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b~3yb8(~ ~Q~,~9 STATE OF MICHIGAN ~ .
Y,f ~ DEPARTMENT OF PUBLIC HEALTH
- _ ~ ~ o STATE FlLE NUMBER
( 031~438 _ CERTIFICATE OF DEATH
DECEOEM NA~AE ~~~sr ~rDpiE u5T SEX QATE OF OEATN ~tiro. D•~ Yr)
ORMANDE C. NAY 2Male a Feb. I0, 1983 '
IMCE-~•~. w~a ~a. r.~..K AGE-un e..w. UNOER 1 YEAR UNDER 1 DAV Ou?TE OF BIRTN fMo. Oay. 1'~l COUNTY OF OEATN
~ee ~ ISPKiIYI ' ' YOS o~r5 ~.W~S Mw5
~iite S,. ~5 se s~ ~ eJun~ 6, 1907 Wa e
lAf'~TfON Oi DEATM ~wypE ut+ ~wriS or Livonia ~NOSWTA~ OR OTHER INSTIiUT10N-tir~ ~N.~w ~..I~« ~....r....r.~~.+.s«~
(CMcA on~ ~ •
~da~ a i St. Mary Hospital
7D ~ Tw? or ~ 7c
~ fT4T[ Oi WTM ~n..or:n US• ' pTIZFN OF MMAT COUNTRV ~AMED. NfvF~ M~~infD SURVrviNG SPOUSE /K w~h. g~v~ ma~den nam~/ WAS OECfDENT [YF~ w
nyw~ cp,,•~1i VMOOwEO. dVp1CE0 lSpec~hi U 5 ~MFO ~O~CfS~
«~w
o w s_ 9 U.S,A. ,o Married „ Alice Webster 12"'~'Yi`~S""'
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5[t ~uwi~~ SOGAI SFCURITY NUMBER USUAL OCCUPATION (Gn~ bnd oI woik don~ dunng mosf o/ KIND Oi BU51rJE5S OR INDUSTRY
~W~p~ woskiny lih. ersn i/ rstri~dl
a 363-07-2732 ,s,. Supervison ,as Tele hane
11ES/OfMtE ~tEMi
~ Cu~~1ErR QESiOEr~CE-StAiE COUNTY LOCAl1iY wyoE utr ~wrrs a STREET ANO NUMBER
(CMek one
Michigan Wa}me ~nds~~'~~~'~ """'S 15319 Northville Foreat
~s. ~se is~. ~TM~? ~ Northville isa A t. 2
FATNEii-NAME srKr . ~~ow[ usr MOTHER-MA~DEN NAME r~~sr r~oo~t utt
16 Elmer Hay „
M/FOFWU~MT MAIL~NG ADDRE55 ST~EET p1 N f D r+0 Or on tOrw STwiE 4817On?
~
~,9„x~„~ 1eD 153I9 Northville Forest Dr., Plymouth, Mich
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bSE TO
MU~TE PAAT I,aI C A R d ~ ~S L. M oa A 2-j A~C R L~ ~ ( ~l
ST~TU~s tME
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UtJSf UST •W
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DUE TO. OR AS A CO SEOUENCE OF: ( w.^~ sw.«~ a++a +'r aw"
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PAAT 11 OTHER SIGNIFiCANT CONDITIONS-Cawaan ca~t.a.+e~q w oatn e„e .w~ .w~~e +o ca.~v y.r ?utr i AUTOPSY (Specily Yes M~+~S CASE REFERREO TO MEOICAL
E I~ pr Np~ I EXAMINER~ /S Yes oi No)
` C~k/BoNi~ 7.1<. PCisS.6~t ~IJ{,-~O~e1R N¢..o l~v-, o no iz+
i PLACE Oi OEATM uw~.. ww f HOSP. OR 1NST., r~e~c,u Do• 24a. ~
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~ 22~- ~ ZIb. rK,.. ( ~ o~. tw~ vs ~ jNro. nwsty wry + x w N t~e
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er cr~sMY riwe ~ ~ / ~ I f i `f ~
~ ~ /SrQnatuA~nd TitN) ~ - ~ !S ture and Trtl~/ ~ ~ ~ ~ : -
Z DATE SKsNEO /Mo., Diy, Yi./ HOUR OF DEATH V OAT ~GNEO lMo.. . Yr. UR~~~pEAT
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z~e ~ R 1\ 1 z3~ 1 P M W< - zk.
~,Wj~ NAME OF ATTEH01 PHYSIGAN OT11ER THAN CERTIFIER /TypeorPnnfJ ~W NCED OEA MO., Oty, Yi.J PFlONOUNCED DEAO Houi/
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23a a o e t 2a. wr ~ a 0 M
~ NA ~A(NO~
A.DDRE55 OF CEi1tIF~1~+ I~ry~ur~ pn ~EO~UI Ex~MwE~i l~yptW Phnf/ ~
~ is ~~Q~`2v` ~ 1' ~ ~tr ~ L.. ~ 2~ ~ ~Q , ~1(L•~?~ ~ ~ A s. N 1dCcc~IC~ /~ce~"-y
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~ wt[.:SUiCDE- wOr rut~4~ pp7E OF INJURV (MO, Os~. Yr./~ HOUR OF INJURY DESGRiBE HOW IN.iURY OCCURREO
~ OA rEpOwG +MSr ~S~rc,ry,
~ ze,. N~turel zse. Ze~. zea
NJUR1l A1 WORK PLACE OF INJUR`I-~~ na~r. r.,... w.a ~.c+ar. orro IOCATION Si~EF~ O~ p F O r+0 Or. v1uGE a+ rp~wn.3..v St~rE
i~ (Sp~t.y Y~s u hb/ wd.~s wc /SPK~hI
~ 26~ I 2af 26g.
e BUPoAI. CREtitASlOt~. FE~tOVAL GTNER CEMFTEqV Ofl CAEMATURY-H~ME i IUCATION o*'~ vuauE o~ iowvs~~r STwrE
/SP.crh/
~ ~ ~ 2,, Cremation :~e Evergreen jz~~ Detroit Michigan
OATE /Mo., DiK Ncl NAME Of FAGLITV Avor~ss oF c~c~~m , 48I54
4 2,aFeb. 14, 1983 Ze~t'red Wood Funera Inc. zae 36100 Five Mile Rd. Livonia
8-36a NNEanI SE UCENSEE REG~S7fuR • D~TE RfCErv`e0 8r REG~STRAR IMo.. D+1!
~irei> lS~9ni?..i b r u a r y 14 , r..~19 8
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CERTIFICATIO~ ~ - ` `
~ - . - _ ~,r~`~ . JlW 24 A11:d7,f~
~ - .r,~~~.
I hereby certify that this is a true copy of a Death,.,~?4~rkificafe. on file in my office.
~ FILEO ' " ' ~
~ " . , ROGER = ~ i F K
~ ~;~`;K 45~ t~~~3F ~`77 - :~'~:f~~~ ST. ~~~E :.~F~.
~ R,obert• F. Nash,; C~t .Clerk
.Y
_ _ f_` -
~ ~ City of^L'wonia; VO'ayne. C.bunty
~ Date ~..~-~~Q-h-~-~ ~ r~3 State of Michigar.
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