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HomeMy WebLinkAbout0957 a . . • . • . . . _ ~ 1 . . 1 . . . ; . ~ , . . ~ ~ , . - . , - . . , !j(~ MINNESOt/1 DEP/?RiMENT OF HENl1H ~'i k 5V~J1~9 ' Sattiaw o/ Vi1~1 SUtit4n • ~ ~ , CERTIFICATE OF DEATH . ,T~,~ ' ~ ~~ws• ~oo?t ~~s• ].flZ ~.OATt O~ D[ATN ~'oM*M •w• ~c~¦ ' D!ClAflO - NAME ` . - ~ ' GENEVIEVE KATHERINE PE'fERSON Female December 9 1 6 ~aA6! s~T {Jt~DERONE •I1NOflONEW S.OAT! 01 MlTN ~+owTw o~• •t~~ ~•lACt a~tt~?• ~.COYMiTqOl~TX ' ~n~rw~n .s ues ~..wres ` 60 November 2 1~16~ . White Henne in )~.IOCATION 0/ OtATM IC~Ttr.~LL~~st ow towrsM~M t.~+«c~•N~~ )I.NOf11TAl Ot OTNLI MfT1iUT10N- NAME I~r wsr ~wt~~~c~. cw[ ~ snccT uo w..~un Minnea olis Yes North`+estern Hos ital~ 3 . reTHru?ce Iss~TC ow ?e~c~c+ courr~,~ . qiuEN Of wNAT 10. MARlIEO NEvEt MAtMEC. 11•S?OUS! - NAME ~ - counm vmoowEb, avo~c[o s.cc~., Minnesota - U.S.A. Never Mar~ied f i Z.Wwi DECEASEO EVERIN U.f. ~D. fOC1At S[CUMtt NYrWt! ~~•YfYAI OCCY~ATION Kwc ¦.o o~ +rawa^ ONO i~U MES Ot WOU itr i ~eMED iOtCEi ~+t+. ou~n.c..osr or ww•a.c ~~c. cvs¦ ~ ~cr~ca i No 4 6- O - 41 Bookkee er ~ccountin 1 S~.tl90[NC! - STATE 1S?. COUNIt Sa It1. VIIIA~',E OR tOWNSMI. SI.~ Minnesota Henrie in Minnea olis Yes • ~ ~~~-~AiN!!-NAME - ~?.pltMRAGE sT~1~~~a~~~ ~7.A001lfS 01 OlCEDEN~ s*~ccr •ro ruwu ' , ~est or~~cc ~ . cawr~tl ~ OC Pet r• t rson Unkno~+n 4 1 Grand Av+~ntte South 40 ~ ~ 1i~.MOMlt-MAIGEN NAME t MIIiMKACE~sr~*cwrawc~c 1,M1/Q~lNANT-NAME noo~[ss . M : couriw~ r i Anna Anderson Unkno~+n CZarence Peterson Santia o P~QJ. 77 ~ ]0_ M~t 1- OlAiM WAS CAYSlO ~ENTE~ ONtt ONE C~?USE ~E~ UNt 1~~. 10 wNp ~C~~ is O~GwOS~SOEfE~tED ~~o¦~~•« CKCa ~O¦ •[trlr[[MO~3C* ~~O m . w. uNMEO~wiE cwusE ' . oc..¦ M ~CS.`~ ~v ~`~•\J~z _ ' . O T • u, F L OuE TO,' O~ wf A_ ` • ~ ~ CONSEQUENCE Of b ~ : r ~ ~ -st ~s t F < t Z C.OUE TO O! AS A ~ - _ u - _ . . ~ CONSEOIJENCE Of ' - # O ~ ..wuro?sr w r.....~o.s.c.o.so..e ~ z .w.T ¦ orNa sa~ar~cwNr ca+araMS ~ ` ~L 1. O\ _ t-~ ~ 7 Kp17 ~Lf OI ~ pttW~G CWM Or p~rw . ~ ~ ~ ~ ~ ~ ` ' a ~ ` ~s ~-t W C S L S I t?)a ACGO[Ni, fY1G04, MOMIGOtOR UH~EiERJWNED ?.OATE Of 1NlU~t ror~w e~• •c~w rovw o1N U s~[ ~~a w wo ~ ~ V ~RUi• - - ~ I IL If OE~EftEO I. - , ! tKta ~pa . . ~ . I, f" ~U? 1NlU at wo..c.ru?