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Death Certificate - Dillon, James A_6/10/1991.r�. _ $TATE'OF: MICHIGAN -� LF � DEPAXIMENi Of PUBIIC NEAIiM STATE FILE NUMBEfl �iPa�r,r _' CF � 7 . �� CERTIFICATE OF �r,rH 0 51 17 91 IN , 1 GERM�NENi . BUCN wK �.�,. OECEDENT'S NAAtL (fnil, MaWq tssp - . i. SEM 3. D�tE Ol DEAIH (MOntn, My. 1u�) � JAi�'Ei'S .: � A. llILIAN p�pl,E APRIL 8, 1991 �� b. �GE-list.BhtnaaY ap. UNOER 1 YEAF <[. UNDER 1 �AY ��. 5. OAIE 0� BIPIH (MOn140ry.Yaaq' , 6. COUNIT 0! DUIH .1Ye"� -� � � MonTHS �� oers Nouns � MINUiES � Q`J��ER %� 1911 " MACOi"63 /y . ' � � � A. LOGTION OF DEAtH (Enler p4ce ef(kully WN�a+�eE OuC in 7a. 7U. ]cJ 1p. If NOSP_ Oli INSi. Inp�Uen1. ]c. tltt, VIIUGE, OR TOWNSNIP Of DFATH NOSPIiAI ON OtHER INSTrtUTION =' Name (Il ipi n n(Mr. Qrve ihetl srN num0ei) , 00 /Emar. fVOOm, DOA (SpentyJ 68325 Cher BloSsom VlASHING'I'�N TiaP. B._ SOGUt SECUAIir NUMBEP "� � 9a. VSWI pGCUP�iION (Gin�irpolwwYOOneE✓nnymmlol 9U. RirvD 0� BUSME55 OF INpUSTRY - Yin Ne Oo mf use rtfi•e0 : ' . : . � {�ELL DRILLE�t= �' SET,F-II�iFIqYED i IOa. CUHIiENTHE9DENCE=' 100. COUNTY, - � IOC. LOGUTY (Lhtt4 me Dv �np.sprary) ' IW(�.SIFEEI ANO NUMBEF p SUiF � � INSIDE ptt OR VrtIAGE Of � � 2 MICHIGAN , GLADS�TIN .- ,'.�iwe. or,_.A[TPifAN .'�' 4731 WEATHERBY_ _ � 10e. 2iP CODE 11 BIfViHPLACE (G(y.Lq'� 11: MAqIiAI SI�iUS-Ma a0 13. SUavmNG.SV0U5E :� :�la. we5 OECFOENI EvER a "' SUfCa fae j�n,COUnlry) Never Ma e0 WQb !E $; QI b Q�rc'.mme Eelar ! it'ma m0) . W U 5 RtMED fORCES' ° � _ f5oenry, vn a No) � ... ,. . �;._ . .: � -'. . . :,i . .,i _ ' '. ;_ �� ' 98b24 � ,< " HAZELTON IND „ „'; �RIED�,«:; MAI)ELINE; ARNOLD , YES L V . . .a.. �rj . .q:. , :: : . . . ` . . . . �i I5. �rvCESiRY-Me.kan. Fvmo Ron.�COWn. Cmbai a Soutn ..•16.�N�CE-4rc�can iMUn..Bbc�, wiu�e. em. O.OECEDENiSEpKaiqN (5{ec�rymy/r5*�wpa0emnynee) �o M�erraR CJrarq. Wle� Hnpan[. �LOMnttun. MaE. II Asun. grve ro�ma61Y !e.. C�rtie+e. Et6tM. f�t�K1�, finW. el[. ($pevly Eet ) fNp�p. �sian 4tlun. e�[. ($p[n(y Cebw) fkminlDry/$e.TMiry (U13) Cdley (Id b$4) °m IRISH -. GERt�fAN -:. SCOTCH „ i�[IITE . '. 8 :. Lj. .. . . . - ' . . � I8. IILNEP'S NAME (f�nl. Mqdt�, b5f), � 19: MOiHEN'S NAME (fvsf. MNtlIG Smvme Defaf Ivsl mlmeO) Z° z.urICiti ':}iAmErr ,10�..INFOfVMANi'S NAME (Type/Pmq 200. MAIIING ADDNE55 (SheeNMNVnmperpRwalRarteNUm6ei;GfrmVillajqSbfqZlPCOde) � s .: - .. : . '_ . . .: . . .. . ' MADELINE DILTAN`'` - 4731`.-:IJEATHERBY,''-GLADWIN;.MICHIGAN 48624 I i 21. METNOD Of DISGOSITION - Burul, Gemation. ' 2b. RACE �:Of p15PO51T10N (Name olCemelery. Gemaldy. `:5'.'� 2$U. lOUiION - Gly Or Vill��G $uh Fsmov�l. Owutbn. Olnee UDK�N) a olnei Wcr) .. . BURIAL ; PiT OLIVE'C[TiETERY:::_ ";�+ Afl' OLYMPUS; INDIANA ( I'1 I � Z3� . I TUFE Of fUNERGI SEd�,CE ll ENSEE • I<. UCENSE,NUMBEA� � 25 NAME AND AODPE55 OG I�tll1TY �-` � ����� i /�,, �OILKl�SNI ��Y M• MALBURG F[NER�1L HOME ��/� 580T' �` "/1� � ROrtEO MICHIGAN A8065 Z6.�P�NI.I. F o t�e E�uaus. vyurias. m wm .otiom t�at ousM �ne aeaU. Do NOT enter I�e rtwEe ol ErinQ. suc� Si ur0uc w eesWnnv �oro.v�ap rest. W6. p nean IaMrt. C onry we uust m ea� Lne. ' I intnv�i Bet«een IMMEDIATE GUSE (final ,. Gj� �� o p�'�M�.t v�ti. y�/1/2Vs t� � 5'j1Y �'N /h^I � oesuu a cmaUOn y . � sW�'"¢ "" �`���� � � ' �UE i0 (Oa �S A CONSEQUENCE 0�)�. ' ' ' � e ��c.