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HomeMy WebLinkAbout0978 o?0t~1-IO~-x - 852190 . , - } ~ STATE OF MICHIGAN 1 ~ ~ 1 ""!0~~ DEPARTMENT OF PUBIIC HEALTIi ~ ~ ~ w ~i"1 STATE fILE NUMBER ~J ~ • CERTIFICJolTE OF DEATH . o~os7~4 B ~ . ~ECEDENT NAME rns~ rroou us~ SEx OAtE Oi OfAtH lMo.Oar Y~1 , EDWARD LACHOWICZ 2 MALE ~ MARCH 29,1984 IN~E-a~ ww~, ac+ w.«~ AGE-~h M~rw H R/ UN R 1 Y QI1TE Oi 01RTH (~No. DiY. YiJ GOUNTY OF DEATN ~ ~sv«~~r~ ws o~rs ~s ~ j~qp~RCH 29 ~ 1915 ` VeAYNE . w`~`ii~e s~ s~ ~ a IOCATION Of OEATH tltt~wtid ~1105PITAl OR OTHER INSTITUiqN-w.r~r.wwnrM. vwu.~~^•~^n•• (CMCk OM ~ ~ndspec.hl ~wsot vKi~ct iwa~s a 1 7e « DETROIT SARATOGA NOSPITAL s~~~t a p~~M ra.w...vSw ~~N p~ yyµAi ~p{J~TM/ w`~~~ StMVMHG SPOUSf fMwr/e. y~vemarden nam~! w~s auam ~vt~ w ~w.'~,,,,,,,,,~ w~oowco. avaao ~sr.~a, us ~w~o ?arcis~ ocw~o.+ s OHIO 9. U.S.A. ~o. MARRIED SOPHIA MAKOWSKI ii"`~"~°' wtnunoM. sEt MaNwt SOpAI SECUWIY NUMBER USUAL OCCUPATION /G~vt Aind oI wwk Oon~ duiiny most o/ KIND OF BUSWESS OR INOUS RY rIt'rrd/ COMhE~ 13 383-07-5809 GENERAL"~"~~1~~~~ AUTOr10TIVE .IIEi~DfNCt rtEMS ~ Ct11UlEN~ IIE510ENCE-STATf COUNTY lp('J1UiY raro~ pTr ~r.n a SiREEi AND NtMtBER ~ i~l Q+a~ot v~u?ce arns a ,6, MICHIGAN ,6eMACOMB ,x .w? a ~sa FATNEN-NAME 1reSt ~roD~E uir MOTHEN-MA~OEH NMAE ~MS* ~eowE ust 16 STANLEY LACHOWICZ ~ Catherine Ruzcak ~N T o ° MAtItHG AOORESS sn~~ w ~FO w arr o~ ~aw s~wT[ zv ~i01,,,~,i0,"~ ,e,. ~ ~se. 18045 EMPZRE EAST DETROZT MI. 45021 ~N 18 M~MEDIATE /fHTfR OAKY CAf/SE PER LINf i0 . lbl. AND fd.J °1i1" ~putE PAR1 1 ~ . _ ~ ~ ~ ~6 ~ fTA 110GT n~ IaI 'Vf(,~,{ 1 ~ ~?ioEqrwG WE TO. CONSEQUENCE ( w.rr w~..«~ ww w w.M ~ CJ1VfE IASt ' ~ ~ ~ m~ ~G/~'~ ~ OUE TO. O!1 AS A OONEE041ENCE Of: 1 r~.w aw~ w aw I tq PART 11 OTHER If 001dert IONS-c,w+or w~aew.y r~..~~ w nw w.. rw~ ~ ru~t ~ AUTOPSY /Spetily Yes WAS CASE RfFEHREO 70'MEOICAI T- ~ ~l - ~ pi Afi~) ExAM1NER~ fSpst~h Y~s o~ Mo1 l~ `a~s, zo. NO 2~. NO PLACE Of Ofl1TM swr. ~rrw w.r f . OR tNET_~ ooti N. m. n» nw..e~ .w rw..wrw .e~ a w,.w~r ..a~.ws s,.. ~~i A~Ii~r~AI, ~e~ IpiPAlTIENT o..» a..