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Home My WebLink About1042 White 04-23050105 ~~164'7 J f- CA_152 CERTIFICATE OF+DEATH r WHITE 04-23050105 `Y ' IOC~I /U~ MYr~t~ MkMM~ D»M~W d tiMk F1wM ~ sun ~w ~wr+e~ CECEASfD-NMIE .t rwou ~~u ,,~x DAiE Of OEATN ~ rowtr, o~~, ~eu ~ ELLIS C. SMITH ,.Male , August lg~ 19?? RACE ~rrtt, «eow, uuncu~ u+ouM, AGE-ws~ ~.~w~ i~t~~ v.+w~ ~ wr DATE Of ~IRM ~ra+rw, wr. COUNTY Of OfAM ex. ~ vecu? ~ a~ao.r ~.uu~ ..o~. wa ww~ nu ~ . IJhite ~ ~y. ~ ~ Au~.17 1903 Wexf ord 1, VIL A, OR TdINtVSHIP OF pEATH wHw un Mp~µ p~ 0T11ER HSi1TUilON- ~w wp~ ~w e~twe~, ane irrer .w .w.~~e ~ s.tcN. ~es a i.o ~ Cadillac es Mercy Hospital ST~tE Of MtM ~ u~o~ w u.s wwr~ Gi12EN OF wMAT COIJPITRIf MARRlED. NEVER MAl~IED, SWVIVNG S!'011SE ~ r vnre. oi+t w~wba Nu+~ i m~ Jopli~issouriM . U.S.A. ~1DO~°ar"rie°d'"`~" Irene I Greyerbiehl .rtee eecaxe N. . l~rtD. Y OlAd SOCU~I SECURRY MJM~ER USUAI OCCV?ATION tar! aw~ w~a oO~+e owu+0 ros~ p I(9iD OF WSMIESS OR iNDUSiRr OCCV~~N W MOt[Y~G U/~. MK V l~1I~R ~ 377-05-6293 , •~~~..~.~ba Executive (Retired) Cadillac Ilotor Car Divisio~ ".,""o"• eesw[~cE-sr~rc eouNtr ~ GTY, VIILAGE OR TOWNSMIP cu~ ~rw SiREET ANp ~s.ee.n ns w wo ,y F orida ,w. Seminole ,kLake Mary yes P. O. Box 1606 fAT11ER-NAME ~ nqr n~pp~ usT lNOTNER-MAqfH NAME rrsr ~,~pp~ ~ ~ ~s Walter Smith Henryetta Leeper~ ~wo.~ur,T_?+~ w?IR~G ADORESS ~uae~ o~ e.?.o. .a. tm p ro.~, sr~ie, zr~ t%~rs. Irene I. Smith „~+365 N.I,k.rlitchell Dr,Cadillac,hlich.496( IART 1. OfI?TN WAS CAUSEO ~Y_ (EMER OMr OrE CAUSE IfR IIdE fOR (o?. (b). ANO (i~ ~y ~wa. w K 11. wreou~e C~ s! Nnrt[n O/+sft ~M p~' ~ • (O~ ~ L ` ' ~ . ? ? r . ~ co~smoMf, u •~s, MMI(11 G~rf ~,se ~o (el ~l Wr~Ol~tt C~Yff 101, OY! t0. O~ ~S ~ COM110VlKf O~: srwnMO rM[ uwoee- ~nwc c.~u ua ' - ~ART ¦ OiNER SIGP11f1CANi CpdDTqNS: ca+anp.s caaeuur..~ r~ oaiw r:r ~!!UMO TO U YSF GI~lN W~Mt 1 Ip1 ~?U~OK1f IF YES ren s~~o~Ma~ ew ~J L. _f ~~4~ ' ~ns eS~ s~oe~ro oenawNU~a wq a oe•~w !i H~. 1* ACCIDEM, SU1C10f. 110AYC1Df. ~..O.