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DEATH C~RTI~ICATION
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This tie to Certify that the following ia a true copy of facta recorded on ~~,~:~co ndi~ridual named
hereon, said reoord being filed according to law. F LO R! D A
j1(AME Q~7 A. (Flni) B. (3[lddle) Q(Lst) D'~'~;i (LLonth) (Day) (Yau)
(Type
or P~rint) A~ M' 5~~~ DEATH august 3 1965
PLACE OF DEATH ~z Color or Race ~9 b~~o~~ p
Nav~r llarr[~d ~ Wldow~d ~
TOWN Keene i~ferv Heunpshire Femwle White
Dete oi Birth AGE tIn ye,a~ BiRTHPLACE o~ ~~T'o~~ ~ wr) g~. a„~c. No.
1.ut BirtDda~)
Aug. 29 1901 63 Xrs IPhiladelphia Penrusylvenin + 159-09-2085 .
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CAUSE OF DEATH (Enter Only One UsRaBe Per Line For (A), (B), and (C)
ParG I D~th wae caueed by:
Immediate Csnae (A) Az'teriosclerotic ~ieart Uisaase_-- -
Dae to ( B ) .
.
.
. . , . .
Due to (C) ' " ' ' '
Mediral Ce~dflca~ion Signed By 'Ititle ~d~resa ` Date ~~igned
Fred A.Alm uist ~.D. I Keene Pdew hampsnire I____ At~~3 196b
P}ace oi Burial (Idame m Cemeter~) I.acation (City, Town, Conntq) (S3ate) Date
Oak Hill Cerr~tery Yieat Swanzey New Ha.mpshire 8-6-65
SUPPLEMENTAL YNFORMATION I~ DEATH VPEAE DUE TO EXTERNAL CALTSES
p Accident , ~ PLc~ o~ Injnry (~tcr o~ ~o,rn~-- ` cscar,e)- - - -
Q 1~B1G1t~8 , ' . iDIoJ (D~s) (Y~ar) (Hour)
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! ~ S ...G~.~'.~+~r..-~/..1......r..C.itXG'lerk oi ........,.Keene..~`~"!...~shf re
~ • Date oi Issne Au~us t.. 9... 19.65...
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