| STATE OF MICHIGAN | |
| NAME OF DECEASED: | Mary Joseph |
| PLACE OF DEATH: | St. Mary's Hospital |
| SEX: | Female |
| COLOR OR RACE: | White |
| DATE OF BIRTH: | Aug. 21, 1909 |
| PLACE OF BIRTH: | Assyria |
| FATHER'S NAME: | Peter Joseph |
| FATHER'S BIRTHPLACE: | Assyria |
| MOTHER'S MAIDEN NAME: | Catherine Rock [sic - Catherine Rizk] |
| MOTHER'S BIRTHPLACE: | Assyria |
| INFORMANT: | Peter Joseph |
| DATE OF DEATH: | March 22, 1914 |
| CAUSE OF DEATH: | Shock of having burns to body. Burned in house, origin of fire unknown. |
| TIME OF DEATH: | 1 P.M. |
| PHYSICIAN: | J. C. Burgess, M.D., Coroner |
| PLACE OF BURIAL: | Mt. Olivet |
| DATE OF BURIAL: | 3-24-1914 |
| UNDERTAKER: | F. W. Bruce Detroit |
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