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HomeMy WebLinkAbout0445 % 3~~E~~1~2 ~d . , . • 0~~~. No.___ ~fyEi/ VIRGINIA STAIE CE?AlITMENi Of HCAIiH-CIYISlON Of VIIAI YTATISIICS 0~ w~O lrrE OQ ~RINI IN ~•i~l No.___ L_~ GFRi1FlGAIE UF UkAlll . Ij ~ U~ J~ FECYq~lEtlt INK G E C E S E O- N A M[-+'~ uf l / 1~ . l~N SE7C ~ OA1E Uf i~iA1H p~qnM, dar. y~~r) ^,.3i'°°k ra ~ Noonan A. TttJGIST~R I~.Male' I~. Jul 22 ~974 i~~r.,x~~om x_ 1 RA~E-VYh:le: N~p~o, /1m~~itan AGE-IASI 1h~•!~r 1 y~>r ~)ndtr 1 d~y pAtE OF SiAiF. i~w..M, CUL'f!.'Y Of DEAIN I~d~an, erc. I~twc~lrl + ~1~1;DAY (v~ar~ll~Nb~. Day~ ~ Mou:+ M~r.I d•r. r~a.) ( • 1. ~llt~' I SaU,7 k. e.Oct . 16 L~910 ..Mqrioi~g~1lia ~ CIIY, 10Y:Y, OR laAl14N Oi OEATH INS~01: CIIY 11M115 HOSP~1Ai O~ OIi~CR INS(ilU~iGN Nl.iAE (7f co~ r~ c~~~+~, p.ve s~n~~ ~nd o~mbe U~ ~ i I raidente (SpeNlr ytf or rol ,b. Mor. ~~u~t~a,m ~~Yes I i~. wcst Vi inia Ur.iyersi~ Itc~s it,nl a~,~h r9------ Y____.P, ccc rc~ in int~i• S1A~E Of BtR.IH ~~~~jfN OF 1N11AT COUNiRY MAVRIEO, k[VER A~.A~'C;Et. SU4ViVIt~G S('~?US[ (:1 wifc, qiv~ /na~dan nam~) o~. n:v! resi_ U.S.A.. nrre countrr) ~ Wlpp\Y[~. DIVO[C[O ~syrci(rI dr~cr bcfor~ ~d• F,+L I 1. *tt * ~ r. ~~.,n. VA~~ i ~o. M.-u-riacl I~~.~Marj~rie ~Bo~1rd SAIAI S:CURIIT NUMBER USW1l OCGUVAU~k1 (q~ve ~b~d ol wo~k dune d~~~nq ktN~ Of EUStNESS OC '\DUSIRY nw~t et wo~kMq 1,(e. eren il .ct:~ed) ~ ~ ~z. 2G1-05-0071 Disabled ~ I ' CE;~UL"1CE-~Sw~~ Cowdr Clty, bwo, or tuN~on I tNSIpE CIIY L11A11S Suect.~and ewn6tr ~ IW~'~~tY YN w no) ~ WV ~~e. Barbour ~k Beli tOn I~.aNo I~l..Itt. 2 FATH[R-N/V.~[ ~ lIRtN%AGE (~ia~~ w M01ME~2-~--MAIO.N NItirC ~ EIRIMPIACE ~~laf~ M s. : , ta,nlry) ; . touMry) , ~s,. Daniel Noonan R~ist~er ~sc. FI, I~~.. N~iuns I~~,. GA 1Yia decea~ed erer m ~he U.S. •.med lo~ceft INFOkY ~-5`!!+AIIiRE A4CSCSS ~~Sp~~~ (Ye~, w, w ~r.tnown) -Ip1 re~. oir~ war o~ datta ol u~vice) I j~ ! : : i: . i No ~m. ,a, Itc..~ord of D~ceasExi I~Ef,. A~r_gant~v~n, WN CAVSE OF DEA!H [~n~rr onlr p~e ca~se per lir.~ (w (bl. and 1c11 ' A~roa:m~~e :n~erval 19. Put 1. DEATH YMS CAUSED SY: ~ • ` ( ~errveee o~•ct a~+d Je~M~ i IMM[DtAIE CAUSE ~~2~.~---~~ Z~~i72X---- ~ Cor.d~l~o~f. if eny, I ! wh:th pwe r:~e b ~ / ~ (sy Dw a ro1 ohooe ca~.s~ ~ --j------- l~n flaCrv~ tF.e unclce- ~ ~ I~'cq [a ~te laal. Du! t0 (CI-----___--_ ' ~ - - - - - : Dar~ I3. OiNfR SIG.•JIFlCANI CONDt110N5~ ew~ditipns ttMnbui:np ~a c'eetii Ix~t n~t ~c~aled w taux 9~vcn in p~.t 1(i) AU1pPSY 11 Yes •ve.e I~ndir+qs , I ~ (Yt~o~ .w) ~ tomiila~cd in dete~mininp ca. u f.f ~'.