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HomeMy WebLinkAbout0348 _ . _ i Rcr:stratwn a:st No - - - STATE OF SOUTH CAROUNA _ - - - !G~ a~:,~~: ~ of ~~,~TN 25~2 - ~ : ~E•^T :r girth ko_ ~ CERTI FICATE OF DEATH ~~.n .,y ~ , _ c:hT IKK ~p_N~ ~w~ +a.e ufr .._.:i:Ni FJl SEX DAiE Of OfATN ~ roMtw, o.r, ~a~~ ~ ~ ..~~i.c.:~ , Leo Rflss :.~ith ~ r:ale , November 29 1 ~!~'0 uCF,~q. ••~aw. ~uMucu. .wo...., Ac'.E-us~ w.oe~ ~.e.e u.a~~.~ oar ~ DwTE Of NlIM ~.ontw. M~. COIR~TY OF OfATM ',?j - fit.. IVK~'(• M~siOat ~itYS~ r03. 0+~1 rOUtS .u~. ~W ~ . . ~ . kThite ~ 5g A ! I . 9-15-12 Charleston C~;r, iOwy. Ot IOUT?O?r Of OE~iN ws~w ca~ ~rm MOShTAI Ot Oif~ER !lSTITUi - ~r .o~ w e~r1r~, cne tr~n ue ..ww~ ~ f ER snur. ,u a .a ~ ' n C~arlestoa Yes V.~i. Hos ital STwTE O~ WtRf ~ M rot r. us C1T12FN Of WFY1T COllNi~T ~ MARRIED, NEVER MARbED, S{ItV1VMIC~ SI'OUSE ~ r~wW, OM r~~otr~ wM 1 i • ` co~.,n. ~ ,w~oo o. o o ~ vec.,, ' ; , aer:t•acky II.S.a. ',~arr~ Lucy H. S~nith ~ . `~~t-E~1:D ~ ~ x.a SOCw SEGURiTf MJwER USUwI OCCUtwT~ON ~ w.e a+a w wu oone ~wwc ..os~ w [INO Of WSwESi OR INDUSTRY E _ J .N ~ ~W~~MG ~Vl. !r!N V ~lTNN 1 f . ~ ~ 55~-26-35-55 ~ Cit Su ervisor ; k.~ E AfS~DFNtE-Si~TE CpV?rT11 UiY, TOwN, OR tOCAT10N p+~ ~R? «~~s STlEET ANO NUWEt ~ s.~ca. jt68 1 203 S 2$ti~l Sti ' . ~ ~y 102'id8 '~r.'i+l1C1e ~k F't. Pierce i ik • • ~ ` FAiM[i-NA+Nf ~~W r.oo~! u3~ MOTME~-MA~FH NAME •aA ~ rMat Wr 1 ~s `raT1C~y r.• ie~ ut21P.1 R@3/riOlf~3 ~ .r:lOi~NT-H~f wu?rwG wDORFSS ~s~an w~.~,. ~.o, cm o~ *w., s~.n. tr~ i.~ V. iios~ij•,ai :.ecor3s ~,n 109 Hee St., Charleston, S.C. 294~3 ~wil ~ pEwiM wwS CwuSEO ~r: ;ENiE~ Or~~? OnE UuSE ?Ea lwf fOf (e~, (b~, ~vr0 f~il ~•?r~o~~...Tt ~+r~r.u NirFeN O~+ye7 ~MO Ot.fw i~ ..rwn c.uu ~ - '°3 ~r~ i t1 •N ~f.: t u f~ ~ - 11o4i•1 Q~ ~ ~ SrT . w a co.st e~ w~ . - c0.~7.r.O~.s. •w, i ! ! ~ ,o .+_°_~~1G I t~ w~ O ~ t' k f+~ ~t ~ tpj? pi P g~,i x t~r. `---J ...~o..rt : ~sy ~o~, e.~t w, w•s • to«~tout«te a~ . `1~t~M~. V Dt~- . •.w4 C~Yff a~f~ ~ ~ ``I ~ ~ ~Aai J OjME~ SKIhIfKAML COK71TION5: CO~Ai~y~i COwT\NYi~w( p~~IM Wt IW~ ~EMflO 10 C~YSt G~+lM M IV1 1 qt i A~«Sr if YES r!~! ~ewD~wGS CO~/• ~ `i . tf O~ N01 j YDIttD 11` G~Il~~~MING (~YS~ ~ _ . ~ o• oe.rw 1?65 ~ ~t~+~ttf.,_/lr?th~w+~i+*w Yes i,w 5 .?CC~JfM. Su+CWE. ?IO+WC?Df. ~ TE WIURY ~.p.t.. w~, r~.~ i ~?tiOIJR ~ MOW IN/URr OCGURtEO ~~rn~ ruruM W~.u~n ?.~r ~ O~ ?~n u. ,i~. ~ ~ ~ ~ Oi w.JfTE~~.ED ~ irtu.. ~ ~ ~ ! ~ ~ ~ 74~ ' 20 ~lOc M ~ 70~ ~ , .n.:.ar w' wOlu tJ?GE Oi iilNlll ~i wo..t. ~~~r. sntn. ~~[*on. ?OCATION ~ snu~ u~.r.o. .ro.. un o~ ~o.,., si•n ~ .,b'~ .1•fC.A t~f O~ ~01 ~y1~{ wpG.,tK 1SI[C~~ ; ~ ~ ~.~~,{s , ~ • ~ CERi~fKAT1Of~i- +P•~w 'O~~ ~uu ..o..m w• .w •••o +.ar s.r wri~ u~.e w I~ ao/~G~. •~e~. wn pE~rM OCCUUEO ~T M! ?YCI. O~- Iw! ~ p A ~pr~iw Mr nY .~Obr ~/7[~ Df~M. ~ W~ Dart. •*W. W~M! N)~ ~ - • V~ 10-7 2 70 iO 11-29-?0 ; 11-29?0 Did ~j:15p •.4.,~~•. ~ T• ~e.u~eo sw. ~Ji~ .t~. III 71 w~ •o r«~ uus~ sr.~eo ~ CEST•FtEt-NM~E .nn p~ ?~w.+ ~ S+GaATU aou~ ti nni ~ DATf SjGr:EQ ~.o..++. w., .~.a~ ~ • n. B. :.jT=.S N..~. r~. . ~ `~r, ]2-1-70 ~~`"+~';ti~:01~f$s~i`~'~~, 109 Bee St., ~T°Ye°sf°on, S.C. 2~?~~°""' ~ ~.;R.w~. GfMAt~On. ~EMOvni CEMEiEmr O~ UEiw~?fOar-Nw•+E ~OCwTWN un w w+.~ u.p ,~`e~oval/Cre~ation i„~,TL;ie:T 1 G C~C~~11__ llsyES i y ATLAi~T { C Oc~tir: _ Z JwiE ~.o•n. e+~, .w r i WNElAI MOIME-NAMf AND ApORESS it~dt O~ ~ ~•~.o . cm o~ ro.~~, u.~~. i~r ~ t ~ ~ 4 l 7 0 Thom scn fi~ner Ho~?e Oran ebur S.C.o~ ,pi Pr~A ~i Ft.Pi,erce, ; ~ ~ fur.E~iECiOR-S~GN~f / T f• O~rE rttt~~ 0~r iOtu ~t ~'+•R ~ „ Z ~ ~ Z ~ N~ ~/,~f ~ • ~ ~ BOGK PAGf J~S . ~ ~ ~ ~ _ 3- _ _ _ _ : '.~r _,~;.-e