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HomeMy WebLinkAbout1747 , ~. S~1b20 i; il OHIO DEPARrTMENT OF HEALTH .,, ~f ~.. M. aciw 4'8 OIVISION OF VITAL STATISTICS r;vEDfOR RND+~NO -•-- - --~(7~~ tw~~.tiNo -- -- t,,,,~coo~ac -..,.,,~wo..~ __-_ - CERTIFICATE OF DEATH w~~~«~~»-- -~~~-~- ~ ~ ~ OECEOfNT-MAYE irM 4~Mr L~M~ tE7I OATE W OEATN ~IIR, p~, Ywq -- ~ AI.LEN CURNOW ~ , M ~ AuR. 14, 1980 - RACE-Mi.~-~~•~~ AG[-lM ~~II~~ YNOEI~ 1 Y~AII 1 UNDE111 OAY OATE Oi ~11iN Wa,O~~, Y~./ COUNf~I Oi OFAiN cw ~itRr.~tlr~ rr~-Q uo.. ~ o..s ~w. ~ N.r. ' - ~ ~ p ,~ ~ ~ i ~July 12, 1912 ,~ Lucas • - CIT/.VIIlAGE011lOCAT1pNOfDEA1N 1WSIITA~0110TNE111NfTITYTION-N~l/Jr~~e/wq~M~aN~~wl+rln! IiN06-.011~NfT.IMa~00A. O~lEiw.N~..Wr+M lJ~thl ~ - ,~ Sylvania h Lake Park Conv. Center ,i inpatient fTAiEO~N11TN~rrwVdA~~~ GTIZENOiMMw~COVMTIIY d11GIN0110EiCENT11tY.~+.Waun,C».ww,E~M.C~1bw. SOC~ALtECURITIINM~E1~ ~ M.~ Rs~w. nc.l /$rfyyl ~ ~ ., ~Iriichigan ~ O.S.A. ,.Scotch - English ,0 383-10-8555 _ ~; PESiDENCE MASOECEI-SEOEVEp1NUS ARYEOfONCEt7 w/U~~EO.MfVEwrwAwlEO. SuM~WNGf-WSE/ry.ryk.M.+~.a+~+.w~l .ccEUECE4SED I~~a+wr.w~n+~u1 HJri.l~Maesyr.dre) w100wEO.D1Vp1tE0/JMrry) . E:, ~~ DfATN „ Hp ,,. Married ,,. Martha Kokko , aHfD IN 'r~ivti:Y. GtVE ~K~~wT~~"'~"~N~~~~t~~N~hrMh.M+I/K+M/ KtNO0iM1S~tifSSONWOtlSTI~Y -u~>t'O^~ 6E`~E ,,.. Superintendent of Public Works „~ Villape Government ~ , RES~OENCE-STA7E C01M'r71r C~T/. VILIAGf p1 IOCATION STREET ANO NtlM~E11 ~NS~OE CtT~I LIMITS rs~yp r., «irq ...Nichigan ,.~ Lenavee ,.~.Blissfield ,.,. 201 Quick St. ,« yea fATNER-NAME ilr» LM~t /~w Y07NEN-YAIpfN NAYE iM YW~~ ~ ~s Ernest Curnaw ~ ,~ Katherine Hc Grepor ~ NfORMAlIT-N/WE/~/-~rl-rry YAIIINGA0011Eft (fT11EETORII.F.D.WJ IGT11d1TpNNl IfTAtEI 121~) ~ - „~ Martha Curno~r ,,, 201 Quick St. Blissfield, HichiRan 49228 AMROX WATE INTERVAL ~twwT t. OEATH wAS CAI~SED BY: (ENTER ONtY QNf CAt/Sf 1ER LfNE iOR (~1. (0/, AND k1] ~f TNtEEN ONSEi AND OEATM , -- ~~ . ~ IYM~E D1ATE CAUSE W / . ~ - ! ~~ ~~~{,~~~~~F~l~- -- OUf ~O.OR AS A COM EMC _ - - - CaJt~wr. ~/ w)_ .Ar! ~ . ~ I ~ ~~ ~~ OUE TO, OR AS A C alENCE Oi. ~ 1~r~ cwur 1~t - . ~ \ kt -ARTIIOTMENS1GN1i1CANTCONpT1pNSCowA~eyiennM~eYplwe-~rewWwYalNtw.M~i.ww/r~//~/ AVTOKII NASCASfRE~EpNEDTOCOI10NE11 /Yn er +ol /SM~Ii Yn r Xe/ _ - ,s. /i(p ,~s Np ACC_SVICIOE.IIOY.IlNOET., OAiE0~1MJlJRY Np1M MONINJURVQ~NAREO/E+N~w.