~, sT~[[r.r~cto~~.o~rcc ~.l A _ sT~c[r w ~ro ww~c~ cnt.~auc[ aw rowr~srr couwr~ sr~rc ! W ~uRO~K [tcJ V ~ ! J 22L MOW MUURT OGCU~lEO It»r[~ ~~Twc o~ IMNA~ ~w~s i Ow ~~u• 11 . ~rc~ 201 ~ 1 < . A ! u ~ 0 27~.CNiy1GAi1pN- M1ISICIAN - ~ tnmcwnoN - ~tacw~ e:ww~ca ot oeoMei ~ ~ W ~ MMMI ~f ~KMt~ ~,w L• ~I ` w~ 1.~ ~l -~f b M/ Ow w M~ia d M~ e~~:~w~ d ~M M~f ~/w N~ ~s~sipiM, i~ wq ~Nw:r /eow U j- ~ • s Nn N~r ~iw/M dn~ M ~7• -1 -'7 L.IIfI.ld+~M~~M~~MsN~ ~cc~MN ru,MMeI~w~Iw»~Mcws~~nrel~Mw. iMMc~er m _ Yt~ . ~ ~ i ~ O~N~iOnNN~rM rw~Nc~w/~iw~~wM~w fIW~~MMM~M ~fMMMIi~I!«M M M• ~ ~ } ~be Mp d w~ ~M~~ ~~R M rKwr~~ ~ tMl ' 77c•~IITaC1AN - fIGNAtY¦ • ~ t-INlOICAL [iA11AWU O~ COlON[!-SIGNAtYtE W ~ - 1-C~ - ~ ~~LJ _ „ ! h 17~M1SICIAM-NAME Itr~C ~wi..r/ MEOICAIE~AMWERO~COlONH-NAM[ Ir.~K O~ ~w~~i~ \L ' ~ • ~ ? • ~ " F- C- V ~ 7~MA/lINO AOD~ESf ?w•s~c~ww, ..ao~c~< <-~-u[~ ow tww[w , 1?OATy~ICNEO o~r ,rc.w d Sistez Renny Institute 1800 Chicago Ave., Hpls., Md 55404 . ~ < Is?ccNi?~~~'~~~At~•~~VAI 2!?CtMEiEt?O~C~lMATOlt~NAME . 14lOCAI1ON IC~~i. ~~?ust ow cor~~~~ ~ss~*c~ O . ~ Removal-Burial Danish Cemete Rural Hecker, MINNESOTA W~ ~MJ«~ pE ~'IOM,w ZS~IYNEtAI MOAA[ - NAME ZS`IUNEtAI NOME - AOOLlff ~ ~ Dec, 1 1 6 PETERSON-GRIMSMO CHAPE 530 oadxay, o tice o, MINN.•o a OAT[ /1?EO ~ IOGA~ REGKTtA~. ~~Si~A~ Rt O~ /YN tE < ~ ~EC°~~' 1~1'6 . 2, 6, ~ - m . ~ . ^ _ . . _ ~ . . . r•..~ ~ ~ '~jt J~~• ~ • ~ . , 119 I, $uth s Deput~ " IIe of Yital 8ecorda !or the . ot `:~finneaotis~; it~ t ths abo~e a trne ~~~~Y 28 . l~ ~1i8 correct. ir~ , af, t,1~e: ;_~S- . til ia Health tr; fc ~K~'R~cok:ra DAplTtiOf~ r ~x , i~ S L L'C tE u!. V ~ y, I•• ~ ~ - n~~GE-R r~!; R~ S,. ; ~ : b . C~:Rf ~~•:4.; L:,~, Dateds . ep~ty Local Registrar . . . . : ~ ,t;~~` a N.:~:;, ~ , M~I alterstioris~`#~ho~rt vere msd under the authority of Mitinesota Statutes ~ ! 19G9, Sectiori 241t~~''and th regulationa of the State Bo o Heal 800R J~ PA6f ~ - - - _ - ,