~a~h ~ ~ . • RY,~ h[itDEYi- SItII:Ot~ii.x~uinF, ~ [~~lr {uiNt~,~aY t~.,.~..-.-~--- . .i ..n~.P`--- - - - '-'•i. Y~ 1 v:: t~ .v.. • aa~wn`iu ~ru:~r .~.~t~:1.• M~a x ~n Hr~ 1 Ol It li. n= U•`3:~:lEkA!.~.tu i+~,-:dy) • fi utrn lY! ' V 1 D+ ~1•. I 116. ~?tc. M i 11d. ~ INlURY %1 Y.'OFl PIACf Of INIURT /~i HqMi, /AiM, c?Rlli,` IQC/~tfCN------;st~ee~ o~ ~~.U .V~~.. c:t~ o• r•v~n, s~aul } lspct~fy y~~ or no1 ( FACIURY, OIfICE 6lDG., E1C. (uttdy) : . ?te. 211. I 71p. ~_.-.7, ~ .~~-„~t.~ ~ha decer~rd r,a,_.TulY -a._X2Z~--- . July_ 22,. 197~. ,w.: <..i ,,ry~ a...Tuly- ?2, _1974_ ~-~",,l" 7~. I/~•!h O~f-(~~~r~(~ J/~~+~: r"1 n~ OO I~lf cl:l~ f:~f~•l el•Jve: A91 M 11:! I.rH .~f mY Innv.~r!~~e. Dur. t:~~ (pv..~i itetMl, _"'S! :in1UQE~-_ 'i J . ~ ~ ' " _ ' _ y ~ (C~yrtt ar ~HI /.IJU~:I, . L~/1iF SIGNtD 1.. W. J1zar, t9.D. n ! jr1W Ilosi~itril -~/,~:L ~ I-'~ ~ 1 2Ji,. ~ 9Jc. l/ !'f 13s - • % CC-(~_ ~ - r30r('(~1~:L..'5~91 - -s_-_--- - lt':~).{,fl,, f[/~' fl[, [tA V T'" CIR,E IRY OR 1:0 .t,~~,R't t.XAI E - l~ l. i:(, ~ 1 C I I Y J+ I O ri N . S I A [ , ~a:(f . ! • _ . - ~ ( ~ , ?.1 :~~1 ~ ~ z.~.. . ~i . , ~ ; % ~ ~ ~ ' J ~1_ ' - - ---~-'t-". - 91h. - - - - ~ i il,~~ ~ • ~ . - 1 _ j__- _ -l. ( . r, yea j ?UNLN/1l~HOM1: NAtit~P.tIp.ADDc[S: (strre~ or k.F.D~Jo.. u+y o~ ~o,~.n, vtte. +~I ~ ~ ~ ! I , 't~ / ~ f ti I'i ~'~~.e~._--- ]1.~.- -L~ --J ?S~. / ~ '/t~~l~ ~.r~-~ ~ t~ ` ~ _l.' •ii/~''~.- .1.~',llf.~~~/'~/ ` / i !U.•, f... 14LCT~R'S'SI(s. AI QE ~Alf St(,t~i[O AS ~~R - _ - - - - ~ ~ E tC'D CY~lc2_Ar ECC•. k~4151 AC'S SIGN.>1 6 ; ~ I , lII , , 't F.Y . i ~~~h / . 7 ~ ~ ~ _ I / _1 ~Sr. ~ ~ 7b.~.'' ; r~ , t. ~l: '`I ~''sC i.~ ~ - ~ ~ I / ' : r l LS . _/I ~ - / ~ '1 1 ~ I _ ~ ~ io:~fi \°iC ~4 t :+:r ~ !i - ' _ - . Y' : ` . ' - ~ . ~ ; : ~ ~ ~ ~ \ i+ . . • s . t ' CERTIFICATE ~ i J~~~:s,.,~ i . ~i~ i•.'. . .~i ~ • ~ ~ ~ _ j ~ ; ~ ? * ;$T,t1.fE O~ I~.ST ~ IRGINIA, ~ . , ~ ~ Br~IdBOGR COUI~TT~ SS: ~ ' I ; e i ~ : ~ ~ ( i ; i: 1,; ;'I, CLL\'NA G. PROPST. Clei•k of I3arbour Cotu~ty, ~Vest ~'irginia, hereby certify that the i r : ' ~ ~ ~ ! "~,~'••;~N-~-~~•idxegoing is a full~ true, correct and complete copy of the Instrument as the same appears . i s _ ~k ~ ~ ~ ~ ~ ~ ~ 1 ~ ` .R~,'..~~ . •of record in m~ o~ice ~ri.....De~~h__R~car_d_----~3ook ~o._._...~--•----...... , Page ~~R.~~ ~ - E . , ~ I «'1'I'i\F.SS my hand and ofiicial seal. ' , ; ~ CLI~I:I~, 13_1H)30LfR COU\TY \V~ST V11tGIN1A U _ ~s7-~9~p~ - ~ - 3 a ~F a~~~` . ' ( ~~~~11CIE u ~UNTY ~L~• ~Qa~H ~4~1R1?i : s~d~~Rvr~~f fn COU~t i - ; 8tr ~0 113e A~'~6 ~ ~ ~ ~p ~ : 21~:~1 S2~ in~c ZJO PACE 441