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Corbin
J FAMILY GROUP NO. This Information Obtained Frgf l /. 1,(&Ze9A) TEAP /l7AX R Z. DEATs/ Gr.P2 TlYOA L✓fi[ rER e�?B/d .1 l9/� GE.✓. Pvr�vror• iFt Children Nem. in Fun CMld on'a DayMonth Year (Arrange in order or Nnh) Dela City, Town or Place County or Province, etc. Slate or Country Add. Info, on Children F 1Birth A Z1&=9—.f y o Mar. Full ams o Spouse. Death Burial 2 Birth a Mar. r" Full Name al Spouse' Death Burial {k t+ Compiler G -Y7 ]� Mar. WA Address sal City. state Date band's Full Name Month Year City. Town or Place or Province, etc, state or, y Aad Info on Nuaner I His Father/vJ// , —4. l e / /l ✓ /nBA/cif Mo1Mfe M.1d.rNama <71/ri6 IFF./Lei Nite's Full Malden Name tz=,—i/—,,,f S /ham c' Z/ Day Month Year City, Town or Place County or Province, etc. Stals or Country I Add. Info. on Wife Occupation If other than housewife Church Alllllalion Diner nueemda, II eny. No. 1912 ata MaXe eeoanle soul for Beth mai. Her Father[)///iAM .0 /j'L /e/e//n I/ Molnar, Maiden Name/�///CA. sea Children Nem. in Fun CMld on'a DayMonth Year (Arrange in order or Nnh) Dela City, Town or Place County or Province, etc. Slate or Country Add. Info, on Children F 1Birth A Z1&=9—.f y o Mar. Full ams o Spouse. Death Burial 2 Birth a Mar. Full Name al Spouse' Death Burial 3 //L Birth Mar. sell Nama - spouse' Death Burial 4 Bath Mar. Full Name of Spouse- Death Burial 5 Binh Mar. Full Name of Spouse' Death Burial 6 Birth Mar. 9,61G Full Name of Spouse' Death Burial 00 Binh Mar. Full Name of Spouse' Death Burial 8 Birth Mar. Full Name of Spouse' Death Burial 9 Birth Mar. Full Name of Spouse- Death Burial 10 Binh .at. Full Name of Spou"' a pech Burial 9f married more than once No. each mar. n) W eto. and list In "Ado. Into. on children" column. Use reverse side for additional children, other notes, references or intormalion. +C4. j11 of residence !n \ 21. DATE OF DEATH (month, day, and year)' 19 mo } CERTIFICATE OF DEATH N• n w a °r o +C4. j11 of residence !n \ 21. DATE OF DEATH (month, day, and year)' 19 mo r CERTIFICATE OF DEATH qa - eldosed r divorced D' of 6,)(EC'F,oN-'- RI'c <+le,{ -e.: 1 21. DATE OF DEATH (month, day, and year)' 19 22. I HEREBY CERTIFY, That I attended d° eased from 19—, to -=_f-= 1-J�—, 19_. r CERTIFICATE OF DEATH qa - eldosed r divorced D' of RTA (moy3,,-aa`5'; and year)The -.I Oklahoma State Board Health (/ _ -rP Dist. Noo.. Dist of Nature of Injury - -'--- -. 24. Was disease or Injury In any way related to occupation of BUREAU OF VITAL STATISTICS - rofeeslon,"or. particular - -=- work done, a° spina -- .�t Primer7 - Na• `:UiI QI� Oklahoma City, Okla. .. _. - . Cl'iet. ,- .� i Reg later No.__-- .. .. '.' ., -. \ ©: No.—__-____- SL„_-__----__ Ward__— . Other contributory muses of Importance: If death occurred In a hospital or Inet/tutlon, give Its name instead of street and number.) ' city or town wher/e� death oorc��curred--yrs._Wmos.—dA How long in U. S., if of foreign birth? a jQ _.. — St,__— Ward - dual place of abode) (If nonresident give city or town and State) 1 'ATISTIQAL PARTICULARS XEDIOA7. OERTIFICATE OF DEATH D -+ ce . 6. Single, ldoweQ or - -'- lor or RaMgrN e4 W Divorced word) 21. DATE OF DEATH (month, day, and year)' 19 22. I HEREBY CERTIFY, That I attended d° eased from 19—, to -=_f-= 1-J�—, 19_. Name of operatlon __-- Date of -- I last saw b— alive on---___- 19--, death Is said to have occurred on the date stated above, at --W rinelpal cause of death and related causes of importance efp as follows: Date of on qa - eldosed r divorced D' of RTA (moy3,,-aa`5'; and year)The -.I 11 IF LESS than 1 Yearel`D{onthe �.� :. Pay, I day----hrs. •j d J or__ _-min._ (/ _ -rP G Manner of Injury__— Nature of Injury - -'--- -. 24. Was disease or Injury In any way related to occupation of rofeeslon,"or. particular - -=- work done, a° spina -- _ 00Nneineeper, eta an as In which U. do �'e silk, mill, Other contributory muses of Importance: k- 1 11. Total time (years) spent m - (- In this occupation_-- Name of operatlon __-- Date of -- I !J•� .., What test confirmed diagnosis?_ Was there an autopsy?— - Town)- - 22. If death was due to external causes (violence) fill In also the following: Accident, suicide, or homicide?-- Date of injury—__19; Where did Injury Specify whether injury roccurredlr In industry,county, 'In homand er of In public place: -----____-- --_ - Town)— - ----- ----- - ✓ 1R MOVAL _ T Date_ - 3 19— Manner of Injury__— Nature of Injury - -'--- -. 24. Was disease or Injury In any way related to occupation of