stansberry (1)

8/10/2019 STANSBERRY (1)

1/37

RUSSELL

M.

BUCK)

STANSBERRY 6?

Waynesv i l l e

RES .

26^ M ain S t

Tipngthy

Dayton

PLACE OF DEATH

Wilmington Extended Care

Facility

Wilmington, Ohio

--

.Snnday May 29,1^8

DATE May 23 i 1916

RETIRED

YRS.

LOYED

La b o r e r

YEARS

POSn iON

OTHER AFFIL lATldNS

worked at one time at the Corwin Canning Factory

and Mulfo rds Greehhouse in Lebanon

FE/HUSBAND DyT58XKLHI i ....Npvp-p eH

S t p n M n th pr D pI Ip St .nns hpr T^f

nf

Davt .nn

HS

) SISTERS

1 Aun t wi t h whom he l i v e d

? jBrothers

aryL_StanF5berrv Crane

o f Wavne sv i l

ie

2 i Si s t e r s

Uncle - Thomas Stansbe r ry

of

Bel

Lb r o o k

) BROTHERS

IILDREN NO.OF GREAT

GRANDCHILDREN

GRAND

PARENTS NAMES

2Pm

day Thursday place FH

Miami Cemetery date

b /2 /b j l

L

RECEIVE FRIENDS

D Y Wednesday FH

P nrn

hp

iKPn

CHURCH CEMETERY

n VAULT PRINTER ESCORT

JOURN L CL SSIFIED OUT OF TOWN P PERS O ITU RY M ILED TO CLERGY

90

Red

Roses

(Russell)

V

N A M E

S

Gertrude I rene I s ley

John Tress l e r Stansber ry

HAIR

STYLING

CLOTHING

MASONIC

APRON

ROSARY

PALLBEARERS

LODGES

CALLED

REGISTER BOOK


2/37

Mary L .

Cook P ub lic L ib ra ry

hioana Room

Genea logy Ve r t i c a l

F i l e

S

t a n s b e r r y

The

fo l lowing

was

copied

from

the

Stansber ry

family s ew

Testament ible dated 8 6 6 ;

FAMILY RECORD

John S t an s b e r r y was b orn O cto be r 5 1829

Mary Jane Stansbe r ry was

bo rn

S eptem ber 21 1836

Es t h e r

S t a n s b e r r y

was

born December

3 1854

W i l li e

S t ansbe ry

was

bo rn Janu ary

7

1857

E lix a be th S ta n sb e rr y was bo rn

March

23 1860

Frank S t an s b e r r y

was born

Apr i l

7

1864

mma

S t an s b e r r y was bo rn

Ju ly 28

1869


3/37

NAME

RUSSELL M. BUCK

STANSBERRY

AGE

6?

RES .

26k Main S t .

CITY

Waynesvil le

LENGTH

OF

IILNESS Tiongt.hy

PL CE OF BIRTH

Dayton

PL CE DE TH Wllmlngton Extended Care

Wilmingxon, Ohio

T IME

Sunday

aborer

-date May 231 1916

YEARS POSn i ON

OR.MALLY

EMPLOYED

CHURCH

OTHER

affiliations

worked a t one t ime a t the Cor^//in Canning Fac tory

and

Mul f o r d s

Greehhou s e

i n

Lebanon

VETERAN

SURVIVORS WIFE HUSBAND

P RENTS Rt.pp Wl otb p-p Dpllg^ S t.TinghPTW

o f

nnvton

daughters

SISTERS

1 Aun t

w i t h whom h e lived

C r a n e of

Wavnesville

i 1 Uncle - Thomas Stansber ry

o f Bel

Lb r o o k

SONS

BROTHERS

NO . OF

GRANDCHILDREN

7 -g-Brothers

DATE

R i .T IRED

2 isters

NO .

