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J U[CEASID HAM, r foal rlsulr 1•ar SER UAII W UE A1N 1 roNrr, D.•, rru 1
t ~ CI/ntlnFl c~T-c:~ ~7,~.ronr.I. , P1ALI~: nrcrr~r~rR 17, 177
RACI wrllr,~rr.a~,, r/ar•N INDI•N, A(d utl uNwa 1 nu u.¦Nt 1 wr UAIE CM Belll Ir7Nrr, _oAr('~ COUNTr Of pEA1N
~c I ws~p llt~ ~~'n.aal~wrrlt a.t .f.w.t r.1 2~ It O1 GCneseC
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QTY, VILLAGE, OR TOWNSHIP Clf DE ATEi 'MSei cm arm NOSKTAI OR OtMER NS11tU1[ON- Ir Nw /N tlnra, cM tn[tt .NO ..vrstt 1
trot. .n of No
Flints hurley :Medical Center
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STATE Of 4RM / r Nor IN u i N.re CITIZEN ~f WHAT COUNTRY HARRk?D, NEVER HARMED. SURVIVRVG SPOUSE 1 u •rW, OM rapN N11re I
j (OINrn11 vVIDO D, DIVpRCE 1 [ttCrt 1
1 . , aaloe.acr Minnesota t _USA i~arrle~ 11 Dorothy Decker
.Nl.e Dltf•teD SUCIAI SECUbTY NUMBER UwAI OCCUrAT10N lout aNlo or Trot[ OONt DIItINO roar a KIND Of BUSINESS OR INDUSnr
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occuartDw rota 11 trlN NNteol
~a+~lur'oN.a're ,~$5-0?-304$ ~e~. (Swner and Operator Is Family Care ome
nvDlNce urotr wtlot eN. ?rm STREET AND NUtaBE!
.D.~saw~. RESIDENCE-STATE COUNTr CITY, VILLAGE OR TOWNSHIP
1e, yes 104 I:'elch Blvd.
t-~ IwFMichigan Iw Genesee 14 Flint "'t"""'°tN°'
FATHER-NAME rltar rapt l•at MOTHER-MAIpEN NAME rltar x1001! t.t1
„ Lewis :'lendel Phoebe Snyder
IN,ORMANT-NAME MAIRVG ADDRESS Iatetl W t.r.p. rq . em d rpvrw, ar.n, ir1
Dorothy '.endel 104 P7elch Blvd. Flint, ?Michigan 4$503
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FART 1 DEATH WAS CAUSED i ~ (ENTEf OMr ONE CAUSE ?Ef LR~ al. AHD terrttN ONtlt ArD .tart
11 IrreOUn Uu
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Corom ON,, rr •N•, 5 '
YIrICN G•re alSe t0 J IbI
lrreDU1! C•Uit 101, Dye r0. W •t . CONSTONNCe O1~
ar.rlro rrt urota-
ulNO e•use 1•sr ~ 495510 e-ccR° :•=~,r., -
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CART N. OTHER SIGNIFICANT CONDITIONS co..anors co.Nntml..e ro ouM wr Nor ttuno ro uuu elreN M r•ett 1 w1 AUTOf'Sr ~ If YES Iru[ rINO1NOt eat- i
I Ka Ot NO1 y0ttt0 IN OeTeuuNwO 4117!
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I~' ~ ACCIDENT, wIC1Df. HOMICIDE, GATE R4NMY 1 ro«rr, o••, •e•t 1 HOUR l eNnt NAr11w q INwn IN r.7T r a rlltt N, Inr l01
HOW IN1URr OCCURRED
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IV INJURr AT WORK RACE Of IN1t1RY.r Nwt. rear. suet*. r.e*ot+, tOCwT10N 1 sntn w t.r.o. No., eln of roa/l+, sr.n 1
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~ 1 S?KIr7 •t7 W NOI ONKE tIOG., eK 1 arKl1. 1 ,
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CERfRICATION- rONrr w• n•t rONM DAr •e•a AND utr 7• Net Atrre ON 1 Dt1/~lew tllt pEATN OCCUltEO rl! rtllte, ON M
eNpIC1AN: rONM Dal nu t00• .M. 1 1 0•n, .r1D, r0 M ttV (
r .rrlNOEO rNt ~n7 ~t • Or r. [MOIr1E00e, Ow
3 ~ ~ ~ TO ~ ~ I I ~ ~ 1- ~ 9 7 7 21E llt. • 3 JPH. to an c.ustls/ suno.
' J~ 21a Oe:E•SEO /tOr ~ 711 211
` CERTIfKJ?TION-MEOICAI E7.AMWER OR CORONER oN M: utlt or r•It row or DE•M trt oKtOtNr rtl MpNWNCtD oe.o
f ta.rwArlpN p Mt t00• uq/Ot rNt wrtSrlGwrpN. Ir r1 OIINION, rONIN DA1 *t.t rpyl
DE•M OCCVM7D ON ME D.n A11D OYt rp Tre C. Vat ltl Sr•re0. M rn
-y~~hx 7?t _ H
tct
S CERTIfIER-NAME Inn oa rnNrl S ee a rlnt DATE SIGNED 1110r1A1, w+.•eu1
iTt S ~ - A Art ?vl ~ 221 n1
MA0.R'Ka ADDRESS-CERTif ER Srtln a a.r.D. GA Ot- N u.n TA
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BUMAI, CREMATION, REMOVAL CEMETERr OR CREMATORr-NAME IOCAt10N CITY, VILLAGE. 71NP. OR COUNTY 7*An
Burial Removal Gilmore Twp. Cem. Farwell, ?Michigan
I 2M
pAtE IrQNTr, w., n•e1 FUNERwa NOME-NAME ANO ADDRESS /untt M ¦.r.e. NO., an W rowN, sun n?/ ~ O
Dec. 22 1977 Dodds- Dumanois Co. 901 Sarlanw'i $t. , F1int,~Mi.4 5 3
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FUN l DIRECTOR-SIGN TURf REGI -SIGNATURE DA tECErrtD • t I T
8-68 it. i,~~r<.1~ I~ L«.a? „,~ecem~er`A1~; 7
30JM _
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PHOTOGRAPHIC CGPY O_F____R_EC_O_R_p _ GC1O°2 - - r
_ _ j
STATE OF MICIIIGAN 1 MICHAEL J. CARR ~ 1 ~ ~ ~
/ r Clerk of said County of Genexee ~ }
( County of Genesee and Clerk of the Circuij Court fur said County, do hereby
~ certify that I have co
, ~npared the foregoing photograpi~ic
= copy of ______C_e_rti_ icate_ of Death o
~ y _ Claude_Otis_Wendet___________________
! s
" ~ with the original record now remaining in my office and it
is a true and exact photographic reproduction and the whoiE
of such original record. '
' In Testimony Whereof, I have hereunto set my hand[ and i
affixed the seal of said Court and County[ this _ 22.rtd _ _ _ ~
day of ____.IlecembEr_______ A.D. 19 ~Z_. _ _ f
MICHAEL J _C~R, Clerk ~
z_ _
gppR~ PAGE ~ Deputy County Clerk
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