USA > Michigan > St Joseph County > Three Rivers > Death certificates, city of Three Rivers, St. Joseph county, Michigan > Part 2
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ently requested to facilitate the execution of the law, and especl. ally. as far as It may be In their power, to all undertakers lo their duty of promptly obtaining o statement of cause of death. Ilank certifontes will be supplied to all physiciany In the Sintn
upon request, and may be obtained at any time from the loen!
Hon company, who must attach It to the box contaloing the
( ...
INSTRUCTIONS TO REGISTRAR,-The registered num-
.. )
STATE OF MICHIGAN Department of State-Division of Vital Statistics
CERTIFICATE OF DEATH
FULL NAME.
Stovas Culterman
Registered No ..
...
1.1
(Year)
(Year)
How long al
CERTIFICATE OF DEATH.
PLACE OF DEATH
County cf
St.
Township of or
Village of
or
City of ..
3 Rivera
(No ...
703
Dealer
.. St .;
23
.... Ward)
FULL NAME ..
stattii
A Leisicle
PERSONAL AND STATISTICAL PARTICULARS
SEX
Female
COLOR
White
(Year)
DATE OF BIRTH
(Month) mar.
(Day) 30
1 ...
857
AGE
50
.... years, ..
4
.months,
22
...
SINGLE. MARRIED,
WIDOWED, OR DIVORCED
married
AGE AT MARRIAGE, NUMBER OF CHILO- REN
( If married, age st (first) marriage ... \\ ___. years Parent of ......... children, of whom ....... are living
BIRTHPLACE
{State or country)
michigan
NAME OF
FATHER
La Zu Hogan
BIRTHPLACE OF FATHER (State or couotry) mass
MAIDEN NAME
OF MOTHER
mary melvin
BIRTHPLACE
OF MOTHER
(State or country)
OCCUPATION Shousewife
THE ABOVE STATED PERSONAL PARTICULARS BEST OF MY KNOWLEDGE AND BELIEF
TRUE TO THE
(Informant)
allen Zürich
(Address).
MEDICAL CERTIFICATE OF DEATH
DATE OF DEATH
(Month)
aug.
.
22
190
....
I HEREBY CERTIFY, That C
Cinq 1
,190.7 .. , to. .... 22 ,190.7. , that I last saw h.LA ... alive on ... aug 22 ,190 .. 7., and that death occurred, on the date stated above, at ... PM. The CAUSE OF DEATH was as follows: Cancer
Contributory.
DAYS
(Signed)
arthur 20 Saidmore.
.... M. C.
aug 27 190.7 (Address).
3 Rivera
SPECIAL INFORMATION only for Hospitals, Institutions, Transients w Recent Besidenta:
Former or osoal residence.
Where mus disexse contracted, if not at place of death ?
PLACE OF BURIAL OR REMOVAL Riverside Cem
DATE OF BURIAL
aug 25 1907
UNDERTAKEA
Schoonmaken & C
ADOPESS
3 Rivero
Filed
aug 24 190).
...
James & Bun
Registrar
-
Ton company, who must attnon It to the box coninluing the
( ...
alopted by the U. S. Census Offfec.]
the Commitice of the American Public Health Associntloo and
body to necompany it to destination.
lesy there are loeni regulations to the contrary. DUTY OF SEXTON. - Sextous should not permit an inter- ment until a properly prepared Burini or Removal Permit IN delivered by the undertaker or person in charge of the remains. A Removal Periolt noswers the purpose of a flurial l'ermit, un. SUGGESTIONS TO PHYSICIANS .- Physicians re enrn- estly requested to Ineffftale the execution of the law. nul expeel. ally, ny far na it inny be In their power, to nid undertakeis in their duty of promptly obtaining n sintement of cause of death. Blank certlflentes will be supplied to all physicians Ju the State upon roquest, and may be obtained at any time from the Jucai
ronfet ra na
.... .........