OF

GREAT GRANDCHILDREN

GRAND

PARENTS NAMES

SERVICE

HOUR

2Pm day Thursday

PLACE

FH

INTERMENT

Miami Cemetery

date

b / 2 / b J

9 , RUY Po-ir

T. T.

THE F am i l y will r e ce i ve f ri e n d s

TIME 9

D Y Wednesday

PLACE

FH

LODGE SERVIC ES

MINISTER C

CHURCH CEMETERY

Va u l t p r i n t e r

NEWS

JOURNAL

CLASSIFIED OUT OF TOWN PA PE R S

flowers 90 Red

Roses Russell)

Ge r t r u d e

I r e n e I s l e

ATMf. < S NAME

MOTMEK

MAIDEN NA.ML

DISCHARGE

PAPERS

FLAG

REMARKS

John Tres s l e r

Stansber ry

HA IR S TYL INO

CLOTHING

MASON IC A PRON

ROSARY

PALLBEARERS

LODGE S C A LL ED

OBIT l ARY M

REGISTER BOOK


4/37

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LOT SECTION

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NO 1 5 1 9 6

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Field J ^ h i o

D I S C H A R G E

Dfeg e m b e r 1 8 L 2 J A

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address 5424 Mari ne r D ri ve

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RELATIONSHIP Daughter

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PROFESSIONAL SERVICES

F A C I L I T I E S

MOTOR

E Q U I P M E N T

C A S K E T

V A U L T -

S U I T O R

D R E S S

U N D E R C L O T H I N G

IT O W I . K S

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G R A V E O P E NI N Ci

C R E M A T I O N

CLERGYMAN

ANLT/OR

CIlURCH

P O LI C E E SC O RT

CERT IFIED COP IES OF DEATH

A V A U L T

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O F D I S C H A R G E

TRANSPORTATION CHGS.

C L O T H I N G

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8/37


9/37

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*

a i

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in wny | | ^

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at..tlie age iif 74

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ly iriteaed hy pe inifbTwhphronght

hltn''their work* Souie yeara ago

felhijiyHliip.

' '

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liiilli/d lHa

MbirithtVnce. Wawill Itiy

hiN'biKly i.o reat in the grave, hi .

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13/37

Genealogical

Gleanings hi

England.

39

Depositions taken at the house of Rev. Thomas Cockshutt inCalvert Coun

ty 18

March

1716:

Richard Reade,

master

of

the

Judith

of

London, aged 38. He has known

Carroll

for

thirteen or

fourteen

years and

knew

Thomas Tancy for eight years. He

knew

Boys

when hewas inMaryland. The deponent had heard

Captain Robert

Redhead, a ship s

master, saythatthe Vine overturned inBoags Bay through

carelessness.

Stephen Yoakly,

mariner,

aged ,51. He has known Carroll and

Sheffield

for a consider-

, . able time. He sailed out ofPatuxent

River

in

company

with the Vine and they

parted

[ ^ company shortly

afterwards.

; Richard

Burbydge,

mariner,

aged 40.

He

was

in

company

with the Vine on her

homeward

voyage

when he saw her make distress signals. The commodore of the con

voy, Captain Roberts

of

H.M.S. South Sea Castle, sent some

of

his men

on

board

the

Vine at

six

or seven in the

evening.

At eight o clock the

following

morning

she

sank in

a calmsea. Her sails were taken aboard the Bradleyof which the deponent was master.

Depositions taken at the house of William

Wilkinson [of

Charles County]

24May 1716:

Alexander

McGrudder, aged

44. He

knows

Carroll

and

Sheffield

and knew Thomas

Tancy for many

years.

John

Anderson, aged

41. He stayed for one night

aboard

the Vine in Patuxent River

and

heard

the

sailors

pump all night with little rest. In the morning he

found

she was

takingin water at the rate of fiveinches an hour.

JOSEPH STANSBURY (1743-1809) OF

PHILADELPHIA

AND

NEW

YORK

Printed report of the case of Stansbury vs. Arkwright, 22 March 1833.

