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HomeMy WebLinkAbout0325 i/ ! A ~A!'1C~AS STA7E DEPARiMENT OF H~~~., f~ t, ~ ' ui L! tC ~ 2 J 7l G pi~iswn oI Y.+ol Sfot~s~rcs ~t - • CERTIFICATE OF DE H r'~ _ . t!V . ~ ~:tl w.~..~lt • . ~ OECE4SED-vuv~f .~a=T ~ . . ".v„~ ~.5~ .StF :.a*E Of Dt~1~ . . .~.c ~ - Lisle Robert McMillen i~ ;~'i z I~iarch 17, I972 Y~C[ •.•~ee .~o~.; ...r~~,a.. ,.:~w~ .IAGE.-:.ir. Lw~~. t.~t__ ~~cea o.. ~Dalt CJF EroTH COJ~StY Of Df~i'+ . e•, , s.ec... ? ~ ..»c.. ~ .e••s ~I rci ' w•s .,::~s - ~ . ~ . , vahite -t,.,-76 ~1'„ ' ~ Jw;e 18, 1895_ „_Sedgwic'.{_ ~ U7f. :^WN OR IOC~T1'J~ Ci` i::~r*j ~ . : `ti~~ e n ~~'h 4 MOSPITAL UR OiMER M:ST:Sl;7fUN--h'aa•f . . . '-e~ ..~.t e .•r ..-r•~ 4 ' . S~/;' 1 . r. ~ . . ~ ~ 1 ; Wichita yes St . Joseph Hospital _ _ ~ f S:~TE O' &..TN ~ «e• . _ . •~C~'..t~+ G° WhRi Cpu~:F.Y ~.~niRC~ED. t~FVE^.. nnERG~.ED. SUP:t.~~.~, 5?:,;ee , ~ re•- ~ ` ' ~ p . ' : w~pOwED. Drv04CED ~ s.e' . • E ~ ~ansas USA_ _ ~o married t~ G~rnet Schoc~: _ r ~ SC:~rt SECUS;i• `:UKEtO •'JSULI CXCUVAT~ON a,.r ...c . ~•r.c cJ.~+:: _ ..ir.D C° 3c_, .c..> ~r.~L'S7~! , wo.. w ~~re e.r.. . ~t:~no i ~ „ 511- 07-4887 Electrical Contractor__ _ i> > _ _ . _ _ _ . ~ =ES:~EwCE-Sia7f iC..J:+~Tr _ - - `~~7Y. 70w~. Q~ lCC~?7ION - •:s.c~ ;~r. .ST:FEi AvD n+J~rEE~ ~ ~ ti ~ s.t~ , ~ ~ Kansas Sed evick +~j~ Wichita es ;t- 2762 S. Sen a _ , . ~ ieintR-tic~: E ~~n; ...pwe ~.s~ { /MOS!.Ek-neR~:.Fr~ r:e•: r ~ • .•~~r_,e ~ „ Grant G McMille:i Ellen Connor _ IN'V~iMAhi-f:AM~ iMAIIING AD'JRESS ~cs~ft~ C~ ; ti:.. Ct•~ G~ •Qvv, S"~'E 7'~ ~ ~ ~je Mrs. Garnet McMillen 2762 S. Seneca,Wichita,Kansas DEATM WAS CAUSED 6Y~ :tN/fR Gr~tr (it~f CaUSt ?[R tWE fUD e-t;. sr:~ .r.~~s:..tt ~wn~..i~ PI.Ii I. 1%. l~ i~lTwtlw OMSl7 ~1N Dt~1M 1~ ~ w.l~ TF C•ulE - ~ ~ ~ ~ I~ietastatic carcinoma. (probabl~r from t~e lting.) ` 1~ vEars a .s . «..uo~t..« o~ : ~ .~`u.> YOwD~i~O~f. ~t •w~ _ ` ~~cn e.~e ~~st ro l I6) ~ ~ ~...~o~.rt uuse ~e~. I o« ro. o~ .s . co~srou~«ce o. ! St~i~N'v 1M~ Y~+Dl~- ~ ~t~wf. ~~VSF ~~ST ~ ~ - - ~ - ~ v~et n Oii~ER S~CiNIf1CANT CON.ri1T10NS CO«o~T 0a1 C~+•uwv,.w re ct.r- ~_~T ..o•.