INSTRUCTIONS TO REGISTRAR .- Tho registered num-
....
ber may be Inserted In spaco above. If desired, for your own cal.
.. )
STATE OF MICHIGAN Department of State-Division of Vital Statistics
CERTIFICATE OF DEATH
4.2
Registered No ..
...
[If deathoccurred in a Hospital or Institu- tlon. give Ju NAME Lostend of street and number. If away from usual residence. Rive "Special Informa- tion " below.]
(7נם)
(Year)
deceased from
adopted by the U. S. Censos Offlec.]
CERTIFICATE OF DEATH.
-
1. ... )
INSTRUCTIONS TO REGISTRAIt .- Tho registered num- her may be luserted in space above. If desired, for your own con- venienec. It is recommended, however, that it be entered only on faro of corllllente, in space provided at upper right-linnd corner. It should be entered finmedintely upon receipt ut your omee, and the date of Illing lu your offfec and your signature As registrar should be entered at the same time on the face of the certiflente In the lower right-hand corner.
L'Icase examine the certifleate carefully before making out the permit and call the attention of the onidertaker or person In charge of the disposition of the body to any omissions. Il nay lem cannot be obtained, the space should not be left blank por a meaningless dash be used, but the word "Unknown" should be plainly written. Ile particularly careful to see that the place of dlenth is correctly stated. If out of your jurisdiction, do not register it, but see that it is flied with the registrar where the death occurred. It Is not necessary to give the "Special Infor- atlon." except for deaths in Institutions, etc.
Do not fall to mall all certiflentes of death filed with yon to the Departinent of State, Lansing, Michigan, on tho fourth (4th) day of the following month. Use the stamped retorn envelope provided for this purpose, and Include a State. ment Card, properly illled out.
INSTRUCTIONS TO SUBREGISTRARS .- Licensed em. balmers, when duly authorized by the Secretary of State to net as subregistrars, mny issue permits to themselves for deaths in villages or townships (but not in citles). They must first have the certificates completely End legibly filled out in ink. and must personally file all certificates with the registrars on or before the third day of the following month without fail. The certificates should not be numbered by the subregistrars, but by the registrars, who record and transmit as If originally flied with thei.
DUTY OF UNDERTAKER .- It Is the duty of the undertaker or other person in charge of the Unal disposition of a human body to observe the following requirements of the registration law : 1. He must obtain a certificate of death (this blunk or any other form over haned by the Seeretury of State for this jur. Juno will be antisfanforv). und have it properly med out with all
Thầy part of the ertilente should porferably he agund by night. tise ur friend of the deerdent, or by tomo competent jent noqualated with the Party, It may be signed by the undertaker or by the physician if desired.
2. The certificate containing the shove personal partienlars must now be presented to the attending physician for the medi- cal certificate of rause of death. If the physician is absent, so that the medical certificate cannot be promptly obtained, the Incomplete certificate may be then presented to the registrar with a statement of that fact. The registrar may thereupon, In his discretion, Issue a. conditional permit, provided the medical certificate be completed at the earliest possibile moment. Hut registrars will exercise especial caution in granting such condi- tional permits to lasure that the death did not result from any Infectious disease, requiring sanitary precautions, or from unlaw- Inl or suquejous means. If any doubt exists, or In the case of a death without medical attendance. the registrar will refer the certificate to the Health Officer (if a physician) or Coroner for investigation and statement of cause of death. If the Health Officer la not a physician, the registrar ainy Insert the enuse of death In 'deaths occurring without medleal attendance from competent testimony over his official senature.
3. The undertaker or person in charge of tho disposition of the body minst next present the complete certificate of drath, cantalning the medienl certificate of cause of death, to the liegistrar of the township, village or etty where the death occurred, and obtain his permit for the burial or re. moval of the body before any disposition Is made of It.
