.COREY .
| Alice Ryan Corey
January 24, 1973 contributed by Ron Renquin DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH ORIGINAL CERTIFICATE OF DEATH STATE FILING DATE FEB - 8 1973 STATE DEATH NO. 73 000172 LOCAL FILE NUMBER 133 DECEASED--NAME First Middle Last 1. Alice COREY SEX 2. Female DATE OF DEATH Month Day Year 3. January 24, 1973 RACE--White, Negro, American Indian, Etc. 4. White (Specify) Age Last Birthday Years 5a. 83 Under One Year Months Days 5b. Under One Day Hours Minutes 5c. DATE Month Day Year OF BIRTH 6. September 14, 1889 COUNTY OF DEATH 7a. Brown NAME OF CITY, VILLAGE (If Neither, Name Township) (Location of Death) 7b. Green Bay Inside City or Village Limits 7c. X Yes No HOSPITAL OR OTHER INSTITUTION--NAME (If Not in Either Give Street and Number or Location) 7d. St. Vincent's Hospital STATE OF BIRTH (If Not in U.S.A., Name Country) 8. Wisconsin CITIZEN of What Country 9. USA X Married Never Married 10. Widowed Divorced SURVIVING SPOUSE (If Wife, Give Maiden Name) 11. Floyd Corey SOCIAL SECURITY NO. 12. 391-09-4528B* USUAL OCCUPATION Give Kind of Work During Most of Working Life Even if Retired 13a. Housewife KIND OF BUSINESS OR INDUSTRY 13b. Own Home RESIDENCE: STATE 14a. Wisconsin COUNTY 14b. Brown NAME OF CITY, VILLAGE (If Neither, Name Township) 14c. Green Bay Inside City or Village Limits 14d. X Yes No MAILING ADDRESS (Home Address at Time of Death) 14e. 200 S. Maple FATHER--NAME First Middle Last 15. Daniel RYAN MOTHER--MAIDEN NAME First Middle Last 16. Sarah BERK* INFORMANT--NAME 17a. Floyd Corey MAILING ADDRESS Street or R.F.D. No. City or Village State Zip 17b. 200 S. Maple Green Bay,Wis. WAS DECEASED EVER IN U.S. ARMED FORCES? (If Yes, Give War or Dates of Service) 17c. Yes X No Unknown 18. PART I DEATH WAS CAUSED BY - Enter Only One Cause Per Line For (A), (B), and (C) Conditions, If Any, Which Gave Rise to Immediate Cause (A) Stating the Under- Lying Cause Last. Duration A. Immediate Cause: A.S.D.H. & failure Due to, or as a B. Consequence of: Due to, or as a C. Consequence of: PART II OTHER SIGNIFICANT CONDITIONS: Conditions Contributing to Death but not Related to Cause Given in Part I (A) Hypostatic Pneumonia AUTOPSY (Specify) 19a. Yes X No WERE AUTOPSY FINDINGS CONSIDERED IN DETERMINING CAUSE OF DEATH? 19b. Yes No ACCIDENT SUICIDE 20a. HOMICIDE DATE OF Month Day Year INJURY 20b. Hour M. 20c. HOW INJURY OCCURRED (Enter Nature of Injury in Part I or Part II, Item 18) 20d. INJURY AT WORK Yes No 20e. PLACE OF INJURY (Home, Farm, Street, Factory, Etc. 20f. (Specify) LOCATION Street or R.F.D. No. City or Village State Zip 20g. CERTIFICATION--Month Day Year PHYSICIAN I Attended The Deceased From 21a. To Month Day Year 21b. Jan. 24, 1973 AND LAST SAW HIM/HER ALIVE ON Month Day Year 21c. DID YOU VIEW THE BODY AFTER DEATH 21d. Yes No DEATH OCCURRED At The Place, on The (Hour) Date, and, To The Best of My Knowledge, Due To The Cause(s) Stated. 21e. 5:30 P.M. CERTIFICATION--MEDICAL EXAMINER OR CORONER: On The Basis of The Examination of The Body and/or The Investigation, In My Opinion, Death Occurred on The Date and Due To The Cause(s) Stated. HOUR OF DEATH 22a. M. THE DECEDENT WAS PRONOUNCED DEAD Month Day Year Hour 22b. M. CERTIFIER--NAME (Type or Print) 23a. R. E. Jensen, M.D. SIGNATURE--CERTIFIER Title 23b. R.E. Jensen MD DATE SIGNED Month Day Year 23c. MAILING ADDRESS--CERTIFIER Street or R.F.D. No. City or Village State Zip 23d. 621 E. Walnut Street, Green Bay, Wisconsin 54301 X BURIAL CREMATION 24a. REMOVAL CEMETERY OR CREMATORY--NAME 24b. Mt. Olivet Cemetery LOCATION City State 24c. DePere, Wisconsin BURIAL--DATE Month Day Year 24d. January 27, 1973 FUNERAL HOME--NAME AND ADDRESS Street or R.F.D. No. City or Village State Zip 336 S. Broadway 25a. Lyndahl Funeral Home, Inc. Green Bay, Wis. 54303 FUNERAL DIRECTOR--SIGNATURE 25b. Dale L. Lyndahl REGISTRAR--SIGNATURE 26a. Patrick N. Kennedy DATE RECEIVED By Local Registrar Month Day Year 26b. JAN 30 1973 * The entries have been transcribed exactly from the original so that any misspelling or errors of a person's name, place name, date, or any other entry is intentional. Her Social Security number is: 387-68-4697, NOT 391-09-4528B, which is Floyd's Social Security number. |