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Jodie G Kanagur, Petitioner V Township Of Waterford, Respondent · 26-000230-TT

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Page 1

JAN 

1 6 2 

6 

STATE OF MICHIGAN 

MICHIGAN TAX 

X TRIB 

GRETCHEN WHITMER 

DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS 

MARLON I. Bl 

NAA 

_ GOVERNOR 

LANSING 

DIRECTOR 

PROPERTY TAX APPEAL PETITION FORM 

DISABLED VETERANS EXEMPTION 

Do not use this form to appeal Principal Residence Exemption, Qualified Agricultural Exemption, Poverty Exemption, or 

other exemption disputes. 

Pursuant to Tax Tribunal Rule (TTR) 279, you MUST submit a copy of the notice giving rise to the appeal (i.e., Board of 

Review Decision or other notice) with this petition. 

If you do not submit this document, you may be held in default, 

Section 1: Petitioner’s Contact Information 

Fir: ON 

i 

MA 

Last 

#lame/Company 

Name, 

Freon 

a Street, P.O. NI a + 

4 

NeViE 

a 

For s\ZWowN 

IE 

TEGocd 

1 

Ter "a7 

Email Addresy 

(do eG &- 7) op] 703 

] 

POET HOM PO DI 

(0) 

Section 2: Petitioner ’s Attorney/Authorized Representative’s Contact Information 

First Name 

[“EN 

Last Name 

Firm Name (if any) 

Mailing Address (No., Street, P.O. Box or Rural Route) 

City or Town 

State 

ZIP Code 

Telephone Number 

Email Address {do not enter unless you want MTT to send all correspondence via email) 

Section 3: Subject 

Property Information: 

Parcel 

Identification 

Number: 

_3 0 

hoy 

erty Address (| 

oy ol 21] 

“4- =O 0 i 

a. 

wwoy 

Cit 

Neg 

t br 

oriord 

LI" 

0aKind 

Pr gan ¥

Page 2

STATE OF MICHIGAN 

GRETCHEN WHITMER 

DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS 

GOVERNOR 

LANSING 

Section 4: Explain the Reason for this Appeal 

MARLON I. BROWN, DPA 

DIRECTOR 

Section 5: Jurisdictional Issues 

£ 

Did you request a disabled veteran’s exemption by filing an application with the city/township? EB Yes 

ONo 

if No, please explain: 

List the 

date the exemption 

was denied: 

. 

Tax year(s) denied: 

. 

DecEmbe IS, 2025 

2025 

Fee Information 

There is no fee required for the filing of a disabled veteran's exemption appeal. 

Signature required 

Petitioner 

or Att rney/Authoriz 

Representative’s Signat re: 

i 

NUNS YC Kuan

Page 3

WATERFORD TOWNSHp 

Michigan Department of Treasury 

7 V2 72< 

| 

DEC 

05 

2025 

5107 (Rev. 11-24) 

State Tax Commission Affidavit for Disabled Veterans Exempfipf= 

Ej 

tssued under authority 

of Public Act 161 of 2013, MCL 211.7b. Fifing Is mandatory. 

ASSESSOR’ SO 

Instructions: This form is to be used to apply for an exemption of property taxes under 211.7b and 241.7, for real property used and AAR FICE 

a homestead by a disabled veteran or an unremarried surviving spouse of a disabled veteran who, immediately before death, was eligible for the 

exemption under this section, Submit the completed form with required documentation to the focal assessor in the city or township where the 

property I is located. 

die Gerson Rao 

THIET nos 

22 Touro CA. 

Cater ford 

Rr ie 2% 

Eitec DESIGNEE INFORMATION (Complete if applicable) 

Legal Designee Name 

Daytime Telephone Number 

Legal Designee Mailing Address 

City 

- 

State 

ZIP Code 

HOMESTEAD PROPERTY INFORMATION (Enter information for the property in which the exemption is being claimed) 

Name of Loca! Unit (Check Township, City or Village) 