4 The undertaker should deliver the Registrar's Burinl l'ornit to the Seiton when the interment Is tunde, or, If the body Is removed by raff or boct, the Registrar's Itemoval P'er- mult must be delivered by bit to the ngent of the transporla-
body to accompany it to destination. .. .... ...
DUTY OF SEATON. - Sextons should not permit an inter- ment until n properly prepared Dorial or Removal Permit is delivered by the undertaker or person in charge of the remains. A Removal Permit answers the purpose of a Burlal Permit, un- Icss there are loenl regulations to the contrary.
SUGGESTIONS TO PHYSICIANS .- Physicians bre carn- estly requested to fnellitate the execution of the law, and espcol- ally, no far as it may be in their power, to aid undertakers in their duty of promptly obtaining n statement of cause of death. Ilank certiflentes will be supplied to all physielons in the State upon request. and may be obtained at any time from the local registrars. Physlelaus should have a supply ol blanks on hand, nud In the event of death, kindly leave the medient certifiento of cause of death with tho fninly of docedent, or binvo It ready for the undertaker so that he will not ho de- Inyed In obtaining the permit. Compliance with this request, which will remove one of the principal difficulties of prompt registration, will be greatly appreciated.
The statement of enuse of death is very important for many reasons. Please be preelse and definite In cratting out the inedi- cal certificate. If the death occurred Irom cancer or tuber- enlosis, atnte what part of the body was affected. If from sepllcenin, give the cause of the septicemia, especially for fe- males of childbearing age. Nerer report a death from "heart failure:" It is universally discredited as a statement of cause of death. If such a death was due to actual heart disease, stato that fnet; or If the "heart failure" occurred In the course of diphtheria or other disease.
caused the "heart failure " give the name of the disease that
EXTRACT FROM THE REGISTRATION LAW. Compiled Laws, 1897, §§ 4614-4620, as amended by Public Act No. 20 of 1901.
SECTION I. The People of the State of Michigan ennet, That the body of no person whose death occurs in the State shall be in- terred, deposited in a vnult or tomb or otherwise disposed of, or removed from the township, vilage or city in which the death occurred, unill a permit for burlal or removal shall have been properly issued by the clerk of the township, village or city In which the death occurs, who shall be tho registrar of deuthx.
SRC. 2 Whenever any person shall die, the undertaker, honse- holder, relative, friend, manager of Institution, sexton or other person superintending the burial of said deecased person, shall enuse a certificate of death to be filled out with all the personnl and family partleulars required in section three of this net, nad attested by the sumnature of a relative or wolno competent per.
pre eratation of a pertinente of denth properly Hled ont. nad st:unit. The registrar shall ismo a permit for the. barlal on removal of the body and shall humediately record the death in the regis. ler of deaths, numbering all certificates consecutively in the order in which they are received, beginning with No. 1 for the first death that occurs in each year. In deaths from dangerous communieable discases, burial or removal permits shall be granted by the registrar only in accordance with the rules of the local board of health and the State board of Health relating thereto. The sexton or other person having charge of the inter- ment or final disposition of the body shall retain the burial per- init when presented to him by the undertaker: Provided, That when a body is shipped the removal permit shall be presented by the undertaker or other person shipping the same to the agent of the transportation company, and shall be atinehed by hin, with the transit permit, to the box containing the body, to as. company the same to destination, and no transit permit shall be Issued or received by any transportation company for the ship- ment of a body unless accompanied by the registrar's removal permit.
Spe. B. An omeint falling or refusing to perform his duty under this net, or nny undertaker violating any of its provisions, shall. upon conviction thereof, be deemed guilty of a misdemeanor. and shall be punished by a fine of not less than live dollars and not exceeding one hundred dollars, or be imprisoned in the County jail not exceeding thirty days, or suffer both line and Im- prisonment. at the discretion of the court. Local registrars shall see that the provisions of this set ure enforced In their juris. dietions
Cames of the law and blank certificates of death will be supplied. by the Local Registrar or by the Secretary of State.
