Death Certificate - Atchison, Benjamin Oscar_5/11/1987,..E
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� � CERTIFICATE OF DEAT ��
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DECEOENT-NAME RRSi NIODIE �AST SEIl OAiEOfOEATH�4o.D�y,Yr.J
+. BENJAPIIN OSCAR ATCHISON z.Male �.Ptarch 12 1987
P.�CE-eq,Y/ItiR,01xY AGE-LeaiBipnOay IINOERIYEAR UNDERIO�Y D�iEOfBIRTH(MO..Ory.YLJ GpUNiYOFDEI�iH
Mn.InEUn,nL(SpK�ry) (YnJ MOS. � O�YS HOURS � MINS
.. White s, 69 sn x e Januar 16 1918 r. Collier
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e.Missouri , U.S.A. ,o. Married ,,. Lenora Burke
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HESIDENCE-STQE COUNTY GTY,TOWNOHLOCATION STPEEi�NONUMBER INSIDECITVL!9i5
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+�.. Indiana ue.Gibson �K. •Fort- Branch � ,.a. 107 E. Fos[er Street �... Yes
� i�THER-NAME FIRST MIDOLE LA$T MOiHEH-MAIDENN�ME FlHST MIODLE LAST
��s Ben'amin Atchison �e Ethel Weese
INFORMANT-NAME(IYMM1RinO MNLINGADORE55 STREETORR.i.O.NO. CItYORTOWN Si/�iE ZIP
,,,. Lenora Atchison ,,, 107 E. Foster Street Fort Branch Indiana 47648
BUHULGREM�TION,REMOVALOTHER(SprrilYl CEMETEHYORCREMAiORY-NAME LOG�TIW CITVORTOWN ST�iE I
�e, Removal ,,,_ Walnut Hill Cemeter �x. Fort Branch Indiana
fUNEMLDIREQOR-(Syn�lurq iUNEfiALHOME RDOFE55
Anderson Funeral Home P.A.
,s,. a.�E.�'„ � 3654 Palm Beach Blvd. Fort Pt ers Florida 33905
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N.�ME NIDAOMIESSOf CERTIfIEO �VHYSICI.�N, MEDIQL E%RIAINLR� (I�q p M�^U ,I
n richolas P. Klokochar, Pi.D. 2335 Tamiami Trail North Naples Florida 33940 j�.
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z,,.rss�.rN.» SU ��.� .... ,,.-� Piarch 8, 1987 ne_ �� ��� i�/"'�j l� GJ—•
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by certify the above to be a true and correct copy of the record on file in the
Y County Health Department at Naples, Collier County, Florida. (Not valid unless
al of the Collier County Health Department is affixed.)
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_ -- � al Registrar o- ital Statistics
Collier County, Florida
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