Trial at Hereford Assizes, Oxford Circuit. [5 Carr &P] [Adolphus & Ellis]

; . [Times, 27March 1833]

,

Thomas Stansbury

by his

will

left a

wood

and lands in

Leominster,

Here

fordshire,

to his brother

Samuel

Stansbury, watchmaker of Hereford.

Samuel

had a son

Joseph*

who emigrated in 1768 to Pennsylvania and continued

there until 1773whenhe returnedto England. Hewentback to Pennsylvania

in1774, came again to England in 1783 to claim for his losses as a

Loyalist,

ki t returned in 1785 and remained in America until his death. Joseph had a son

Samuel bom in Pennsylvania in 1772.Samuel died there and was the father

.

of the present

litigant, Joseph

Stansbury,

anAmerican citizen.

The

defendant,

Richard Arkwright, was a gentleman of large

fortune

who had

purchased

k theLeominster estate. Evidence

was

given

at the trial that therewas no other

; Stansburyfamily livingin the Leominster area.

Born in London 9 Jan. 1742/43, son of Samuel and Sarah (Porter) Stansbury; died at

New

YorkCity 9 Nov. 1809; married 2 April

1765,

Sarah Ogicr; landed at Philadelphia 11

Oct. 1767. Pro-British, he was imprisoned 1776-1777; given a pass, with wife and six children,

to New York

City,

1780. Itwas he who carried Benedict Arnold s first

proposals

to

British

headquarters. Dictionary of An:erican Biography, 17:516. Also see Lorenzo Sabine, Ameri

can Loyalists

Boston, 1864 , 2:325.

^Lewis D.

Cook, f.a.s.g.


14/37

further

this deponent saith

not

Swom to

and

subscribed before

me ^4 ^

ubscribed before me

y

4

t^e^_ 854

m r r ie on the

day

of

A

D

185^

{e^.

and

\ /

^

by me a

Warren County \

PersooaUy appeared

before

me the undersigned Judge

o^lhe

Probate Court within

and

for the said

ounty

of

Warren J-

who

being duly sworn

deposeth and

saith that

he is more than

^ ^ y

of

age

and

has

no lawful

wife

living And

that

^ -

is

more

than / years

of

age and

has

no

lawful

husband living;

that

she

is

a

resident

of

the County

of Warren

aforesaid;

and

that he

knows of no legal objection to

the

Marrmge

contemplated between him and

the said

^ And further

this

deponent saith not

i

Swom to and subscribed before me

j

P//^/?/C

f^

J

day

of c/ 186^

his

^/_

day of

MARRIED

on the day of

A

D

185a:

-

by me

^ 1 :


15/37

akrenOounty, i

V.f the

undersigned

Judge of Ihe Probate Court wiUnn f

PersonaUy appeared before

me

the under^

g

county of

warren

.

ho being duly sworn deposeth

and

saith that he is mo^an^ ^

nd has

no lawful wife

living- Xni tUt

of age and has no la /

and

y / ^ Js-.o.o=^

*

1

t

fthe

County of Warren aforesaid; and

that

he

as

no lawfu l

husband

living;

that

she

rs

a

resident

of

th

ty

^

V

.s o f n o legal objection

to

the Marriage contemplated between h.m

and

the

sai . .

nor^of no leg J

. . ^

Sworn to and subscribed before me, )

W t

MARUIED on the

day of./

A.

D. 18-3^ . -

and

by me, a

/ . r ^

yj /j

/ / . Oy

I

//LfM . . V ^

arren o 7

Personally appeared before

me

the undersigned

Jud.e

county of

Warren

C U ..

,,,,

.ho

being

duly sworn deposeth

and

saith that he ^2-

of age andhas no lawful wife living. And

that

^ years of age

an

is more than.

4 f

Af

fbp rountv of

Warren

aforesaid;

and that he

1

knows of

no legal

ojec

lo

further

this deponent

saith no

Sworn

to

and subsm^ before me

this

//^/i.dayof


16/37

FRANK

STANSBERRY

Mary

L.