CERTIFICATE OF DEATH.
PLACE OF DEATH
County cf ..
St for
Township of. or
Village of or
City of .
3 Rivers
(No ..
420. maple
.. St .; ...
1
Ward)
FULL NAME
James avery
PERSONAL AND STATISTICAL PARTICULARS
SEX anale
COLOR
white
DATE OF BIRTH
(Month) Sifat
(Das)
11
(Year)
1 830
AGE
... 76 years,
11.
months,.
12 days
SINGLE, MARRIED.
WIDOWED, OR DIVORCED
married
AGE AT MARRIAGE. NUMBER OF CHILD- REN
( If married, age at (Grsl) marriage ..
26 years
(Parent of 9 children, of whom 7 are living
BIRTHPLACE (State or country) Somesat Shire Eng
NAME OF
FATHER
Thomas avery
BIRTHPLACE OF FATHER (State or country)
MAIDEN NAME
OF MOTHER
Charlotte Wilson
BIRTHPLACE OF MOTHER (State or country)
OCCUPATION Fammia Retired
THE ABOVE STATED PERSONAL PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF
(Informant)
Gro 4
avery
(Address)
Benton Startin Im
MEDICAL CERTIFICATE OF DEATH
DATE OF DEATH
(Month)
augo
23
(Daj)
(Year)
190 ... 7
1 HEREBY CERTIFY, 19 ,1907 to ang 23, 190.7, that I last saw h .. .. alive on
Cuc 23 190.7., and that death occurred, on the date stated above, at ... 32.1.2.M.
The CAUSE OF DEATH was as follows: Hemorrhage from stornach due ulcertavad of stomach from which he had been Insuffering for sometrie Contributory Fratture of left
fumeurs)
0
( DURATION )
4
(Signed) ...
M. C.
aug 2490) (Address)
110 Main
SPECIAL INFORMATION only for Hospitals, lastitations, Traasieats or Recent Besidenta: Former or usual residence.
How Jozz at
plses of death!
Where was disease contracted, if not at place of death ?.
PLACE OF BURIAL OR REMOVAL Riverside Cen
DATE OF BURIAL
aug 26 190)
UNOCATAKER
La Colla
ADDRESS
3 Rivers
Filed aug 2.6 1907 James E Bun
Registrar
1
slopled by the U. S. Census Offlee.]
( ..
Use Committee of the American fallo Health Association and
bradly to noenmpany It. to destination.
lexy there are local regulations to the contrary. DUTY OF SEATON. Sextons should not permit an inter- ment until a properly prepared Hurlal or Reinovnt Permit Is delivered by the undertaker or person In charge of the remains. A Removal Peruilt answers the purpose of a Hurini l'ermit, un. SUGGESTIONS TO PHYSICIANS .- Physicians are carn. estly requested to Inellitate the execution of the law, and capeut- ally, ny Inr us It inny bo in their power, to add undertakery lu thetr duty of promptly obtaining n statement of cause of death. IlAnk certifientes will be supplied to nil phyaleiany in the Stole
registrar. J'Isaletons shant.t 1.n. . . ... ....... . ...
upon request, and many be obtained at nny tima from the lout
..... )
ber may be Inserted In apano alero, If desired, for your own con- venienen, 11 h recommended, howaver. Halil ha ..... .... ... ._ INSTRUCTIONS TO HEGIBTHAI .- The registered onm.
STATE OF MICHIGAN Department of State-Division of Vital Statistics
CERTIFICATE OF DEATH
Registered No.
43
[If death occurred in a Hospital or Institu- Clop. give ita NAME instead of street and number. If away from usual residence. giro "Special Informa- tion " below.]
That
attended deceased from
CERTIFICATE OF DEATH.
PLACE OF DEATH
County cf
It fue
Township of
or
Village of
or
City of
SKRivers
(No ...
