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CER'II~E~ ABSTRACI' OF DEA7N G'ER7IF'~CATE /
GEORGIA dEPARTNIENT OF PUBLIC HEALTH
VITAI. RECORDS SERVICE
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1pECEA5ED
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MARRI NEVEA MARAIED O U Marii~d o[ Wldow~d Itaw el Spoua~ EImALtFJI'8 GNAniYE
WIDOWSEP iED O ED O ! ~P~ L•
OSUAL OCCUPATION (Gi~s bnd o! ~etk ~ a~III~ OH IIO CIAN
doni durin9 mast oI wotltin9 tib. ~ns i! :~t~»d) U~~ ~S•
R~tfs~d salq~e Lil~ Iir. o.
WAS DECEASED EVER Q1 fJ. S. AHIiED FOSCE37 ~n.w. awvmaa R. L!N'S ADD
( Yes, ao, o~nakaown~(U Yts. 9in war es datN ef Nctk~) I~~-~~ ~~p Y~ 0~
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- FATHEB'S I1 ~
~ Solon D~vid plat! Itr~ . I~ra~a f. Pl~tt ~ila
f MOTHIIi'S WIIDIIf 1~AME , aMAll!'S ADD8F~.4
' Dora Br t•11• Rob~sl~ - 180~ s. 3SrQ a!. !t. Pi•rs~~ _l~a. _
~ CAUSE OF DE111'H [Fabr odi on~ eaus~ P~r tiw Ier (b). ud (e).) PLEASE PHIIfi iI1TE~YAL iE71AFEif
OIlSET ALfD DEASH
PAHi I. DEATH WAS CAOSED IIts ~a ~ ~
O~+~D1AiE CAUSE (a)
z C~n3itions, il +mT. DDE TO (b) ~ia~ ~~•tia~ ~~n•
O which qa~~ riM b
F. abo~9 cauf~ (a). YVf'v~~ ~i,~~ ~O ~
~ s~atir.q l6~ tmd~r-
iy~aq caus~ lafl. DIIE 70 (t)
PAM II. Ot6~r Y~CiW COYd1fjOCf COOfI~LYi~Oq l0 dM1h bYl fA1 i~Ia~ M!L~ btmlOil dWW ~~~M m P~if I I~~ ADTOPSYt
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- ACCIDF.Nt Q~PLJICE OF IIINsY (~.q.. is et +bo+d I B~JUIY CUIIED J~~
¢ SUICIDE p Loo~. Iae~. (adorl. ~trMt. Whil~ at Nfo~ ? I~+bT ~+~T thN 2 att~d IL~ d~e~as~d 6e~
Lo
NOMICIDE Q oESc~ bld4.. ~tc.l NW W67~ d Work O l~ te - 1! - thal ! last w~r IL~ d~eiaMd
tCITY OH 70W1i)
(C~ ) (SlATE1 ?OiE OtoaW) (DaT) (Y~ar) ) , .
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s.; ~yn ~ ~ ~ _ _ l! ud tb~t
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-HOW DID INN6Y OCCUH3 stceu~e e~ r.w
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D~~ sEC• a. . G D a stc~a
REG. 9~q~~ yar~tra l[. z'bo~aa CL~ton, oa. s0~ ~••le•a~
1 EO AND RECOROE~~
S~. LUCIE COUNTY, FLA.
NErr~~r; y~RIFIFO
state of ~eor~a j83~e
~
county ~f - '69 SEP 2 6 AM 9: 0 8 i
~ 1
, ''r ~.~cgrtify that the foregoing is a true and correct abst c~"" ;
~:+~!'c.:~~ ~~.,~F f' l7R~S ;
~ ~-.~~,~}f'~Ke•.~ct~A.`oP death as shor~m on a permaaent record oY dea~~ CIRCUIT COURT, ;
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