Death Certificate Information
#3199634

Decedent Personal Data
Name: Virdell May Willis
Date of Birth: January 31, 1938
Birthplace: California
Date of Death: October 10, 1996 Time: 16:35
Age: 58
Social Security NO.: 564-62-1446
Marital Status: Married
Education: 9
Race: White
Employment: Unemployed
Occupation: Homemaker
Kind of Business: Own Home
Years in Occupation: 43
Usual Residence
Residence: 2019 Hammonton Rd #65
City: Marysville
State: California
Zip Code: 95901
Years in County: 30
State or Foreign Country: CA
Informant
Name-Relationship: Andy Willis-husband
Mailing Address:2019 Hammonton Rd #65 Marysville, CA 95901
Spouse and Parent Information
Name of Surviving Spouse: Andy Willis
Name of Father: James Fulfer Birth State: OK
Name of Mother: Eva Watson Birth State: OK
Dispositon
Date: October 14, 1996
Place of Disposition: Sierra View Memorial Park 4900 Olive Ave.Marysville, CA 95901
Funeral Director and Local Register
Type of Dispostion: BU
Signature of Examiner: James C. Johnson License No: 7834
Name of Funeral Director: Sierra View Mortuary License No:F1365
Signature of Local Register: Bette G. Henton M. D. Date: 10/11/96 GR
Place of Death
Place of Death: Mercy General Hospital County: Sacremento
Street Address: 4001 J Street County: Sacremento
Cause of Death
Immediate Cause: Shock
Due to: Multi Organ Failure
Due to: Diffuse Arterial Thrombosis
Due to: Antithrombin III Deficiency
Autopsy Performed: NO
Other Significant Conditions Contributing to Death: Coronary Artery Disease
Recent Anterior Myocardial Infarction
Any Operation Performed: Cornary Artery Bypass Surgery October 6, 1996