800
SixIti
2
Ward)
. St .; ....
FULL NAME.
Itensietta Louise
Webber
[If death occurred In o lforpitol or institu. tloo, give Ita NAME fosteod of street sod Dumber. Ifaway from usual residence, KIve "Special loforma- tion " below. ]
PERSONAL AND STATISTICAL PARTICULARS
SEX Female
(Month) 6
(Day)
(Year)
3
1906
AGE
1.
.years,
2
months ...
22 days
SINGLE, MARRIED,
WIDOWED, OR DIVORCED
Single
AGE AT MARRIAGE.
NUMBER OF CHILD-
REN
( If married, age st (int) mfisze
. years
Parent of ...
.. children, of whom.
„ sre living
BIRTHPLACE
(State or country)
3 Rivers
NAME OF
FATHER
Guy Webber
BIRTHPLACE
OF FATHER
(state or coantry)
med
can
MAIDEN NAME
OF MOTHER
Etta murray
BIRTHPLACE
OF MOTHER
(State or country)
Cniclugar
OCCUPATION
THE ABOVE STATED PERSONAL PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE ANO BELIEF
(Informant) .C
J. G. Collier
(Address)
3 /Rivera
MEDICAL CERTIFICATE OF DEATH
DATE OF
DEATH
(Month)
(Day)
2.5
190 .. )
I HEREBY CERTIFY, That I attended deceased from aug 25 190.7., to Cinq 2.1. ,190 .. 7, that I last saw him. alive on .... aug 25 ,190 .. 2, and that death occurred, on the date stated above, at2/55.1 ... The CAUSE OF DEATH was as follows: Phosphorus personag. due to exciting matches ()
Contributory
(OUMATION)
OAYS
(Signed).
Simary
.. M. L.
aug. 26190.7. (Address).
3 Rivers
SPECIAL INFORMATION Duly for Hospitals, lastitotions, Transients or Recent Residents:
Farmer or
asnat residence
How long st
place of death!
Darı
Where was disease contracted, if not st place of desth ?..
PLACE OF BURIAL OR ACMOVAL Linden Mich
OATE OF BURIAL
aug 27
....
190 .. 2.
UNDERTAKEA
L. a. Collver
ADORESBU
3 Rivers
Filed
Cmq 26 1907 James & Bum
Registrar
( ...... .
INSTRUCTIONS TO REGISTRAR .- The registered num- lier may be loverted In apaen sunye. If desired, for your own con- renlenee. It Is recommended, however, that fi be outered ouly
.. .. .... ...... ... .... .. .... .. .....
registrara. 1'hyatrimien ahetetel finve ne supply ont lobstertı. ...
tens there are local regulations to the contrary. DUTY OF SEXTON .- Sextons should not permit nn inter- inent until a properly prepared Hurint or Removal Permit Is delivered by the undertaker or person in charge of the remains. A Removal Permit answers the purpose of a lurial P'ermit, un. SUGGESTIONS TO PHYSICIANS .- Physicinun are earn. estly requested to facilitate the execution of the law, and espeel- nily, ny far na it may be In their power, to afd undertakers In their duty of promptly obtaining a statement of enuse of death. Ilank errillientes will bo supplied to all physicians in the State upon request, and may he obtained nt any tline from the luent
Truly To accompany It to destination.
... )
adopted by the U. S. Census Office.]
STATE OF MICHIGAN Department of State-Division of Vital Statistics
CERTIFICATE OF DEATH
.
Registered No
44
(Year)
DATE OF
BIRTH
COLOR
(OURATION).
1%
INSTRUCTIONN TO REGISTILAR .- Thn reglafered nin. lør thay be Imerted In space above. If desired, for your own con. venienon. It la reenmended, however, that Is bn cuirrel nuly
CERTIFICATE OF DEATH.
PLACE OF DEATH
County cf ..
