Death Certificate

PLACE OF DEATH

STATE OF MICHIGAN

448

County of

Clare

Township of
or

-

Department of State - Division of Vital Statistics

Village of
or

-

CERTIFICATE OF DEATH

Registered No. 23
[If death occurred in
a Hospital or Institu-
tion, give it NAME
instead of street and
number. If away from
usual residence, give
"Special Informa-
tion" below.]

City of

Clare

(No. 5th St.; 2nd Ward)

FULL NAME

James Thompson

PERSONAL AND STATISTICAL PARTICULARS

MEDICAL CERTIFICATE OF DEATH

SEX

Male

COLOR

White

DATE OF
DEATH

(Month)
12

(Day)
28

(Year)
1906

DATE OF
BIRTH

(Month)
6

(Day)
14

(Year)
1839

I HEREBY CERTIFY, That I attended deceased from
Sept, 1906 to to Dec 26, 1906,
that I last saw him alive on Dec 26, 1906,
and that death occurred, on the date stated above, at 3 aM.

AGE

67 years 6 months 14 days

SINGLE, MARRIED,
WIDOWED, OR DIVORCED

Married

The CAUSE OF DEATH was as follows:

Asthma

AGE AT MARRIAGE,
NUMBER OF CHILD-
REN

If married, age at (first) marriage 28 years

Parent of 10 children, of whom 8 are living

BIRTHPLACE
(State or country)

Canada

NAME OF
FATHER

Robt C Thompson

Contributory General Anasarca

BIRTHPLACE
OF FATHER
(State or country)

Scotland

(Signed) H G Sanford M. D.
Dec 31 1906 (Address) Clare Mich

MAIDEN NAME
OF MOTHER

Christine Douglap

SPECIAL INSTRUCTIONS only for Hospitals, Institutions, Transients or Recent Residents:

BIRTHPLACE
OF MOTHER
(State or country)

Scotland

Former or
usual residence

-

How long at
place of death?

- Days

OCCUPATION

Miller

Where was disease contracted,
if not at place of death?

-

THE ABOVE STATED PERSONAL PARTICULARS ARE TRUE TO THE
BEST OF MY KNOWLEDGE AND BELIEF

PLACE OF BURIAL OR REMOVAL
Cherry Grove

DATE OF BURIAL
Dec 31st 1906

(Informant)

Mrs Thompson

UNDERTAKER
A Thurston + son

ADDRESS
Clare Mich

(Address)

Clare Mich

FILED 12/31 1906 J. E. Doherty Registrar