AOCIDEM, SUIODE, IIOfsICIDE, A Irolla, O•r,.eul NOW INIURY OCCUlREO I e/nee w1Yr or Itwer IM raft 1 M rut n. uW ul
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INJURY AT WORK RACE OF WIURr.e Lo.f, /•f+, urn: raon, LOCATION I sneer a e_f.o. IIe., CII? oe qvr, un I
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~ CERnNCATION- rO1n1I Oat R•f nP/0I wr tf•f •110 WI L¦1 IIW/M/¦ •llf! Or /010/010 Igor vlea we oewnf OCtYe0e0 •t elte ftKl, Or Ale
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fla eraser fsor 6 2 11?. lle. TII. Tb. M. fo Ire uYS«s/ saae.
CERTWCATION-rsEOICAI EXAMWER OR CORONER: a+ nu fasts or nr wolr¦ or oe.nl M! OKeoe.n ...s rw.lwwas Oew
!f•rw•ItOtI Of llr W01 11/1e/Oe M wvHhG•teYl, IM ..t O?wlwe, YpMlr WY feat OpYf
Oe•Ir OOaI¦fee OM M 0•>! •ne OW q f11! IJ1Yfeq~ fr•lee.
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I'r'e ref'°C . MCGa f f , M. D , Sst;NAtuRE A E SIGNED /+w*t. o•., feel
TTY Tlc 1 20 77
HARING AOORESS-CERTWER frreT a e-f-e. /lo. nr a grlw u•n etr
hio 43606
RlM1Al, CREMATION, REMOVAL EASETERr OR ORr-NAME tOCAT10N CITY, VIL.LA~GE, TViIP. OR COUNTY un
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F :e.. Burial :e?. Ferndale NI. 1d andotte, ?di chi an - -
DATE 1 FUNERAI.HOME-NA1ME AND ADO~SS t tteeef Oe eJ.e- tb., em Oe TOMr, iTATe, br 1
:w an 2~°""1~7~' „e- Ru Funeral Hocle. 234 S. Custer Rd. Monroe, Mich 48161
B-36 f SIGNATURE REGI A oA 0 IveO sr sous RlGI•!W
5:niL OF. r1IChICAN ; I .Warren J. I/aBeau Ci~r? of ti.c count of
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ountY,'of I~louroe j K°nroe, and o:.ti.e Ca:cu:t Coert ::!e:co: t'r:o Butte i/e:I.~; a Cour: of
- record and hcv:ug a seal. do hereb7 Certify, t::~Ts itr.~. evwpcred the
-
aunezed copy of - Death.. O.f
. .............A.~....Edward Mathis..
~ 1
{i - ''a'4 ~Lth the original
~~%t`- r~ '_,=~r ' ord of s~ia Death
.'f~ ~nor reoainiug is my office. and ha~E found the said copy a correct
. ` trdascript therefroo and of the s~hote' of such oric3ir.ui :cord.
' IN ?FSi Ts:v;S1 ~irlF.iFAc . I haw he: cur. to set ~y hcra cam: c f i fixed
-
~ ~he Seal of sa:d Circuit Cart. at iAor.>'oe this 21Stday of ,-..January
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- 19 77.x...........
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~ 4`72560 ~ ...<-~~._~•..~m 4
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1980 JAN 15 ~!1 i i~ 19
FILED A FECUtUEU
S RO~E~R~POITRASA•
CLERK CIRCUIT COURT
REC8R0 YERIi1f0_~~
gp~ z~ PACE