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HomeMy WebLinkAbout0341 1`7'765'7 - . . . . suroRO E~u~orow ,F ILEO E~ OUNT Y~FLA. ~ ° . LL C ^ ~ ~ ~ ~ 4 ~ ~ n MARY R. ~/?N!D • •TAT[ O' T[NNtSf[[ `~SS~ R. M. lIWcM~o~, N10.. M1.H. DEPARTMENT OR rtfBLIC MlEALTM i NAlMVILIt 'a9 APR 30 AM 59 - . ' CLERK CIRCUIT ~ "%~T . CERTIFLCATE OF DEA1 H ~ TENNESSEE DEPARTMENT OF NIBLIC NEALTN nu ao. t DIVISION OF VITAL STATISTICB ?~0?fllY pK~~p _ NAlNE ~~at r~~~ uw QATE OF OEATM ~rwtM. M~. n~u~ ED. GFORGE P~Rb'E7t STANIEY Z:~:P.CH ?7~ 19b9 1 tERAtA• ~wCE ~nan. r~sq. wr~~.u ~rM~. SE1t AGE - uu w~[a ~ vw ~ r OAtE OF ~1RiH ~ro~. wa. rMu tK. qMWn r~nw~c~nwa~ roi. ~w~s Mows r~M. DE~iIDER 2(1 17v1 tiCK IMK. ~ ~1'T~:~ 1. j':~'+ 50. o? sb. s~. L. ~ . COUNTt OF oEwtM tm?. TOwN. Olt lOG?ttW~ OF Otl?tM ~~u~ an uwn lIOS~ITAL OR OTHER INSTITIiT10N - NAME ~ CHAT T~~ 0?~ ~ "~`~n .~s o~ ~a or wor n~, un men ~w wrw~ ~o. H.~I.ILTCRZ m. k. Y~S -~e. t~~ORIAL STAtE Oi tltiM n~ ~pt ~r ~.l.~., CITIZEX OF WIIAT COUNTlr MAtl1ED, NE11Et MAtt/E0, SYt11M11C f~OYfE ~n ~nN. M~! r~na rArE~ si~,x¦a ~~+u towttn MIIOOWEO. OIMOlCEO pMCiM ~,uEa y~:r,n~ v.:~.n. iaap.~~r, ,~.LUCILLE ?'ROGTOR STA:~IF.Y ~ v o~.T~ socmt sECUern Nur~Ee USWLL OCCYIATION ~M~t aM p ~Wa ~OM NnN rOR O/ uNO o~ Mis~MESS o~ a~oo~m ~ ~ ~n u....... p .m..N ' »s. R~AL RS'TATE . ~ .~15- -~~~5 ~`~Or ~ RESIO E- S~AtE COYMTT CtTY. TCMIN. Ol LOGT10u ~~N pn uw~f SitEEt ANO NVY~EE tw. TENNBSSEE HAMILI~ON ,k,I,00K0UT M'N. S~°o••o~ 1001 UILA I.~:KF ROAD f!?THH - NAME MOiHER - MA/DfN NAMf INfOtMANT - NAMf WU?1NC /1DDtETf ' ~s. P,GBs!?T L. STA'•'7.EY F:ARTHA PiOPRIS t~. WIFE: LOOKOUT 1~:QAr"TAIM~ T~~T. 1~. r~tt oEwrM wws uusEO n: IHVTER ONLY ONE CAUSf IER UNE fOR (e). (~J. w1(e)] wnoawe ~.nn.a ~rreMwn twrit ~ ~ _ ~ /f ; ~ j V • ~ L 'i la1 Q"h ~.r.'~~~..~..