� f'i1-rYLt� /� P✓e r%�-�� Ct.-� <. rt�n�-�� �� 7/'7 �SeovenwPr�4st canaaans. DUE 70 (OF �S � CONSEQUENCE 0��: ' . . I If �N'/ ha0mg ta ImmeGUte ' uuie. Enter UNDEPLYING . .. .� . .� � . . UVSE (Nuaf! w injury c''" � ' �� � „ lNt �WIeO ert �s � ' WE i0 (OR AS � CONSEQUENCE Oi�'. �� ' � .a � nwltuq M�N) LISi�. , � ,�. �y.�' ...-e�i'��$. _:_v', .;::$ TsaS.._. ." .�..�•�z"s�_ 3T_. s:i?titi ' ...<:"e...a:.:.' � �¢zw.,tiap-,. � '�!GAPT'll.''Ol�er.signilicdnt coM�ioni"�mV Wing ta,EOl� WI Mt �esWlinB � I�e-eMerFji� cause�6rven PaM1il .�: 2L. W�ANAU70YSY 9.. 2)61 WFRE �UTOPSY fINDINGS � � � - ,: � y 1 P[qFOPNE�7 �; AYAIUBIE FRIOa i0 i � i {? _ ' . � . (Yes a No) ' �' �OMFLEiIOH 0� UUSE . � .. . �' . � , ' . . - . . � - � OF OEAIH? ryesaNO) . _ . '; tF . . . no 28. ACTWI PIAGE O��OE�iH (MOme. NursinQ 29. WAS USE REfEPREO t0 MEDIC�I 31a. � i�e cave ievieweE aek OetermintE mt ta Ee a mMkil e.amineis ose- MomG HospUl. Ampubnee) (Spttdy) EIUMMER? ($pecJyYnwNO) (C�K� , ._......, .... ... - M[ ❑ . . .>-.-..:. �Yl On I�e Wso ol euminatian �nE ol imnUga�on. n m� op�nm U<atn acwreG ' ; 30a.- b.�ne tes� 01 m� �ro.koge, aeatn xcw�M �I tne ime. Ea1e ana pxe am Cee at t�e time. Eale aeW dace an0 O�e to Ine cavu(s) aM manne vaieE. � '^ loll�tullse(s)sl teEY, •n+ � / . . 2 < � � (Sg+utwe arp.. Gtk) � / �� �.� � .. � ' . (A Nre mo Lllel' `� . 100. UME 5 GNEO (MO y. Y) 30c. 71ME Of �DEATH . � ' i W 310. O�iE S�GNED (MO.. Wy. n.) Jlc G�SE NUMBER - -v� V � j z a > '- � > !d o i z ; / : :' : - • � �� �.�30E.'NAn� Of �IIENDING VHYSICUN If OiHER IH�N CERiIIIER (IypemRmQ. �w � JIE. PFONOUNCEDDEAD(Ma..O�y. Vr.) 31e. IiME OF DC�IN ...,._ ._., ...... - ' -- . ON M �92a. NM1E-AND APDHE55 Of PERSON WVIO COMPLETED UUSE Of DEAiH QTEM 26) (lype a P.inl)BRVC� C� L 32D IICENSE NUMBFF ,!j "�,� �i:i r l I�I V i - JF2 L' �OMC � FMi 4C( = � ��D' 6C �1,� � _ 3L. �CG. $UICIDE. NOM., NAiUAAI 3]!. OAiE OF INJUBY (MO_ Dsy. Yt) 33c 71ME Of INJURY 3b. DESCfl�BE NOW V�JUFY OCCUFFCO - OR PENDING �NVESL (SOecdy) , ' � M � I Z��� � ���33e INIURY R WORN 3JI. PUCE OF INIUFY-N Mme, b�m, ibe��. bt�ory. ]3Q LOC�iION-SVeet a RJD. No G�p VNaee a i.p Slne . ($yKi(r Yes a No) . ' otlKe eviMme. etc. (SOe[Ay) . . g.35 3a�. REGIS�RAq'S SIGN�TURE _ � 3�0. O�iE fIIED (Mmtn,W�.Yea.) / Rev.v90 , � . /L < s<r, . . _':. """$;' � �' , t : � . : ^ .... . _ . . . _ I, EDNA MILLER,'�CLERK°.OF THE COUNTY OF�MACOMB AND OF THE CIRCUIT COURT THEREOF, � THE SAME BEING'A,COURT':OF RECORD HAVING A'SEAL, DO HEREBY CERTIFY THAT TflIS IS A COPY;:OF. THE RECORD NOW REMAINING IN MY OFFICE AND OF THE WHOLE THEREOF. -d .3.6 ' . . ,. IN TESTIMONY WHEREOF,.I HAVE HEREUNTO SET MY � NAND AND AFFIXED THE.;,SEAL OF SAID COURT, � r=�`, : THIS :' 9 th DAY OF =,:Apri1 lq 91 -} , E . ^ .: .. �,� -�:� '�_ ..`� !CGl�.�ZCO l .; ..: � - �,.- �?�C'7 , : ;_ �: �•�; �, r;- . � . . � : .' ; . : . DEPUTY _CLERK ' ..• ,- . - <: ,� - :;:r .._ . � .. _ .. . - _, ., ... , . �.._...' a� � .:< -'�, nc � -��� � . � .. s � �: t �e, �� x rd w ' . �a� . °` ' - �' �=- , __ , .. - - , � �° x _. . � '?� � i •