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HomeMy WebLinkAbout1923 r . _f a~.~~~~. TM~};~ ; f."~' ; 's Kk `4'1~ ~ : ~':~31 g~~~~~ ~ + A~ ~ : 3Z~ J ; ; z s~ - 3' , ~ ~ sI.E~K f~~~~ ` .r ~`AR~ Y ~ ~~c RE ~ • " RAY BLAh b~~N SIATF. Of IEh:VES~.L't ~ ' ~ ~ a / Go+c~~.o~'~ DEPART~IFNT OF PU~LIC HEnI.TH ~~'~~~~~1 hASHVILLE 37219 ` Z~p-f . Fo«~r4!r, A1 U. M P N ~.7i.1715 Cw.a~~ I hereby certi~£y the below to be a true and correct copy of the official document on file in this Department. Valid ONLY when embossed s~al af the T,~uaessee . Department of Public Nealth and multi-color seal of State R~~i ~ affixed. . . , s~ ~t~i ~ "r,a~,r ~ +a _ i ' f.. T' rr V.~ • :r_~ t. x ~ j t , ~ ~,f~~+ ~ EUGE1dE W. FO ~'~L='~~ , : . ~-,T ~S~'-. C.OTiI[R1SS1Q~'.~~.~ 'r:~ .jr „ . A 1 ~ t• a ~Yn , ~a~_. ~ ~ ~ CERTIFlCATE OF =;D. " ~ ` TENNESSEE DEPARTMENT OF PUSUC _ ~ `t ~ ~ ?ts~: ~ ~EG~~~ VITAL RECORDS ~~„`t '•sh ' e~ • , • - ~RO?ERLT ~ ' DKEASFD - NAME naA rwu uu ~ tronw. ~w*. rwi ~ :z0. : , NS RyZLE~[ . ~ANUARY 31 19T5 .~~T Iti FERMA- RME 1rMItE. MFGM. ~rWC~ ~rMU. SEX AF.E - uu ursu ~ Kwe ur~~ ~~~r pATE Of NRiM ~roMrM. wr. n~ai ;;R 6U1CK INK. tu.~sna~n nnrsw~ i~ws? ros. Mss Moua r~r. 3. : ~ Sb. Sc. N~~+'~~ 27 COUNTII OF OEATH - CIiY. TOWN, Ot IOCAT1pN OF OEAM ~av~E un ur~t! FiOS~I1AL Ot OiHER fNSiRUTtON NAME ~sMCUr nt Ot wOi of MOt ~r E~~au. inrE At[R wM wYr~:t~ y ~o. ~r • i ' ~G y~ ~aVAt~`:~'~?iILT i?QS? ? ~ Sf~iE 4: IItIH nr ro~ ew us_+., CIT~ZFN Of WNAT COUNitY WtliEO, NEVE! MARR~EO, SYtYMN6 SIOUSE as wt~, ~nK r~r~tr rwrt~ ~ os~~~i ~ES•~iRCE •~E COOrvn . ~ WIOOWED, DiYOICED ~fwa~n A pM[IE CE:~~ ~7 1L`~.i`tsw~~ , '•ll ~ ~ ~Qy~?~ ~~J`o17W~1 n. BAILEY , • l!~ED. DI~TM ~ 0<44~~ED ~r SOC1A~ SENHiY NUwlER SEtYKE w~r1~ ~oKts USUAI OC~4tAt10lf ~urt [~reos vw~ Iwt wuiK kINO Of WSINESS Ot IIiDVS1t~ . iaS~rt~~'Oy. C~tl ' K~K~~~ iA~ O~ MItS q fIf~KE~ rott p ro~nwp t~tf. t~t~ ~s bntW ~t ~~s~;twc~ ~tron llo. 1ta1~~ Ib.I10:i'i.~1F.~ l3b. _ ~:ss~uy. RESIDE4CE - 51AIE COUN~f C11T. 'OwN. O[ tOCA1tON ~wi~ot c~n ur~•c SttEE~ A?iD HUY{f! tsrecV .iFS w ~b_ FI.O??ID6 ?~b. ~ uD~Y'?'Ot1A ~3:::CH j:.~ ~ l~23 Z:_,L~1 BL!