HomeMy WebLinkAbout0231 ~ `~T~''~•z STATE OF MICHIGAN t~ ~
CEPARTMENT OE PUBLIC HEALTH
. ;n -
~F
f..-~-~~ r ~ STATE FILE NU~ABER
`~'==K~~ CERTIFICATE OF DEATH
c 009743 B
DECEDENT NAME irAST EaJ:wi EAST ISEX (PATE OF OEA:H /db,Cay. Yi/
I 1•~.
'I.~ L. CADYALL{:D d ; z Male , a Vic. 2 .
1529
1 W1Crr•! vir.a. i~? Ai.•c AGE-tau M,a.: UtiDER t Y,A9 URGER 1 OAY GATE DE BW(`E /Mo, Oay. Yi1 tCDI)NTY Oi OEATi
lsaKiEy~ ~zl ' i T-ow.s t.o,..s .E..s _ Oakland _ _
White ~ 6 se. sG e. Seta ..?L 124 _ ~ 7a. _
•OfJLTiOV Oi DEATH ~ aT\ tyMTS Os jHOSPITAI AR OTHER WSTITUiIOtE-wr.. `r Dot r e.-v+. u.«r u•a +,...e.y -
IGeck on! -
f ardsplcrhj trwts o: Pontiac ~t. Joseph Nercy HospitQ.l
i
70 ~ nv? of ~ 7c
_
s•ArE c• lNtn. rr..,:r M usw CIEI(EN Of WHAT CCNi.VTRT 1 Yao•i0_ r•EYf• 4.\niYfO SURVMNG SPOUSE 'Hw:{e yrnmadrn nirnej r""~ OECEn~tiT f\fa w
K hfai4 ~~~`Tr Mr~x tiEO. O.wrICEO rSpwhr u5 aRYf7 rJw,;,ESr
~~„r,:, ~ a 1~21ssoTiri' a U~.AA ,D Married „ Eleanore Davis ~;Z"~'"Nb'r
~rLiTrT4"Y~r+ ' -
sEe rA•r.,, SO%IAL $ECUR/TY NI:iMBER USUAL OCCLSPATION (Give Arnd al work ,!Cure d~r.'ng most O{ r KitiD OF BU51`YESS OR IADt;STkY
•E~a•- wWkrrrg {i{!, frrM a{Iltnd/
^...•r'tE• _~g ~ gTl Automotive ~
~f5.f\CE ..svs 13 0-10- 2 t.a. Tool D~si er tao _
p,RRENr RE5I,ENCE-StwlE ,ODUNTY `LOCALITY ~ttyoEan uvrscT --~TSTREET A:VO {.UY6ER
/CAerk ona ~r--~l1 II
r and JP~hI u ws+oE vRtwGE !ewes aE
,sa richigan Ise Oai~larrd ~ IsG r~•,w, ~E , ;
Waterford Ise- 4-1.66 Cass-El_zabeth
FATHER-NAJAE TusT WOC:E EwsT MOTHER-MAIDEN NAME Rase w+OC,E u5r
~T~ James Caw laden in. Vir a Nensoa
INFORMANT tA/ULING ADDRESS srsEET oR Rt0 w dTr oR Towy SiwTE Zy
S ~ /e>, /Sign,?~.!/ ~ lee 4406 Cass- iz bath P.d Pontiac ct~~, 4$054
asf 19 tMMEDIAT SE ( 7FR ONtY O:lf CAUSE Pi:R [tNF fOR /aI. /0/. A.1tD /e/.l wr.r ?.e•«. a.r+ aw na+
t/ Cn:.•Sf~
year-.; _ la? ~~~/r w.Ma _ I ~ S •
t"•CE0.• ~ OUE TO, OR A5 A QE:
Iel - - 1
OUE TO, OR AS A OONSEI]UENCE OF: ~ 1 ar:aw eee~aa. a.w lar+
PAP.: u rJTHERcS,,k;NtFh;M(]T CDNDITIO.VS-cw/a~ro.. cavauy .o aaar+ ew .+a ..u't~w-~a w» yw ~ruEt r AUTOPSY /Specr!y Yas I WAS G?SE REFERRED TO ME01!'AL
7KJU/ti- ~ - 1-R t 1 `~?L~ ' No ! EXAMiNER~ ~s~lY Yes e, Nbl
r 21 17 V
.DACE OF DEATH ,.rv,~ ww t.er.a F t105P. rnae,e. o0 2N-
'oslel Awipre\a.~y / • O bnr R~... awaare /S,paah/ ~ ~ T•. eas. aw! aar.rwr.A ea ra a ~..esr a.r.rr. u..
