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'DETROIT DEPART('IENT OF {~et.'ry~
- t VITAL STATISTICS DIVIS: ~ /
• ~ Q'R'712~: -
r ~ --i CERTIFICATE OF DEATH
,«„e 11YeVR•• Ow.II..., d Porte ?4.M st.w NY wr.ren
-NAME ear r.~sre our SEE DATE CIF DEATH t.owrN, s•*, nu 1
~ MARION ~ E . NOVIS - ~em~lle ~ Apri 1 15, 1976
RAC! ~rwe. NeNO, •reelew wrersaw, AOE-ua rnsa 1 re•s won r M• DATE CIE RIRM rrplnN, COUNTY Clf 0[ATH
r eec. a etRCYT I srawr null ros. Mn wouas w+ 1
white ~`y A. . Sep•3o.1913 t. wgyne
IP OF DE/1TH s
ec~ ctt «
rro HOSMUt OR OTHER lIST - rr Na w e11Nee, eves sneer •Ie wureee 1 ~
- - Detroit h- Yes Plymouth General Hospital ~ ~
STATE OF RRITH r Y Nor w us.•., were CRQBr CIF WNAT COVMRY MARRIED. NEVER MARRR:D, SIRVNlK SPOUSE r w wre, Or•e aa•axw wwre s
~sv-. arf0lrKT Michi an ~~•1 USA "mar°°Sr°~e~°1e'eCAe „.John Novis -
rr.,tt DKew3t0
. rD a Dr•rw SOCWI SECURrtY NUMRE! VSUAI OCCU.ATION ror•t ataO or wort swu eweNto Trost W RR~ CIF RUSlESS OR INDUSTRY
O:C Var/D W •rpearwO aYe, MN Y elrMfO 1
tF 3~i ~ q 66~ „ Housewife Own Rome
eer~_er.ce atroee
,o..~ssa.+. RESIDENCE-STATE COUNTY CITY, VILLAiGE OR TOWNSHIP 11e'•e ever erns S1tEET AND NUMBER
IeeN;ichigara ,w Wayne 14 Livonia ,w ~Ces No ,y 27828 Barkley
fwTMER-NAME rrar trope t•St MOTHER-MARTEN NAME Nat rrOpe aW
I?enry Jacques - No Data
INFORMirrT -NAME MAR.l1G ADDRESS Isnen M a.r.o. NO., Crr• a ro.rN, st•A, tr1 ~
.T~hn Hovis ,n- 27828 Aarkley, Livonia, MI. 48154 ~
Ire.
FART 1. DEATH WAS CAUSED RY: (EME! OMIT ONE CAUSE rfR UI~ FOR (o). (6J, ANp (c a u
eennew oNser •ne oe•rr
p. rreoux verse t~ i
. 1.1 ( • •GraTdiac Arrest l y
r~
wrc• a iise w It,i Sclerosis ~ ` - ~ - / 1- •--t- ~ t _
rrreeun e•use tor, ow ro, a •s • cowsaorrNct or:
et•trw0 rrre rrwote-
li rnwo c•uu r•sr
Icl
t TART R. OTHER SIGNIFICANT CONDFt1pN5: ewanows epnewVrrrlG ro oe•rN sw wOr wrrao ro oust (,l•eN rw rut r rot AUTOISY ~ YES •rne nwerwos eoN-
r •es oa Not awns /N oenerrNO1G cause
w ourw
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~ ACCIDEM, SVK10f. HOMICIDE, w r rowrw, er•, •e•e r HOUR MOW INIURT OCCURRED r erne wrest or rw/un rN ?ur r a r•er w, veer re r
~ r ssecw• r
I I4 !11 Ik M. IM -
INIURY AT WORK F1ACE CIF NnIRT wr trot!, rut, Breen, r•eroa•, IOCAT1pN r snen Ot s.r,. wo., em oe rorrw, serer i
rs?ecrn ne w Not Dart! eroe.,erc. rs?ecrnr
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CERTIFKJ1TgN- rowrN w• rtu a.owr erw• •e•t - •w0 r•sr sw•v wr/Ntt •rM oN r pD/oro .tor •re•t tw ocwrN OCCVelEO a trre er•n, w tyre
INTRICIAN: TO arprrN ey1l •[Ae too. .tree q•,r. rrrOYel T] Wte, u0. r0 eM .tsr
!ta oauu ..0 5-24-75 TII 4-15-76 TIr 4-15-76 :N. not „9=50 ~ Gen wsa~nii4go
CERTIFICATION-MEDIG?I fEAMtNER OR CORONER: oN rwt swws a rrre rrorre a pwM rwe Oe[tobA rr•s teowovlrceo oe•o
eurw•rrow a Irre soo• •ro/w rra rw•nrrG•rrp.., r• w..wN, arO1nN w• au rrOUt
ot•rN oeeuuw ow nre an •wo Due a rrrt e.usersr sr•YO.
!Ie M. M.
I R J.'nMohtadi ki. D. A~ Y''~ _ A. ~ ~~`-16"°-~6•,.e..r
MAR,/JG ADDRESS-CERFYIER tern o. e.t.o. r.o. - - m q stn eve
~ ~ 302 ZJ. riain S ~To~hvil~.e '°~icY~ 48167
4 rWR1AE, CREMATpN, REMOVAL CEMETERY OR CRFIMTORT-NAME LOCATION CITY, VILLJIGE, TWP. OR COUNTY sere
„e.Aurial Ta ~OY~$'1' LAu~ n Saginaw, MichiRs~n 3
DATE w, o••, •e•e r WNE H ME- ANO sr ter e.r. a oe r r scar tY r 1
~ f;.~ 1976 ;~11~c~e ~hane'~=~~3d ~ ~11~e ~ic~ ..fie trot t, M1. 48219
g ~uF~~~ ~~j ~ TRAR- . . R~~ v . t[GrstlurR
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I HEREBY CERTIFY THAT THE FOREGOING IS A TRUE COPY OF ; V : ~ FILE IN THE
DETROIT DEPARTMENT OF HEALTH; ATTESTED BY THE RAISED .Z~~~n~- ~OF DETROIT- ,
. 4'7121 -
. -
1980 lil~Y 2~ .A~~ ~1~ ~4 THEODO~. /~~-`,``11 rr~ - .:D ; ,I r
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- ~t:~ sTr r~ c~~~ll u DIVISI -
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AP F. 1 9 1976 ~a~Tl~ ~rfr(FIF;~--$ - . f
DATE,.
. ~ g~331 P~E1919
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