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• t- ~/.3q 4S69f~ CERTIFICATE OF DEATH E "1
~ local Ire rsrNe MIdIRSS OgRtl~eeR ~ Mrs e~nte~~~
- tMet t /
~ LOIIIS$ WIL$ELMINA BLLARD ,.Female December 6 196
RACE .Mn. hoes. areauw •Iw•l. AOE-tllel t . [lAT! OE ERERII t.ol.l..a. oollMlr a OEA/N
etc. 1 eeKtrt 1 • t tease 1 nos. «tf ItOlln rsw. t
~ White ~5 .June 1 1 04 ,<Kalamazoo
r/eN c It11N Al - 1r IIOt w el.rs, Otte sleet ND tltlnewl
Kalamazoo ~~e~p ro Borgess Hospital
STALE Of RRTM 1 r rot rl s.s.a., rAre MIIMT OOIRAt11 MARRREO, NEvlR MARRMIO, SE'OIISE I s t'rs, srte wNl merle 1
\\VW.I„~ Michigan `°w"f1 IISA N °OM~ar°
r~elOd~`«t ,1. Basil C. Ellard
w w .owls ere. a
er r eiew a .Ines Nrs wew roa a R!O Of RU~fEit Ot It~11STRr ~
IT 368-O1-3028 „ Hbusevife Home
•owts~a.. RESRJEeKE-STALE COIMry dry. TOAtM, Ot lOd?110N sure tr. toles
,w. Michi n Kalamazoo It~~rt
ga ,k Kalamazoo TMp. No 1631 Henson Ave.
EATIER-NAME wet rMee t.e1 MOIIRIR-AMgEM NAME set weMe IAet
. Cla ton 8elfer~ - - Loulee _ - --Simmons _
1 MARRV(i A[IORESS Is/sttr a e.r.s. tto., as a to.r, sues, eI1
Mr. Basil C. Ellard U1. 16 1 Henson Awe. Kalamazoo Mich. 4 001
ART I- [IEATN wAf CAUSED RT: IEenER ONtr ONt uv:T K::eeE r.:a iel p~, wlav K.: un.eer otaet .l. se.w
IR. .
N~ Carci Hama of the ovary with •metastases
f:OMMIOre, w ar?, -
•r/cr oaw nee to PI
Ir.ea•n ealrse let, we ro, o. as . eo..seorerce or:•
at•rlro tre Ilrse?
enMO t:.I1M Ust
lei
MRT R. OTHER SIGNRtICANt CONOITIONS_ corslrs.u eotwtrlltwo q tNarl eltr rot seats q uII1M olre.l w tan 1 w AUIO~it R1 TEf IeeM nrNre,e tor.
1 M Oe r01 11NeM W Nnerww0 t'aM
p oeant
*1- ~ l11.
ACCIDENT, SIlKIDE, MOMK7DE, I rOrir, tress 1 NOW INIURT OCCURRED 1 ewtes w?Me o. tr/Yn w ~aet t Oe eYt ly ItNr t• t
OR UHDETERMR~ED Is+ecrtl
TRt. TN. ik. M. TRE.
~ INJURY AT WORK EIACE Of RVl1AT.t tore, taut' suer, r.eroee, LOCATION / smn Oe s.r.s. tt0., 4er Oe torn, etw 1
1 wean as oe //O1 OrtK! tlss., e1C. ~ erecr+ 1
JM. T1N.
CERTRaG1TtON- aortr trr tnu rotes w ttas ..n 111tt Yvr rtr/ree sure Or 1 M/n^s t/Or near M ORA1N OOCYSlO at sle lass, Or 1!
,~f 8 25 69 TO„~ 12 6 69 ~ «.6 'e',~9 ~ •-oN".` 5= 30pw a
e~e",w°,tr~
~ ~ CEJCTMICATION-MEDICAL ExAMISER R: Or Ire e.trs or trr tore a Beast rtt seceettn .ae watsw/cs seas
etarrutrow w • east .rO/oe tae wvesrwatrow, w w ouwrot., rwlr «t nu rose
e.ewwt Occueles Or M «A wt. M t0 +oe 41geg1 stale..
TT?-
CERTIF~-NAME tote p rswr N6.e! oe ttlle IrtOrry trsrl
TTa - ~ :kl 9 9
;~""°It~!"E~io~f~'S~ Med. Cntr. l~~ft~u~l~td.. a amazon Micfii an "9001
RURIAt, CREMATION, REAIpYAI OR CREMATORY-NAME lOCA110N an p Istwl sur!
1 seecrr /
Burial TR?Mt. goer-Rest Cemete Est. Kalamazoo Michi n
' lalallr, tW l T1N'1ERAl HOME-NAME AND ADDREJ,'i / efeeet Oe U.O. t/0., alt Oe 10tH. erAfe, >.w 1
D c. 0 6 .Lan eland Cha is 622 Burdiok St. Kalamazoo Mich.4
4564 ` ' .
1919 A!!~ 30 ~ ;
~ 3 S3 S
FIFE ~ RECpRpEp I hereby certify that this is a true copy
5~~~01~?tY.F ~ ~ of the Certificate of DEATH on :iie in the
~tco ~t r~~,Tnast T ~ Office of the Co-nmission~r of :-i~alth
YERIFLO ems- r~+ 1 ~
~ in Lansing and record.,d in the office
' ~a~ ate.. _=;~~~`f•=.,~ of the City Clerks Kalamazoo, ~ Michigan.
,
~ # ' { • , /Dated tliis~day of....~...19.~ .
. ~ ~ ` --mss' - _ f'_;
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' f' Registrar
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