Cook

P ub lic L ib ra ry

Ohioana Room

Ve r t i c a l F i l e /Genea l ogy

S t a n s b e r r y

The

fo l lowing

In

Memoriam

fo r

Frank

S tansbe r r y

was

p r in te d in

The

Miami Gaze t t e , Wayne sv i l l e ,

Ohio

Thursday ,

Janua ry

13 ,

1949

Pg . 3 .

Frank

S tansbe r r y ,

son o f John

and

Jane

S tansbe r r y , was

born

in

Wayne sv i l l e , Ohio , Ap r i l 17 , 1864

and

pa s s ed t h i s life

J anua ry

6 ,

1949 aged

84 y r ,

mo.

19

d ay s .

H e w as married to Ella

Bu r n s

a n d to this union s e v e n children

were

bo r n , t h r e e have p r e c e eded t h e i r f a t h e r

in

dea t h

and f ou r

r ema in

t o

mourn his p a s s i n g .

By t r a d e , he

was

a shoemaker ,

bu t fo r

many y ea r s

was

engaged

in

p a i n t i ng

and

a l so in th e

pack ing and s h ipp ing o f pou l t r y .

He i s th e last

of a

f ami ly of f i ve

ch i l d r e n ,

t h r e e

sisters,

and

one

b r o t h e r ,

all o f whom

have

p a s s e d

away many y e a r s

ago .

Due to h is

advanc ing

yea r s h is h e a l th

began

to fail and a few

weeks ago

a

change came th e f e eb l e body

cou ld no

lo ng er w i th sta nd

th e r a v a g e s o f d i s e a s e and th e wea ry s o u l pa s s ed

i n t o

eternity.

He was

a

good ne ighbo r

and

k ind f r i e n d .

H e

l e ave s

h is wi f e , t h r e e

son s , and

one d augh t e r , s i x t e e n

grand ch i l d r en and te n g r e a t

grand

c h ild re n , th re e n ie c e s , one nephew

and many o t h e r

relatives and f r i e n d s .

Oh

why

shou ld memory ve i l e d

wi th

gloom.

And

l i k e

a so r rowing

morner c r aped .

S i t

weeping o er an empty tomb

Whose

c a p t i v e h a s e s caped?

The

j o y s

we

l o s e

a r e

b u t

forecast.

And we shall f i n d them

all

onc e m ore ;

We l o o k beh i nd u s f o r th e

past.

Bu t lo t s

all

before.


17/37

A U T H E N T I C A T I O N

PROBATE

COURT

I,GEORGE J.

GOUNARIS

Sole Judge andEx-Officio Clerk oftheProbate

Court

aCourt ofLaw

and

Record within

and for the County of Montgomery Do Hereby Certify that the foregoing is a true and complete copy of

MARRIAGE; JOHN

S T A N S B E R R Y

V O L

63

A N D PG 54 4

GERTRUDE I RENE

I SELY

DATE:

DECEMBER

1 1914

as the same appears in the Records of Said Court.

In

Witness Whereof, I have hereunto se t my hand

an d

affixed th e

seal of said

Court

at

Dayton

Ohio

this

^0

day of Q^T . ,

A D.

198JZ_.

ly

Ex Offici


18/37

s j _ ^ .

No. 4 0 3 1 o

A FF ID A VI T F O R MARRIAQB LICENSE

F o r

M r . . a n d

His a^e is.. u .. fjears

R e s i d e n c e

P R OB A TE C OU RT

State of

Ohio

Montgomery County ss

Occupation

F at he r s n a m e

C f f ^ /

M o t h e r s n u u de n n a m e

I f prevwusiy married ho w often

Plttce

of

hirth

-

Her as e is .....J...S.. years

Residence ...A.^..7. .~ 1 ...

P l a c e

Occupation ....

o f

hirth

..A

a t h e r s

n a m e

Mother s

maiden

name,..^I^tt6it;^tJ^So. .ui^/ite^^>mu .