22! ~C+,w e
?2e r
fi~•~ a M Wf• 01 !•e'•natw a.1W fMNSl~9\ rat a0 tea. Elarel` Y-M90 p M
23a. Tow r.r tr.rey\. aealr ooa.r . r.e o,n av l..a n LJ e.... Oeea a.! lreo sM ew w r•.a e..eral •eaga
fSgnatuus and Tine/ :•n* ~ t tS.gnatura and Ti:ks/
~ ~ DATF SIGNED /Alo.. DrA Yil _ i HOUR Of O£ATM ~ Z OATF SIGHED /Mo.. Osr Yi) I HOUR GF pEA(H
S ~ zee. - 3 2k. 3 c.._ ~ ~ Z4L ! 2cc M
it- ?:/it2E DF Q*7F.NDts1t3 ?ItY51lWa tf OTHE4 KHAN C'cRTIFICR / TYOe or Pnnt1 W PPONOUNr_~O DEAD i:AO.. DaY. Yr l ~ PROI:OU!~CEO OEAO INcur/
I
- _ 23d _ - 2te QN 12~e 4T M
Ai
\kilE /?NO I(ODRES'S Of CEnTIAER rNnr _ a_: . Y - PYinU ,
2i ~ Yt ~ •
~•A'~.'~ ~Tr~ ]ATE OF r. s- .r. URY DESCRiB: HOW 'NJURY OCCURRED - -
Crr IEegrrEG eKVEiT ~SY M:
Ne tuna l + ~w. ~ 28c 28e
llA/RRY AT WGRIC - -PLACE OF W1URY-Ar oa.•.•.:a•.. ••a+t r.cran urv LOCATICte STrrEE' Cn Aso %o Cn'. vrttA6C Oa r~•trMyr;? SEATS
!syroa-.tr Yrs w {ebl ..r.y /SPxrhl
26a. • 26t. - 289
BURIAL, pIEMATIO:d. REMOVAL, OTHER CEME7ERV OR CRETAATORY-NAME LOCATi7.V oTr, va~.wGE. o• tannsrr+ S*ATF
tSpceh/
.+.a .+7 r 2ir.
_ rr+•ru+(s_an5iii vcraE2te 27c
- - _ a~~rL-_L3.ckigan
'DATE /4Ei~. WI: Yi/ NAIYIE OF fAdUTY ADDRESS QF fACIUTY
2904 Orchard Lake Rd.
2te. z - Funeral HemtD , zao Kp an Har r ~T u•ht ~nz~
'v'.380 :ti':f:•~. ^ L`ttN Jr ~j t+EG15*RAR GATE R EIYE eY 1: I? TRAR (~id-L~=;,
:wr7R: L
• i ~9~ ? ter '9~ pt~,~1 ~2~e Ot C 3
- t
S!'AT~,Ur MI(,•NIGIW) (~O APR -9 ~ O9
COUVT! OF OAKT,ANn)SS ~~~0~ s~tiuc~ECOU~ r. A•
City of Pontiac RLEROK~ CW? RA
GltptT
~EE014# VfNIF1f0
I, Elizabeth M. Fletcher, Clerk of the City of Pontiac, Oakland County, Dichigan, do
hereby certify.that the foregoing is a true copy of the record remaining in my office.
Given, under my hand and seal of the City of Pontiac, Oakland County, Michigan, this
-°~~~•day of December, A.D., 1979. -
~ -
-
J.
zza eth Fletch r
City lark trR
BOOK c.~7 Pllfi~