HomeMy WebLinkAbout0917 v~ STATE OF MICHIGAN S'
Lf DEPARTMENT OF PUBL~C HEALTH
CF SL~ STATE fllE NUMBER
C~RTIFICATE OF DEATN '74(~jSl
. 0769749
DECEDfNT NAME rues~ woo~[ uSt SEx QI1TE O~ DEA1N /Ab. D~y. Yr./ !
, F,.[~IOGENE GERTRUDE JOHNS4N 2 FEM~ILE , OCT 02, 1985 ~
MCE-a~ ~MU~ M`c~ ~uwc AGE-ua ~.~wti UNDEN 1 YEM UNQEN 1 DAY Q~TE OF BWTH lAb: D~Y. 1'~I COUNTY Oi OfAiN ~
~ 1SPKr1Y1 !Ya ~ros~~•s ~.cxiws T wa
s, y0 ss s~ a NOV 06 ~ 1914 KALAMAZOO ~
IOCATqN pF OEATH ~~ry iyr~S ~y HOSPITAL OR OTMER INSTITUTqN - W.r ~er ~ w~~« r... .~.~er w+....e~.~ ~
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„w:v~~ti~ []„a,oE,,,,~.c~„r,,:o. KALAMAZOO ~ FRIENDSHIP VILLAGE: MED.CTR. !
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«~~o« s MI _^.~9 USA ,oMARRIED „FRED a.JOHNSON 12 NO
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5tE ~r~M~u SOC~A~ $ECURIT~/ NUINBER USUAI OCCUPATION ~Grve k,nd ol wwk dpne durrng rtqst o/ KtNO pf BUSINESS OR INDUSTRV
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caunE~aNa „ 368-03-1990 HOMEMAK~ OWN HOME
~ESOEMCE ~iCYS _
CurwEMr qfti~pEr~E STAIE COUNTV ~ LOUI~TV wsw[ un irwr5 0~ SYHEET ANO NUMBER
~ ~c'"`'` 7656 W. MAIN ST.
and sPKVh'/ wS~M v~tuct ir,ris or
,R, MI ,s~ KALAMAZOO ,s~ fx? *w• a OSHTEMO ~iLAMA200, MI
FATNEA NAME rwsr woat ~~~st ~ MOTNfR- MAIDEN NMAE :w~t r~oO~E ~ ~~5~
,a FRED BOSKER Y~~, r HATTIE STRYKER
WFORMANT MA4lMiG ADDRE55 siMti o~ ~~D r~0 O*v O~ torw St~r[ 2~? p
~°;°;N'~"~ ,a.. rs~»,~,,,~, FRED O. JOHNSON ,eb 7656 W. MP,IN ST; KALAMAZOO, MI 49009
c~~ t 9 IMMEOIATE GUSE (EM1ER O/Y[Y ONf CAUSF PER L/NE fOR /i/, /bJ. .4N0 (cl.1 r+v.~ e.~..+• a.nn .+s ~.~e.
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r~r~coutE PARt t . ~f ~
s~~rw~cf~~.[ la! S(~ 1~N ~ I~iv \;Y~i J\1v~: ~ a~ i ~ O~ i~
DUE TO, OR AS A CONSEOUEKCE Of: I~r e.~.«~+ e~n w~.u
c.ust usr
ro~ ~~1 h v~( i G v _ i~a t~ ti t.
