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D. UT'Y. TOYrM. 011 LOCATgw t. IS KALE OF pEATN t. CITY. TDMh, tHl fACATtOw tYS10E CITY ltY1TSt
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NAPE OF ill wtM 1w AM~tt.f. IM tt?e.t ./hta) Y IM IA Y[S ? b ? r
~F'tAt 2212 North 45th. Street
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{ COLOR OR RACE ~ PARRIED Q wEYER YARRtEOO INd 1w1Y.F) wtM
. t 1 e . Male Nhite rIDDTTEO avoRCta DeC. 0 188 7T
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p i • t n 3 7 10. tiSUAI OCCYFATIOw IOMr City/./eai /.•t IOD tctf100F WS,M(SSOw NIOUST11r 11 NwTNKACE (~'dt «~etA tr¦nI,
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D 1 .c k 1 nk 1~ fATNER S wAYE ll MOTMCR'S YAIOEM MAYE
t,p.:r/ t.r F.dltard lYei r 39811e Sahuri t~ 'a
1 wAS txaASED EVER IR U S. ARMED FOMC[St Socul SECURITY ta. 17 fY1..M • M.tfAT~K Ciarcline lh'elberg -
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Ro INTERVAL tETMEER
tt CAtlOR N KATM (~itr.¦IF .ttr tswa yr? tltlt /br (.1. (DI. N/ (tl.) OnSET AMD IIFATN
Tun.r.l _ FART I. t><ATNrASGAYltO~Y~ ,,~,i~ 1 Y~. a~ns _
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I tte¦ .f ~ ~ TIME OF N.Rr y(.wtA, 11.f. Ytrr
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JA/ NUURY OCCURR[0 FLACE OF tMJURY (t. L. M «.Orwt Mtr. »1 CITY. COMM. OR LOCATgM OOUMTY STATE
MNKE AT ROT MNtll4 m w~pp~ ~/~r1. rtd..)Att~/I Martin Frlo1'1da
~ MORK ~ AT IfroMX Oll •JY. cie t~,et Stuart Rural
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3 _ tin on tA. d.t..t.t.d Al+or.. Rnd to tM 0..t o/ aT~ Atw~ldp, lrom th. o.u....t.t.d.
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€ ICE ADOR[SS ?It. DATE SIGMEO
.l l t t.¦. tts f1fiMRTY.R (Dryrer «wql
e . r. s. Stuart 1Rorida 7 ~
~ t..,Ia. A Corona
. e e,tr. e.. ~ outltu. eu,lATTattJS DATE L7t. MAYf OF arET[Rr OII eREYATORr 2]/ LxArlOw lCttF, tarty. «t..Rry) (8.rs)
~ RtOdtAL t.Y n) 18 196 Rillcreet Nenarial !'t. Pisres (St. Lnais) lr].orids
e t . 1. f A is 2E F 011 S STOMA ADOIIESS 2f. OAT[ RECD. flr tACAI REO REGIlTRAR'f SMi11A . .
n R... E.O. Milton W. Baird Ft. Pierce, lla. 18 1965 Blanche Martin De
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