County O 

[ 

Name 

pf the 

F.acal S 

ol 

J City 

X Township 

[| Village 

RE 

lor- Faved 

Parcel Identification Number 

I 2 2 37 - 

Date the Property was Acquired (MW/DDIYYYY) 

2 

= 

Fl 

2/7/202/ 

SE 

inet Proparty 

Address 

© 

B 

ZIP Cid 

3 Poi Woy CA 

Weder Bred 

AT [R75 

Hod2 Far 

Wo. (Eheck all boxes that apply) 

Lo 

RR 

1 lam a disabled veteran, or the legal designee of the disabled veteran. 

| am an unremarried surviving spouse of 

of a disabled veteran who, Sl ig death, was eligible 4 the exemption 

under this section. Wi; clou” ~~ 

{eo CoN. 

spousal” 5218 FS 

rom 

mM 

1 own the property in which the exemption is being claimed and it is used as my homestead. Homestead is generally defined 

as 

any dwelling with its land and buildings where a family makes its home. 

AFFIRMATION OF ELIGIBILITY (Check the appropriate box and provide a copy of the required documentation) 

[A 

he disabled veteran has been determined by the United States Department of Veterans Affairs to be permanently and totally 

disabled as a result of military service and entitled to veterans’ benefits at the 100% rate (must attach a copy of the letter from 

the U.S. Department of Veterans Affairs). 

4 The disabled veteran is receiving or has recelved pecuniary assistance due to disability for specially adapted housing (must 

attach a copy of the certificate from the U.S. Department of Veterans Affalrs). 

The veteran has been rated by the United States Department of Veterans Affairs as individually unemployable (must attach a 

copy of the letter from the U.S. Department of Veterans Affairs). 

GERTIFICATION 

| hereby certify to the best of my knowledge that the information provided in this Affidavit is true and 

| am eligible to receive the 

disabled veteran’s exemption from property taxes pursuant to Michigan Compiled Law, Section 211.7b. 

vi am a Michigan resident. Cir «st 

he oho eR My Ne ane 

| h Jshancd 

D1 cod

Page 4

‘BOARD OF TRUSTEES 

§ 

. 

Anthony M. Bartolotta, 

‘A 

ERE: 

RD 

Assessing Department 

Supervisor 

Kim Markee, Clerk 

TOWNSHIP 

Steve Thomas, Treasurer 

5200 Civic Center Drive 

Jeff Gilbert, Trustee 

Waterford, Michigan 48329-3773 

Sam Harris, Trustee 

Telephone: (248) 674-6270 

Fax: (248) 674-6255 

Marie E. Hauswirth, Trustee 

www. waterfordmi.gov 

Gary Wall, Trustee 

December 15, 2025 

Jodie Kanagur 

4633 Fairway Ct 

Waterford, MI 48328 

RE: 4633 Fairway Ct, 

Parcel: 13-27-304-007 

Ms. Kanagur, 

This letter is to inform you that the Disabled Veterans Exemption for 2025 has been DENIED for 

the above referenced property. Due to being remarried, we are unable to grant the Disabled 

Veterans Exemption. 

Enclosed please find a Notice of Denial of Disabled Veterans Exemption. If you disagree with 

this denial, you may appeal to the Residential/Small Claims Division of the Michigan Tax 

Tribunal within 35 days of the denial. An appeal with the Michigan Tax Tribunal can be initiated 

by the timely filing of a petition. The petition must be a Michigan Tax Tribunal form or a form 

approved by the Michigan Tax Tribunal. Michigan Tax Tribunal forms are available at 

www.michigan.gov/taxtrib. You can print and mail the completed form to the Michigan Tax 

Tribunal at P.O. Box 30232, Lansing, Michigan 48909 or complete the form online and submit 

electronically, if provided for by the Michigan Tax Tribunal. 

If you have any questions please feel free to call me at 248-674-6271. 

Sincerely, 

Joyce Lyman

Page 5

: 

— 

. 

