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HomeMy WebLinkAbout2344~\~/A~ ' ~ STATE OF MICHIGAN Lf _- __ 1 ~~~ ]' ~EPARTMENT OF PUBLIC HEALTH ~1~'403 ~ ~ ~. ~ 0 2 3 4 516 CERTIFICATE OF DEATH ~ STATE FILE NUMBER IoEC[uEnr w-~ w~s. ~.oou usr , sEx wrF o~ oF~YM ut~w. o.r. n~ ,. Garnet I,. Mitchell ~Female , 9-25-1980 MCf-h~. w~.~~. M~4 ~ww AGE--ni M~ UN~~. ~11 ~1_YEAII ~NQER 1 QAV _ DATE OF MNM /Ab. DIf: n'.l OOIN'~lY Of OEATN -_`----- w.~ re~ /Sprah/ Ki/ ros 1 O~•2 MOUK~~~rr.s .. White s.4~1---- 60-- 1-- ~` --1---- "- ~-10-1933 ,. Wayne -- W~'JITION OF DEATM wyp~ un a,yus a ~NOSMTAL OR OTMEN WSi~TUiqN-~r.~ rr.w..w. r.. w.....~..wa~ ,c~-«. o,~. De t r o i t i • - ~sPK~hl ~~ws~ot vaisu i~r~rs a ~ Sinai Hospital 7s. ^ ^"' °' ~ , ~ia • ~ st~rc ar wrM ~r...,. usw pt12fN O~ MMAT COIWiR'1 y~MEO M[vl~ ~~~wt0.- SlH1NVWG SPOUSE /Ywdk ~w m«d~n ns~.~~ w.s aaocwi ivE~ +~ .~.~..~««~i w~oowEO. ava~uo ~s~«w~ ~s w+wo ro~asr «~~ow .. Michigan a U.S.A. ,o. Marrieci „_ Richard E. Mitchell ;'2""~""""" No ~-~n~. stt r~rw~ SOGAL SECURITY NUMBER ~ ~USUAL OCCU-ATION /Gn~ trnA d wwt don~ iu~wy mosf d KlHO OF sU51NES5 OII MIOUSTRY coun[c~ ~ wwAy~y p/it evln :I ntr~d/ ~5,~,,~«,t~ ~a 382-30-9914 ,., 'Optometric Dispenser ,., Birwood Clinic ~ CUMENTIIES~DENCE-STAfE aouNTr ~ -~ wcwurr ~c.y«an~..na Farmington 3iREETANONUMBER ra»~4 ~. Michigan Oakland in°tP"'h~0"""~"°` """~ `"":°` Hills 29816 Fernhill , s,. , w ~ s~. ^ iw. o. ' , sa fATNER-NAME a~ir ~roo~e u.st I~OTHER MAIOEN NMAE ~wsr rooiE uit ,s Robert C. Cochell ,,. Josephine Kniffen INFORMANT 61A1LING AOORESS st~EEr o~ ~ro w ~~ r~ ST~-F t+ `°~°',;,,'°"'~ ,e,,s~.,.~,,,.-- Richard Mitchell ,s, 29816 Fernhill Farmington Hi11s,MI48018 ~C" w~ ~19. IMMEOtAiE CAUSE /fNTfR OAKY O/Yf CAUSf ofR~ fOR l+l. fel. A~ND fcJ./ ~ w«.+ rr+ w ~w~ ~rwOU~E -ART I'.1 ~ ~ n`~~~1~~f '~ '~. //~~/~'i St~t.~.,sE G"~it A~,C C w-~ ~'Q~• ~ • ~~•"otK~wc OUE TO. OR AS A CONSEOUENCE Of: l rw.r ~.w w~..w ~~USE lAif ~ I~~~ ~ ~ ~~' ~ _ ~ ~~ _ - ~ ~ %~/t DUE TO. OR AS A CONSEWENCE `~%~"~'(/`~/ - '/ ~~r«.r ...M ur ~.M • (cl v _C~'~`-S - - ~ `~ `-~--- "- ` -_ ~!`~ ~ - -- -~ ' YARi II OTHER $IGNtf!CANT CONDIiION~~r~ rs~e.+w~y b MKw wM -a ..ww wv y~..... ru~r ~ AUTOPStl ISPKM ~'is WAS GSE NEiENHED TO ME01CAl `/ Ar /yu/ EX/-M~NER7 lSp~c~M Y~s oi 11b1 ---- 2~ YC~ 2~ ~ pi pEAiH ..a.. w..y >:oi.