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NILL5UUF20UGH C.VUNTY HEAL.TH DEPARTMENT
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~ 1105 E. KENNEOY BLVO. P.O. BOX 1731 TEIEPMONE 223-13t1 ~~s
TAMPA. FLORIOA 33601
CERTtFICATE OF DEATH
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DECf~SEO-?~AME "'~t ~•s~ SEX DATE Oi OEAIN ~+o..~w, o•r, •e~~~
VIRGIL WAYNE WILIIAMS ,Male ,October 14, 1972
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+ USA Married Cordie Wi lburn w o~ ~
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fwiHEt-NAME ~iq~ ~u0p~ us~ MOIMER-MAbEN NAME ~~lsr auoat wr
Adrian Witiiams „ Anna Carmin ~
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„Mrs. Cordie W. Wiiliams ~n8445 Ftagstone Drive Tampa,Florida 33615
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;~o Removal ,,.Powell Funeral Home ri,South Boston,Haiifax, Virginia j
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; ctober 1~~,"1~`J2 ~~oza °~'EOwn'~n~o~n~ry ~1~apef b9`d~ 1~P.~i~Yl~borough Tampa 33614
! ' lU ~ STRAR-SIGNAfURE ~ A - ' OATE rvt0 ~1 ' ~ECf1f?RA~
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< , ~ames R . Roel ~ < < ~ j ~ y o /
' I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY
' - OF TNE LOCAL REGISTRAR'S RECORD ON FILE IN Tl{E }iILLS~30R0UGH
s ~;i ~`~i;:J,~~~'~~, COIINTY HEALTH DEPARTMENT AT TAMPA, FLORIDA (WARNING: NOT
= c~~ ti~; 4 ~ . VALID UNLESS RAISED SEAL OF THE HILLSBOROUGH COUNTY HEALTH
` ~ ~ „ ; = . DEPARTMENT IS AFFI .
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4-. f^ = 2~_l 447 Jphfi S. Neill, M. D. P. H. , irector
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' ~ ~ ~~6unty Health Officer & T,ocal Registrar
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; ~b. . OCT 171912_
~ Da te DEPUI`Y REG RAR t
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