I=5-2(, 

OAD pec 

for Proporky 

Tax Exemption - 

SunViving Spavse-o 100 v. Dicaliod 

\orferan 

To Whom 

it ory Concorn, 

T om 

Writing 

are Formally 

anbeal the 

dec igion regarding my 

proberhy tox 

exemption ond 

To 

requ ost 

recansidoration 

Mise ON 

m 

<toduc 

as 

A 

Survivin 

spouse. of aloo Sorvice 

- Connocted “wor 

vetoran. 

Ave. 16 Sorvice-cannoc 

tol conditions 

Lo 

Ni 

passing, 1 Was recognized as 

Nr < SUVVING Spouse, 

0 

lator morriod. My Second 

h ushend, 

Normoun Rorort kanaa 

ur has since 

1s 

Ade fe 

1 was 

granted

Page 6

2 and frat, vodor VA 

regulations, 

my 

Cemarviage does 

no-+ 

eliminate 

My 

aligiby lity 

now Thott my second 

hushooin A 

14 Aeceases 

Roasad on his Juidance Com 

theo VA 

LT was advised 

that T 

now 

val by 

{ov 

the 

SUNVVING 

Spavse. Property fox 

2xemdt on 

Assoc otod 

w 

th 

hy Fst 

hoshon A Ss 

[007s 

<oyvvice- Conh Qc ted 

disabitily status. + Qh Therefore (guesting 

that 

my application for Taxexemption 

be roviewed gacin 

in 

ight of this 

kor mock iam 

T 

hove included 

suppor ting 

ocmentation ‘aquired 

ncluding VA 

oli bi | ty 

| eters, cleat corlificates, 

Mrciag e Corti cates andl 

Proof of 

Dono + Ss 

Thank. Naw for 

your imo concidavation

Page 7

Department of Veterans Affairs 

6437 Garners Ferry Road 

Columbia, SC 29209 

December 03, 2025 

In Reply Refer To: 319/NCC™ 

~ 

JODIE PIANKO KANAGUR 

XCXXX7 ~t 

ow 

4633 FAIRWAY CT 

Gerson RS 

WATERFORDMI 48328 

Dear Jodie Pianko Kanagur, 

This letter is a summary of benefits you currently receive from the Department of Veterans Affairs 

(VA). We are providing this letter to survivors of disabled Veterans to usc in applying for benefits such 

as state or local property or vehicle tax relief, civil service preference, to obtain housing entitlements, 

free or reduced state park annual memberships, or any other program or entitlement in which 

verification of VA bencfits is required. Please safeguard this important document. This letter is 

considered an official record of your VA entitlement. 

Our records contain the following information: 

Personal Claim Information 

The claim number shown on our records is: XXXX 

You arc a survivor of the Veteran. 

Military Information 

The character(s) of discharge and service date(s) of the veteran include: 

Honorable, Army, 07/16/1971-08/30/1978 

(There may be additional periods of service not listed above) 

VA Benefits Information 

You are in receipt of: Dependency and Indemnity Compensation 

Your current monthly award amount is: $1,699.36 

The Veteran died on active duty: No 

The Veteran died as a result of a service-connected disability: Yes 

Was the Veteran considered permanently and totally disabled at the time of death: Yes, Effective 

03/31/1992 

You should contact your state or local office of veterans’ affairs for information on any tax, license, or 

fee-related benefits for which you may be cligible. State offices of veterans’ affairs arc available at 

http://www.va.gov/statedva.htm.

Page 8

Department of 

[3 

Veterans Affairs 

PO BOX 5365 

November 18, 2025 

JANESVILLE WI 53547-5365 

Veteran’s Name: 

Gerson, Ronald, Sam 

3000849_119918**********AUTO**5-DIGIT 48327 

T386 P 

JODIE PIANKO KANAGUR 

45 

4633 FAIRWAY CT 

WATERFORD, Mi 48328-3484 

sts 

SE 

HE gl ge 

This letter is a summary of benefits you currently receive from the Department of Veterans Affairs (VA). 

