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HomeMy WebLinkAbout0171 - - _ - - - ,S- 3470 sp ~ / fORM Dq-702 - - _ - S=~`j ~ : - - _ . - - Re~istratan Dist. No ~i 1 A STATE OF SOUiH CAROIlNA ^s"~ ! s84 _ rteQ~svars ho_ ~6~Q44~AA ~Q~~ OF NfALiH CERTIFICATE OF' DEATH rr~c, OR •21N~ ~N Birth No. ~ PElMANlTii INK OECEASfD--N4~+E ~~~u .~.sou iwar $flt DATE Of OEAiH o.r. n+~ ~ SiE kfMllOpl F0~ } ~~cr~cr,a~s , ~.illian Snrott Criffv r Female , T`.arch Qi_ 1965 _ tAtE •n.m, ~~cw. ~.e~K.w u,~uM, wGE-~.u ~we~ ~.e~~_ u..~~~ ~ o~~ DATE OF ~17TM ~ro~+rw, w~. COUNTY Oi DEAtH ~ ! t1C. 1 LlL~~7 ~ ~'~fM ~ rl~~S1 W1f MOu~f ~ rM. ti~~'~^ ~ ~.fiite ~ ~33 ~ 5/12/1931 - Cffr. iOMM. OR tOCATtON Of DEAiH ~~+we t~n iu..s HpSMTAI OR OMtR lIStITUT10N-NUN 11~ M0~ tN l~iNl~. Lh! 1i1~1i AMp MVr~l~ 1 s.eur. .cs o~ r+o n Sumter Yes Tuomey Nospital } SfATE Of 6~A1M tu ..o~ w u.s..., .....e Ui1ZEN OF WMAT COUr+TRt ?~tAtR~'_D, NErER w~ti1E0, SVRYryt~G SPOUSE +u e'"~"`:w'+ w"!' # taw~nri wwc~weo. orvo~o ~~.ec~,~ ~ ~5,,.< «„o,,,,~, , S. C. ~e P~arried _~~.GenP Davis~ i f fv _ ...er~ oKt~sto ~IAI SECUR~tY NtJ~UfR USUAI OCCU?ATfON ~ a~r! [wo O~ roae oO++t ouuwG rOft W KllD Oi WSfNESS OR INOUSiR`f ~ '.tD U Dl~M . urpltlMG l~H. !Vf`~ H Rt.l~tp 1 ~ ~'_CUt~Fp W ,~s="~„a», aM ~t Denuty Re istrar ~A = .c;~~eace ~troee ws,w em ~ras SiREET ~wD NW?~ER •~~:ssw«• RESIOENCE-StAlE GOUNTT CITY, iOW1i, OR IOCwT10N ~ ~ ~ snun ns o~ w ~ Fld. St.I.ucie ~k Fort Pierce ~ FwTMEi-N~wF r~u~ ..~mt _ usr MOTMER-NU1DfN MAMF rusr rroa~ uu f John Webb Snrott Hinnie Sue Sauls ~ is. ~ INiORMANi-N.1lMf . - MARING ADDiE55 ~sMer o~ ~~.o. ?a.. ur• o~ ~o..., sun. :r~ ~ ° Mrs.Frances S.Reynolds, „~ort Pierce Fla. 1)~. •...aa:~.*E [.v.i PwRT 1. DfnM wA5 CwLLSEO ~Y: (Et+?F~ O.vt~ OvE C~Uif /f~ lWE fOR (o~ (b), w~ (e)) ~e~.e~r o«sei ...9 w~~ It .~rta.c~ c.uae ~ Carcinona of breast and uterus " vears I ~j, . •S • OYSfOJi C ' ~ _ ~ I o - • ~ COND17tONS. ~M1~ I t ~ ` MwICM G~~t •IS! IO ~b) . . . ~rrlO~~tt t~YS! 10~, p~ ~Q O~ ~S ~ CO~+SlO~F.Kt W~ sr.