If

previously married, how often

I f widowed or divorced, iive married name

Rame of person expected to solemnize this marriage is .....CZZ ic...; T.I.LtfA;


19/37

CONSENT

L

o f

said

iji, hJjL xojjjcrw.ê

ta sa id.

^4ttest

By

. .Probate Judê.

Deputy Clerk.

I

of said

erebyconsent

to her

nmrriajfie

to

said-

At te s t

JUOr

hereby consent

ENTRY

PROBATE COURT MONTGOMERY COUNTY. OHIO.

101

and ^yU/vUL^. . A

COPY OF

LICENSE

3

ss .

f

if is ordered tha t a license be this

day

franted them.

i _.....

S TA TE O F OHIO

Montgomery County

No

l

PROBATE JUDGE

PROBATE COURT.

I I, ROLAND

W .

BAOQOTT Judê of the Probate Court within and-

for

the County a-nd

State

aforesaid have licensed and

do hereby

I License

an d

Authorize

Mr \J t and to be joined in marriage.

Inîtness Whereof J have

subscribed

my name and ajjixed the seal ofsaid

court

at DATTOjN OnlO

this day of. A. D. 191

CERTIFICATE OF MARRIAGE.

STATE OF OHIO

40315

Montgomery County, ss . j

I Hereby Certify, JJuit on the

day

of A. D. I solemnized the marr iage of

an d

r \ u s vy:>^

Fi l ed a n d r eco rded

..ôvys..:;. 5 - 101

2X: ^ oStt~ 7 i-r

obate

Jude

By

Deputy

Clerk.

1 Jo.

9n ^

.Probate Jud ie


20/37


21/37

^T VvT our iJ^hsA^

f

I I t 1

-From

4->rvvJ

- R u ^ -

J C a a d e l a b r a .

P r a y e r R a i l .

. B i e r .

L l L

o T J

. M f r . .

. C o l o r

.

Hosiery-

M e r c h a n d i s e

EXPENDITURES

D e c e a s e d .

D a t e

of

D e a i h

P l a c e

o f

D e a

j

^VTr

^Jny

L a s t P l a c e

o f R e s i d e n c e

B i r t h

P l a c e

Date

Ptir ^h

/ ? ^ / f Y

? Years ^ Months

g e

S e x .

wi

S i n g l e .

L D a y s

. C o l o r o r R a c e

M a r r i e d

l / ^

W i d o w e d .

D i v o r c e d .

Length o f Residence U.S.

S t a t e

City -

U s u a l Oc c u p a tio n

I ndus t r y o r B u s in e s s

P lu s ba n d s N a m e

W i f e s M a i d e n N a m

U

a t h e r s N a m e

B i r t h

P l a c e .

n

M o t h e r s

M a id en N a m e

B i r t h P i a c e

S oc i a l S e c ur i t y

No.

I f

Ve te r a n

W h a t War.

C a u s e

o f

D e a t

P h y s ic ia n

2

- A g e .

- A g e .

H o u r s

y

_ A d d r e s s

I n f o r m a n t

A d d r e s s

Cemetery

L o c a t i o n . .

D a t e

o f

I n t e r m e n t

l i

Lot

or

Grave

No. ^.

O r de r e d

B y

A d d r e s s .

A d d r e s s

C h a rg e d

T o .

^

7 r ~ ^

I n v o i c e D a t e .

Est at e Atty.

A d d r e s s

CUSTOMER S PAYMET^T RECORD


22/37

NAME

Kathryn K. Stansbe r ry

age RES

2115

Clea rv iew

Dr.

cirv

Bell.br>Q}t, Ohio

s u d d e n

LENGTH OF

ILLNESS

PL E OF

DE TH

r e s l d e n c e

TIME

9 am pyvY

Sunday

PLACE OF BIRTH

Pennsy lvan ia

D TE

Nov.