Joseph
Township of.
or
Village of
or
City of
3 Rivera
(No ...
115 andrews
Sı .; ..
3
... Ward)
FULL NAME
Jnu Carver
PERSONAL AND STATISTICAL PARTICULARS
SEX male
COLOR
White
DATE OF BIRTH
(Month)
aug.
(Day)
25
(Year)
1844
AGE
63
years,
months,.
4 days
SINGLE. MARRIED.
WIDOWED, OR DIVORCED
married
AGE AT MARRIAGE,
NUMBER OF CHILD-
REN
( Il married, age at (first) marriage 21 years
Parent of 4 children, of whom
are living
BIRTHPLACE
(State er country)
Ohria
NAME OF
FATHER
Jas Carver
BIRTHPLACE
OF FATHER
(State or country)
Ohio
MAIDEN NAME
OF MOTHER
Sarah Woods
BIRTHPLACE
OF MOTHER
(State or country)
Ohio
OCCUPATION
Wood worker
THE ABOVE STATED PERSONAL PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF
(Informant)
La Colla
(Address).
3 Rivers
MEDICAL CERTIFICATE OF DEATHI
DATE OF DEATH
(Month)
8
(Day) 24
(Year)
190. 7
I HEREBY CERTIFY, That I attended deceased from
aug 22
190 2 aug 28
190 .. 7,
..
that I last saw h .. . tralive on
Gung 28
190.7.,
and that death occurred, on the date stated above, at ... ).
17 M.
The CAUSE OF DEATH was as follows:
Brai
trouble
caus
usamaty.
... (OURATION) .....
Contributory.
(DURATION)
(Signed) ..
.M. L.
aug 29 1907 (Address)
Nivers
SPECUL INFORMATION only for Hospitals, lassiszzoas, Transients of Recent Residente:
Former oc
How long al
usual residence.
place of desth !.
Darı
Where was disease contracted, if not at place of death ?
PLACE OF BURIAL ON REMOVAL Riverside Cem
DATE OF NURIAL
Sept
1
...
190 .. ).
UNDERTAKEA
La. Collver
AGGRESS
3 Rivers
Filed
aug 20 1907.
James & Bu
Registrar
1.
adopted by the U. S. Census Office.}
STATE OF MICHIGAN Department of State-Division of Vital Statistics
CERTIFICATE OF DEATH
1.5
Registered No.
. .. ..
{If deathoccurred la a Hospital or Institu- tion. give ita NAME Instead of street and number. Il away from usual residence, give "Spectat Iolorma- tion " below. ]
... )
atomy to Brownpany it to destination.
less there are local regulations to the contrary. DUTY OF SEXTON .- Sextona should not permit an inter- ment untli a properly prepareit Burial or Removal l'ermit Is delivered by the undertaker or person In charge of the remains. A Removal Permit answers the purpose of a furlal l'ermit, un. SUGGESTIONS TO PHYSICIANS .- Physicians re caro- ently requested to facilitato the execution of the law, nu expect- ally, as far ne it may be In their power, to nid mintertakein In their duty of promptly obtaining a statement of onuse of death. Ittank certifienter will be supplied to oll physiolany in the Stale upon request, and may be obtained at any time from the loont l'heralelane alınuld lenve a supply of black. ....
Foglalrara ..........
--------
nu farn af rørilfleala, In atane provideil al under rieti-lenni
CERTIFICATE OF DEATH.
adopted by the U. S. Census Office.}
PLACE OF DEATH
County cf ......
Township of.
or
Village of or
City of S.
(No. 714
............
3
Ward)
[If death occurred lo a Hospital or Institu- tion, give its NAME Instead of street and number. If away from usual residence, give "Special Informa- tion " below.]
FULL NAME.
