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~ ? iH13 IS A TRUE OF TH 1 C[IlTif I . ~ y~p~~ RE6ISTRM a.--: - • - - - ~ -~r. , ~ . . . . - - • - - - -_'ni'~T,LI_ G .~~U,A"L"~:: . . _ . _ ~ T, ~ . NORTH CAROlINA STATE BOARD OF HEAITH i'- ~ ' • f r• OFFICE OF VITAL STATISTICS `~~'~'k: ~ o.st.~cr ..a ^ ~ow no. _ t~~l~r,.'T` r, `D "G°"""O" G~ ' h~~ CERTIFICATE OF DEATH ~ ' ~''~"°~'j rlawMN ~ ~ . f , r. ` - OtttwYO _-.~X ,w ~,.e , . • ~ ~ n n L fA ~l.,~nr~..~L~ 1. l(U117u.e l7NL~~ ~n~U~.~ ~ r Zt _~~^17~l1~"' ' f.~,•~. . Sfs C010i O~ ~AC[ SfAIE Of YliN rr rW «~~atw ny OAif Oi MliM ru~ ~ ~ ~ ; ~ Fc~~fe. (~~hi#e s r:.C. . 8- -19 - ~ T - +u;t o~ ouiM uxw ~ts~oeact _ • ~,t-~ ti~•~ . UtY q S1ATE ~ ~ ,j .i~~ w ~.'tcc~ tentxuc~_ ~ " Ch,cvclottc N. C . N. C t`` , ~ ; x . ' e~i~uii ~ ~ : lurE O~ •.p w urR t w r.r~ naSDE UI~/ lWli Clri Ot ; . f S ~ _ ~ , - «oswlu oe aaar. w+aw ~pyy~ ~.'~g '~~5~,`'.',? yyl~!,t3 ~ 1 ~ mu~~o.~ Ct![v(.~0~ ~!C_m.01~~(.ll-j w V ~'Oh112~.(1Ld ~11 ' e . ~ - s!' 'r • ' . 3 ,..,.ofa we~o ,u~+sEa sw~nw+~ s.ovse • •w s......«.~..u ~a[~ ~oo.cu a ar.a w: s _ . . . - tm urm ' . 1M100MKD. pvO~EO awt~w ~ ' . ~ ~ ~ ~ .i .w.h' - ~ ~ n ws o~ ~o ~ ~ . w::a.u.cert (~I.i.t.l.i.am fiobf~.irtb fc~a+shctm S.t. ~ Yee t_- uiucr. a w,.w~ ca.+~m socuu s~cwn r.?wcr uww? occur~r~p+ o• n+o or Mnartu oe .ous~a a .o..o ~.w r r~rw „ ItSA Ilocid~«~.i.Sc 14 . /~Itil~2 MAMt ~ MOIMIK WOLN HAMf - If ~~-~R~1~ l 1~. l 1 ~ ' ~110~YANt ~ 1MMf ~OO~iSS . i s • 3 a ~ ~ ~ 17 ~ s h• i ?Nt ? oc~m t~usco sr. ~.«a a.~ a+ uw w.a r.+. ~ u.w~.n .n~+r ~n.n«. o.~~ w Mas „ + S~T / i- . • . . ~io . ~a" ...w.a c.w. • ~ ~ ~ .l \ ~ v ~ .1 , , : . . f - t =o~ou0y ~ Ir. ' ~ ~ . t . ~ -c. ~..w .w ~o r ww ,a w u ~ co.arow.tt a. { ~ ~ i r.aa.u c~++~ w , . ~ . u...ti rr .wa~ - - .rwG treY ~W ` 1> ~M q O~ ~f ~ COwa10MK~ b. \ • : • . . ' _ i • ~ . • - . ~ ~Mi R Olnt! St~.frCwNi CpO1i10NS twry..~e w a.r w~ .o~ awu ewse em.. w~. \ Ay7WSf7 fEi ~~r r.o~.es tc.s.xrs w t~• ' \ \ \ IKf q r4 WT~O C~1A! O~ M~r i ~ ` IVe ~ ' ~ ~ • J ~ ' . 'J , IV"s IIs. ; - ACCr'V.d. 31K+OE MOriClDf.'O! Y?~DEiEHwrED XWE 11OW OCCUf~ED ~4~ur ~uMt or ~w~•w ~r1 ~ u r~p a+u~ ~r ~P .ar~c... ' 700 tyE Oi .aao w .w •w AT wWt hACE Of NARtI ~•or. ~ua u.u~. ~.c.on Uit Ot t i.D. C0~1t+7Y S14TE N~~ . • •v~cn ~y w w oi+Kt ~OG. !K .v~trn ' ~ • • ~ p,~_ . ~ ' ~ CE~tiKwt~O~N~-Mt1Mr~ ••nNwo rt rcr.w r.ar ~----n--_i • CE~idKwtiO?+-lrEOK/U Etuwwf~ O! ~CTwG rEOiUI Elt.u~nwFi. w w~ w.sor nr _ I. ro ^ - - ~t- _ ~.s~ w~ .~w w _1 'r. ~ ~-Of~IM - (IUM~f+OYd M! /MI~M.O~/rNt~~G~f1d4 a.+.o.. ee.n. ~,u w ro w~, c.rww u.~ - ~ r jl r< ~ r pr w~f M~~ V~MO ~YTl. MID ~'1 rI O~du. I~Or M CuNi f~~~[O 'tj. ~/O~! IMf ptfWw ~N MOi'~/'K~O qr ' r W'_'_ N ' _ _ ~ LC,nwtur. p CEttfl~t ww~.a u~u pAtf yG?~(O wOOt:SS ~ o.. . ~ r . . ! . ~ ~ ~k ~ ~ zm ~~-.~'t'~~~ ax-~•')o~ ~5,~.:~ .i ( :,-.,t~1~+ . . W3i~l.-CiErwhOr~ OTnE~ O~TF ` tiAME Of tEMEIE~ Of C~EMATOtY ~ lOCwiqN A""'~ ~'p' ~ . va.~r.p~~~ ~ ~ - I} . ~l?r r p ' • )4 UC1li.U(.(. 2~? 3~ 2 Y 74 ~ i'{. • Z~~l l. QJ111(~t, V~~~ 2ad. l, ~~neS~lAtiO ~V ~ l. • ~f~vE~l4 ~RY+E wrn .~arf3 SK?1AlUfE Of fUl1EU4~OItECtO~ - LKE?aSE N0. n ~ Cavtn ~cc~tQhaC +tor.? _ flurr,t v ' N C ~ ~ • 1• ~ . '~"~"1 t f ; f ' ~ - ~r u~ WtE NCD ~f ~OCAI ~E4 LGlY af IfFi+SI~A[ y~ iYlE Oi E~MAIM~E.[ w wrrw 1KfnSE NO. ' - 7t•?~~Q 2 7 M- :~,,~="031r?~• ~:I • -`:'V : S '•1 _ 77/ - - • - - ~ - . . . _ ~ . . -~.w~-w«~!'"+~.+• ~ ~ .-~`l.' 't~V~/i~~%~{! . - - - ;-,L~••Tv F~.a. 43~1~.'7 . ,~9 ~A~, 29 A~~1 I~: 20 ~ ~ . ~ : - . . . ~ ~ , sooK 958 ~ - _ - ~ ~ ~ . ~ g _ . ~ .~r~