+i~e r+e o..oe~- ?nra t~ust ~•si ~ ?AYT n 0~1+ER SK,NI~KANT COP1~Ii1pPtS. ~~a~~.x~s co~+en~ui~+w w oe•:w wi ~+ot ee~~eo so ewst &+e~ ~ r.n ~ a. ' AU101SY If rE5 Ye~e r~..o~.+~s eo~~ ~ ~ ~~s o~ ..o~ uo~~eo oen~~.~•..~ e.us a ot•rM s Ib H! ~ ~ ACCIDENT, SU~CIDE. HO/+~KMJE, OAT~ 4WUx~ ~~+o~+*w, c+~, ~[•e~ ttO1JR~ . HOM~ INjURT OCCURRED ~ trut~ .uiun or ~wwr r~a~ ~ oe ?.n a, rtir~~~ ~ OR UtiOETERMWEO ~v[c~r~~ ~ ~ p~. tpy _ 7k_ M. ~Oi ' ~ INIURY~AT WOt!C PIACE Oi WR~RY.r ~~~e. s~neT, ~K~Jtr. LO'ATION ~srtetr o~ ~ ~.o. «o., em o~ ro~M, si•*e ~ ~ ~ ~sreenr ~es c~ r.o' on~tt ~~oa..ek ~ssv~n~ ~ 7W 7q t'h ~ CERTWCAT~Ow- .a.*~ o.• ie,~ ..o..m o.. re.~ ww wr s.. ~..:..t~ •u.t w. ~ oa/o~o wr ,st++ :r7 DlATM OCCUl~fO .r n.~ ru:e, c; :,.i TO ra+rM wr ~t.~ soo~ urw w~m. ~„ou~~ ~~n, ro ~.r ~ef~ ~~rtt~9eo n~e 3/8/65 d rt [w.+tea:e. W ` t4 oru~uo rro.. ~J3? ttr 211. ~4 1+. to rw! cauun. sr~~tt CER1tNER-N~ME ~n?e o~ re~»n I S~wTVtE swae o~ .~ne OATE SIG?~tf0 i.~+u~. o....eu~ ~ ttf 1 Pa A~:~vPnC 72c ' MwllwG ADDRE55-CfRf1i~ER s~aer or r r.o »o. un i sr.re t~~ ~ n~ ~ 6W1A1. CRE?aAiION. AfMOVAI fMETfRI' OR CREHU?TOR~-NAn~E IOCAAON un w ro~» S*.?f ~ ~ s?ecn~ ~ i ~ ! 1 Burial ,s Mannin~C.em. ~kMannin~, S . C . _ ' , ' ~ ~ ~ _ 2 DATE t..oN*w, o.~, rt.u FUNfRAI NOME-NAMf ANO AUdtESS ~ sn[tt o~ ~.r.o. ..o., un ot ~or+.., srare. tn ~ y ~ } 7S~ lta i- ~ ~ ~ y S f;~~E~AI D1R_ 1-S~("iNAfU~ REGISTRAi-S~GNATURf , OAiE tFCErvED tI lOCwl tr~.~S:~+7 ~ ~ ~~ei.1_ey-Brunson ,S~.A.Neise,TID :w 3/12/65 ~ _ r•. # _ I f - ` • ~i ~ .::RTIFIF.B~ CJPY ~ . .~:y . , . ~ Attests: The above is a„t,mte ~nd lega,l. copy of the facts contained in the . original certif~.a~t~e filed in the records of the Rureau of Vital ~ P.ecords, Swnter.~jCity-County ~epartment of t, Sumter,S.C. .x ~ ' ~ - ' . ~ i 5 ~ ~ - ~ . ~ . . . J~ • ~ Uate ' _ • ~ ~ . ~ ~ SEl1L `Z ? - '~y~" Re~istrar ~ `s ~ ~ ~ ~~``,~~~F t ~;a::~ % ;~EC0,~9ED ~ ~a' f1LE0 ~~D : • . ST.IUt'.[ .Ot1NTY FU. ~6 ~ ~ ppr,f ~i,iTRAS .~p?~y sU~ CLERF. C;~JUtT COllRT ~C~Q ? C7 q frnr,. ~1~ -i~-~r0 ~ ~s ~ :~e;; ; BOGK~O PAGE 1,~j1 9 49 aM ~ ' - - - - - - - ~ - ~ , . . - ` .