~. - -- -f MOSP OR .» ow -- - IN rl ~ • d . . i!SP h'1 ~ • 0:lw Ir~. w/ K.~Y/ ~C/r`~ ~,~j ~ cn~ w sMr~.w wa ~e w~ w~wscr •.«~~« s car ~ ~-~tn I n~n w» ~ ~ Oo~~ (~ O~ Nl MM ~ M . YWM ~wM'W'0~ ~~ aM"a ~MA ~co~~M M M 23i io M MM d+/ \woMMy~ OIJp~ p fwy Nt~ W~ N LJ e..~. ww w r.o w s.e b~M awM'N VM~O IM u+wY ql~M p Z !Sg^atum and TifhJ ~ _ ` t(Sqnatuie ~nd TitN/ ~ ~ V DATE SKiNEO /Mo. Dag Yi.~ R Of OfATH vZ DATE 51GNE~ fMo..Oq; Yc/ 110UR OF OEATN ~ t> 23~ ~ O 2k : P• M w< 24A _ 2~c M ~ ~ ~ -- --- - ~ x - V~ NAME Of ATT D~NG PNY$Iq 1 TME TMAN ~ER /T~o-Prinf/ ~ V110NOUNtEO OEAD /Mo. Diy. Y/./ PIqNOUfiGEO DEA~ /Hbvr) 23d. /~~~uQ~~iln ` 2~d ON 2M AT M~ • ~f 2NAME ~ ~i`=CERtIF1ER /+~~ o~i ~ { / -' \ ,^' 28~~s ~y~~ ~' +'\ ~~/V /' • ~ ~~+ O ~~ .«. w~c~ ~.o~.. .~,w o+-re u~~uar r~. o.-: r..~ Noua oF u,~um oESCtueE Mow wue,r occunnEo a~ ~t ~`~`' 26a " / ~ 26A 26c 26d N.IUNY AT WORK PLACE Of INJURY - ~~ w~. r..,.. ,r..,. e.ns~. ,~e,~. IOCATION sr~tr o~ ~ s D-a on. vRUC[. o~ rorr.~snr sr~re (Sp~n/y Y~l W Abl wr.~ wc (Sp~uly'1 za. zsr ~ ze9 SUR1Al. CREMATtON. REMOVAI, pTHER CEMETERY OR CNEMATORY-NAME LOUTION Ofr. vauGe. o~ rowwy.s Sr~r! ' 275;"'~'~ Bur ial . 27~ ~ Holy Sepulchre z7c Southf ield, MI . ~ ~ OATE /Mv, Di1! Yi.l ~ NMAE Qf FAUl1TY • ~~~~ fp,~TM12 Mile Road 2„ 9-29- 80 ~ McCabe Funeral Home 2~ •~ ~ ~ 8-38a ~NEML IKEH E REGiSTMA D~V REG~STR/-N liMo. OM ~s~~sl `~~9" .e/ IS%9^f .l ~ t ~r`~IJ~V r..~ ~ ~ ~ • s"1~ ~` V : ~ - ' •'. . e"J Ty . ~ " ~ - : . - ; . . ~ ~' „ -- . • aw~w _ ~ t } ~ 1T; i _,~ . _ . , . ,,y~` ~~ ~ '~"P ~{~ ~ . ~• .. ~ 1 , ~ .~ ~ J . s~ ~-+. : ~ ~. r tUIS CERTIFIES THA? ?HE AEOVE IS A TRUE COPY OF E11C'[S REC , ' OF TfiE PERSO;I NA`tED HEREOTI. AS PILED A? 28E D.ETR~OI? DEP ~J ~ ~`~-- . _ _ . -. _ . . _ _ • r. • , - - ~ ' /~s ~ ' .x~ ~ ,• . ~ . " ,' OOL~A?i A. YOUYG. MIIYOR ' CIiY OP DETROIT' . $EP 3 01980~ DATE~ 5155'79 c . ' _ t = ` . j u,v~s~wue. ~ru. uECOans .DEiROIT DEPART`tE.YT OF N[ALTI[ •.. ' • 19~t FF° -2 pM ~: 26 F~<<r ,ctic F~c~r~~t a st ~uciF cc~uv r Y r: a ROGEit POItRAS CLEHN CfRC:i!' Gr~Uf~: ~ s,: ,. .", , : ,_ .. ~~ a ~ 4 ~noK 347' P~~E 233$ ~ ~. _:~~:, _~ : ~ ~`~~~~s.:~.-~:. - ~ $~~ __ ~ ~