~rr, w~, ~t•~~ MOUR . HpW iN1UR~ OCCURREO 1 tMl~ rY~1N! W IN/Yti IN ~yi 1 O~ ~~tt 11~ rter ~t~ tsMGV~~ 7A. ?N ?Oi M. l01. INIURY AT wOR1C ?IACE Oi w1UR~.r wo..~. ~?u., s~wer, r,nw•, IOC~iIOn ~ s.~eeT o~ ~.~.o. Mo_, em o~ ~ovr,., sr~a ~ ~srean ns o~ Mo~ pqK( FDG.,lK. ~S?K~q1 7M ~ CERfWUT10N- ..own~ w~ +e~ ro«m , o.r rua ~u+o u~sr s~r wr/wet un! Ow ~ ao/oa nOt mtv+ rwt DE~tM OCC~11~eE0 ae ?uKe, on ee , ?NYtKUw: ~ - ~ ~ TO / ro-+rw e•~ nw~ ~oor wn ~ a~.Mr ~wou~ o~w. uo, ~o *~e ~er , ~ ~-/9 ~ ~ - a ~.,a,~. Ta oece•uo rror 21~ tl/ t4~~ ~o nee twuft~s~ s*wne ! ~ CERTIFKATION-ME01[At EXAMWER ~ CO20NE~: a. nn ~.s~s d n~t ,qw «~.T„ ~~e o[ceoe.n w~s .o ~ ~ liu+~w~iqM W M! qOf ,wY/O~ M! u~vESt~G~iqM. w+ r? W?~qM, ~N - ~ Ot~M OCCV~s~ OM Mt Oaf! ~WO 01R M~M! UUSFISI St~TlO. MOYt ~ n' et rn M I CE~T1f1E!-NAME m+e o: re~~n S A o[wee o~ nne TE S '~..wsw, wr, nui f James Sanderson If.D. ~ ~ ~ MARPlCs ADDRESS-CERi1f~R stetef a wo. w W.na ' ?_O Cobb St Cadillac I;ichi~an `~+~601 c . ~~nu, aEwu?T,on. .~~+ovwi EMfTERY OR CRfMATORY-l1AA~f ~ocwna+ c~n, vatw~E, Twa. ort couHnr s.... ~ zN Burial Grand Lawn :k iJayne Count,y, ty]ichi~an OATE ~.,pun,, p.~, n•~ ~ pIwERAI MOME-NAME ANp AppRESS ~ si~e[r a~.r.o. No_, em oe rorr., sure, i~r ~ ~ ~~u_ st 22 1 oss P~orthru & Son 2240 Grand River Detroit,rli.48219 ~ 8-36 iur+e at- nrrE 8_~ R~ST R-~~A~~ K 1-x • U S C DAfE tECE~YEO ~y tOC4l RlpISTlAR ~ 300M n? li ' n. ~ Au ust 22 1977 ~ - - _ _ _ - - _ - - - - - - - - - ~ ~ - - - - - - - F ~ , STATE OF ~1ICHIGA.'~) - ~ County of Wexford) I, Keith G. Knudsen, County Clerk of the Circuit Court ~ of eaid County, do hereby Certify that the foregoing is a true and correct ~ ~ copy of the original. ' ~ : ~ ~ Signed end sealed.at the City of Cadillac; f.~'i,- ~ this 22IId day of ~u~~~~r ~ , -?.'~7'/ - F ~ - • It; .'~~~Or~:.~D • - ~ - . . ~ , ~`~1b4~ ~ -Y G. SEN.~.Co nCy Clerk 'r9 2G p?:~ ? ~ ~ i ~~t . ~ ~ ~ ~.f~ $y..:;.,. _ . t . ; ~ Deputy Clerk ~ t- ~ - : , i;. -+e --s ~ . . ~ € i ~ ~ ~ ~ - ~ 3U7 ~E 104~ ~ i~"~,~. ~ : ~ s _ _ a=" ~ ' ~~s ~ r~s' ,r ~ ~ .