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490209
STATE Oi SOUTN CAROLINA
DEPARTMENT Qf MEAtTM Af`D ENVIRONMEr~TAI CONTROE
STATE ElllTN NUMR[R CERTIFIC~~TE OF DEATH
DECEDENT_NAME f1e51 MEDDLE lA1T SE r ~ r ••r. - -
William _ _ _H~ ton Sa ~•c• ~ ~ - ~ ~
RACE ~•r AGE-lov !,••h tlNDfr F rEA~U~+DEr I DAr pAtF OP IIrTN Ilr.Jh'f Cr N _ - ! -
•wr•• y • 1w•
~ err lrrr / ~ MOS -_-Oars --1 NOUR3 w;r:S
• White ~e » k I6 Sept. +E 1U147e_ ___R_ic__hi_ar.~
'~S---L---i -----1---~ -
CITr, TOWN OR lOCA110N Of OE A'M 1 MOStELAI Ot OTNEr INSTIIUTEON-Nel•• tR ner .n •-rAr. y,a V.••r o ~ - ~E•• T ~ •
~e Columbia _-f Veterans Ad:-_iiniotr_atien Host ~ t «1 Inl._tier:t
SI ATE Of 111RTM EIS r•or .w CIU:FN Of what IMAfrIED. NEVEr ware;EU TSUteIrENG SK~~ 5+ r~ .,e. - - - e• c.•~
U S A., nowt rorreT.Tr COUr.rr~" wlOOwfD. E:•'rOICED w ~ y•• ~•n :•r'.... t •Fr I•.
•r..l0 r'~c"ES~
~oLCar o USA _ ~o Ma_r_ri_ed_ _ F _ Agr._E ~ u_nr:I1Ga ' " ` yc;
SOCIAL SECURET• t-=--~ - - - - - - - - - -
HUMlEt USUAL OCC UTATION 16..• l•nd d .e•~ done e.•~ny n•c•• ~t,vC FUS:.:f SS O~ D..S'~~
' el .o.l.wy i /t t•ew F n• ••d
,;r „ 247 16 8041 +•e Salesmat. _ _ _ ~+.e Insura::ce Ss: _sr.an _
_ rESEDENCE-STATE COUNir pTr_ TOWN Or lOC•1ION :S'EFFt Ar.D au.rREr ---T~~ ~ r;Tr E,..
<H? y
i5° So. Car. TTp f;ichland jug Colur7bia 301 Wet.b hoar
1: / fATNER-NAME IErST MIDDLE LAST ~wJtNEr_MAICEN r:A,rE IIRSI r I;;:F t•SI
l `
Fra k Sa er Lois t:cC::tchen
INFORMANT-NA.wf Ei,p• or h.nr - wAfUNG ACDef SS STIFFt Oct • D '+D
Eea D+aabar Funeral Ho:.re I Eeo 3926 i~evine Street Colur.'ia S~~utt;~ Care ~ ir.c1 2`~2:~1
W?tal. CREMATION. CEMEiErr OR Crlwatprr_Nwwl i ~ -
REMOVAI, OrAp ISpenfTl ~ Clir f.: T;••:
Greenlawn *lemorial '-Irk l;c~ll::Ibia
.re buriah lyE `:o,
' fUEVERAI OE • rSON A N UC NC EMRAIwErd.3• •1U - _ -
~ .r. I i ~ •IC
MME OE EACIIIIY uC NO ALDPESS Oc rAC uTT
„t Dunbar Funeral Home gyn. 92 2.9 1521 Gervais St. ,Cola:-:bi ~ .L.
Z 21e ie Me Otd of rwr lno aedye. dw'r eace••e0 c• Nt e. wrt, dose owe - ~ 2:o U- bor. or •.o+• n . ene c - - ato•n
~ < Wo[t end d•e b rAe once! { vole-1 { Q!• ~ ° •.H o• rAt r +e. J%• a- . c ~or• o+• •c • .o r ~
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DAif S GNED NOUR OF DEA n C•iE i~:,vEO ._~_a ' .;:.'r•
. oxz ~
E.zo ~1!__SiLS.c1r~_~~~1-.`' ,rr 3:30 Al~; M ::e
= c- NAME Of Ai1END1 C: ?MTSICIAN If QfFI (i THAN Cf CiiE1E71TIDr w Ir•••~ i ~pv /ROh:, •.~ED OEAD - _ ~ i rc _ _ ~E - ~ ~ -
`t +
~W _ BEd T'Ot7Y_A._i,ORE~ Ns.D. ~ _ _ -
v NAMC A• . ADDRESS OE CERnfIER 1?NrSIC1AN1••EDFCIit ErAwAAlr.Er GGUR COroNErE n,ot o• n - - r.
~ VETERAtJS AD;~I?1ISTRATT,Ot.~~~SPtTA~TeC
lilu{6ia SC ' 29201 :-4
IEG+STRAR : - LATE /ECE++ED Er •fEC•ri't• - -
_ ~
~ rt - - - 2 -
75 IwAwED;ATE Ca USE iENTteION.r E E I[f lWE ANR I ~ _
r FART 1 \ i i~~'. p` • , .11 F
~ ~ E I-.• Respir2tor~r Arre t. - i : ,
DUF TO. OR AS A CONSEQUENCE Of ~ 'ti}_
r l!E Pneumonia. ~ i r~ x+ . - _
M' -a~ - ~ I
t DUE 10. OP AS A CONSEG.IENCE OF n ~ / E ' ~ ~ _ r _ ~ -
PART O1MEr S1GNIiICANT CONDIi1C/NS-C d,ne+. < r N` rrd r cow + vARyl ~r . w• s
Ii • 1 r%•ed jo; ~ S 5 ~.SF iF c:cE:. 'p wi:.
' I•
qqq Sv ~~,JI' GATE Of Ir11Uft ~ ~ F!fOEA INIURT OCCi_ttFU
3 •Y IIMDIM~ IN.fl1 .iN.~I. ~
7~0 ~~{E -~~{C-~. _ _
Eh1Urr AT WOf?. r..`~ It.ACE Of tF:;.:Rr-A+no+e. ru-+. uatr, foi+on .IOC•'IOh STREET C)i I r L Np ~i " . g•a~r
NO ~ .TF... p.~1.1 n...•(
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4E~02O9
a 2 ~
1980 NAR 20 ~
,moo
fItEO ENO flA.
S ROGER pjtRAS
CtERM L'.~1 CCURt
t~'K327 Pa~E2474
.r.Y- s.,... - - - nom.-'.+:u.