Death Certificate

BIRTH No.

CERTIFICATE OF DEATH
MICHIGAN DEPARTMENT OF HEALTH
Vital Records Section

State File No.
2800 3066
Local File No. 3

1. PLACE OF DEATH 
a. COUNTY  GRAND TRAVERSE

2. USUAL RESIDENCE 
a. STATE  MICHIGAN

b. COUNTY 
GRAND TRAVERSE

b. CITY OR VILLAGE 
RURAL WHITEWATER

c. LENGTH OF STAY 
-

c. TOWNSHIP, CITY OR VILLAGE 
WHITEWATER

d. Is Residence within limits of  
a city or incorporated village? 
Yes _ No X

d. FULL NAME OF HOSPITAL OR INSTITUTION 
WILLIAMSBURG, MICH R#1

d. STREET ADDRESS 
WILLIAMSBURG MICH R#1

3. NAME OF DECEASED  JOHN FRANKLIN THOMPSON

4. DATE OF DEATH  4 18 1952

5. SEX 
MALE

6. COLOR OR RACE 
WHITE

7. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED 
MARRIED

8. DATE OF BIRTH 
MAY-4-1876

9. AGE 
75

10a. USUAL OCCUPATION 
PURCHASING AGENT

10b. KIND OF BUSINESS OR INDUSTRY 
CONTINENTAL SUGAR CORP.

11. BIRTHPLACE 
ONTARIO, CANADA

12. CITIZEN OF WHAT COUNTRY? 
UNITED STATES

13. FATHER'S NAME 
JAMES THOMPSON

14. MOTHER'S MAIDEN NAME 
ELLEN CROSSEN

15. NAME OF HUSBAND OR WIFE OF DECEASED 
MABEL THOMPSON

16. WAS DECEASED EVER IN U.S. ARMED FORCES 
NO NONE

17. SOCIAL SECURITY NO. 
-

18. INFORMANT'S SIGNATURE 
Mrs. Mabel Thompson

ADDRESS 
R#1 WILLIAMSBURG MICH.

19. CAUSE OF DEATH 
Enter only one cause per 
line for (a), (b), and (c)

I. DISEASE OR CONDITION 
DIRECTLY LEADING TO DEATH (a) Arteriosclerotic heart disease 

ANTECEDENT CAUSES 

Morbid conditions, if any giving 
rise to the above cause a) stating 
the underlying cause last. DUE TO (b) - 

DUE TO (c) - 

II. OTHER SIGNIFICANT CONDITIONS 
Conditions contributing to the death but not 
related to the disease or condition causing death

Interval Between 
Onset and Death 
ten years

19d. DATE OF OPERATION 
-

19e. MAJOR FINDINGS OF OPERATION 
-

20. AUTOPSY? 
Yes _ No X

21a. ACCIDENT SUICIDE HOMICIDE 
-

21b. PLACE OF INJURY 
-

21c. CITY, VILLAGE OR TOWNSHIP 
-

COUNTY 
-

STATE 
-

21d. TIME OF INJURY 
-

21e. INJURY OCCURRED 
-

21f. HOW DID INJURY OCCUR? 
-

22. I hereby certify that I attended the deceased from Nov 1946, to April 18, 1952, that I last saw the deceased alive  
on _, 19_, and that death occurred at _m, from the causes and on the date stated above. 

23a. SIGNATURE 
R. R. Huston M.D.

23b. ADDRESS 
Elk Rapids Mich

23c. DATE SIGNED 
4-19-52

24a. BURIAL, CREMATION, REMOVAL 
BURIAL

24b. DATE 
4/21/1952

24c. NAME OF CEMETERY OR CREMATORY 
-

24d. LOCATION 
CLARE, MICHIGAN

DATE REC'D BY LOCAL REG. 
4-29-1952

REGISTRAR'S SIGNATURE 
C. Hamilton

25. FUNERAL DIRECTOR'S SIGNATURE 
L. O. Martinson

ADDRESS 
TRAVERSE CITY,
MICHIGAN