File No.:  1489501
  1. DECEDENT'S NAME:  Lena Millie Chaney
  2. SEX:  Female
  3. DATE OF DEATH:  January 27, 1999
 4a. AGE - (Last Birthday Years):  92
  5. DATE OF BIRTH:  February 25, 1906
  6. COUNTY OF DEATH:  Washtenaw
 7a. LOCATION OF DEATH
     HOSPITAL OR OTHER INSTITUTION:  Oakwood Hospital Beyer Center
 7b. IF HOSP OR INST Inpatient, Op/Emer Room, DOA:  Inpatient
 7c. CITY, VILLAGE, OR TOWNSHIP OF DEATH:  City of Ypsilanti
  8. SOCIAL SECURITY NUMBER:  404-20-1571
 9a. USUAL OCCUPATION:  Cook
 9b. KIND OF BUSINESS OR INDUSTRY:  Medical Care Facility
10a. CURRENT RESIDENCE -
     STATE:  Michigan
10b. COUNTY:  Wayne
10c. LOCALITY
     TWP. OF:  Van Buren
10d. STREET AND NUMBER:  44401 S. I-94 Service Drive
10e. ZIP CODE:  48111
 11. BIRTHPLACE:  Prichard, WV
 12. MARITAL STATUS:  Married
 13. SURVIVING SPOUSE:  Colin Chaney
 14. WAS DECEDENT EVER IN U. S. ARMED FORCES?  No
 15. ANCESTRY:  German
 16. RACE:  White
 17. DECEDENT'S EDUCATION:  8
 18. FATHER'S NAME:  Samuel J. Pancake
 19. MOTHER'S NAME:  Mollie M. Lakin
20a. INFORMANT'S NAME:  Raymond Bates
20b. MAILING ADDRESS:  218 West Congress, Caro, Michigan 48723
 21. METHOD OF DISPOSITION - Burial, Cremation, Removal, Donation, Other (Specify):  Burial
22a. PLACE OF DISPOSITION:  Highland Cemetery
22b. LOCATION:  Ypsilanti, Michigan
 23. SIGNATURE OF FUNERAL SERVICE LICENSEE:  Russell B. Horning
 24. LICENSE NUMBER:  6816
 25. NAME AND ADDRESS OF FACILITY:
     Stark Funeral Service  Moore Memorial Chapel
     101 S. Washington St., Ypsilanti, MI 48197
26-33. CAUSE OF DEATH:  [See scanned images]
34a. REGISTRAR'S SIGNATURE:  Peggy M. Daines  /bls
34b. DATE FILED:  January 29, 1999