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~tate of ~e~t ~1irg~riia ~Coantp of ~?aieig~, g~~ _ ...c~
\ ~T~UCfE COUNIY ~LA. , v~
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- OtERK C~~tGU11 COUIlT ~
_ ' ' RECORO YER~F~ED~.~.......
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r~- Book No. Page 344
(In the C7erk's Off'~ce of the Coamy Oaa=t af Raletgh QountY)
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I, FRED T. STACY, Clert of the County Onurt, ia the C~u~tY and State
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g an offioe of rcoord, and Davi~g a aeal, do hereby ee~fY tha~ -
t;~~, the rocords in my off'we sho~v that
~'~4CE H. +~OCD ~
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J' c NAME IN ~JLL `R~ •
~ Whit e ~ Ma 1 e
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~ September 27 1957 "
~ ~ ~ Date of D~ath '
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, ` 3' Canse of L?cach. CoronarY, Oeclusion
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Place of Death: t~lat Top
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A~: 53 - Yra. ' 1~tonths ~'Ys
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~ Occupation t/Ierchant ~ ~
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~ CODSOIi Of Oi t1IIII11fI1C~
~ ' S. A. Ford, M.D
~ Saurce of information '
- In tesrimony wheroof, I have hereunta a~"ued my aignature and official seal at
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]j- y wesc Vtrgin;a, c~~s-27th ~y ~ Iy 19 2
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Y •,'~1. 1 _ ~ Clerlr. By , ~ l.. z ~~~~Y Clerk ~
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