We are providing this letter to survivors of Veterans to use in applying for benefits such as housing 

entitlements, fice or reduced state park annual memberships, state or local property or vehicle tax relief, 

civil service preference, or any other program or entitlement in which verification of VA benefits is 

required. Please safeguard this important document. This letter replaces VA Form 20-5455, and is 

considered an official record of your VA entitlement. 

--America is Grateful to You for Your Sacrifice-- 

Our records contain the following information: 

Personal Claim Information: 

The claim number shown on our records is: 29 557 928 

You are a survivor of the Veteran 

Military Information: 

The character(s) of discharge and service date(s) of the Veteran include: 

Army, Honorable, 16-Jul-1971 

- 30-Aug-1978 

- 

(There may be additional periods of service not listed above) 

Eg 

VA Benefits Information: 

You are in receipt of: DEPENDENCY AND INDEMNITY COMPENSATION 

The effective date of the last change to your current award was: 

12/01/2024 

Your current monthly award amount is: $1,653.07 

The Veteran died as a result of a service-connected disability: Yes 

You should contact your state or local office of Veterans’ affairs for information on any tax, license, or 

fee-related benefits for which you may be eligible. State offices of Veterans’ affairs are available at 

https://www.va.gov/statedva.htm. 

Need Additional Information or Verification?

Page 9

VA Benefit Details 

SERVICE-CONNECTED DISABILITY: A condition incurred during or aggravated by military service, 

for which the Veteran is receiving VA benefits. 

COMBINED SERVICE-CONNECTED EVALUATION: The Veteran's disability rating for all condition 

determined to be service-connected. 

. 

CURRENT MONTHLY AWARD AMOUNT: The monthly monetary benefit paid to the Veteran or 

survivor receiving benefits under a VA program. 

NON-SERVICE-CONNECTED PENSION: Benefit for a non-service connected Veteran who meets 

specific criteria, which include disability or age, wartime service, minimum length of service, and income 

restrictions. If a Veteran is eligible for service-connected benefits and pension benefits, VA will pay the 

higher benefit. 

INDIVIDUAL UNEMPLOYABILITY (IU): The Veteran is receiving payment at the 100 percent rate, 

even though the combined service-connected evaluation is not 100 percent. The Veteran's service- 

connected conditions cause him/her to be unable to obtain or maintain substantially gainful employment 

because of the Veteran's service-connected conditions. The Veteran must periodically certify continued 

unemployability, but if there is no scheduled future reduction or medical examination required, he/she may 

be considered by some states to be permanently and totally disabled. 

PERMANENT AND TOTAL (P&T) DISABILITY: The Veteran is considered by VA to be permanently 

and totally disabled because of his/her service-connected conditions. 

SPECIAL MONTHLY COMPENSATION: The Veteran is receiving additional compensation for one 

or more of the following: a service-connected loss of or loss of use of one or more specific organs or 

extremities; a combination of severe disabilities; is 100 percent disabled and housebound, bedridden, or 

in the need of the aid and attendance of another person. 

SPECIALLY ADAPTED HOUSING and/or SPECIAL HOME ADAPTATION GRANT: Grants provided 

by VA to service-connected veterans and service members to help build a new specially adapted house, 

to adapt a home they already own, or buy a house and modify it to meet their disability-related 

requirements. 

Wartime Service Periods 

Mexican Border Period: May 9, 1916, through April 5, 1917, for veterans who served in Mexico, on 

its borders or in adjacent waters. 

World War I: April 6, 1917, through Nov. 11, 1918; for veterans who served in Russia, April 6, 1917, 

through April 1, 1920; extended through July 1, 1921, for veterans who had at least one day of service 

between April 6, 1917, and Nov. 11, 1918. 

World War II: Dec. 7, 1941, through Dec. 31, 1946. 

Korean War: June 27, 1950, through Jan. 31, 1955.