%D. fAiHER - NAMi A?01NEA - A/Cfil NAME IN~iMANi - NAM~ ~A~:~ns: np.tc;S ' ~ rr ~r~. Rc`R~'E?T A NAILEY ~s_ - tf_ ' ~~sr aE~iH w~s C~usED ~r; [EN1ER ONIY ONE CAUSE tER tINE fOR (o), (6), ond (e)] u~p~'~~:t ~r•Eeiy t . ft*rIw t ~ j r 1YitNA1E ~C1Wf! ` / ~ ~ i ~ ~i ~ ~..~-i~'Gt~(l Gt~t~ f/.~ t...~ ` .~,.,o. a. _ . , WNKa 6~wvsE Ris tE o' ' b _ - IYYEOIAiE C/WSE (o). w~ ~p, ~i w co~ [ p_q ~ SiAi1N6 iHE UHOER• ~ ~ ~ /J ~ c (~IN6 UUSE IASf ~C) [•-Eti-C,C- 'Z""1 / ~Z/ ~ ~ rv .t. - ?A!T 11. OiMEt Sl6NliKANT CONO~I:ONS: CO~~~np.f COwtu/un~i p NwIM ~YT w01 ~luiq t0 UrfE in1~ fAt~ 1(O) AUTOKY IF TES ~rue ~+r•c• ~ ~t(S +~bf f10Elf01M : ~ ••u ' ~ a .f.~~ _ ` _ . ~ ~c i~,,• 7'_ I;,~,~ ~.r-r--~ ~ i~i~~L 6ille%r.c~y~r~`` , ~1,; . ACbGiNT. S.nG:E. ?~U~IICt~E. D E OF INJY~Y .rosrw, ew*,~ ~ MOUR HO'N tNJORI' OC ttEO ~twr~yAu~rvte p nuv~r iw ~~tr 1 W~~tt n, { OR UN6ElE~M[y!0 ~irK~h. ~ ~ ^"t OR kED!UL 7~• M. lOd. x EC U? ~ K~ CER- ~N~utY wi wO~R ~UKE Of IM~UlY wt ~f. riur. sraa, ~~orr. ~OGbON .uu~r o~ ~aa. ~o,, c~rr w rorw, s*wr[~ , 5.* CC MtIETE ~s.tun rts w ro~ a~~ei naa, ae. ~veeean ~'_~l _ERTtFi- 70r, ld. ]Oq. _ - " ' ' ~':'~S. ~r~r5!C~~N - CffTtitVitCN : ikAlUpE aeG~t! L4tE St6NED .rC+'~. ^ ~ U 7 E CAH. ~ ~rrt«sa~ (N( OKfAf£1 AM~ ~U1tM occouu ~ _ ~ ' ~ ~ ~ . . . .~[4 Or t~F :~•E ' .~i l~•J r,. . • • I~ 1 ~ ~ rf ~~:~t~?Gf. Oir! f0 inE -~.Si=i~ i"+.:~. . ~ , 3 . ~ 110. / Vl ~ v . 1 i15. - ` YED~Gti E7Ny~NfR - CElDilUirOr1 ~~w ~ . t~ttt i.AiE S~6NED uo~"'. e• ~ ~.~~E~:DED iY or ~.Yl M IM! WrIMAt~~•~ or ~r[ w~~ - ` f.U~N'JRIZEO «~M~ /M7ff11GAf,011. IA Y? OnFi~. NAM OC- " ~Y NEI~ CY1~19 OM TMl ~A1! At~ WE f0 IMf CAYf(Ifi iTATL1. ~~'OR TO CERi1FtER - NAME .n~ oa n~rr~ ?un~n6 woo~ESf s•utr o~ ~_r~, w. an o~ ~o~r ~ . ' • r: ! { i~~~ - - - ' ' ' - ~ ' 1 . u ~JtsAl. 'RF?3Ait~H. tEMOYA~t ~~.:f ~rGw•w, .•.s. l~~. l.~i':~Y l•P. i::v1~.LG2Y -NAMf ~l-OC1:.~N . • ,i•o '3UT:IAL 3~ 1975 akSPttIh~~ litLL ~.1=.ADTS(ii1~ i:,i:;:. , ~ fUNERAI H t~ - 11DUD.f S nn~n o~ ~.r.w •o_, c~n o~ :o~, s~~~t t~a tE61SitAR - S?6NAfURE . ~ S / M / h ,a.L. - X. ~-~Tr~Tr-` nr~ZT• •T co., ~~~"'ii.:~_-..: l6o.~C`. ,t/ - - ~ - - _ BOGK PAGF1~2,3 ~ - - - _~.s: ;v~nF - cr ?