~. d...rw~ .~..ro. .~..,.w~.., oo..d...~. «o.~.. N M. . 23~. s~ rr ~ a.~r ~we rs~ru w wr a ax ww w wn w ws a w o.+.«a a,~N w eww~ ww ' yf~ ' 2 /Sqn~tun ~nd T ~i ~ r " ~ , ~ /SDn+tan arrd T'rtN1 ~ I ~u OATE 31GNED /Ab.. DI~; Ytl HOUB OF DEATH DATE SIGNED fMo-. D~Y. NOUR OF DEATH 2~b. ~3c. ~ ~ ~ 41 2~b. 21t. W? NAME Oi ATTENDING PHYSIGAN IF OTMER THAN CENTifIER fTj7NOrPrinf/ ~ PRONOUNCEC OEAD f~NO-. Diy. Yi•1 ~0~1WNCE0 OEAO /HOV?1 23d. 24d. ON ( 2te AT ~1 H AODNESS Os CEATIftER m+~t OR rfq~e~t Ea~w+[~ /Type o?P?infj ~ ~ ~ii3~a~ ~ ~'~~~s ,wsv. a2s~~a ~E~Y C"_~sr /~E~~.,- ~az? : Kc. wKpR cqr. w~ruiu~ WTE Oi INJURY I~Mo_ Oh; Yil NOUR OF INJURY DESCIUlE NOW M~1.N1RY OCCl1RRED OII ~EtAlVC MVEfT /$(y~(J~rl } zs.. NATURAL ~e~. 2~- NJUM? AT WOlCC PLACE Of INJURY-iu na~e. i•r.. s.~w~ ~war. aea LOCA710N sra[i o~ ~?o No or~. vnucc w rar~s.~v sr~r[ ~ lSp~cih Ya u My ~.~a ~ ISP~nh1 ?N 2N. T . @UWAL. CREMATION. REIiWVAL. OTHER CEMETEf1Y OR CJIEktATORY-NAME IOCATION • on vruGt. o~ ~ow+eSMw st~t[ ~ i~~ BURIAL 2~e. RESURRECTION CEI~IETERY 27t CLINTOI\ T~'P . MICHIGAN o~TE ~a+io.. n:?: r..~ NAME OF FApIIIY woo~ss oF F~aurr 4 8 0 21 2~e. APRIL 2 19 ~4. L.T. SOBOCINSKI zeo. 22121 KELLY RD.E.DET.MI., B-36b ~1NEML SE IICENSE NEG~STXAR ~ATE RECENEO 6~ REWSTRM'/Ma. DIy I.St~l1ItYM/ e~'-w'~~ ~ ' YI./ /$IAIIIfYR _ . (4178) / 28a. ~ ~ t~~ Q. . - i`ti ~ K ~ _ . ~ /,r. , ~ ,~y i.~'~ f , ~ . s~` t s` c' . tv~ r . ~ ?HIS CEA?ITIY8 1811? YfiL ADONE IS A T1tUt COTY OP l/1Ci5 RLOO~DLD 011 ,t, i~ .y: OF THE t~SOfl NJ1?~,D tILALO!!, AS lI1.FA A? 'lUE D~iROTT DLPI11tTl~liT OF ~ ..w, ' ~ ~ ~ . ~ 1 k ~ ' ~ ~ ~~~;4.~15t ~ . l . ' . , a t~ . . ;j CI~l~ OT DElAOOIJl1C~ MATO~ AP R 21984 ~iA-' . r' ` s OT lStAi. f ITAi. ~t00~d5 ' DA?ED ~I~DIl' 0'l itFJ1LT8 O~ Uy~1 ~ I~~ 8~~4,~0 FILE~ 't'=^ .:4 ~ OOUGL,~ ; ' . FR~: ~ ST. LUL Y. 0 R 56d ~E 977 gpnK ~ •