Loading...
HomeMy WebLinkAbout0751 a ' J j 4~'T~52 • WEST V{i'iGl~tLt $TA(E pEPAQiM.~C~f OF HEAITIf UN~lOt3 OF VITAL STAi{STKS 7 Qp ICK RefRf NtlAtafR PHYSICI4N'S CERTif(CAIE Of DEATH stATE~fE ~ NI1R '~.v O of C[L'Wf 'LANE ftiSf M(A:IE IASI SEX DALE Of CC A1M INo,Do,. Yr.) i.o~aise ~'.omord` Coskins , TMaale ,t~to~r,`~~t,t9?t3 RKf ;ey,w~.t., fiu.S, Amer•con AGE--l.nt6Mdo, UNDER IYEA! U}MXRrDAY DAZE Of 5fi1N (Afs_, Do,, Yr.) CJIINTT Cf Of AIN t;e., a.rtrs1«•y, q ! MOS. oers HWRS Alai. ti•I::ltc C~ _ dSe .t,25 t916 io. KQnPCVI~e _ C4Y, iG•a E: p,T IC-•-f1S qti CF D:ATN •tK)SPII AE CR CIItCR rlStiIUTKJN- Wrne,tl wei....rAfr, R,.f •t:aet.r.d w~a6<r? f IKi:P, f.T 1•bl. <<: cov 3Uq n.. a# a' 1:Ibans 1~? Gero~tirro Dx,j _ .a. r_h~,r:•E?_ . ' ".1 ! SIAa CJ C'i:Hll.c!.: O.S A, GDIEN CK :vHAICOJNlLY MAC4f D, E+£vfR /.tARR[O,-_ SU;ivA'WGSfOVSE (If ..b, p:n sa.d...av) WA;CiI~t Ytl c\tRr-V.S. - wnArmWq) WfDOWiD,DAORCED ISpc.y) AfA•iULwCI S? r,,,,-.} v ~ • 1D u. NCrlq~!1 R,) N_oskf 1TS. i?~o<oyr..~.ae, ~~0, •.l ~.l{ SOCIAL SECUittY NU.N[fR USIlAI OCCVAA/KJN (G+re l.ndd w~i dfnf dorinp ~osf e/ RNDa RVSliii OR R.tpUiiRY -~'•'`:ei0[ .o.l:. AM,e.c<JreArwh ~ 2~•4-3~3.-725 Hoifse~vi~e Home _ . 1 _ -r ~--~E CtRtS RESDEtuCE-STATE COUNTY Ci•r,tAwNCR lOCA110N SlKEt AND NIJM6ER Tt.cSpf ~aY INMS .pn,y Yn or l.e, P~'J I~alaP~r:ha• TSt St~• t+1b3T1sS isa. 14 Get"onim7 Or. NO _ FA:I.ER-NAME FMSi Nai01f IASI A!OI HER-MAGfNNAMf flSl N.DD/f IA~T • - _ ' Rey?erly Jr Fiol n~xd 1,ids ~11111~-nson R.fOdMA!:1-~NAJME (t•pe e.W~t) MFi~ ADMESS SIREEt ORRED.NO. CRY OR IOYM SMTE 1~ lR~. i?cY.,~^r. R,' fioskir_s: lt~. t4 Goxonir:o '3xa' St,~ At~~ans LTJ 25177 6JR41. CaCJMlgN, tf ytOvwl, OtHf R,;r,e.•yl CEMETERY Oi CRCAUlORY-NAME CGCAIgN CDT OR iOV/N SLATE _ Burtat _ CunntncTi~rah ucn. Park Sto AlUans, t:'i/ _ ~-i fU!.ti+Al/'~+vK IKEt.~F.1.H Pe•wn A.t...v1• x? ftANE Of fAC[tIY AMFESS Of fACRIfY ~.''r ' ~2.~, CT' „-aRttt~?ett runeral Halle 1oA05 6t11,' Ave:' Ste ,?li~ans, :4''.'= r+e 1. •:!el~-,Iro-!<S~J- .ra •dM••a r.r r, lstr orc• c -i,+re W'1.. CAIE SIG..aC+Ato.. Du,. HOtM Cf DE!ttl rrxel.: ,.,,red. ~i S ~,U-n Jt~ IS:~-or,.,.: rl ~i0 Itb. - ~ f/- 73 )ic. ~f i7 M _ ,A:- Nw.E CY wlItNOt KIANf O7 rER li•AN CERIf lR(ypf a. ir:wt) e ~ .tlt.r: E°° ' rte. ill_EU SN- JE _ e1 e:i_.t' ~Np ALORESS (?F CER(RER ITYf,f o. Ir~nl) ~ ` ~ • • } . ~.p~.JNS RFGiSaAR plAf.,; (C~ - DALE EhY06T REGti1RAR lMe., oo,. Yel . 'r RtYI 7_ l1GV A r •.CNG(vE 77n +S:y-.Wv.r~ ~ Zyc ! ?7b. ~ f\1 ''t0 W~tEUTAiECAUSE ;ENtt AU'f 1 o),(b).A.VD(c)) •tr<..nljat~cc..o•neto-+d.ktAS ••!tCUiE R/UT _ ArJ•,E r • rt/E F tol L_ Gl' S ~ ? t G~-~!<-.,."~lyl~-~ ' ~ /!Nr t-~ U++f 10, GR A A COthSt Ol!E `.CE CN •4!ee.ol tat. ct.• nn:et and ~r i.-SSE LAST ' OUE iO. CR ASA NSCG.EIfCE Of: TQ .i 1. •-eenen.ctu4dca!i C:btV YG~~IC AN(COE.UITgK C.w+6 tona•catr Evt ep o.d.r.M!!wt rc:,,ted ro.nw gae-n•.+iARTI(o) Auiorsr (~p.oy r« ^~f=C}`-,~-•'i:1h 1q NEUKAE f'ARf aNo) t.tFfA ~!<1 G: lGdtit{R - ACC Ci `t11SF_«.y r., er No, DAZE Of NAi~lINs, Do,, Yr.) r><y:R01 WiURY DE'[RR}E I:OW t.WUiY CrCCUiRED 7M s • n.Y r v[7 E • ill JrCf )EA :6t - M ]6d aUnYATWVG(ISpn,}f y, 7I ACEGF+~1L'RI NMne.l~•n,.reer,~ .oH..el.•i.f.%y, lOCA1tON SIREEiORRfD.NU. . 1 Ja 2Y :6l _ ~M t±R~3fr~41 : , : t ` , . I iiercby r_er~i-?`y that the above is a true rhoto- ;•r _ static (?,:i;otcgraphic) copy of a ~•ceord filed e•:ith the I)iliision of Vital Statistics, Nest Virginia , . . •i i,f~~S, Stato i?eparti~~ont of Health, Charlesi:on, best . c~ dir9inia _ t . ~ l'" ' - _ - a',` ~S7 . ; ; . _ i t:.ess rly hand and seal ti~is tw_ent *-cir,1Tt11_ ~ ~ . s., ~ day of __--~:ovenber l9 . :S fr w'., ~ ~r•~ , 7 ~.;C • ~`1K •J~l