Ertle Q. megury
PERSONAL AND STATISTICAL PARTICULARS
SEX
Female
COLOR
white
DATE OF
BIRTH
(Month)
6
(Day)
29
(Year)
1905
AGE
.years,
months,
...
days
SINGLE, MARRIED,
WIDOWED, OR DIVORCED
Улицы
AGE AT MARRIAGE,
NUMBER OF CHILD-
REN
If married, age st Erst) marriage.
..... years
Parent of _______ children, of whom.
„are living
BIRTHPLACE
(State or country)
mich
NAME OF
FATHER
Leslie MeJury
BIRTHPLACE
OF FATHER
(State or country)
mich
MAIDEN NAME
OF MOTHER
Lilian Gleason
BIRTHPLACE
OF MOTHER
(State or country)
Truck
OCCUPATION
THE ABOVE STATED PERSONAL PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF
(Informa
La. Collar
(Address)
Three Rivers,
MEDICAL CERTIFICATE OF DEATH
DATE OF DEATH
(Month)
9
(Day)
(Year)
190.2
I HEREBY CERTIFY, That
attended deceased from
July 21
1907 .. , to.
...
., 190,2.,
that I last saw her alive on
Seat
1
and that death occurred, on the date stated above, at
60. .. M. The CAUSE OF DEATH was as follows: Laba Masculinca
Contributory ..
(GURATION)
(Signed)
.M. L.
sep 21907 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients or Recent Besideote:
Farmer or
nsoal residence
How long af
place of desth?
Days
Where was disease contracted, if not al place of death ?
PLACE OF BURIAL OR BEMOVAL
DATE OF BURIAL
Saft 3 1907.
UNDERTAKER
L.a. Colever
ADDRESS
IMce Rivers,
Filed
Sept 3
.. 190Z.
JAMES E. BUNN
Registrar
1.
INSTRUCTIONS TO REGISTRAR .- The registered num- ber inay be Inserted In apace above. If desired, for your own con- renlence. It la recommended, however, that it be entered only nn face of certificate, In space provided at unner rielit.hanil
akro dentinatlou.
ment until n properly prepared Hurini or Removal l'ermit Is delivered by the undertaker or person In charge of the remains. A Removal Permit answers the purpose of n Burial Perult, im-
DUTY OF SEXTON .- Sextons should not permit an Inter-
=
STATE OF MICHIGAN Department of State-Division of Vital Statistics CERTIFICATE OF DEATH
Registered
46
... )
SUGGESTIONS TO PHYSICIANS .- Physicians nro carn- estly requested to fellitate the execution of the law, and especl- nily, ns far na It may be in their power, to aid undertakers In their duty of promptly obtaining a statement of cause of death. Blank certifientes will bo supplied to all physicians In the Sinte upon request, and may be obinined nt ony time from the local registrars. Physicians should have a supply of blanks ou bond, oud In the event of death, kindly Jenve The medical
less there are local regulations to the contrary.
.(OURATION)
Y
INSTRUCTIONS TO REGISTRAR,-The registered num- hier may bo Inverted lu mpare above. If desired, for your own certi- venlence. 11 / reretiredled, however, that ll be entered atly
CERTIFICATE OF DEATHI.
adopted by the U. S. Census Office.]
County cf
Township of or
Village of. or
City of
Three Rivers,
(No ...
Corner Cushman & Oak
... St.
/ ... Ward)
FULL NAME
John G. Sackler
PERSONAL AND STATISTICAL PARTICULARS
SEX
mais
DATE OF BIRTH
(Month)
(Day)
16
(Year)
1834
AGE
73 years,
Y
.months, ..
25
.days
SINGLE, MARRIED.
WIDOWED, OR DIVORCED
Married
AGE AT MARRIAGE,
NUMBER OF CHILD-
REN
{ If married, age at (first) marriage ...... 2 ... years
Parent of of children, of whom 3 are living
BIRTHPLACE
(State or country)
3 Tivo, mich
NAME OF
FATHER
Frank Sickles
BIRTHPLACE
OF FATHER
(State or country)
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