~:.•u -o u~i~ c.~.e~ ''~UTO?SV ~'vE5 ~t~e nhm..es co..- ittlS G~ w0~ ~ S~~t~lD Ct~fari~.~,.i• Uu1f ~ _ _ _ - pf DF~TM <<M ~res I ~es .,a /~CC~DENT, SU:CtDE. MOMICI~E. DAIE Oi IN1UIiY ~ ro~+~~. o~•..t~~ ~ MOUR : MOW INIURY OCCUORfa ' f~•i~ °~Wr[ Or ~wu~~ r.~i ~ p~ r~~t rttr nl OR UwDfTE?r++r~EJ ~an:«•, ` ~OU yoy . 7d • N ~7M s~nt., •.c,u.., n , INIURY ~T WOpK ~iUCf Of iNJU+~r .~c•r, ' tOC~T10?~ ~ s ee o~ ~~.o »e., c•-~ o~ ~o~~w, st.i~ ~ ~ SIlC+t~ ~f1 O~ ~OI IOtr~CF ~.3G..l:C '~fC+rr i i ';s ".r~~+. ~G~ ~ ~ ~ Yro CERiIf{LR7iQN- +(r•'H Da~ ~ r'v~ ~ rt~• ~•.~D NS' S~~ ~W:"n!t w~r.f D'. :t C'_ ~ L~D ti.:t v~[vr ~r( OF~TM OGCURtF1 aT Mt ?UfE, OM ~M[ ' •r1•SiC1aN~ ~ TO rG«~M C~t •f~~ r_.• .tif~ Ot~tM. ,wGJS ~ D~~F. •~+G, ~O M1 ?FS~ 3~ t n~'fw:fD t.~t ~L~~L 'Itn C L'~ a M~ aMOr+ItUG. DUE ,:o ~,:t.:E~ 3 ~~9 3-1?-72 3-16-72 { 2,: aid not G J io rnt uvst~s~ S~.nD. _ _ y~ CERI~F~Utn7r+-N.EG~C~t Ex~4~t~t~ Oo COCO^iEQ e~ +~i ~•s~e e~'-. .ou• c• ce•*~ i~t oeceoe•.r ~•s ••e~v.+ce. rt.o ~`S ll~r.n~T.<+.~ O• i..f ~^31 aw f F~v:at- •'~0•. ~ra Y~ CI..V•~-., MO+fM - w0.:\ Df~'r OCCU~~fC 7~ D~tf D~ !O i«l,i~V5i~5i t'~+fD M, i?p ~~1 1 L 2 i2~ A_• M lA _ 1 ' - . - ' CFEiiFtE4-n~a,vt ~ ~.f e.•• - - ~ S~GN/1TUR~ 1 - ~ ~ec.:~ o~ r,r.e '~~~E S~GvED ..•o~~~, o..,rt.~~ ~ David Y.irk~ 1~. _D.,_P. A. _ r~s ~y{~,%.~.:__, ~~s ~^c-~ ax 3-23-?2 wu~:!wG aDOR S'~Cf4T6:(a anen ca.-~ ~o. u ' s rr r.? ; ~t~~ Hil~side t•Jichita Kansas 6 ` • 6Uh~Al, CREMAiIOh, 4Err~V~t 'CE/~E:ERY O4 CREMAtORY-r~a~.f 1C,twi~ON c~r. o~ +o.+.. a*.n ~ ~ s.euo , , ~ burial i;., Memorial Garden's ~ Wichita,Kansas - ~~e DATf ir _'-0~~-~[~~ ' ttUN~kAI MOME-NAME <M~ LL•CPfs$ ~ ST~•!/ Ot e~ D O. C~:r Or iCwa, Si~!~, i.~ ~ ~ March L~G~, 1972 Downin Mortuar 327 N. BroaCwa ~ Wichita Kansas 67202 OwiE ~ ~ t7 IGCa: 4[GISi~a~ ~ f:IrtE'rRl.~JiREGlOa~53.aht/~/--E----t? . RiGISTRS,F-5~ r:~;~~~H~ ~ ~E`~ ~ . 7SF.-~-.~i ~ '.1J Y~ ~`~i 1H rh~( ~ ~ 4! xg. - - S' x„~.~ ~-ar ~ 3`" k~~~:~.~~'~ ,.~.x.. ~ _ ._r : rY,~`' . ~z ~ ~'~.ri=~