HomeMy WebLinkAbout1051 ~i
49368'7
STATE OF MICHIGAN
~ 1 - DEPARTMENT OF PUBLIC HEALTH
~ /n ~ ~ o~ STAiE NlE NtJMBEN
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~ 013 619 6 '4 - -CERTIFICATE OF DEATH
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DECEOEIiT NAME west aroaE ulsr SEx OATS oP OEATN /IMk. Oa,t riJ
FRANK L. CHARTIER SR. :.MALE aJULY 8 1 80
RACE-ra. tas.. AGE-w a..w DATE OF sIRTN /Abp. O+ta t'i-/ ootuaTY oP oEATN
raDa bArs wales aws
~ C~fG'~I~ ~ 3 5e- s~ B.OCT. 10 10 6 ~a.I0SC0 COUNTY
o~ oE/?n+ wsw an wTf a I Y IMOSNTAE oR oTHER WsmuTwN-w.. w.n.... «w. f...n....4..~«t
and ap.oily~ ~ a.loE vnlAaE ur~rs a (
~ „ ,SST . JOSEPH HOSPITAL
• sratt a MM ,Mro,w'JSA ~jT12EN OP WHAT COIMITNr ..a.wE0. "w'rt" r.Mta SURVIVWG SPOUSE /Mwiht Riwe»a~daw wawn) was aOt [vta n.
v.~oowto. o~oacto rse.dl+ us aaaao wlaces•
,«,~p., ~ MICHIGAN e. U.S.A. ,D. MARRIED ERMA AVERS ,'i °~''"""a" NO
rgnrunou-
stt warwua SOCUIL SECUIrTY NUMBER USUAI OCpI?ATION /Giw Rind d waR dbM dbniny ,wort d KIIIO OP BUSWESS OR WOUSTRY
`~``~n~~~"~'I ,.b EXCAVATING
~o....t"':~ t~.375-22-7545 ~ t.a. CONTRAC'~'~
asotwa ~rtus
CNIIIIENT IIES~OENCE•STATE COUNTY IOCAU7Y w7ipE an u.rrs a. STREET ANO NUMBER
Sp.CrM? apoE vRlacE lwwrS OT
,B~IICHIGAN ARENAC ~C] ~ os AU GRES TWP. ~ Tsd 66 N COURT RD.
fATHEII-NAME Trasr .u0oet u~t MOTHER-MAIpEN NAME fMST r~wObat - usr
1e CHARLES A. CHARTIER „ CABBIE SIMONS
I,VFORMANT ~MAIIWG ADDRESS srwttr oa nro pp ari w row. cart >y
ERMA CHARTIER ,x,966 N COURT RD. t AU GRES, MI 48 0
. aq, Is, .r...i
vnw•oavE 19. 1MMEO~ATECAUSE /ENIEROAKYOA~CAUSEPERIINEfOR/a/.%bl.~/4.J I.r..+r,.~wwww+u.
rw
putt PMT 1 - - ~ ~D
~ lad Malnutrition & CachelGia 1
;TAwNG ME
~KT+w DUE TO. OR AS A CONSEaIEtICE OF: 1 r+.r..r a.w....rw w arw
tavsE uSr
L~ RN Metastatic Hepatic Cancer , ~ i~d
DUE TO. OR AS A CDNSEOUENCE OF_ I rro... M"M'•...w w eir•
lu -Carcinoma of Pancreas 1 ~
• PMT 11 OTHER SIG?IIFICANT CONOITNNIS -w.+a.. ~++rM r+ .+w" s~ "M ^y'~" r r"^' a-M " ?wrat ~ AUTOPSY /Speciy Yes WAS CASE REFERRED TO MEOICJ1l
or IYbI EXAMWERI /Sipeeil~r Yes a llbj
20. NO 21. p
PLACE OF DEATH nw rr..t w~s.a F HOSP OR WST., rrcaw ooa 24a. ~ r?.. w. w.ww w ww+...a .er r M a .WSS ..r..w..a..
~....t AwMY.cM /SpaaM O 6... wi.. raw.. /Spablyl .Ch.:.
2za. 22b I n t tit a o. w w...r .w..w w•o..»..wr. w »......w .oa... u » '
23a- ra r...se w .a rr.aga oee..w w w w we. w s.. /a//~ - r.wa Ne. w trs• w w r s..rw .r..w
p Z /Synatere and TitNl ~ a7ff~ / ~ M /$rgnaturs and Titbl ~ _
? t DATE SK+NEO /AIa. 0~.1: Yii HOUR OF DEA DATE SIGNED /Ab.. Daf: Yi-J HOUR OF OEATN
2~. I23e. M °i tab. 24e. M
u~ NAME OF A ENDI PNY U OTHER THAN CERTIF~R /TygorA~urt/ ~r PRONOUNCED DEAD /Ab., Day. Yi/ PRONOUNCED DEAD /lbws
i
23d. tad ON 24a AT M
~ NAME AtW ADDRESS OF CERTWER tw•vs+GaH w r~tacai Exawwtp /Type a flint/
F zs- Norman Pa ea, M.D. 217 Neiman Street East Tablas, Hichigan
~ att.. scoot. •.or..utuaa~ DATE OF WluRY fMa. Day, Yr-1 HOUR Of WR1RY DESCRIBE HOW WJURY OCCURRED
Ow wE a.VEii 'Scee.M
26a. 266- 28c 20d.
f+lJU11Y AT WORK PLACE OF WJURY-ar we.... raw, sr.a. r.cw..nt. LOCATION SratEr Ow ws.o wp on- vwwt- Ow Tpw.yr STATE
/Sp.eillr Yes o? Ab/ a.rs •r /Spae/Yl -
28a. 2N. 26Y-
CREMATION, pEMOVA~ OTHER CEMETERY OR (XIEMATOt1Y-NAME IOCAT101y - on. w?tACE Ow Towwsw+ fTAtt
2,,. BURIAL zTb. LINWOOD CEMETERY :~G AU GRES MICHIG
- ~ ~ PATE /AEa, Dar; Yr./ NAME OF FACILITY ADDRESS OF FAdUTI MI 48703
2,d. 7/10/1980 z .FORS FUNERAL HOME ab101 E MICR . AVE.
8-38a FUNERAL SE l SEE REGISTRAR GATE O 8Y REGISTRAR /Ma. OsK
(t/781 /S,9naTwel r /Siynaturel r ~
Zee- ~ 29a ~ 29
j, 2 ~ 47
' i I STATE O; MICHIGAN 49368`7 fILEO ANQ 6ECORpf ~
5~TRgS i
j COUNTY OF I OSCO I Jane Paeas f______deputy- ' ~ {
4i ~
~ Clerk of said County ands_______s1eR,ltt~C________Clerk of the Grcuit Cotut for said County, the same being a ~
~ ~ :
Court of Record having a seal, do hereby certify that the above is a tnre copy of the Record of Death of : ~ -
I'
Frank L. Chartier Sr. ~
' _____now remaining in my office, and of the whole theroof. ~ `
i - - In Testimcny Whereof, I have hereunto set m hand and aEfixod th ~ ~
- of the C~.rnvit Court the--------------24th-----____-- ~_day of
.,c Jul i --80 ~ s
f}y' ~ ~ e
S t ~ ~2Nt
I ; s • ~ ____Q,_ KE I
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