HomeMy WebLinkAbout0712 :E,. - - STw1E lglllG DAIS - ~,,,.,,.n,ri,
STATE OF WISCONSIN / ~A
DE?ARIMENT OE MEAl1H AND SOClAI SER:'KES S1AlE DEATH NO. v~J1( .
pIVIS10N Oi NEAIiM
.ccAE fllE NUMl1ER ORIGINAL CERTIFICATE OF DEATH
'ctc[.S[D-NAME MrdMt tM1 SEX OATS OE DEATH OeU r n ~
MILLIAIC PAUL BART~L z~iale ~ '
~ - rw c t• A~t;~
eA((- WHdR Nf~re, AnrerrcMilnlren.Ets Y~MI R~rrAder Ilnltr One rex Wrder Ont Oor ~T~IRTN Mtn1A ~
ilhite 80 t ~ Aril 6 1895 a~ Langlade
_ lSOesilp Ss. A. !c. A p i
p ~ H.NE Or (tlr, Vlll (11 NtitAer, NMwt /etrnsAi~) Iwsidt Ciry M NOS/ITAI OR O1NER INSIIlY110N-NAME
W i ;tocoi~on_ el OtKA)~ Vi11Mt liwib (11 INI iw itAH Gwt Intl Mid r r l
~ SI ~If Lti RERiN CITIZEN N Coewtry SylV1VINEii SIOYSE (11 Nib, Giw MerdM NMtt)
3 ~ i ~ f Nor M u S . None (euntry) f7 Nevtr Merrill
t • o, lo. p wi~e..~ o oi..rrN Kargaret auetlich
SGC ut S[(UUIr N0. USUAL OCCUMTION Gift Kin/ el Nor? Ovr:rp Meat of wxkwy lilt KING OE WSINESS l)R INOIISTRr
EeM it RNrrtd ,
FE SiGE N(E. S1ATE COUNfl NAME Ol 1 VILLAGE IMide Citr M MAILING ADOtESS (NOntt ANrtss M trot el DeNA)
pl 14aAer, Nowt lewnsAy) VdNrtt lieub
,<a ~~isconsin Forest Ea. Pickerel IId. o ret~w lee. Pickerel Wisconsin
-1 IAtnER- NAME fN•1 Mid/It lttl MOTHER-MAIDEN NAME lirsl MiNlt lest
~,5 Emil Bartel ,a Minnie KnoKelke
n aIGRrNAIiT-NAME MAILING ADDRESS Street x R.r.0. No. Gtr er Villgt SINE Zy WAS pE(EASEO EVER IN Y.S. ARMED EORCEST
i ' EII r s, ee wa x Dotes of Servra)
t~:rs. MargaESet 3artel Lae. Pickerel '~lisconsin 446 17c. p res w fl un?ne.,n
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" t ~ e rr,RT 1 DEAIN WAS CAUSED fr -Eller Onlr Ont Ceose ?tr liwe Eer ( ell (q Dvratron
Cc~d~t.ons, 11 Anr, A Inrnedrett Cerro: ! y
,~~I ~ i _ ~ C
~ ~+~~cA Gave RHe le OV! N, x es •
~ i-••T.ed,mt [ow.e IA) R. (onseewnrt el:
j., S!c•~nq tAt Unde~-
l r ~ ^ q C verse lest. pef le. x e• e
"j _ C. Conseow+rce el:
i rtRT II OTHER SIGNIr I(ANi (ONDt1tDNS: Cerrditierrs ContrrptA+y to ptotA Otrl n11 Rtlored le Cerrst AUTO?Sr ISpecifr) •Mtt! AYtOtrr rMretNCf OONf1pER~
~ G~.ea .n ?ert 1 (A) M OET CAYif p etwrllt
I~~rts o w ~ w
r~ A(CtDENT DATE Oi MonM Der rear Moor NON IN1URr OCCURRED (Eller Notwe el Iryory in t a pert 11, Itt:rw ltq
i~ Ct sutaoE IN)uElr ~,rTKM.
o' :o~ ~Ho!alaDE zoe. S sx. ia.._ -
v' ;tilU4Y AT WpRR ?lA(E OE IN)UR IMOme, form, Street, iettxr, Esc) lOCA11 Sweet a .0. a• a Y: ?e4e Stok Zip ;
O Yrs ~w Z01 (Specil?) IO¢ ~ t • ,
4~Oe^ -
,ER7:n(w1tON-MOnrA Dor rear MontA per Yea AND l;tSi Sww NtMrNER ALIVE ON 010 rOV YtEw 7NE DE TN 0(CUttEp At lAe ?Ixe, on Ae
7`HtSI(tAN Month oor Tex R90r ALTER DEATH (New) Dote, on/. To TAe Rtst.
Of Me Rrowledge, Drtt i
: n,trnded Tire Trl ~ rw 0 w To lAe CousNs) StaeO
Orcrosed lftww
Z 121
~ 1210. 21c 211. 41e. M.
Fa. t•(w1rON-MEDr(Al ExAM~NER OR (DRONER: On TAe ~esis el TAe HOUR Ol pEw1H ]NE pE:EpENT WAS ~RONOUNCEO DEAD
E .-m .wt,on of the 6odr o*dra TAe tnvett~gOrgrr, to Mr Opinion, OwtA Monts Der rex NotN
-c,.•rrrd on lAe Dote and Doe Te TAe Goose(s) Stored. , ?
;EK11ctER-NAME ITrpex/ring SIG ATUR - ItER Titlt DATE SIGNEp ManrA Dor rex
t
~ ~ ~ ~ ~
iJ o ~ ~ W ~v ?3tt. ?9t. 5
i •.•4 t,NG OGRESS-(fRTtrIER - Street or R.i D_ Nt. Cara 1 Store Zip
r
~C3.2 S' ~ ~~~~lhc \C~.4CcnSrn i
y dad
- URIAI CEMETERY OR CREMAIORr-NAME LOCATION Crtr Stole
? CREMATION
~ ? REMOVAL Chapel Hills Garden 'Nest Cemetery Villa Park, Illinois
i ~ 7/c 2.s. 'l.t.
a ~F ~ ~ ~ ~1- OAiE M.rrM Dor reor rU`~ERAI NWaE-NAN.E AYp ApCtESS Sweet a R f.D. w. Car x V:Iloye Srose y ;
d - J zse. Brost Funeral Home S . I.1ain St~,7~ombaY` ?11. t
r _•.Eewl DrRECtOR LIGNAi REGISTRAR-SIGN LIRE- DATE Rf(EIVEO H local tee~srrx 1
E% '~--~-I7-~-~
LANGL~~`'.•000NTY"'-~1.~91 CERTIFICATE OF COPY OF RFCc~RO
f T,.t.,~lre,' un~enb.ign¢~ .Reg.ibzen o~ 'Deedb .in and ion ba~.d Counzye
~ do he 6~~ek,.~~.~~ zhgz zh.~b .c.b a .tnue aF eonnect copy o~ on~.~6 a.~
~ Cen.z~. •a~e.o,~ Ueazk ab neconded ~.n my o~~.ice ~.n Vo.~ume
$ on peg ~ •?,2 F.ceed .the 20th day o~ Oct. A.fl., 19'~
W~.zneb thy.'; h4ltd and b eaL zh~.b• 9th day o ~ July , 19(3"
C
~ REGISTER OF OEEUS DEPUTY
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t 49364
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1980 AUG -6 P!1 ~ 31 -
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~ ~ R F A.
~ROG R POITRA
x CLERK CIRCUIT COURT
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$ooK~ PEE 710
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