15 1918

FORM LLY EMPLOYED Head Cook

years

POS n IO N

CHURCH

entervilleS c h o o l s

OTHER AFFILIATIONS

VETERAN

SURVIVORS WIFE/HUSBAND

Thomas E . S t a n s b e r r y

DATE

9 - i

RET IRED

PARENTS

1

DAUGHTERS

2

^ SISTERS

1

Mrs. Jim Linda) Green

-

Huber Heif eh ts

Edith

Gabriel - Dav t o n

2

Margare t

Smith

- Huber Heigh

3 3 G-randchi 1drfin

Jaoqu ip

Adnrn, A

l a y

4

5

SONS

^ ROTH RS

I

John

Kr i sko

-

Ash land

0

Wes t Al exand r i a

eorge

NO .

OF GRANDCHILDREN

NO.

OF

GREAT GRANDCHILDREN

GRAND PARENTS NAMES

SERVI E

HOUR

2

Pm D Y Fridav

PLACE

FH

INTERMENT Mi am i

Ceme t e r y

D TE 9 - 2 3 - 8 8

BY

R p v .

L T . Ynun f r

_

T H E FAMILY W I LL R E CE IV E F R IE N D S

TIME 6-9

day Thursday

PL E

FH

L O D G E S E RVI CES

PHOT

MINISTER

C

CHURCH

CEMETERY

VAULT

PRINTER

ESCO

N E W S

JOURNAL CLASSIFIED

OUT O F

TOWN PAPERS

OBITUARY

M.vILE

FLOWERS

85 Fall

Arrangement

wife-mom) 15 Pillow Grandma

Adam

K r i s k o

F A T H E R

S NAMF.

MOTHER S MAIDEN

NAME

Ka t h ryn

Pe t r o s ky

D I SCHARGE PAPERS

FLAG

HAIR

STYLING

CLOTHING

MASON IC APRON

ROSARY

PALLBEARERS

L O DG E S CA LL E D

REGISTER BOOK

REMARKS


23/37

HIS IS ah;exj.ct copy issued

in ^d

LUCAL

rtiJJLriAiirtiUt,

Auima uuuwj.

LN

U h H E A L T H

DIVISION

O F VITAL STATISTICS

CERT IF ICATE O F

DEATH

Al RESIDENCE

EKE DECEASED

iiD. IF DEATH

.

\.8RED

IN

. TOIION, GIVE

OENCE 6EFOHE

. . SSION.

Reg.

Oii.

No .

Primary

Keg. Dial. No..

Kcgiti^r s

No._

DECEASED -

I .

- N A M E i / rw

MiJJ I t

Ldt t

SE X

DATE O F DEATH t .Woni

3. 8 .1 / . -76

Dorothy

4

l_

j) (ye^n) r~

ftanatte

UNDER I YEAR

Phi ins

Female

UNDER I DAY

DATE OF BIRTH F.\ lofr/>. U.4y.

S ea r )

1 2 . 2 2 - 1 8

COUNTY O F DEAT

7 Adams

A G E

hnthJiiy

So

race

H />/re, nriTO, ametican

tnJi-in,

e /r . tUpeti ly)

Whi t f t

^Idi.

D.its

l l o u t t

Sc .

.Till*.

CITY, VIllAOE, OR lOCATION OF

DEATH

7h^_ Wffflt Union

^7 yra^

INSIDE CITT IIMITS

(Specify

ye t or no )

7c .

HOSPITAL OR OTHER INSTITUTIONNAME FT/ uol in ttther, gite street an

. 73S .

CITIZEN

OF WHAT COUNTRY

7d Adams Coiinty

MARRIED. NEVER MARRIED,

WIDOWED,

DIVORCED

iSpetify)

SURVIVING SPOUSE .

i ll

uife.

gist

maid

n.

J a c ob M.

Phillips

STATE

OF

BIRTH

tt f

no t

in

U.S.A ., name

tounl ry)

8. unio

SOCIAL SECURITY NUMBER

i2o PQO - I / i - / J t 7 7

WAS DECEASED

EVER

IN

U.

S. ARMED

FORCES?

