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Home My WebLink About2054I.P a d . ;~~,•,: i : r`.aR c Ir c~.r~ c ~. yr ~ t ~ -ry5 - ~. FL08IDA F DEAT ~ coDE No. • L USU Sty T1S ~ _) ~ a sT~ /U aetttAs yeporas• Ilmttt, .rrtt• >iCB11: i t. LEN6TH OF 4 CT St.Augustine ~ 2 Y•.~s'""' io°O~ ~E •OF Ilt twt V tmottsl t: tmtUia/es, she e-tet s6l.a u Ieetttlta) d. STI ~~ ~ F7 a miler t~osti-t~l woc AfTATt FIL[ NO._. REdIBTRAR•B NO• tZJ _-_ ~-___ _ _ RESIDENCE lTY4tt• atnattd Itrtd Ir t~:sut-oa: rrWLr~e trtort Florida b' COUNTM S ;, .J oh~i ~~~ __ lIt sstttds aotvarW Iwct, a-c• RLAAI.~ -- - - S~.Au~ustine to t.*.L s-.. t«.r-.e- -- - - --- 27 Grant St. 1 NAME OF a. lflrst) b. Uliddk) G (Last) 4. DOF1E (Month) (Dad) (Veit) DECEASED crtrpsosP.+at, Robert Geer a IicCain Jr. o_E,-TItJu1~T~9K~ .-___ i SEX L COLOR OR RACE 7. MARRIED, NEVER PARRIED. WIDOWED, OIVORt:ED (8pettTl L DATE OF RIRTH !. A6E pe sart a a.na. tw ..:.n• :a ^n l Ott et - v..rs+ Lv.;Hocrt y~- ~ ~ m tt r~rried ~ L. ~~_ + Oct.- 1 1 IOa. USUAL OCCU-ATIONtah. Clad d aert IOb_ KIND Of WSINESS OR IN- 11. RIRTH~LA ltitW K lenlta rrsatrjl IL CITIZEN OF WHAT ~ ara' s ~T a '` «ea It reutall D C r uon T. ~: cam. 1~ ~~t~iRTl D Sebast~211 Flt . a _ _ 17. FAi11EL~ NAME - K MOTHERY MAIDEN NAPE Robert G.2~ScCain Sr. - - -~'= ~ ~ --- - - -- - - -.. _ ___ _ - - ----- li- WAS DECEAS® tN U. S.wwEO FoRCESt li SOCIAL SECURITY n. INFORMANT'S 516NATU ~, ~ ~~~ t=K r- R..bsw) tlt s.~ d•..•r se dta.t rtrtc.) NO. ADDRESS ". o"IISE of DEATH ~11eD1~3 ~E~11=~~-~R '~D AND RECORDED ~ ~'~" ~ ~ ~ cam cti) . 1. DISEASE oR CollomoN wRecTLY ~-DINe to DEAT~r CorTiGarv ~hrorlbos' . . ANTECEOecr cAUSEs w e~iaia eI/ ~O. ltoriid toaditiosi. if saty tli•itV UE io --- ..~- ...~,t ,.~.. astie+tiL as te>..s.. ,:.. ~. w `~..~ ~ ta, anw .ao tia .rt..tRiw toa.as task '69 SFP 4 PM 3 : 3 2 or +i J i DilE TO (e) --- at..R I -a ai•+s. aaayisatiow v)t i o A tll d l tl. OTHER S16NIF1CANT CONDITIONS tl'/ G ~ .. . .a.s ca.aitiawa ~e:.;>~;,tD :o t~ ~ >-~ ,~1 - Z o _ G • tad to tA. ar ~.~.. n'' TIATTI of o noRAN 11~, wuoR FINwNSS of o~aATwN C LF R K C I R C U 1T C 0 U RT x w1lTOrsYt O ~v tPttt~b) laaedls'1 21b. KACE OF tILIUlY t~s.. is tr a0est TE) 21a (CITY OR TOWN (COUNTY) 21a. weunrnr r+e. tarsi, taa.tp to:.rl. ta3c. ttit-. Mme) u eesL wa SUSSL) sutcto[' ltd. TIME Wtota) (DaT) (last) t1Tos*f 21a gIJItRY OOCURRED 21t HOW D D 1 U Y R7 OF tntiaT ~ott+alae INJURY - ~ ~ - a sen ^ atsotc ^ ~:~~ ~~ T-24-.•3 Ig , to_?-24-53 __ ~g_, that t lase saw the deceased • zz I hereby eatt~ _ ~ d- s ~~ i` 1 ~ .. .:. -- aline on -# t ~I[eotb otxTnltd at 6t0~ ~ •-•111 from the t:auaes and on the date stated abore. __ _ 23a. SIG ~~?•. ~~:'•' - (t1ar~ ae title) 2T6. ADDRESS 2Ta DATE 516NED ^u r^lori~a :~u~tir_© St. ~.> _ w. . , . lit NAME OF t~/ETER 'IKs. R U Rl t ; }• - Y OR CREMATORY 2~d. LOCATION (Cib. ~+~. m manb) (State) , _ , - , ~I nON.. RE~I ~ ~~~1.~~-cc.~ ~y~s=: = - $ebastian _ Sebastian Fla. _ TS. UNl3/-L OIRCt:It7R'S S16NAiYRE ~+~~~ D"~ - R - ~ ~ ~ Craig Flaneral Home - -~-. _ - _ -,..; ~-' ,, '~ ~~` ~ ~"~~"~ CERTIFIED COPY j Y. y- ~ ~ aka fT'Gn T• 1 HElR_~~~TtT~FY. "SHE ABOVE TO BE A TRUE AND CORRECT COPY OF THE ORIGINAL . .~ , RECORD ON EILEINT THE BUREAU OF VITAL STATISTICS OF THE FLORIDA STATE BOARD OF HEALTH AT JACKSONVILLE. FLORIDA. 1NOT VALID UNLESS THE SEAL OF THE iLORIDA STATE BOARD OF HEALTH IS AFFIXEDI ~//~~ eTAK R[GteTRAR v~~ L~.k~:Ov»~e 'JUL 2 21968 ~ C.o.~.'~c~- ale[eTal. BUREAU OF VITAL STATIfTIGti _~ . --~~_ We[eTOR. OIVIf10N OF VITAL REGOROS /~~j q~ ~j/~ 3 ~~,~ i V f/1VC~VIr . '