HomeMy WebLinkAbout1915 ~VV ~ VV t
x,92 CERTIFICATE OF DEATH ~
IKY rra /IY.an Mk~w• OpMnaM d µYc I+..M star tr1 rpella , .
OECEAS[D-NAME INf1 rlaatf 1•fT SE1< DATE OE OEw1I1 1 rortw, Mr, riu 1
1. x'9979 ~rshall Lerapr Pill :.Ilple s
RwCE r+w, weoao, ••rflc•r wyl•w, A(iE-I•sT v/Nea s n•a Y.eea s Y?r DATE OE RM1N IroMM, Yw?. COUeITt OE DEATH
efe. . fNCrr 1 ualws • rwf 1 rt?f_ Mri wT/1Ma ww. ff•a 1
~ Mhite S~ , k_ • larch 1 191 T.
VIL IP OF DEATH walae cwe Irwn NOSMTAL OR OTHER RtST - Ir wa w tetra, ona ftrtl •.e wwNeal
srecr. •es a wo
Trenton Yes T._ Seaw $os ital
I STATE OE 11RTN Ir woT w Y.a.•., w•ra CITIZEN OE W/1AT COUNTRY MARRIED, NEVER MARRIED, SURTINNG SPOUSE Ir rre, oar r•rrw w•re 1 ~
rlrewu . Illinois (plwlla.l , U.S.A. ~IOOw~ r~e ~arecrrl 11. Jane
~.I•T otceue. SECtIdTr NUf11Et USUAL OCCWATION lolw arlY a roan Ya1+a~waww rwT a 1~!!D Of RUSNESS OR NOUSm
u"10. w tr•ra rpawq sire. Wer Y rtlat.l
occ~rre w I: 3g,4 ~ 9726 ,y 1leaehing I>t. - Sdurcatioan
ImvtWr. Owr
Ilt.awce r!Oea
.or~ss~Orr. tESIDENCE-STATE COUNIr CITY, VILLAGE OR TOWNSFIIP wNIM cln urws STRQT NUM1E
/ freer. rif a Ilo
I« Mich. L. Ilgyne Trenton ar. Yes I«.
fATNER-NAME r1asT r10Yte I•al MpTNER-MAbEN NAME rNft rrrr I•f1
It Albert gran Pixley 1•. IZanc
INEORAaANT-NAME MAIR•IG ADDRESS Isms a a.r.Y. ro., cltr p qrw, fT•Ie, tY1
Mrs. lulershall L. Pixley Same as B 81 air.
rwRT 1• OEATN ww_
S CAUSED !r: (EN1ER orer oNE uusE ?Ee lU+E ?aE ML Al AND kA NTrteM owsn .we YeuY
Il Ir.ew e•YSt
C pl Acute Myocardial h'lfarction
cow«TIOwf. Ir Corona Arteriosclerosis Severe
rwlcw a•re nfe q AI
IrrlQM•Tf UYr /al, ~ q 01 •f ~ CGyStOllfwG p; -
fT•11r0 Iwe YMYN-
f11M0 C•Yfe I•fT
,tI
?ART OTHER SIGMi1CANT CONDITIONS: cowpwowf ew+r.rwwq q oe•tw aYT wo/ rum+ q 4Y1e onrtw w r•n 1 /YI AUTOK~ ~ 11ES reae nwawof eat- ~
1 rif M MOI ~
~ N ,w rle/luuww0 GMIY •
ID.
ACCIDENT, SU~KID~E.yHnOtaflCgE. A I rorTw, wr, •[u 1 nO1R npW INIUIr OCCURRED I e./na .uTw a IwrYn w r•n 1 oa ?•n w, Irtr sa 1
~TatT1I$1 ~s 111 M. tY
~IN11Mt1 AT WOMC !l/?CE OE eexlRr wows. ru.~, slaeeT, r•cgn, LOCATION I sneer a a.r.Y. rro., cm w rorr, sTUT 1
Isrecln ris a wo1 orrlq tuo.,eTC. Isrecwrl
11r. ~
CERTiRJ1T1pN- .orrw Y•• rtu rowYl Y?• •t.a wwo f•ft Lr wr?wea Y111e or I Olo/e+o wOT •rr TNt OEATN OCCYtlEp •T wle rues, w M
r0w1w Mr TIY actor •rTla aura Iwow1 Y•le, •M, q ar rsT
?Ilrslwuee TO
I .TrwY.. Tw! l~yl, n~f 11 1 -72 Tt.. d o A:° L~
TIa e+ea•steraOr T11 13-/i tk
CERTIEICI?TION-MEDIU1l ExAMriER OR CORONER: or Iwe a.f/f w Twe wOw or oa•w/ Twe YlCeotwt .•f no..oiwleto Ye•e ;
~ ta•rYr•T10r o? Yr aOYr •rIY/a tie Iw.eslle.rlpw, w rs o•.«a.. ~-5-~ rOwlw e+•r IW wow
` ot•Iw elr q ..le c• nl s rtY.
t>. ~O CreL'B A? 111 M_ i
CElTIf1ER-NAME mr a wrn oeore d ntst DATE SIGNED IrowOl, wr,.t•t1 '
L ~A oms ~ L. A. Comstock ~ ~
MAR1eG O?RTMER sires a e.r.o wo. em a slwae :r
I E-~°-°'~-~- 3700 West Ad. Brenton Mich 81
. QEMA ~REMQVAI EMETERr OR CREMATORT-NAME LOCATION CITY, VILLAGE, TWP. OR COUNTY sT•ri
hem8~~ Te?. ~OOdmere reIDg
OJ1TE'- •+1 I • Teal WNERwI HOME-NAME AND ADDRESS I stern M aa_e. r/o., em Oa To . sure, elr 1
- ~ :~tarcs ~ l~"!2 l~l N. Ride 22
x;,-
8-36 , ' REGISTRAR-SIGNATURE ow aeearren 1r I etelsrawR
e~ba ~ ` a.~ .Ride ,.Francis S oma ~
300M . ! , f
~
t, that ~i8 1E
Y; , ; ; ; ` ~y I berebY certif'Y
~5 Ak 20 wile atcthie oYf e.
~F~t,Ee ~r A~ cC~AGi a
S I.i.tlCff COUti f Y, F l A. Trenton. HicDigaD -
n~R PaTRAS ~ Be~istrar• ~UL 31 1974
~a~ CIRCUIT COURT
s
4
~ i
BOOK 333 PEE 1913
3
_ _ - - fir'
_ -