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HomeMy WebLinkAbout1783 S~ 1648 ~~ , . _ , . . . . .. . --~,r oe~rr[wT a sow- srev~s - M~ssou~~ av~swN oi aE~~TN 124 s~wK r~Lt M~~ ~ ~ ~n~ryc+~w. r~o+u• ~sa~rw~s aw a~owuu ~~ ~ ^` _ -~ ~~0 ~i j CERTIF~~1T~ OF ~EATH ~ ~ REG~S~ TION NO _. M1MAl1Y IIEWtT11Ai10N OIS~II~Ci Np . -_- __NEG~STM11SN0 .~ ~OECEOEM!-IIAVt s~A~~ ~ WOO-t •A1~ ~E~l . OAl( (l` O(ATN~MK (~r, lr / ,- .. JEROME GFNE tlBL :. male ___ , March 23 ~ 19~0 AAC!- N~-~-Mi.~4t~.A~w AGE -lW MMMti 1lMO[N 1 rEAQ UNOE111 pAY ow~E o~ ~~wrHl~..lltr. Irl U)UNfY O~ OEATM usr.~~l;Ircdr! lYnl ,~ wvf ~~S TYWt • ~a + tJ}f~ t~ ~S~ ~ y~ i St. j t ~ )a ,Le~~!~ e[1B vS ~OD ^'J~.~r Rw 1/~ ~~Y.TOrIN011lOCAilOMOfOEA1N N06IIfAtOwOt11E11~Mft/IYT~ON-NMr ll/r~IN~ .p~'tu~rtt~wl'~r"'k~l ~. 12 mi. east of Lebano~ on I44 . ~ S~AtfOFN11TN/U~4rQSA. C~11IkNpMMA1CONNTIIY ~WRR~EO.NtVE11WON1EO. S1M1Vrv~NG3Widf //J~ylr.{wrirl~le~w~~r/ INr-SOIC[DEN~lVt11~MYf ,.wr ~~.~uql w~oowco. avo~cEO~yt.,V~ ~ wwMe o r onc[s~ ~~~~•*M • Ninnisota ,. U S A ~• marrled ~~ Lucille Barker i,t ~~~ES r~~ oct~wwto w • • t i - ~asi~tutWM. SOC~~IitCUwtTrNUWEII ~ uSUAtOCCU-wiMN/4wrLw/oJ..~~J~+rfrry~•woJ aN+OW ~VS~NtSSOwiwpusiwv Slf w~NO~DOK ~all~iJ~-nA~/nIM~ ~EO~wo~wo ~~.».E.~.« „ f~~ -03-73~.6 ~..Su~ervisor Mobil 0~ wis:0! !~ qELOENCE -iiATE COlN1i~ pi1/, TO1Np OR lOCJ1?ION ANO IV COOE StREET ANO NuMtEw ~MS~OE C1~Y luMTs l~yr Yes r JW) ,,.. Texas ~~.. Collin ~~ Plano 75075 ~~. 34~0 Bi~ Her~ Trai~«. ves fAiNER-NAYE ~I~ST Y~pOaC M1~ ' MOiNEM WIUEN NAYE ~ I~S7 w00~1 WT ,~ Joseph Ubl ~„ Lund Caroline ~bl ~MSO~~T--~-ME (IyMeaMir/ ~rwnw4~Oa-ESS s~wici o~ w r.o .+o c~~v o~ ~o+..+ s.w.a aa „~Lucille Ubl ,a 3400 Bi~ Horn Trail Plano, Texas 750?5 MJ111Al.AEMAi1ON.11EYOYAI.OTNEA I~/lJ DATE CEYEIERY 011 CREYAIORY-NAYE IOCAi~ON C~tv o~ ~O.~w l1AT! ,~ cremation 3-27-~4 „~Greenlawn Crematory ,k ~ Springfield, Mo. it1flEMlSERVICEI~CEMfEEOrhr~wACa~A~S+d~ MAMEO~fAC/t~iY AD011ESSO~fAC~I~TY /~Ary/ N1MME11 ~ p~a,;,~ ~~ ~ Palmer-Pickering ~ Lebanon, Mo. pE(~~ • OATE RECE W ED ~Y RfGKTRM /lFa. !#r, /Y / tta ~s.~rw.~r~- . _ . ~n 1~ i~s. ~2g-~ ~~ ~a row.e.ia.,rr,w.reM.a.~amo. aw.e.r.a.c..w rra»~i. tx a.~.s..efa..Wwo~anero....~~b..M~... ~; e.n~om....e,~r~u.c cw~lY flwd. s ANf yd W~ce aM Oue a W wrlfl vNed ;~ rs.