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It has not been edited and may therefore contain several errors.


n	-----------------
___________HBCIST1AWS NO. Xf _ ^
OCNCJE iWtar. *----~
:Si3Si??rf >COWTT Wc
e. CITY Ili kmU* ipwm	RUfcALi
OR
towh Bay st. Loui~,
d. IF RURAL
Give location 302 Sccond St?
c- (Lr?? 6>a PERRE ^
? DATT (MouU) (E17) (Yar)
death June IS) 1952
10a. USUAL OCCUPATION Wb.tM<l..l
Retired Daker
7 MARR1C0. NEVER MARRIED. WltXti^D^DIVgnCCD <iwur>
10b. KIND OF tUSINtSS OR IN-DUSTRY
Food Poking
Augustine
15 WAS OECEASED EVER IN U S ARMED FORCES?
1| <T?a.	|	ilf r?*. vw
?; Ho ! none
1?. SOCIAL SECURITY NO.
Unknown
t. OATE OF BIRTH "Ay 22, 1072	i. ASE 11. r?.	r no ? rum nmpm 1		Mk.
11. BlKTHPVACE ?* MlWy) I3ay St. Lou in. Ki33i33iDnd			It CmZlNOF WHAT srY?	
MOTHER*S MAICCN NAME Christian	Vonau			
17. INFORMANT
Mrs, Leonide P. Cabell
(Daughter)
It CAUSE CF DEATH Four ?alf oM?i? i?r for <?). *ad (e)
tk* *m?4* ?/	iwtk
?	?rt*r?4u,
tit. it nrmu tk* 4u-rtf, (m/btv, w ttm rkiet atiW 4*Mk.
I. DISEASE OR CONOITION OIRECTLY LEADING TO DEATH*
(?> .
ANTECEDENT CAUSES A/w Mtf	if #??. #??# DUC 10 <b>
hm r? a# ?*?v	r?>	??t*?
(A# %%d*rij4%f mmt Uk.
HCQ|CAL CERTIFICATION	>,
?tnrV>Li*^r 'S'GsC*.
out TO (e)
II. OTHER SIGNIFICANT CONDITIONS Qwtflm #?eiT**ed*f tm (A* rfrtfl M mtt rdatM U IA*	? wXirtii	i-e<A.
ivrrtitvM. KT?cn MKT AMO OCA TN
IU. DAT! OF OPERA-TION
190. MAJOR FINDINGS OF OPERATION
2D. autopsy?
mD roQ
XU. ACCIDENT SOODC H0M>C1DC
lit. PLACE OF INJURY
lie. (CITY. TOWN. OR TOWNSHIP)
(coufrro
UTATt)
XU. INJURY OCCURRED 2lf. HOW DIO INJURY OCCURT WMAtn WWHILfr
ZL I hereby ctrti\ ali* on
tkaf I clltndnL^ke deemuql from 6-/0-	,,V'3'..to	4-/*-..u&z** 1 hut taw Ifu dtttattd
pAr "*	,anA	that	dn?h	oeevrrrd	U	?	? QQA. m.. from Iht wiuw and on Iks dale rlalrd abort._
23*. SIQNATURK
IU. IURIAL. CREMA-
now,---------
23b. AOORCti
Oi OATt SICKED
N REMOVAL 1
nurial
?STSCt?	'i
June 17. 1952
OATt RETD BY LOCAL
Me. NAME Of CEVCTtKY CR CRCMATORV
Cedqr Rest Cer.retcry
Par 5t. LoiA^.g. llisalaslopi 6A9/52
U4. LXh-'ATlOM (Ottr, w*. m MI IT)
Bay S^. Louifl. Mianiaslppl
a. FUMRAL DIRECTOR
THE FA1EY FUli^
AOON
September 9, 1993
HOMEI Bay3^Louia , Liloa?
%?JSL2iLLi
?
?
t*
fi
N
I
Alton B Cobb. M O STATE HEALTH OFFICER 12*31*92>
D?v4d Lohhsch STATE REGISTRAR
A RSXCOUCTtN OF TXS OOOSCNT R0CCRS (T V0? ANO MVAUO. 00 NOT ACCEPT IM?S3 FUBC^fQ WARNING. SEAL OF TX USSBSWl STATE BQAAO Of HEA4.TX 6 PRESENT. IT IS IXEQAL TO ALT? OR COUNTERFEIT TttSOOOAOT.
THE FACE Cl THIS liOCUMtm HAS A COLCHtO HACKCiHCUND OH J.M.Tt PAPLH T.T IMC< Of THIS CCCUMiMI CCt.tAlKa AN At^I HCIAu ?.VAIIHMAMK flCKC I.! AN -NC..1 IO VIEW


Perre (Perry) 018
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