• W~ TO. O~ wt A CO~i~OYtl~d p: . E co~anoNS. ~wr. b j ~ ~ ~ vrn~a+ a?vE enE to ~ IMrEOUtE uusE (ol, wi ro. o~ wt w tow~a or, ~ fTAT1lIG illE YNOEI- IriNG GYfE 1ATi i`' fAlt 11. O/ME~ S1iMifIC/1Nt COND~t10NS: tOMM~W~f tO~reHrn~K t0 MArw Nrr Iq~ HiA/r t0 twrM MHI n~ARf t I~~ AY10K~ ~i YEf vrltl Nw~rN tOr- Mf O~ AW LNM~ MN~~MM CAMI M MwtN AC(IDfNi. SYK~OE. NOYK~OE. OATE Of INJYt1 ~~o~tM. M~. rWi MWl l~01M INJINY OCCYltEO ~NrN iuqM O~ ~~M~ M M~t ~ w Nut n. nq~ M pR yNOEiEtrINEO aMU~n ~ EDICI~L 700. ' { M. IOd. y 6 CE R. ~MJY[r AT M~OtR , IUYCE OF 1 • worl: ~~r. pw~ ~KtO~R LOCAiION ~stwt oa ~lJ. w.. an p t0~~. f~wtt~ O w? l Ei E ~snan ~u oa .o~ Q.rKe*l~+:v.Es ep~a~n i•~ ~f:' } ;~s.,, . _ CERTiFI• ' NOVRS. ~~(WI = tEtbilGT t~.: l~S~ ^TURE f/ ws~ W1TE fKNEO , w^r. tW+ ;iE G1N. ~ wMMM fw~,~~di~l~ ~MTw~~ 1 n ) J l/ ` 4 1 .r.Me w?c.. a. ~J R~a}'q/ a; .C . ~ 1 ~ / ~ r~ _~gR1~!( I~~L~.~, ~ • ~ `~-L~LL•~, ~ 1~ ' ti Y a~ lte. nna MiE S~GNEp ~ronr. M~, ~w~ MEOiCK EiAY1N -~[If~CAT~O~Ii+{ ; ,*:st ; ~ r D E~ i1f o~ tiN e~lwf wrr~uTlOn p.w~ ~it ~N/%' . o~ ny ~w~l~j~e~llaW _ . MMM'et r_ !QRIZED cwwo~nNlAn ,:-...~.P~•f:;,, ' ~ E. tlo. _ -~i•. s• . , ' 4 ~ OD CERTI~IER ,N r~ s 'P! . . " ' t:~^%tr`C ~ . ` r~uu~K ~oOtE ~ a v.~. rV. , ~~~n ~_o.w . t! n t c-- ~ ~.r ~t; - . • ; ~ l.(.., l ~ ~"1ro. ~ - . ~ ~ "i~%~ ~ , ' n~. • & i E x Wt ~ :•.n ew~ Cdi/ETERY OR C~fMAtOIY - NAME iOtAT~ON nn oa ~ w~n f Wt1AL C!l11ATION. tt,l?O~ i., d{,•., ~'^8urialf~- C /,69~::'-' Fbrest Hills Chattar?ooga, Tennessee - wnR o~ ~-M. ro.. an o~ eow. r~n. an RKK - SI~IdATI/RE ~•n ~c w~ec ~ j -`~'1s ~ ~'~:rr~r(li VtI ~ • NMfrM~ ' 7t. 1'1 CO 71?. (r . . ~ ' - ' . ~ . , , ? I hereby cer-tify the above to be a true and correct copy of the orl~lnsl record an file j in ~hia Departsent. Valld Anly wi~en Mb~aaad ae~! of th~ Tir~n~aa~~ D~prrtw~nt of ~ub1lc ~ Y~alth ~nd wult~-colo~ a~1 of St~t~ t~~litr~r ~r~ ~tllxed. ~ ; - : -ISSUEO _ : ~r ` ~ ! ' y~ _ APJt `e ~~6~ . lsaj t~ j ' : i. ~'~:~i,~ ' . ~ ?="y t~~` - - __'rat^ tE:dSiawA-~~ ~c~~ a~c~ ~_s_~ - - - % < ~ _ - - - ~~T~ ~ - eT_„_~,.,~-y`: ~ _ -