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JacobsCo Ike/QNS- 0MO.". 1&9 I t LCLIat= V JD r S Born D ` �, ,� Where Died Cause Death Buried where Occupation r Hobbies, talepts, awards, achievements wily � �.Luii nameU_,qluN tS E)1z SETH 61,9r,('400D -1A0385 BornSept, -, �92� Where ' !e occ vLZ Died. Cause death Buried where Occupationar ,P41-a#fRt.T" �e_a7��R � &1ec f�► c e , Hobbies, talents, awards, achievements D11 1 41 n _ _ Date of Marriage ! w Other wives (it a y)y Father J'�VoM a �, L , C D �_� Father 8 7-- Q T _`' Mother(include maiden name,Mr�„ry, �o l � c�i'�C 6 Mother (maiden name} j N1yj N I��` `j'oR p, M ! Q_4 t/ojq Use back of page for listing grandchildten and all full •'similar information about them. CHILDREN When Born Where Born Died Place Married (Give full names) Give full names,in order Mo -Day -Yr. County -State Mo -Day -Yr. Burial Date Name '• I Caine death 4.��•19 4 Date birth where UV). • � Caine death; CAusa death, T.,_ A� n D _ Cause death) Davis county Public Library OCSvi�1�,� Cause death` i Date Date birth Name Date Name Date born: Date Name Date born Date Name Date born where where where where r i - ( Date Name '' � ,Cause death ` ate born were ki vv v) I^\ V1 ki