Page 10

TH 5 AN Apo raNT RECORD 

SA¥EGUARD IT, 

[1 CATT HAME 

- FIRLY NANZ GoDog RAGE 

GERSON RONALD SAM 

VBEFARTMENT, CONFONENT XHD BRANCH OR CL ASE 

ARMY 

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2.9, 

= 

ZURITY NUWBER 

Cl 

TUTVEAR 

oNTH 

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ATH 

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TEAR 

MONTH 

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(24S 

RANK 

bo eLecTive service Huusen 

: 

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NA 

SIETECTIVE SERVICE LOCAL WOARD FUNBER CITY STATE ANG 

1 

- HONE 

OF 

ALi 57 

T TiME SF 

TAY ARETE TeeE 

P19 

pa Es 

© 

Oak Park, 

MI 

48237 

Ca TYPL OF SEPARATION 

DISCHARGE 

3. STATION OR INSTALLATION AT wHiCH EFFECTED 

Fort Bragg, 

NC 

28307 

YEAR 

WON TR 

08 

1 

BAY 

crrecTive 

oATE 

eo. CHARACTER OF SZRVICE 

HONORABLE 

I. TYPE OF CEATIFICATE HSURD 

DD Form 256A 

10. REKHLISTMENT CODE 

TT LAST BUTY ATSIONMENT ATD HAJ OR CONN AND 

249th CS CO 

FORSCOM 

FC 

12 COMRAND TO WHICH TRANS 

IRRED 

NA 

FRRNTH 

AL 

13. 

HI OULIGATION 

WONTH 

TAT 

VEAR 

NA 

Fort Ord, 

CA 

93941 . 

DATE OF REEVE [TE FUACT 54 ENTAY INTC CYARENT ACTIVE SIAVISE [Grey 

ove ane ETP Cod), 

. 

DATR EMI ERELD ACTIVE 

QUTY THIS PERIOD 

MONTH 

05 

BAY 

10 

TEs SATAY SPECIALTY, nuMAER ANG 

76b20 

Material 

Supply Spec 

750403/None 

SURAELATED CIVILIAY GECUD ATION AND 

0.U.T. HUNGER 

; 

Parts, Storekeeper; 

289.358 

i 

178. SECONDARY SPECIALTY NUMIER AnD 

TITLE 

NA 

TED CHVIL1AA OCCUPA TIOH ANE 

£.0.T. HUMBER 

! 

NA 

ATIORO OF SEAVICE 

MATHS 

a; MET ACTIVE SZRVIZE THIS REFIOD 

[x 

E SERVICE (a 

+ 8) 

RIOR INACTIVE SERVICE 

2s day 

ve, 

TOTAL SERVICE FOR F 

(/) FOREIGN ANG/OR SEA 

§ 

11 

£ THis PERIOD 

30 HIGHEST COUC ATION LEv Fe. SUCCESSFULLY COMPLETED (fn Years) 

SECONDARY HIGH scroor] yd 

YRS (117 grades) COLLEGE 3 

RLY 

22. DAYS ACCRUED 

LEAVE PAD 

INSURANCE COVERAGE 

{s1s000 

(3 $8.00 

$20,000 

[Dswo0e 

{I none 

None 

None 

4. CISABILITY SEVERANCE Pav 

[23 

PERSONHEL SECURITY INVESTIGATION 

5. BATE COUPLETED 

NA 

TY vee 

NA 

Kno 

ives 

AMOUNT 

Vietnam Cross 

of Gallantry with Palm, 

26. DECORATIONS, MEDALS, BADGES, COMMENDATIONS, CITATIONS AND CAP AGH RISBONS AWARDED OF AUTHORIZED 

National 

Defense Service Medal, Vietnam Service Medal, 

Army Commendation Medal, 

Expert Badge M-16 Rifle 

Vietnam Campaign Medal, 

TT REWARKS 

Item 18f: 

Korea 

770124-780120 

Time Tost under 

10 USC 972 

- 15 Days: 

from 

01 

Oct 

73 through 

15 Oct 73 

. 

26 Days: 

from 04 Jul 

75 through 29 

Jul 

75 

72 Days: 

from 19 Aug 

75 through 29 Oct 

75 

Individual 

requests 

a copy of DD Form 210.2 

~

Page 11

0643390} 

State of Michigan 

7139 

This space reserved for binding. 

