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MISSISSIPPI STATE DEPARTMENT OF HEALTH VITAL RECORDS
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NUMBER
DEClASEO ?NAMl
L.
STATE OF MISSISSIPPI
CERTIFICATE OF DEATH
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STATE FUE NUMBER
77-t05958
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Crrr. town. o? iocation of Q?*tm *Bay St. Louis, Miss.
WNOtl I OAT
DATE OP BIRTH i mOmth, ?a?,
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iSTfTUTON ? NAMf l? n
DATE OP DtATH ? ??*??. *at, n
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COUNTY OP OCATH
miim cm iMam Mon T?t 01 mo
Yes
HOjrtt aV6*OTM{? MSTITijTOn?naj*< I ? ~ot IN IIMH, sot tmn am i
? Hancock General Hospital, Dunbar Ave,
STATE Of UtTH Ilf MOt IM w.t i? MAMI
COMMTtvi
i Louisiana
CITIZEN Of WHAT COUNTRY
i United State
MARRIED. NCVfR MAJNWD. WCOWJO DfVOtQD < i
it widowed
SUtYTVNG SPOUSE < *? ww?, Orv? uMn mum i
ii. None
SOCIAL SECURITY NUMBER ?
USUAl OCCUPATION iOm kmc o* won doni	mosi	Of
WOtiiMO L*. Mm tt HMN I
IV R R Agent Retired
kino o? *jimu o? Mousnrr ,? L & N Railroad
JTMtT ANO NUmIh
l4t 203 Union Street
REStOENCE ? SrAtt
Miss.
COUNTY
Hancock
OTY, TOWN. OC LOCATION
lfc Bay St> Louis
tofttM tm IHM*?
I VKlM nt Ot MOl
Yes
^ATHCR?NXMf
Jefferson Seuzeneau
MOTHM?MAKXN NAMt ml
u Emma Thiel
I NPORMANT ? NAMf
Sheldon M.Seuzeneau
limit ot ?.?.?. mo., cirr ot 10*1, iuti, i?i
MAIMG AOORCSS
203 Union St. Bay St.Louis Miss 39520
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WM>h Q?Hff ANt HWI
dcath was caused it
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(ENTER ONtY ONE CAU? PfR IINE POt hJ. rbj. ANO
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: PART H OTHER SIGNIFICANT CONOfTIONS C0m*Mi0** CO*?t*tff'MO to otAtw Itff mo? Nuric IO CAUU CMN (M ?AJ! I to) * DATf Ot INJURY	via!
! ACClOCNT. su<cc. ho*m6de. ; OR UNOCTERMNIO tMKtnri Mi
AUTOPSY
im ot moi
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Ot MAIM
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HOW INJURY OCCURRED <	O*	tMnrtr	in	?*tf	i	ot	>a?t	n,	?*?	it	t
7M________________________________________________________________________
INJURY AT WORK I i	n?	ot	*?oi
piaCI Of majry At ?o?r if?n o*rKiMe,K
i imit o? ?.?.?. mo., on ot vowm. *iA?t i
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73
TO
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4	13	77
n?
CERTtf ICaTION? i ^NTliClAN:
i ArrtMOtft mi
711 OKlAttP HQm v	*	*	w	|>l>.
i Cf?Ttf<ATON ? I^OCAt EXAMINER Oi COtONft: OM fwt *a?.* o* tm	MOvt	O*	MAIM
I ttAMlMAt?OM Of IOOV *N*/0i Ml IMVttTlOAlOM, m m o*w?Om.
I 01 At*. 0<cu?*f0 OM ftt? ?Att AMO *0 ?Mt	ftTAfte	2, I 00 P *W ?
! Ih.
AM? UK UW MM/MM	OM
?ohm i?v n*a
12	77
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tor Arm maw.
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I HCWNl ?Al nONOVMOl M*l MOMtH	ftAT
4	13
1:10
DAT< S^pN^	^
|CEITiMER~NAMf ?rr?f ot *o*m*i
Ztspu* /wA
cm o? iowm
HOM oa nn?
S>m 644 Dunbar Ave			
M BURIAl, CREMATION. RfAtOVAl H i %Pf<trr t !,?. Burial	n? Cedar Rect	lOCATtON tiff Ot toww tun ^ Bay St.LouiG Miss	
K DATE lMOMVH.OAT.nAtl 1,M April 15 1977 .	PUNERA1 H^ME ? NAAtf ANO AODtfU * MNIt Ot I I ? mO , CITff Ot IO?rw. ?Ult, IW 1 tu E<Jhond Fahev Fun raJ Hnwp Rnv Sf v,-^?		
vam/LuTT to4tM? incrr. //?			?ah ?tcirvfo it lOCAt MOWtAt * U-lK-77.
TH($ (S TO CERTIFY THAT TMg ABOVE tS A TRUE AND CORRECT COPY OF THE CERTIFICATE ON F?LE M THIS OFFICE
Ckh?- 8 (Lf^C, . November 11, 1992
- - ?JCTK3M
David Lohrtscti STATE REGISTRAR
A HBWXWCTK* OF THE DOCUMENT RENDERS IT VO? ANO INVAUD 00 NOT ACCEPT UMiSS EMBOSSED THE MBStSS*??! STATE BOARD Of HEALTH K PRESENT. IT IS liEQAi. TO ALTER Ofl COUKTERFEIT TWDOaWBfT
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