DUE TO. Op AS A COHSEQUFNCE Oi 1'"'aN' ""'a +"r Nn^
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PART 11 OIHER SIGHIfIC/?NT CQNDITIONS-Co~a~w w.a.+M b w+~~ e~ ^w ~+ww ~o c..r r•." ~?~~1 ~ AUTOPSV jSpetrly Yrs WAS CASE REFEqREO TO ~1EOIC/1i
I or 11b1 E%AMINEA~ ISPK~h Y~~ or Hol
bS(LUUn~?an?~:~ ~.~v~~1.1~1.~ fZO Il0 2~ IIO
~ RACE OF DEATH ~H«~a Krvy raw~. • F HOSP. 01i INST. w~ca~. ou~--- 2Ia
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Aa 1aoN~ nb Inpatient
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p Z ISq^alure and T~fle1 ~ S__., ~_N ~ J' lSr9nature ans TiIM/ ~ `
. Z~ DATE 51GNfD IMo., Dar Yi.1 HOUH Oi DEAiH <Z DATE ShiNEO l~., ah'. Yi-) MOUR Of pfATH
~V L V~ `
s> 23b ~ p, '3 L`t ~ 23c _ '1 ~ y S PM W< 24b 24c M ~
V~ NAME OF ATTENpING PHY$IqAN IF OtHER ~NAN CERT1f1ER (iyptd Pnntj ~~%it PRONOUNCED DEAD /MO.. Day. Yi_I PRONWNCEO UEwD IHOU~1 '
` 23d 2ad ON 2te AT M ~
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HAME AND ADDRESS OF CERTIFIER I~VS+CUM OR MEDK~I Ex~MiMf111 /T~pe p/ Plintj
2s ~L.OV ~ 1.. n S_ G 1~. c?~± i~r, iV11 1...1~ ~lo?n ~Ct ~-t?•n?tv,• N. Ll 4~j041
~ac;. ~;,r.:,F :~,,:a. :..run..a ~(1AIt OF 1NJURY I/.b.. Da/. Yr/' M(~UR Of IN.yURY ~~ESGNIBE H01M1i MiJURV OCCURREO
. M ?EMDWG NvESi ~S:rr:Iri
~ 267 26b 26C ZBd
~ NJURY AT WORK PLAGE Of INJURV-~~ ~a~e ~vm m.a r+c+on. a~ce IOCATION S~~EEt ai ~tD MO OT`I. VI~\AGf oe rOwNS+~v ST~tE
($petdy Yes oi IYoI w+e.q. Mc /Spec/I~l
~ 26e 261 26y
i BURiAI. (~tEMAifON, REMOYAL O~HER CEMETE1tY OR CREMATORY-NM1f IOCATIpN or vsuGF o~ rowr.s,.~r Sl~~[
' ISpec~Nl
~ 27: BURIAL 2ie SPRUCE MEM GARI)ENS KALAMAZOO~ MICHIGAN
r ~ ~ DATE lMo. DaY- Y~~l ~ HAME OF FACIUTV ADORE55 OF fAGitTY ~
t z~dOCT 05~1985~zaL,ANGELAND MEM C L;622 S. ~RDICK;KALRMP,ZOO, MI 49007
B•~8 FUNERAL 5EI lt E REGISiRAN OA1 CEI 0 BY REGISTRAR /Ma, piy. 1
rjl$3 IS~gnaturtlL ~ tSqnsrur0l .Ysl ~I
i 28c ~ 7/'Z~y~~' \ 29s ~ 29b _ v 1
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~ STATE Qr MICHIGAN I, JAMES O. YOUNGS, Clerk of the County of Kalamazoo
ss. and of the Circuit Court thereof, the same being
~~QUNTY OF KALAI?iAZCO a Court of P.ecord having a seal, do hereby certify
' that the abbve is a true and correct copy of the
~ ~'j ~C 3~ P2 ;35 original thereof on f ile in my of f ice .
:
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~ Signed a~d sealed at Ka azoo, riichigan,
4 Fllc ~ .
~ ROGE~~ ~ . this_~~hday of I985.
SL ! UCi~ , _ .
'740081 . JAMES o. YOUNGS , County Clerk
. ~ ' ~ Byc~ ~ Deputy Clerk
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NEIL W. MacMILLAN~ ES •
POST OFFICE BOX 167
f'' 1074 N.E. COMMERC~AL STREET
~ ~~K ' ~ENSEN B E ACH. FLORIDA 33~5~
aooK 7 pacE ~~.s
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