HomeMy WebLinkAbout0478 PATE NLING DATE
STATE OF yyI$~~NSIN
YyplarPrintin .onMNO.vstf DEPARTMENIOF HEALTHANpSOCIALSERVICES frATEDEATNfw,
iDOM•REY. LTI
P""T~t ~ ~ 0 ~ b j ~ OR4~iNAl CERT{FICATE OF DEATHx y ~ 27r 1978
Lw, y, NO e~
I1~ArW,« LOCALFIL{NUMIER Nwq gWNU/MWA. r
CoMM O[C[OENT.NAMt rlm S,SY ~ q~a
J ~ ' couNr? of oa^' wl~oe pwn ,
Jose h ' + y A UN R I AY GATE OF {INTN N
rewrr January i? F 1928 Milxaukee ,
Mi: A~?, WAIN, TINY, ~ I 1 I
NN.MN,ATMNMINNA, N/• I /e.MOW, M' / M a NWrM DMMIArUt. op^'
A, HOSPITAL ON OTN[M tNfTITU110N-NAnN prJtAtM Ra
White 6. r r H MN Ut t t~A. fM +
~ fNItO yaATN A0B i'~eY~l 7e. re tNM
V N~^"'~ p CtTr,rILUtGE 70 West Allis Memot'i~ p
West Allis fugrlrtNGfFOU{ftNr"',f'"""'"""""rl AFiMeOFORt[p ,
~ f~ M?r„« NNM M«nA nee Becker ' f. T
Intuatton W STAYS OF {IIIfN 1N not In CITIZEN p/ wNAT COVIJTIIY ~f. INVAIN 4, w,raAre „.Do~thy INDUSTRY
p 4A,A. AonNAwnarl f D,vo~c.A TM,Mworl RINOOFIUfINESfOR
fl],lnois U.SAAA +I cker
usuALCl;cuPATIoN~c,rA?,NNiAMUwwr'nl Mfg? Ket~eY-'1~'e
DIAL SECURITY NUNIER n4, a~n'r'~'"pl iq,
R T ffltl OF R[{IDINCE NJUOE cITY OR fT11[ET ANO NUrI{lR ,
318-22-0042 1A. Buyer
tf, couNSY IyY,Y1LLA0E0 oww 'M{yAG[~N+" ?412 eri Crt
R!{IO[NCE4IAT! rN 1 LAN
Greendale NAAM
Yiaconain w,Milxu,ukee ,N. N[RMAIO[NNAM[ jailer
' /i FNK •"'~N
. rPe tw $ C Hennessy t, ftaA
""""N' W Joseph eur M YrtA«
MAIUbG AODAESS 11rM M A•o •0, Ne.
ri,ntl Gl+Bendal,e / Wisconsin ~ 5312
~ INFORMANT-NAMLITyOAa ?012 Dxycien Court {t?tA
Dorothy gennessy oNr«YUNIA
11i C N ERYORCREMATORYa'tAME LocmloN Mi1xgl2kee Wisconsin
, w/w / tEAA~MM Mt Olivet Ce~etery fufA
, ~ ~l,GtrnMNn Uf.OU« t/n. Ill'rY {aNt«R.iO.NO, C~tr«rel.M
A
~ t O IAIAAionrAAt Mfrcn NAME OfFAC1 ITY t Greenfield WiA 2
AL Rvlc a EEDr• AA,tno Max At ass do Sons 4 4 So 60th S «..,,..NT.
r ~ f~We 70r. wtNe AMIM ,rh/,tNAt,M. m Tr NMiA" ANT
~ ` ~ YJA~ On eto uAr? M sr~
f WN, ttAM AM Mw AAA ArA to 1M AAUN1~l t1r,AA
f «Ty MWN«, MIT ANYrrM M nN t"^!~ Nn MA o'K rN MN a
r ~ ftA Y• •ttM r~/,/6/Jrj f MoTNN A N
1M /ArNld NAIN• N
V p N µlNan AnA TrnA ~ N W OAT ft EO M
ff N Uq DE N ~ s<
f DA I N r0 NMtMt Ow TAY f~' IWW+
• . / ~ / ~ uN1 t»
~ ~~g M
_ ~ MOO,OUNC 0
le. McAM DAV rw N f1ANA Tail Ri a«r~mu •
' r j. NAME OF ATT{NOIN MY 1 IA I FM f ~ Yw ffA.
'r t ~ ~ ~ f ' Sfo, UAnT ~ ,w
I ?rMtl / U 7.1
NAMI ANO AOORtff OF C[RTI 1 R IrNruCUN, MEDICAL E KAMIN/A OA CON II111TYMM ~
Es . OAT[ RE tv D ~ l1V w
~ rw
. • f, t y .'i
.I ` ~ re 0
i ~ ,i.,~ • MM IMNrM rNN Mink
r ~ wR ~ / w"~" ANO ItI.
A pr, p ~ E' , N,f R DNI.r ONI CAU41 rlA UN. ?OR NI, UI, I
i ! -rT ~ . / VIAik AU nw. Mwwr
P Y NrnAM ~ ' . • r
~ r? I J
N u,c.o,f!~:' 0, A AcuNlcuutN ur
~ ~ ~ o
Cr1 .y .'Izif~ yY, ~ ,_,w• ~ A N NGl I
~Y ~~~Z M
' y' \,I WA CAS: Rl ERR D L
nMAAr~HI AVTOofY J EJfAMINEROR~ONONEN '
~N~~ W u~~ ~t
>ra wx~L, "i~ly~s~ ';rN NA
NAtNAd ~7..'. ~ Nli I(41NT CONDITI N~{AMei~'•~r ~u °O~~ nut n gar a ~wr Pren ' ~rN (]Nn ;
_ ~
~ • HOUR Or INJURY G s Rte NOFIINJUNY OCCURRED
OATS Or fN14NY M 4„ I
1.11Md~} f, ?oM, IIMt ?M Ar M vnu« '
flyltltl. Ns WANMA NA
ww 4/ WMNNI flee ML".~.~.r----- ~ rh IOCA
o INJ YA Or INJURY•M M^w, r,nA. N~An,tKwr,• r. w~VMo, ~N• TI
IAMIh1
t]YN ~N/