Marriage License 

State File No. 

Local File No. 

To any person legally authorized to solemnize marriage in the State of Michigan, 

Greeting: 

Marriage must be solemnized within 33 days of date of Application for License 

in the State of Michigan between 

Ronald 

Sam Garson 

Jodie 

Lyn 

Planko 

and 

Full name of male 

Full name of female 

Maiden name of female, if different 

38 

4-20-48 

25 

6-14-61 

Age at last birthday 

Date of birth 

Age at last birthday 

Date of birth 

3681 

Karen Parkway 

3681 

Karen Parkway 

Residence No. 

Street 

Residence No. 

Street 

Pontiac 

Michigan 

LE054 

Pont lac 

Michigan 

4804 

City 

State 

Zip Code 

City 

State 

Zip Code 

Toledo 

Ohlc 

Detrolt 

Michigan 

Birthplace—city and state 

Birthplace—city and state 

Twice 

Nong 

Number of times previously married 

Number of times previously married 

Sam Gerscn, 

Jr. 

Maurice 

Phillip Planko 

Fatber's full name 

Father's full name 

Harrlet 

Danto 

Florence 

Jane Yeberman 

Mother's maiden name 

Mother's maiden name 

Giled in this office by which it appears that said statements are true. This marriage license auth- 

\z parties named above within the State of Michigan by any person authorized to perform a 

laws of the State of Michigan. 

In 

witness 

whereof, 

I 

have 

signed 

and 

sealed 

these 

presents, 

mis 

19th 40 

September 

10 86 

LYN 

B. 

ALLEN 

Oakland 

County Clerk 

County 

__ 

9-12-36 

S.No Dbaaaan) 

Deputy County Clerk 

This marriage license void on or after 

Qotone r 

16, 1986 

ate 

Certificate of Marriage 

Between ron 

1d 

Sam Garson 

ang MU0G1e 

Lyn 

Planko 

I hereby certify 

that, 

in accordance with the above license, the persons herein mentioned were joined in

Page 12

DUPLICATE® 

No. 

19. 

JUS 

. 

COUNTY, MICE. 

- LICENSE AND CERTIFICATE 

OF MARRIAGE 

*THIS DUPLICATE LICENSE AND CERTIFICATE 

must 

be delivered to ome of the parties Joined im 

ERATTIAge. 

)

Page 13

blank must be completed by typewriter 

Except for signature, spaces left” 

or printed legibly. 

By Authority of MCL 333.2813 

09/24/96 

DATE OF APPLICATION 

I 

Mariage License 

JIE LL 

State of Michigan 

7764843 

To 

any 

person 

legally 

authorized 

to solemnize 

marriage 

in 

the 

State 

of 

Michigan, 

Marriage must be solemnized /n the State of Michigan on of before 

OCTOBER 

27, 

1996 

DATE 

DATE CERTIFICATE FILED 

NORMAN ROBERT KANAGUR 

HEAT 

JODIE LYN GERSON 

FULL NAME OF MALE (FIRST. MIDDLE, LAST) 

FULL NAME OF FEMALE (FIRST, MIDDLE, LAST) 

PIANKO 

UAST NAME BEFORE FIRST MARRIED, IF DIFFERENT 

47 

06/07/49 

35 

05/14/61 

———FRESENTAGE 

———oAveoFBRTH 

————PRESENTAGE 

DATE OF BIRTH 

31016 EAGLE DR 

31016 EAGLE DR 

RESIDENCE NO. 

STREET 

RESIDENCE NO. 

