This text was obtained via automated optical character recognition.
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