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i.'t.f-ilFlEi A~::;ACI' CE~ L'EA~i CEiii1FICATE
GEORGIA DEPARTMENT OF PUBLfC HEALTN
VITAL RECOROS SERVICE
Custodian's Na ~
NJ1ME OF lF'ust) lldiddl~) lLaat) DATE (lloalL) (Da!) (Y~ar)
D
y~
,~o~? P~UL axos BRO~rINa I D~?~ 4 3 1970
PLACE F D ( oun1~) I U H~41DE!(C ( ~c~ . ioatitWioa: rNid~sc~ D~for~ adminioe)
Rabun GeorRia White
Cit7~ or loC1a Y
CQ N
Q I SlAY (ia tLir plac~) ~Obe7:'tiSti01~ 7~i Q T I~le Q 81'AY (is t~L~'u plae~)
~ Cit~ oi
io~~
Nam~ ot Hosp. or Iastiluti~ I~A~ OF gtr~N Add»s~ or H.F.D. and Ew~ Na
~dgscrsat Irlsdical Ceatsr
SEX 811CE Dl8 LACE (Stab or lot~iqu eountq) CIlIZEN OF VYHA Lq g~{~
coutRa~rt arxovnr. 0 4-6-1970
P'I I i~T , Weat Va. (Lo[~iu'i) US? x.,o N'p ( ca~?noH o
DATE OF BIH?H AGE (In Y~us);IF DlIDF~ 1 YE11H IF UliDEB ?A HHS. N11ME OF CE1~7EHY LOCATION (Cit~ or iowa) (Counl~) (Sta1~)
A ril 18 1909 °i•'~a.. n,,. xo~, wo.
P ~ ~ ( I ~ Parriah Prk. I Cleveland,White, Ga.
MAR7t1ED NEVIIi MAEAIED ~J U l4a~ri~d oi Widow~d Gi~~ Nam~ o) Spous~ EMBALISEB'S SIGNAZUBE
w~oowse°r~u?iEn°p En o I$ula B. Bs`otming ~aond T. Butfingt.on
USUAL OCCUPATIOIi lGi~s hod o! work [Il~D OF BUSQIF~.4 OS NOBT(CIAI/
dons duriay moat ol workin9 lil~• ~~~a il r~tir~d)~II'IDOSTHY J w I.ancaater Jr.
h~nt • ' ~
wAS DEC ' D. S. AAI~D FOHCFS? SOCUIL SECOHRY HO. ItOHTICL1ti'S 1lDDaFSS •
l Yas. na, erNO
or~a~(I! Y~s. yih wu w datN ol s~rtie~) I 2~V~1(~U ( Oq Cleveland, ~+i•
FATHEH'S;i/1h[E INFOSMAIfi 8tlafioaahip
B. L. Broxning S~il.a B. Broming Wifs
bi07}iE8"S MlUDEN NAME Q~OSMANT'S ADDHFSS
Cloheann Thmm~aon Robsrtsto~, Ga.
~AUSE OF DEATH (Eale+ ony on~ caus~ p~r lin~ !or (a), (b), and (e).) PLfJ1SE PAIN! [NTERVAL DEiWF.EN
ONSEi AND DEATH
PAAT 1. DEATH WAS CAUSID SY: `+e~b~ ~ci t houra
IMbff.DlllTE CAUSE
Cerebral arterio ros - deteniine
~i 7 C~n3itions, iI tn~. DUE !O (b)
~ ~x~h~~fi qa~~ ris~ to
j C above cinf~ (i).
¢ s'a'inq 16~ und~s- .
:::q caus~ lut. DUE TO (c)
i PAR? U. Oth~r siquilicant cond'?tion~ contributino to d~atL bnt nwidabd to tL~ brminal dis~as~ condition qi~~a ia Pu1 I(a) { AIiTOP3Y7
, ~
~ a ~iabet ~ Y.. ? No n
~ ~ ACCIDEN! Q~PLACE OF INJUBY (~.q.. io or ~bout INJUHY OCCpHSED
< SUICIDE ?!hom~, lum. laNor~. str~~t {Nhil~ at Work ? I hu~b~ e~itifT that I att~ad~d th~ d~c~as~dq~n~ ]{~~`h
~ - HOMICIDE []'oHic~ bldq., ~tc.) No1 W6i1~ a1 Work ? ~g~~ ~ ~9~ lhat 1 lut ww tL~ d~ceas~d
i ;,tTY OA 70WN) (COUNlY) (STATE) 'nME (Mcn1D) (DaT) (Y~ar) (Hour) aT~ 7 ~
~ pp ali~~ ~ 19~_, and 16a1
~NI~Y dK~ ~n~ d
6i_~
l~r,m., from tb~ uusN ~ad on tb~ da1~ ~ut~d abo~~.
~ HOW DID INJU9Y OCCUA? SiGNATU9E DprN or TU~
t .
~ John T. CrenshaW M. D.
~ ~ aTE REC'D B~ LOCAL . GISI6A8 G ADDEFSS DA?E SIGI~D
~ AEG.
€ _ 4-20-1970 ~ Martha K. Thomas Clapton, Ga. !?3/70
~
~
~ State of Geor~ia
a ~
~
~ county ot _~Aai~i ~
1 hereby certify that tne foregoing is:a true and correct abstract
3 of the f~ts of death sho ,0 .~,Jp~~sqanerit record of death on
_ file in ~his office. •~w~~'`~•~v~~i ' Medical Officer
~ V . l ~7 ~f
s ~ Signed hT? 1'~'2l> T~ L~? LiilY~n_~
x Custodiau of Vital Statistics Records
~ ~ Clerk, Rabun County Health Iieparta~ent
~ SEAL Date Issued ~~,a~~
a .
~ ~-5 .1~ . ea~ 203 ~16~4
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