~.w r~i- __~ rss~w.r...r r.4~-' ~~ . . . _ C~s~t~.r.i pATE S~GNEO~IM.. Arl. Yr.l Md111 Oi DEA1N ~~ WiE S~4NFD/Jb. AO~. Yr MOIAOi OE ~ ~~ tu. rn. y~~~ ~~j,«,C 2.6, /9ga I zk- ! J: os P. ti s~ MAYEO~A1TENqNGIN~SICUN1iOTNENT/tANCEN~~i~fN/ry/ep/NI// =~Y MaONOUMCEOOEAO1~b,Q~J.Yi/ ~NNMIOt/NCfOOEAOf/j+// ~~ ~~_ ~ ::.. :x o. h~~,.~ ~3, /9~ia` ~- AT /:_~S P.~ NwME whD wO0aES50e CERi~s~ER VMrS~CUw. MEWtwI ExwWMEw Ow ~qqNfw~ /Tj/eorA~wrl ~O. uCEMSE -+D. ~~~s .~py pw .wsr ~.n op~. IfM:Fwr~ (~.tpMM1l~s~frl ~~~"~~ ~ IfZAX W. P/C/YEiP/A~.L' isa(~~~OME~P 15 ~~~~ ~ IYYEOIATE GU6E /ENiFR ONLY dYE Uf/SE IfR LINf fOR (al, Al. ANO kA! ~~+i«.N ee..«w w+n +wa e~N. » c.. ~wvE 2Q ~ N~S! *O ~A~T • • .v..toi..[ ~M ~ J. - ~_~r _.~.,1~/ _1_~.~-...r uusE 1 - - ------ -- ~,ww w~w+e.. ~n .ea ~rw s+~+•"r. rwt pyE TO.ON ASw~pNSEpUENCE Oi v " _aoew.•~~e • 1 ..~s[ ~~si /7 ~/ 1 y~ i~~ ~-~~C{~ -- - - - - - - - - - - - - - -f Wf TO. Ot~ wS w COMSEO~EtitE O~ ~w.+r w..wrw ow~n ~we ~N ~ 1 ~ k~ 1 ~ ~AI1i OiNERS~GN~f1CANTGON0I~WMSCawd~erw+u4~+ywA~+U~b~n1w~M/ed»tw,~M~~~~RTI•M AU~OKv/S/#.~r)'cs ~ASC~SEwE~EwaEOTOyEdG~l A .rN.~/ E~~~rWERfqCOpOhER f ynp. 1'P~ ~ I). ~co It. ACC SU~C~DE ~~OM.4NOET. WTEOfW1WY(ILi..4~',1%I »OUROtIN1URV OESCNt~ENQM~h1lMVOCClMNEO ORfENp~ ~hvj,j~ (~~r). ^. - ~MJURY A~ ~ \ ~, l ~' ie~ : i :~~}i . ~i , r--a " ~ ~ ~ i ;~. .,.i l :..~r! .A ± ~ 2l~. !3~l ~.3-S~ t!c /_•se P. r 2la. ~ nfr.Ytf FOFIN~IRY-Alhonr.4nw~wal. LOCATIOGi nrwtcrow~.r.o.wo.c~Trowrow~rticown+. sJ rc~ /~ tfOEGE~SEOwAfstY~lE ,.+~' y~'~ ~yp bice 4~LliL we [Spn',/sl ~O 7 [~~~I%~~ Ca • a~us*E!o OAnEUU~wCt1 ~ ~. /"~~ WL~ . ~ . ~. ~ RS ~ NO O V~IC t F: ` - ,j-~..y ,~,~`° ,.j~~J • , ~ . _ l~'~_ , . l~~ L . w~ : 4.i.!'. +• . • f - ~:.; j~ .. :r :~.T~1~ ~`~i CERTIFIEO OOPY OF AN ORIGINAL DOCUMENT ~~~'~ ~o. if rophomyraphed, or if ssal impre~sion cannot be feltl , ! : ~~ f ~fHSS DOCUMENT IS PROHIBITEO BY LAW (CHAP. 19Ci.380 RSMo 19691 ~ Q ~T'lQN~ STATEOF:~IAIS~.IR~S; :fi~: .,:j CITY OF :IEF~ER90N _ `+f s+~ rrmed therein ss it now sqi~er~~ Witne~s my hand as State Rp~: ~~ ~ , ~___ , ~,: f11EREBY CEfiT{FY that this is sn ex~ct reproduction of the oertificaty for the penon ~ pwmanent ~ecords of ths Bursau of ViW Re~or~s of 1M~ivision of Harith af Misourl tbsr of Vital Statatia ud tha SeN of the Dbisia- of Heslth af Missou~i this date of `.f . - ~"~ ~,i..~,.d,i,/~ ~'~'~ . ~ 8. Ridwt . ' ~ _ ."~ ~ '-"". . Stst~ RMistrs of ViW iestittio~ ~ _ ~..~_ S~_1f;48 1930 DEC 24 p~; ~2: 00 FllEO RAf FrCpN.i'F 0 Sf.IU!'+f COUY3Y.{t~. ~nGER r0~ ~ ~ns CLERi( CIRC~IIt ~OU4~ n ~'.^.F'! .' f : , ~ ~• e~x345 PA~E 178i ~