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P Y ' f1lE0 AMO RECURoEtl
i ST.~UC~E COUNir i~~.
TRUE ANC CORR6CT COPY OF ~ tIOCER POITR~?S
87ATiST1CS OR TNE STATE OF ~ , c<<R~ c«cuiT cc
SERVICEB. AT JACKSONYILLE. ~ " '~r''nf~?
' Ot MtAtTN AND 11<MA.ILITATIY[ ' ~i U~O 10 n9 aN L
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394183
tO1~TRAR FOR YlTAI 1TATI~rIC/ ~
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„"*~""R"R`°" AFFIDAVIT OF AMENDMENT TO DEATH RECORD
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NAM[ OF _ _ ~ - - - - - ~ STATE FILE NO.
p[CG~ED
p¦ .R~N*, . Nathaniel Baker ; 77-073707
i pA7[ ?~~MTN owv r[~~ ,PLACE OF DEATN i Ci?Y, IOWM. OR I.OCA~ION
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{ owTM ~ October 24 1977 Hillsboroup,h ; Tampa
i lTEM OMITTEO OR IN ENROR DEATH CERTIFIC~tE SNOWS i SHOULO Bt
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~ 1. Deceased's Name ~Norman Baker :Nathaniel Baker
5a. Age ~ 64 ~ ~ ! 63
6. Date.of Birth tSeptember 8, 1913 -~September 8, 1914
8. State of Birth ~New York ~EnRland
12. Social Security Number ~ 50?-01-8976 ~ T264-88-313I
13a.Usua1 Occupatian Pt
hysical _Therapist _ _ _ _ ~ Bridge Tencler _
15. Father's Name ~ Unobtainable ~ Samuel Baker
' a den Name Unobtainable Sarah Patchunsky
1 MiRt~• CU1U[ TNAT A~Oy~ itATEM[NTi ARE 71~U[ ANO COAIIFCT: ,
1NfOR ~G A.~_ J-/'~~ ~ ~ ~ " ~RE~ - ,i i, ;
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~ SY~iCwli[D AMO SWORN TO B[F011t M[ OM t-~ SIG~iAtLRE Di NOiARY. ~ ~ ~ NO ~ O 1
: eL~YAIF. M(~A~~.iD3`f~C ~Fi4RtDA AT
!L.' ;r'- 4~ 14 ~ % ; ~ _ j"~ . . ~ MY COMMtSSfOV iX91R~S iMl. 3. 19T8
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. SUtfCIl1~~O ANO sWO1~N TO B[f011[ MQ ON ~ ~ j'S~GNATURE O~ NO~ARr N9J~~~C~~7eQ~I/~#~OC~OR~DA lA~~
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ABSTRACT Of SUPPORT~NG EVIOENCE
NAMt AND R1N0 Of DOGUM[M~ fiNtLUD~riG K WMOM ISiUtD AND DATE O• IiSU[ - DAt[ OAIGiNAI DOGVM[NT
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Certificate of Naturalization 7418000 02/14/1955
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i lNFORMATtON CONCERNING REGISTRANT AS STATED IN OQCUMENT OF CORRESPONOtN6 NUMBER ABOVE
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ADDITIONAL INFORMATiOtV i
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