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~ ~ ~ STATE OF MICHIGAN ~ ~
DEPARTMENT OF PUBLIC HEALTH
~ ~ STATE FIIE NUMBER
~ O~ O c~ O O CERTIFICATE OF DEATH ~4164'~
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DECfDENT N111J~E Fsst ~roott u?Sr SEIf DMiF Of OEATN /Ma, Day, Yv,/
Erra G. RICHARllS 2 Female , March 20, 1981
IMCE-hs. AGE-~w ~.na.~ U / YEAR UNDEq 1 pAV Q11TE OF BIRTN /M0.. D~y, Yil GOUNTV OP QEA7H
~ ~~r~i ~ d,~ a A~. ~ 18~ 1911 Ma~omb
lOCJ1T10N OF OEATH ~ ws~OE Gtr uwTS as. { NOSPITAI OR OTHFR INSTTTUTION -hrw~ ~r war w«e~+ :~.r~ nnw Me wc.ws«~
~°,y~ a Karren ~ Ni tin e Nursin Home East
. . n- ? „M. ~ Sh ~ 8
s*~Tt oF wm~ iar..or.~ us.a dnZEN Of NMAT COl)NiM ~~eo. wEVE~ ~ru~to. SURVtVWG SPOUSE (N wile, prw msiden namsJ Wwf D[[EDENt EYFR N
~«.w~ w~oowco. avoac[o rsr.ca4~ u s wiwco rwcES?
~ KY 9_ USA ,o_ Married Elick Richards ,'~°'~'"'Ntt'""
stt ~riwwt SOCULL 5£CUAITY NU108ER lJSUAI OOCUPATION /Criw krrd of work done duriny mast o/ KIHD OF BUStNESS OR INpU57Rn
~ 381-12-4399A ?w.*i ah...r.., Ancan.a~
~a. Bus Dr~ver ,ao. Hetsex Academy
~ CIRAEM' 11ESDfNCE-STATE OpUNTY LOG~UTY wsio[ pn urns or North Miami STRfET /WD NUMBEq
Florida ~ Dade ~••~*S o~ 1105 N.E. 128 th Street
t Ss. t 5b. t se. ~~w?. a
FATHER-NAME w~Sr ?roo~E ~wft MOiHER-MAWEN H11ME we~ wooiF usr
1e_ John Creenfield Jasephine Melton
NIFOMIANT MAIIING ADORESS ar~Er o~ ~ r.o No arr o~ rowr+ s~~s~ n?
,s._ Oneda Kans~oan 2643 Arbor Dr.. Ft. Lauderdale, FL 33312
19. IMMEDIATE GUSE (fN7fR ONLYONE CAUSF PER UNf fOR /bJ, .4N0 /c/.J ~„~.,,,.i e.r,...,, a,,.r.,,e a,~,y,
rr.EOU~ vAar 1 I
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nif t,) O17 ~ P•S ~J I/ L Qlt/~'~ f~Q,./ ~c,c C~ I ~l D/U %~1/ ~
uu~~u~r. DUE TO. OR OONSEQUENCE OF: I w«..~ e.e...« o+w~ w s..n~
L~ l61 • t
OUE TO. OR AS A CONSEQUE:iCE OF: ~~~i„ o„N,
~ ~el ~
PAA7 11 OTHER SK'aNIFICANT CpND1T1pNS-to~wROw, oa~e.aucp n e.~~~ a.e ~a nw.e m cwa~ w?Mr i AUTOPSY (S
M+ pscify Yes WAS CASE REffRREO TO NlEDICAL
~ ~ 20. EXAMiNER) (Sp~tfh 1~es o~ hb/
PIACE OF DEATH ura~a i 21. O
wsny Noe+.. F fiOSP. OR INST.. r~acav oow 24a. r rne ~«.».a r+a aN.swn.a na m t~. ..recr ~w~wrs cas.
, w.a+t w !y~ vr~.. w~.~ lSV~7Y1 ,c'n.ct U
€ n,. . O ne. 1 .
Z~i- ie M M.1 ? P+ 14 Ds+~ d~aymiybw ind~ar msslq~tbn. n nM oV+'b^ NaM emw ~O ~t 1M
~ ~I oourrW M M • MO pau ~nd M+ to t,ti. 4a ~wd p~u W 6r to W c+vsNa! CitW.
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p~ (S+ynstunsnd TiU~1 ~ ~ ¢ /Sqnatureand Tit4) ~
Z DATE SIGHED (Mo., Day, Yr./ HOUN OF pEATH V Z DATE SiGNED /Mo., Uq; Yr.J HUUR OF DEA7H
Q s 23D. ~ 23c ~ A1 W< 2tb 24c. M
~ t~i€ MAME OF ATTENDFNG PHYSIpAN IF OTHEA THAN CERTIi1fR (Ty
p eorRint) ~ W PRONWNCfU DEAD (Mo., D
a
y, V~J P
R p N O U N C E O D E A D /
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24d. ON 2ae AT M
w u N E O AODRESS OF CERTtFlER ~nnSiCuw on ~~p~ (Type pi pr~nt/ Ribiat D 0 p C
~ ~T LaureriC@ S. . .
~ 25. ~ e~ ~ • ~ C ~ ~ L lL.~IJ• le. lC C ~ /y ~ ~ D ~ p <
utc. Suax~E ~o++. n~TU~~u QI1TE pi INJURY /Mo. Day, YiJ ?IOUH OF INJURY DESGRIBE HOW pV1UAY OCCUQRED
o~ r~+o~+c rwtsr ~SO.c~ryt
20s_ Nattll"$~. 26b. 26c 26d.
~ NJURY AT WORK PIACE Of {NJURY-iu ~o~.. r„~. ,e,..~ rwar. en,~. IOCATION $TIIEET OII R i D r~o. on. vuwec. o~ rownsNw STATE
/Sp~eily Yu or 11b/ e.+yy. Me /~~~Y/
2d~. 26f. 2gy
~~CREMATION. AEMOVAI, OTHER CEMETFRY OR CRFkI/1TOftY-NAME ~OCq710H Oi`/. vniw6E W tOwhsNrr 5i~7E
- 27, GYemation Z,p Forest Laxrn Z,~ Detroit, t~ichigan
~ ~ ~ OATF /Mo., D~y, Yr.J NAME OF FAOUTY ADORESS Of fApUP1
~ 27d 3f 23~81 Za/~l.H. Peters Ftuzeral. Home 2~2004 Schaenherr~ Na.rren, Mi
8-38a ~yn~RAl LICENSfE . iIEG{STRAp ' DATE R~EH~ ~i ~G~~~~~(Mo..Osr.
~ane~ (j ~ is
~..1 zsb. en
•g6 JAS113 ~2 •0?
,
~ . ~~3 '+r~~~~~
~ a C~~;i'Ir{~Q;CUrY , ~ F1L:
..k c.ar~ ~AR' 2~3 1981 ~ 5T ~
BOOK ~~S P~GE ~n ;
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cARn~~~U~ sars~u~i-s c~E~~: ,