STREET 

wv 

mr 

e8977 

J 

LL 

CITY. STATE, AND ZIP CODE 

TITY, STATE, AND ZIP CODE 

OAKLAND 

1 

OAKLAND 

1 

——RESIDENCECOUNTY 

UNGER OF TIMES PREVIOUSLY MARRIED 

———AESIDENCECOUNTY 

NOMGEROF TIVES PREVIOUSLY MARRIED 

DETROIT, MICHIGAN 

DETROIT, MICHIGAN 

BIRTHPLACE 

— CITY AND STATE 

BIRTHPLACE 

— CITY AND STATE 

RAYMOND ROBERT KANAGUR 

MAURICE PHILLIP PIANKO 

FATHER'S FULL NAME 

FATHER'S FULL NAME 

HELEN 

R HAMBURGER 

FLORENCE 

J WEBERMAN 

MOTHER'S FULL NAME BEFORE FIRST MARRIED 

MOTHER'S FULL NAME BEFORE FIRST MARRIED 

NEW YORK 

MICHIGAN 

MICHIGAN 

MICHIGAN 

——— FATHERS BIRTHPLACE 

— 

OTHERS BIRTHPLACE 

ATHENS BIRTHPLACE 

——NOTHERS BIRTHPLACE 

v 

d in this office by which 

it appears that said statements are true. This marriage 

\inge of the parties named above within the State of Michigan by any person 

sjage ceremony under the laws of the State of Michigan. 

Jinese presents, wis 

2 

Hay of SEPTEMBER 

19. 9% 

LYNN 

D. 

ALLEN 

OAKLAND 

COUNTY 

COUNTY CLERK 

we 

DEPUTY CLERK 

« Certificate of Marriage 

| hereby certify that, in accoydance with the above license, the persons herein mentioned were joined in 

ge 

me, in 

NEST 

safrt 

counyor SAKLWD 

 micHGAN,

Page 14

CF. 

CK INK: 

/ 1:'DECEDENT'S NAME 

(First; Mode: Last) 

Lo 

. RONALD, 

USUAL 

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oh pr 0:0F Fer OR INDUSTR! 

working $s Donot use retired): 

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fue: t 

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325; NAME: AND; pyre OF. PERSON WHO COMPLETED ‘CAUSE OF: pre (ITEM 7% ype. 

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DATE OF INJURY (Mo: 

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; 

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nd 

having 

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isa copy of the record. now remaining in my office.

Page 15

a 

STATE OF MICHIGAN) 

yy 

\ 

ATION 

O 

AL 

RECORD 

4 

\. # 

COUNTY OF OAKLAND 

STATE OF] ICHIGAN, 

: 

LF 

Zh 

ay 

i 

STATE OF MICHIGAN 

je 

ET 

: 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Er 

Eh 

CERTIFICATE OF DEATH 

3 

; 

1. DECEDENTS NAME ” (First Middle, Last) 

[2 DATE OF BIRTH 

|" 

Norman Kanagur 

' = 

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: 

: 

; 

h 

i 

| 

5 NAMEAT BIRTH OR OTHER NAME USED FOR PERSONAL BUSINESS 

"Joa. AGE- Last Birthday 

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3 

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«73 

| 

7a. LOCATION OF DEATH 

; 

7b. CITY, VILLAGE OR TOWNSHIP 

OF DEATH 

Z 

i 

28 

; 

Au 

HH 

4633 Fairway Court 

48328 

Waterford 

1 

5| 

5a CURRENT RESIDENCE - STATE 

8b. COUNTY 

~ 

|8c. LOCALITY 

E 

Michigan 

Oakland 

Waterford 

Lf 

- 

Be. ZIP CODE 

; 

0. BIRTH PLACE 

10. SOCIAL SECURITY NUMBER 

| 

1748328 

. 

Detroit, Michigan 

12. RACE 

; 

13a. ANCESTRY 

14 EVER 

IN THE USS. 

