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CERTIFICATE OF DEATH ~
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DATE O/ DEAt» .o"+- o.. 1..
1 Ed ar John Cha lin >t"lale ,December 20, 1977
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(White 75 /Oct.7,1902 Pinellas
Cliv rOwri OR tOCwhON of oEAt/, .+Nef C,h lr.rt /losnut OR OMER R+int([IION-NAME .r «o• a.wt. c,•t unl..w w,lf/.
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,,largo No 10908 108th. Street North
SEAT[ 01 RIRM . u «or V • . , «..f CITIl[N OE w/uT C~IMITlY A+,\RRlEO. NEVER MARRIED. SutvlvlrfG SvpuSE : ~ .at, ant ...q« «..1 ,
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(Illinois . U.S.A. „~arrie~ „Mary Kre_nn__
SOCIAI SEtuRlir r~i1fM~E~ USUAL OCCN?11ilON .wa awe o• .ua t10.1 ola,.a wu w tWp pf {uSINE51 OR INOUSTRt
3 21-14-4097 "°"'"a "'/".t°'
It 111 Elevator O erator Office Building
ttSrO[»CE-S/AtE COUNtY UtY, tOwN- OR (OCAtION l.f.D1 an .rnf StREEt ANO NuMRER'
Florida Pinellas T Largo ,f.ft.r• i~ol 10908 108th. St. No.
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George W. Chaplin Nellie Hughes
IN/ORMANI-NAME MAIf1NG AI1pRE SS ,uun o. r. a ..o on a ro.«, u.", r..,
II~Mrs. Mary K. Chaplin 110908 108th. Street North, Largo, Florida
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IUpAry CREMAtIpN, R[MOrAC w OR C [y/.iOt~-NAME '/OC~iI' ' c.n of ro«.. p..,
:''burial ` a~~~~~,I~~11 Memorial P~rk Largo, Florida
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NOS en( ~N ~Sf ~ f / . o.. r`' o pr• o. o«. 1. n •
q-ecember3~ 977, ~u,~iera~.'"°gome ~'~00 ~emino~e gYvc3,, Seminole, Fla.
•uN /REC'TOR ~ e'' - r[ St R--SIGr•Arue[ _ o.•t ntt:•to f..oe.l ne.sn..
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A CERTIFIEQ bluS~ lA EM805SFD SEAL OF THL~ R~ t
G i STRAR OP !I TAL S _A7'I S'liCS` -
I hereby' ct~rtl~f~`t~'~this is a true and correc[ copy nt a ::~rt:ifiratP
art file i.n the office of the Loral Registrar of Vifal at.or.i.stics uE tfft~
Pinellas Count Health Departure l-, St. Petersburg, Fl.arida.
Oct 22 1979 _ L`
D~p~tty Lt•c:al. Rrgi crrar
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!lED ~M~ -~`~EG
=r•LUCIF G~u~*I Fly.
RG'=: - ,S
• CIERr. ; ~ ; CURT
o~ ~ 8 3s A w '79
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