. / i

lYes, no, or

untnoun)

flf yet, givedates of serviceJ

i jb. No

41WL7( / )f | r (

/ /

USUAL OCCUPATION (Citse *irjJ of u ork

working

Hie, ei en if retired)

one

during most

of

KINO

OF

BUSINESS

13b. Self

OR INDUSTRY

RESIDENCEsta te

COUNTY

14b.

Adams

CITY,

vi l lage o r

LOCATION

i4t P e e b l e s

INSIDE CITY LIMITS

fSpecify

ye t or no )

lAd No

STREET

AND

NUMBER

. . . R t. i F. ?.

fatherNAME first

ng :o

dtath

bat r.;t reiaied to cause

giien in part

I la)

5A;ofpie bfUs^t (Speiify) |

Tfi. I lot r

v...| I'... t s

MTENDED

T

TO

^ .

7/

I

-y '

cX/'

o. 7 30 7i

||...^

JS N-y // 7('

Ill,ur t,l

death

rt-. .t., J


24/37

Siti \i Cvt s/ A y

/t l

} PLACCOFBII

It r

^ IbMnMp

if.

? r

STATE

O F OHIO

BVftCAU OF VITAL STATIfTICt

CERT I F ICATE

O F BIRTH

;c%jnQ i>/teaLJ5b

MM.

PULL NAMK OP CHILD.

^

\ i

-

. . ^ . . .

lA

a 4 v J 3

nSw*o*^ * VR VISIRW

ntat taw

M to

Be^Maw4.

Mk*

WMaUI r rve rt , ee

/y

mstOKNC

navton. nhtA^

:v iu i

AOe

AT LAST J

I BMrNOAr , 7r...

P l^ Tri t^ C :)

Dtto

birth.

o t h i

MOTH e n

.mm,

Daytou. OhiJ

eeuoA

OA

MACS

m r i f fXACC

I AO e AT

LAST

t l l THOAr

Pavton.

Ohio.

eeouPATio j

omoui

oeeuoATtoN ^

.AND INOUSTNY HOl l

RAWifn

^

4.AA.QS

. .ltl

(I>M>

:Tar

A L_

I Tmff

N i nB r

t l chlldrM

bom

to

tftit

RotlNr

MEMBIIII

pVVIBIfl BBIB

.

A

Nombor of ehlMrwi

of thlmlhr

now IMnfl

Wm Preph|ttcUe tsilntt

Ophtholmla

Noonolontm

Modt..... Ce*.

0 iMkMt. Prvpkr IaKiP and l l torata r* fkrntvbad

m k r

uH i o i t tatk buakd cr uraltr.

CeimPICATe OI^TTtNDlNO PHYSICIAN ^ MtDWIPC /

t hwtbr oirtMr ttatt ittaMtod lb* bMh oftMt

ckM

bomdhr,

OMtttO

I^TTtNDlNO PHYSiqAN OR MtDWIPC / /

J rjL.va Jh-ca.

iliiivc^ trtns:

(Mini

Atiii i r i i^^

t AWlkM tiMV* WM

HmOImO yb faMaa^

IM

Mertia, lb**

Ib a

latbaa* baaaabal

Ohm

MM

oMod f roM a loppliimntal r opor t

(tlinotom)

Plloi.

I HEREBY C ER TI FY THE ABOVE TO BE A TRUE AND COMPLETE

PHOTOGRAPHIC REPRODUCTION OF THE CERTIFICATE

ON

FILE

IN THE

OFFICE

OF THE COMBINED HEALTH

DISTRICT

OF

MONTGOMERY

COUNTY,

DAYTON, OHIO.

THIS CERTIFICATE

IS NOT

VALID

UNLESS SEALED BY LOCAL REGISTRAR

iLt


25/37

2 8 y -U 7 - i y 8U

NO .

S

by

Sun t a n Koqa l Ve l v e t

A25646RH Sierra Bronze

Batesville

\7;=

/-v'/

C4rfi7-< L cJ/./.zi/i>L,

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29/37


30/37

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31/37


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