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COMMONWEALTH OF VIRGINIA -CERTIFICATE OF DEATH
DE?ARiMENT Of HEALTH-BUREAU OF VITAI RECORDS ANO HEALTH STAi15TICS-RICHMOND
R ffGSrfArlOq CEfrrICATE STATE tAE
fOR IOCAI AfEA IAlrfEf MIMfEf ~~f 11
1 EUII NAME Iw.ll 1•••tii•1 pN/) ] SEII rb b.ab f
a DECEASED HORACE T. BAKER 1
OKEOElIt ~ au a 1•••) IJ•r) It•rl • AGE d _~!':+4~fJ!CA!. _!!r-'D~SLaI_ ~ caof ~
DfArll oECEASEO 1 d•rl A«t+ Of LACE White
Dec. 13, 1975 60
• wME a IgSE1rAl Of (A nta•. » t11M1 z CCMMtrr OE (a r•d•p•wdewt a?,, btrn Many)
NirlTU er OE rll Dtwrl/ !
nACE of ~@nE:ra1 Iios ital of Vi inia t3cach
OEATN • nh' Ot roww W ...•1. » t/•Ia1 ••.s. tw, v t..a y.,,p• • Srtf Et ADOfESi OR 1T w0
OE REAM .n w Of MACE OE D(ATM
Vi inia Beach ® ? 1060 First Colonial Read ~
? 11 COu/+n OE DECfASEO'S la w•••wwd•w/ t+r• b•`• W.•1
10 STATE ftx rotrlf,./ COUHrfr10/
t = 11SElAL OECEASEp' t ypfyCE ffSOErKE
i RESIOEf1CE T] Cltr of rOwN t.~de tw, « Itw.w 1) sr/nET AOWESS Of fr 41O ~ D/ CC/0f j
u OF pECEOENT OE fESrOf/+C w• O/ IrESTDErtCE
s ~ Nor~olk ® ? 9254 lticko Street ~ 23503
S g 1. NAME IK TAT/IEf IS MAI(1EN NAME Of i
i d DECEASE A1n1/Yt DEC ASEO 1
Was~i.n on Lee Baker tsa ~e bra 4
€ T• ofcEASEO unzEw OE N. Av,erfo ~ ttfrEf MAnrto ? T• r MArrnfo d w+oowEO. ?+AME OT SPOUSE.
2 ; ~ RERSONAI wluT cou+tn r DrvO~CE ?EAyF KAra[
p _ qSA wwowED ? OrvOKEO ? Rl1Cn tll@WS Bak@r i
2 [ BATA EEf eiv.• e - 9w .t Vtna~Y - J ]I WTWIACE IN•/e M tarwr•1 71 flA?i n Y•iM Ir r Itls•1 r..er) 1'
o E e ee M~R
•LL'~^: Ptarelx.e tawlj, w +b+~ p ocCEASEO OE Cf )
' f oRCroA+T 230-07-2879 W w II Hobson, Vi inia l+tarc~ 1915
o ~ ' n USUU Crf EAST •:/+o OE wsrau n s+dwwr Of SOUfCE
' i occurAtloTl a rfr ~tMAtgra ~
~ POYCfylI1 Public Works USl/i "1~m hib. Base ~ti1~Ze 1
» g E '
~ E _ CAUSE OE DEATH fEw/t. rrr tw tataa P•t W bt /A?1R tlw~ (Cl. NiffvAr fEiWEE?+ ;
= r /Aft 1 DEAfN WAS CAUSEO 1r OrtSET Alvo DEAEM '
~ Z Y IIIIMEOIAiE CAUSE IAI ? ~ ` . j
} : t0 = c.ws+bw. ~ aq. -i.t? os...... in ~ : .
i MIYSIOAN_ ~ b .w+•ba/• lAl ratty ~
Y ` •wde.l,+y «ww• ba OIR TO 1
' s i c....r...A.r V K) S
! t --+•+~"`I""' /AfT t _ O1NEf SIC~a?rCAwr COrtOITlOwS COatle•UTNG TO OEATI/ f11i NOl fflA.EO TO inE TEtATrtA[ ]•s -AUTQ/Sri rat ro ~ ~
~ • /r "t = DISEASE CdtprlOTE GNEN N /Afl 1 (A? - AUr1T0/tE0 ? y~ !
r r....~ti..r p, JN
t V ]•b r EfMAIE. WAS t//[!E w rfEGn1A?•Cr ]•t r ElttfM+AT CAUSE. rt w•s ]Od DESCIe•E ItOw NAlfr OCCIMREO 1••I•t w•Ma aT wwy w Pan l ar /arI f1 i 's
« ? ~ N /AST ) MONi11S) ~ «rrs.~.vr. ~ ~
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< 1•• ? w0? ..iwa.w? .dl Iitn taY, r..N wp.tt MO lu.v1• ,
TJ ]M rW1E OE NR1tI Ir 1 N•r1 (T+a1 al N,Un OCCUffED 7 RACf OE WAMV Mr, lanes. ;]•1.
r+•n . !Y ~ it+, a. b-w) (twr+,l ireN1 i
,.r M M A M «I.J• w•/ ..A~i. Toabry. I/rt•1. ell<• 01df.. Nc.
..s-~w•w rw r /M
« ~ ]6 1 CEtrirr M.eT l ewtwd•d r.a tlat•oled Irow ~b~owd rl•e/ d•oll• altrr•d a.~--tNf II/M) Ir•.a r,. te.lla YaNd obo.• ~
~ ACTUAI . ADOfESS~ (CtTr AND SGEEi 1 DATE SIGnEO. !
weu ffMOlr h KAC l••+• tHwe/er, ar aerNry _ (alr «twrr) (Ibu) i
°`""°A~ Forest Lawn Cemetery, Norfolk, Virginia
~ WNERAI ~ ? ? tfMOvAI ETC.
i I~..a e..~. «...»w «.wf.. «t.1 .tAMT o. Eu~EfAf HolloEaon-Brown Funeral dome, Znt
4{, C , ~ 7 - 1 HO" F~ ° Norfolk, Virginia
F ~ b Jw•wAw• •r rpp. ' 1
/ DAiE tECOlD
N
REGISTRAR t. /J Tr[D
This is to certify that this is a true and correct reproduction of the original
record filed with the Virginia Beach pepartlnert of Health, Virginia Beach, Virginia.
;;:-Date Issued: a -a 6 ~a .
?;s~, Y - ty Registrar
. .
~ ,
.ti~%:.'~.. ; ~ IS PR(J]3HIBITED BY STATUE. ~
t ri >~~C.TIaN OF THIS DCX.'U'(gNP
. ;t . i~TI~SS IT BEARS THE II~RFSSID SEAL OF THE VIRGINIA BF14~Ei
s ~ tv~ #iDF~~'CF HEALTH ~Y AFFI}~D.
~~~J. -~'S~fgr~ ~ 353.27, Code of Virginia, as Amended.
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1980 MAR 24 P!~ 12~ 14
FILED ANO P~COh{IEO
ST.LUCIE COilNTY.FLA.
ROGER POITRAS
0.ERit CIRCUIT
R~G!R~ YFRtftED_
i.K `I~o PacE 2~.4
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