| MICHIGAN DEPARTMENT OF PUBLIC HEALTH | |
| NAME OF DECEASED: | Anna Thomas |
| PLACE OF DEATH: | Genesee Memorial Hospital Flint, Michigan |
| USUAL RESIDENCE: | 2281 South Center Road Burton, Genesee County, Michigan |
| SEX: | Female |
| RACE: | White |
| USUAL OCCUPATION: | Housewife |
| KIND OF BUSINESS: | Own Home |
| DATE OF BIRTH: | April 10, 1885 |
| AGE: | 91 Years |
| PLACE OF BIRTH: | Lebanon |
| FATHER'S NAME: | Joseph Rassey |
| MOTHER'S MAIDEN NAME: | Mary --Unknown [Dorothy Harragh] |
| INFORMANT: | Joseph L. Thomas 2281 South Center Road Burton, Michigan 48519 |
| DATE OF DEATH: | June 28, 1976 |
| HOUR OF DEATH: | 1:55 P.M. |
| CAUSE OF DEATH: | Acute coronary occlusion Arteriosclerotic heart disease |
| SIGNIFICANT CONDITIONS: | Peritonitis secondary to ruptured sigmoid secondary to pseudomembranous colitis. Marked rectal distension secondary to fecal impaction. |
| CERTIFICATION: | On the basis of the examination of the body and/or the investigation, in my opinion, death occurred on the date and due to the causes stated. |
| PHYSICIAN: | William F. Mueller, Jr., M.D. Pathology Dept. Hurley Medical Center Flint, Michigan 48502 |
| PLACE OF BURIAL: | New Calvary Cemetery Flint, Michigan |
| DATE OF BURIAL: | July 1, 1976 |
| FUNERAL HOME: | Brown Funeral Home 1616 Davison Road Flint, Michigan 48506 |
| FUNERAL DIRECTOR: | Virgil L. Varsie |
