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HomeMy WebLinkAbout28135~ ?i~S•7 ST•k2,180 ~ . .s _s-- ~ ~ -~~~ 1. ~~+~~' _~"" . Gra~vson ~-aTY '-„o n+ Galax ' a~TK ow uetT~ttrr~ow ' ~_ .. ~ -: ~. w ' _ . . , ~ ~.r c~$~~ . John a. fOC 6. OO~OR oR RwC~ i <- ~ e Rhite • i~iiar~ ooar.w.~o« tu~.sw+...ar~ ..e+..~ ~ac ~ rorkiy i~...~. r:wir~o -Dxtor ~ ly, fATM[R'i CBRTIRICAT~ Ot~ DEATH ~ ~ ~ ~~ COMMONWt/~LTH O!~ VlRdIN1A ~ OtwMtrat K NfA~M ~w~W M Vnk Rwh~t~CS ~r ML MAOIlTl111AL OItTIIICT L'. ~~~:~~~~ Oldtown ~ ~~ Vird3nia ' . a ~TM ara~son ~] IMII ~~ a c~TV ~ ~la~ ~~ Q~111 ~ IJrrr TOMIN' Cl~~ ^ OWM ~ ii~ir d. ~n,an~ o. a. sr+ecrr "°°~"` tr•••r.s^~~+t•r~a .i ~ '~"" 306 I,afa~ette st. ~~k1 a ~ 1. oATt 0/aMU (D~f) (Ter) ltills Pb~-ell o°~~'r+ 1 7 1956 ~. MARRICR NiVtf! MARRI[O wioowm. avo~ecco ~y3 ~. OATL OF ~IRM ~. AO[ (~ tYt~ w. w~w~) l ~1 VM~ 1 T~ N ORYY~{tM. rto.~. ~. tio.. ~s. ~ ~ }Sarrisd 3-7-1881 ~ 0 10 tiU0. KIMD OI ~YIINOi OR IN- „# T~. SIRTN/N-C«Itre ~~pm~M'~ i ~• C~TfLOtOR M/NAT ~ ~ Optometrist Northar.ipton S. U. Count~r. N. C. 1 r s. MoT.aw~s MAIOiN NAY< ~ (`,~ c~ n ParrP11 Cornelia Po~erell ~s_ w-rc o. wuss~no ae w~or ocawsm ~6 ~fOCU1L f[CUMTY ~~. aw~o~w~w~ ~.~'~s ~j ~ e~. Po~ell N~i~ Ta~lor P~e1..1 Yes ~1°OR"' Ga~,x„ 9a. ~ U, cwstos orwn~ 1, ascwsE ow ooNORwN MEDICAL CERTI ICATION . x+r~wvw~ ~wm+ ~.y ~ a..e p. u.e w~cenr ~wawo To our+• n-~o ou~ ~fiaOl.tW (•) ~~ir",'+~Q~L.,i J~ ~ •Tii~ lru ~t ~eaw W rle rJ 1~iy, ~re~ ~ Mrt /MM~, u- Ue.ir, e1Vr. !t ~ur~s Yf ~W{Y. M~ tN ~[~ll1/~ ~1~f t ~ ~A~ ~~ {i<C~tE Oi O/£RA• 2N. w~oax~ suido[ •~~uot wMnewotr cnuaos / ~- lf..ii. nwi,i.... ~:~7-. .~w*. 01,[ ,o N r~~•~tJ a!GQL.~~.s.- '3- S/ i1.ca~ +ue a tie ~l~wr ervt (s) st~f- j1 /~/~ ~~ 'r'/ fir e+~InlyYN ewa /ad. ouE TO (ol A '~T' a~. V(~ 11. OTME~t iKiNIFICANT OWIDIT10NS / - . CI~/MI ~R~I~~~/ ~I ~f ~k ~ /~ ~ /~~~ K~/ f(I~fl~ M fAt JYM# N[M<I~fO~ ~'MA1~1 ~t1~~. .~~/ I JL~-~'~'~ 196. MAlOR IINDIMOi Of O~iJ~AT10N / 20. AUTO/SYl ~.ci~)) 21b-`~ ~~1.R~r~( ~ ilis.. a~c) ~~o. ~urr. towN. ae aouHrvl ZYS ^ t70 19 (iTA1i~ :KTw~ O~+s) (o.sl (t..) (tto.) - 21.. WJYIIY OGCYRRCD 21L NO1N OIO ~MIURY OCC~IM • a W6ik sc Nor Whik ouuwr ~ Work ~ a~ Work ^ ~ I iers3j eerrJ~ tLt I.u~alr! tJk lea~faf Jrsw i ~&.SS^ a~~ _~9~.~. uW I Lsr rss rJk Jne~rel .ai~e ar~4 i9-~i~ ~1 tLt lydA Maar~! ~l.l --~ ~.s., ~ u4 ~~rres ~rl ow l~ir J~la sleki/ wi~~e. rk:fi6~N UJ larp~ o uac) z3b. woae :ela a-ts swwco t~ : ili~. - '~ -.'r ~'1. . ~a!-a~c /''~- / - // -~ ~ WL M/RIAI_ Tq ~. 2 NAME Oi C[MtTtRY OR CREMATORY` 'L4d. IACATION (4q. ~~. ~ aor~l~ ~ (Snr~ MMOVAL ) '~ ~ ,~ _ -~==- r .~ G~lax: Ya. ouc.wcro sr I+OCAL ' . FYNEI~IIL WRaTOR'i ~~ r~ ' ~ ~9r... ~~ • -~ iIONATURE / j : s ~ ~t . . = - ~oowcss ~~~ "i ~~~ :~ r~~~#._~~'~~z,• . 201 91. Center Street, Galax, Va. +,~:-~. ~' - ..- :~t - . - ----- ---, _ . .:,. ., . ~-. .. ~.: ~ :=.~~E, .is; ,~` C:fy that this is a true and correct reproduction o~ ~~b~S~ ~~c ~` ~ e'pf~icial ~ecord filed with the State Department of Hwith,'R1c~inic,~id, Virginis. .~•- ~~;., DE C ~ 0 ~980 ~ Date lssued• DEANE HUXTABL , State Regist~ar ~ ANY REPRODUCTION OF THIS DOCUMENT IS PROHIBITED SY STATUTE. DO NOT ACCEPT UNLESS ON SAFETY PAPER WITH THE VITAL STATISTICS SEA~ CLEARLY IMPRESSE~. Sectton 32.1-2j2~ Code of Vtrginia, as Amended. 5.1 ?..;Z,,~ 'J~i~ ~nil 'J Fi.~ J~ ~ J ~~~'~~34~ ~~{:t28i2 F ~~ ~t Lhl ~: i;,• : t ? c~~i:,'Ctf lC•U~'I.i!;. kCu`R f'~: : -~~1:i ~t Ef;f r;~; •.;~ L~:~~~t ;'~ .' ~. , . . - . ~~_~' . ~..~~~ ~: r -_ _ - ~ . , -~_~ ~ :~~