~rwN~M+1wIM/MM)1.1~111 ~ " --- ON -ENdNG ~NV EST. /Srcyjl IMe~M. A~. Ys/ , - - ?O~ ]m 70c M 70! INIIJRY AT YqIIK KwCE OF INJU1111 Ar 4..r. Jlr.~_ wwel 1~r~ f IOCATION /Srw~~ a. R f. Q.s. Ht7 r.~y~. s~N. ay/ -_ ~(~Vixaa+rl ~W[_~.liMqbl /1 // 7A / / ~ o NG CI Ody To b~ Cowd~ud ~7- CORONER Oaly ]la To W ba w~ M vw_ W s.0 w ca.rb! ??s O~ tlr bs~ W~.~w+~a~on ~M/or .ww.~ynow. +~ rwr ,~ . Mw~ ,.. .-i M Nr t.w. ew q~_ MO iMC~ W dr~ b 1M wMltl ns~d !i ~/ ) ~~ ,. (Jr+~re ~1 TrY/ DAiE SIGNEt . 61. Y R OATE S~GNEO /Ya. p). Yw/ MOUR Of DEATN ~1 a7! ~ ~ ~ , y I~ ~14 ~ ~{~ 1/V • ~~t. Y T70. Jh _ / -wOMOU~+CE00EwDfM•..O.l.Ywal -~OMOUMCE00EADINe../ ~ v I .7lA.OM ??~ AT w I M/uME AMO AOpNE55O~ CERT~f ~E~t VN~f~C~AN OR Cp10MEN1 (7~ sM+~~ ISrRn rR.i.Q +~. ~ r~W~f~. ~ru. ~M/ , ~ / 1:S ` ~ , i ct~~ L. -S~c~?.:c~~-L,,~ ~~)~ !1._Sj ~~ci /~/r~~ t/~.c ~ f ~~URIAi. CRfYAT1pN, pATE NAYE OF CfYETEN~ 01~ CREMATOP.1/ IOCATqN (CYQ, ~~.O~fOMf1/ ISNUI) E , Burial ,.~ 8-17-80 ?4 Pleasant View Cemetery ,., Blissfield, MI 49228 E NAYE Of EY~ALYE11 4LIC. N~.1 fUNE11AL O111ECtOR'S SK.NA qE ILIC. Ns.l ~ ,, n. Ii.P. Tagsold 3948-R ,s "~~~~ 4014 iUNERAI fIRY AND ADOIIESS tSTNEET NO.1 KIT1/1 tStATEI QMI j +_ f „ Ta ~~ 1 Ho ~.~101 Lane ., Blissfiel~ M 4 8 w7E NE ~r R T T !/ TE ~EpY1T tSStJEO SIGNATIME OF • 155UIMG ~ERYIT p~~ u w~ pEG ~ ~ .~ 2 ~ . _ ,~ ~ ~~ ls -'~,, ~~ .- ~ 6 511620 ~~Aret~- oor'tify thie to be a~e ~ ti~Af~~Cr~ pt ~r a r~ ^c.3 e:~ °ile in tDe ~ $t1f~t-± ~: :'t• t : ..'' _ . . Toledo. ' , _ ~ ' . ' ~0 CEC 24 IU~I ~ 37 n~i~grti: _ ~~~' - . _.,, n~~o. . ; ~::' ~ ' ~- .; ,~ , ~__ . FIL~G RN~ F~CU6I~0 C ~ t,. . ~ • . , r ~ ~ , ~~ ~~~ ~ - € ST.tuuE couvtY r~ ~. • ' ROGER P01 ~ RAS , ' ; ' ~ ~: ,~ ; y, ~ s ttERK C4'tCW 1 CQL'RT __ :. _ ~ . : ~'~ ,~ :r. R~:g ~~•'yf'~; R[tr~rti ~~ eE: ~tr. -~ n~t_rc :.. :;'_E~~., is _ ~ . - . ' ToleQo, Ohio ~ ~ ~ ~ ~ ~ r - ~ " ~ I f; ~ I MacMILLAN & HALLBERG ATTORNEYS-AT-LAW 1074 N.E. COMMERCIAL STREET JENSEN BEACH. FLORIDA 33457 i - ~ ~x;~~-~:; `;%~~ ~7~5 311~3i( PA&f ;, ~