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HomeMy WebLinkAbout1530 i i ~~~..StaTE pSt~t~i^tiJ~jr ~ rt`toc.E No ~.:EDICAL EXAf!INER'S CERTIFICATE OF DEATH 7 rift, ~ECOws sit aATt a DEAiN r... aECEASEa ~ ; GeorSe Frank Soxerbr,Il ?Hale , 10.31-79 L ~ ~ OR a RACE STATE Oi BIEiM w w w vtt, COUKtt OF 91RTN DATE OF B~RTN M••nr. D.r rw~ AGE w .,wa • vit• • • u+•-.. ~w V y wr•r w.rn N,r ••rr0••r war-_ .v.ra. ..w ~ ~ c h • j a g .White s. Distriet Of umHia b 5-2-1931 ,48 ~ _ r.06r OA raSr ~Sr.c•r Opt. NS.7E Gr. lY TS ~ ~ b 0 PLACE Of pEA1N CIT1I OR TOMIN ?rwt O' w wr w w.~w aa, srwlr n.c. s l O t ~ H C~TY M7yfTN pA Er•a M. h.wMt~p• aSMOt rES OA MOr ~ - ~ ~ e. Hacon e,Franklin ~'"tR°Angel CoasaunitF Hosp. ~ D.O.A. ~ Ye• ' ~ c ; ~ V 1~SDENCE-STATE CUIINiY ~ ON STREET IMO NEJEEBER OR RFD NO. ~BaE dir W"S ~ ~ ~ pycfr r- « A1I o a o o .,.Florida „Saint Lucie k Ft. Pierce oa 1029 GrardvieM Blvd. Yee ~ . ~ p OF WNAT OOIJFiiAYT DIVORCED pr[Cnl SIfiMVrq dPOEl6E ~ +E .~•a r.ew rw~ > ~ ~ ¢ ~ ,o. U.3.A. „Married Velma Aldesinan _ ~ N SOCIAL MJNBEA IASUAL OOCIJPAT10N so or .oa yore ar.a KI1O OF IuONEl3 Oii NDtISiAY MAf OEtEDENi EvfA ~ u s ' E s ..aw v .~ow•.o ate. E1lM ~ sows tAl~ FCICE,l7 ia. 543-28-5475 i.aMiiSieter i.d NO m O ~ FATHERS NIMO MOifERS MAIDEN NAME ; ~ ,a Georse Freak 8overbp,Sr. ltoaella Szuba 8oxerby n. ' a = ,a. .saDRMAHr~ NAME AiO ADDRESS REUTIOni To oECEA.sEU is.Mr• Vc A. SoMerb 1029 GrandvieK Blvd. Ft Pierce Fla. 334 Wife ~r, ~ L ~ `y IARi t_ OEATN CAUSED !Y: arrw or• are ewe ua rot w w .4 rT,.Ep~orrt*R ,M,~ ~,w, U ~ C LL io ~ w •EI~IATE cAi„E C ~.Q I 0 U' M ~~~~5 'JrM / N . T ~ °m - ooNariaa. F AfK ~ ~ ~ ~ CAUSE ~ pl otlE TO. on AS A OONSEOUENCE OF: G w ~ 1 <~V ~ ~ 1 ~ U ~ Cl o W STATNG TIE l 0 0 ~ E H tn0 cAIUE tASr. ~ m O • ~ i0. kl OIJF TO.OR AS A COl6EQUHICE OF: , 3 D o ~ O ~ ~ PIWT L OTNE7i SKIaFICANT OOIOEiIOtIS ~ ~ r woun. wn w wr~.o nuE .e of •o ~r ~ re w arw ~ ~ rsw a~oeo~o~e~o ~ U ~ 2Oa 200. N tJ 20¢ C ~ e ~ j ACCIDENT, SIiCOE. MOIr•CIDE. EROETE3M~M~ED. OE9CiOE NOW WUFTY OOCUliID Isnw tort Or warr+ w rMt r Ot rmn . NATURAL CAUSES, OR PEJOYiO ~reorq ~ ° Q~ w E c r ~ 21a ActstoFai[' :is~• E-l.KlKocv'(61/ g ~Gu 'TC.NftNJ • n t1 ~ b T71AE OF o.• Syr ~A .aA/1Y AT wp111[ PEACE OF ~JRr ar rorE raw• s+~[r CiTY OR RfD. COUNTY STATE ~ s~v+r..ts .a s.catr. ato. Ert eretrn ` o ~ U t its ' !ta Zia 2i1. MEDICAL E]IAMR~A CERT~iCJ1TgN. ar. nt ras v M pu.w•rOw or M t0o• •ro.ot rr! •.•ESrprrp. w ~ N C ; ~ v. OrroOw pEtrr OOOU.EY A M 0•r[ ar0 OY[ •01rE tta.ly Rar® ~ . 9. ~ ~ ~ ~ ~rM OOC1/SieED THE DECEDENT WAS PRONOIJfiCED DEAD' I DATE SIBNED rrornn w. e!M ~a O F= m ~ 7 r rn ~GT t t 7~ t ! ~ 25a Q~ ~ a W p Q S10NA ADDRESS MEDICAL. ~ C (n ~Q(~ ~ © m p V 7!p ~ ~ 2JG 270 ~ ! L = C ~ EUiiAL CREMATIOEE OTTiER DATE NAME OF CEMETERY OR CREMATORY LOCATgN or. rorw_ ow oou•Tn srt*E+ 1 ~ J A Ro.n o o W ~ ~ 2k Burial 2.e.11-2- 2.t WOOdlaxa Memorial Park 21Q Franklin,N.C. U ~ C z ~ d RIWeiAL NOME '•••R 'm'Er 90NATUIE OF FiINERAL DIRECTOR t NO. ~ m ~ ° ac Br7ant Franklin,N.C. 472 i~ n ~ la_ 4 ~ 2S. ` m DATE RECD 8Y EACAL REOL SiGNATIliE OF REatsTww t.wrm IiCB~9E MO- •:s Foa~I zien fi~~ NORTH CAROLINA MAOON COUNTY I, Hilton Fouts, Reg,~ater of Diaeda of the aforesaid County and State do hereby certify that ah~-_~ ~ grog ie a true and correct copy of the record as ! recorded in Book b in the Office of the Register of Dbeds of Macon County, North Carol,> YI~iBr.SS ay ham pdd~ off~oi¢~: "seal, this day of _ , 19-~-IC• K ~ r ~ 1 - d~"' Register of Dbe s for Macon County, N. C. 17 ~?~g ~t0' 16 2~ 44162`74 s F1tEC FND ~~~N vf.{ti,%.. ST.IUC~E. C~~ r I,~ ~ CLEF K Ct"r'.C C ~ " C')~"~ t "~~.;.v i ! ~ an~x~~ P~GE~~7 {