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. UNITED STATE.S OF AMERICA. '`1 ~ 4 5''1
COPY OF RECORD OF DEATH
~o~~ soOTHBRID~~
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~ f0~ dOIITHBRIDC~
I, the nnder8igned, hereby c~rti.iy that I am clerk of the ....................oi....................................
that as such I have custody of the records of deatha required by law to be kept in my office;
that among such records is one relating to the death of .
Robe~F.tr.. ~.e...~~l~r................................................... .
and that the following is a true copy of so much of said record as relates to said death. namely ;
~ Date of deatb ...................~IlUtly...~~..19?A.................................................
Place of death .................u~ut?hbsid~r,e~...M~?s.a....................................
Name ~obert.. F'...Baker ...................Paula. (Cassids)...Baker
lt dse~u~d ts a sarrisa. widoid or di~ax~d ~om~o, sh~ o1w maiaea a~ +nd ora+~ of ~as?~aa. . .
Sex Color ..................~n'~~?tR....................
Single, Married, Widowed or Divorced .....................Maacr3e8•••••••••••••••
! g ~ ~ Years Montha ~ Days
A e .
i
; Residence ~aut~ib~~,d~e•..~''t~~~.w.............................................
` Occupation ............................~octor._oi„medicin~............................
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; U. 3. War Veteran ............................~~~~rA~~4i'i:...-~'rR~~~................. .
s s~.E,r, w.r
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~ Place of Birth .................................................'ahitiuts.Y.111~~..T.~.ss..
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~ FATHEB MOTHER
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~ Name Freder~ck...:~cer ....~.:ar~-...~ er......................
Maiden Name ~
~ IiOllanc~ ~ ass. ' "
Place ot Birth ~ Place of Birth............:^.!or..ester.~....:
a~s._
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~ Cause of Death ~-'-cute coror_ar~ thro~bosis
~ Pl ce o ,`K~?ti,rlsville I~iass._..,... _.,...~t. i atrick's Ce~.eter;~
-A a f Burial . . . . t. .Name oi Cemetery . . .
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~ Date oi Record .............................................+T?~t?~y...~.,...1.~~Q.........................................................
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, And I do hereby certify that the foregoin~ is ~O~copy fro~mo d records~.s •
- SEAL ~3' ~nd and seal o! aaid_.. _...._o .
~ • on this ..............1?t ~
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Year.._...1~.?.4~ J / ~ .
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Page_.......__.'~.1.~.~
No ...............124 ~ C 9 ~ P / ~W
600K ~
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rORM 4!!1 HOOBi Q WARREN. INC.
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