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White 

: 

: 

American 

[ARMED 

FORCE 

H 

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Yes: 

3 

15. USUAL OCCUPATION 

~~ 

[16/KIND OF BUSINESS OR INDUSTRY 

[7 MARITAL STATUS pe SE, EE 

Director 

: 

Food Service 

Married 

| 

Jodie Pfan 

: 

7” 

9. FATRERSNAME 

(First, Middle. Can) 

76. MOTHER'S NAME BEFORE FIRST MARRIED. 

Z{_ 

Raymond Kanagur 

5 

Helen Hamburger 

z 

y 

«(¢’ 

21a INFORMANT'S NAME 

21b. RELATIONSHIP TO DECEDENT 

21c. MAILING ADDRESS 

z 

3 

2 

Jodie Kanagur 

Wife 

= 

© “22 METHOD OF DISPOSITION 

23a. PLACE OF DISPOSITION 

} 

23b. LOCATION 

-CW 

3 

z 

Burial 

Hebrew Memorial Park 

Clinton Twp, Michigan 

Z| 

24 SIGNATURE OF MORTUARY SCIENCE LICENSEE 

“25. LICENSE NUMBER 

26. NAME AND ADDRESS OF FUNERAL FACILITY. 

4| 

David M. Techner 

© 

[The Ira Kaufman Chapel. Inc., 

g 

Southfield, Michigan 48075 

: 

"27a, CERTIFIER 

] 

282. ACTUAL OR PRESUMED 

| 28b. PRONOUNCED DEAD ON 

Certifying Physician 

 - Tobe best 

of my knowledge. death occured due 10 the 

TIME OF DEATH 

ht LOG, 

08:37 PM 

December 11, 2022 

i 

[J Medical Examiner ~~ On the bass of 

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120, MEDICAL EXAMINCR | 30. PLACE 

OF DEATH 

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[33. NAME OF ATTENDING PHYSICIAN IF OTHER HAN CERTIIER 

3 

3 

December 12,2022 

22-8295 

; 

Z|. 

34.NAME AND ADDRESS OF CERTIFYING PHYSICIAN 

Zz 

Adil Akhtar, MD, 32255 Northwestern Hwy Suite 197, Farmington Hills, Michigan 48334 

|. 

351. REGISTRARS SIGNATURE 

3 

3b, DATE FILED 

| 

ber 1 

: 

/ 

Ss rr 

£; 

Degen 

3 

36 PART L ENTER the cham of events- uses, injunet or Soamikanone 

= hat directly caused the death. DO NOT enter fermunal events such a8 Cardiac Test, FeSpiralory 

Test or veamenlar 

=. 

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“IMMEDIATE CAUSE (Final 

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disease or condinen 

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UE 

GOR AS A CONSEQUENCE 

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(disease 

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‘mitiated 

the even resulting 

LAST 

x 

PART II. OTHER SIGNIFICANT CONDITIONS conisthutiog to death but not resulting 

i in the underlying cause: 

given in Part I 

39. MANNER OF DEATH 

x 

SE 

i 

408. 

WAS: AN AUTOPSY PERFORMED? 

40b, WERE AUTOPSY FINDINGS. AVAILABLE 

3 

; 

; 

hs 

‘ 

| PRIOR TO COMPLETION OF CAUSE OF 

| 

£5 

Natural 

No 

; 

© 

Not Applicable. : 

[ 41a. DATE OF INJURY 

J 

41b. TIME OF INJURY 

41c. DESCRIBE HOW INJURY, OCCURRED 

41d. INJURY AT WORK 

|41e. PLACE OF INJURY 

41f. IF TRANSPORTATION INJURY 

* 

(418, LOCATION 

EE 

Nar Nal a Yor) 

EFI TOIT 

: 

I, LISA BROWN, CLERK AND REGISTER OF DEEDS OF 

= 

3 

= 

SAID COUNTY OF OAKLAND DO HEREBY CERTIFY that 

3 SUL ” 

WARNING: 

the foregoing is a true and exact copy of the original document on 

” 

: 

3 

E. 1h 7 

ANY REPRODUCTION IS PROHIBITED BY LAW. 

file in my office. 

e 

WD 

an 

DO NOT ACCEPT UNLESS ON SECURITY PAPER WITH 

COLORED BACKGROUND AND TACTILE HOLOGRAPHIC 

SEALS IN UPPER CORNERS. 

NOT VALID IF PHOTOCOPIED. 

DEC 2 

1 2022 

DATE 

, mn 

, 

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