Death Certificate - Blanton, Thomas N_4/25/1990_
I'FiERF�Y CF�i'PIFY this to be a true and c� ct
; copy � the urigirial death; recorrl of
,. . THOhIAS N. BLA1dT01•7
as f13ed in the Bureau of Vital Statistics of
the City of Harlingen, exaa.
Issued:l-16-90 •
. C Regi ar
STATEOFTEXAS CERTiFICATEOFDEATH ST�TEFILENO.
V 1.NAMEOFOECEASED p�Flmi �O�MICOIe �qLaSi i �G�M�Iden . 2.SE% 7.DATEOFDEATM
n BI I
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q Caucasian ❑res mHO 8-8-17 72
" B.SOCIALSECURITYNUMBER Ba.PIACEOFDEAiM�Cnsc�onlvon�)
i
0 MOSPIT�L:�InDWen1 ❑EWOato���ent ❑DOA OTMER: QNwaln9„�me OReelGence OOlnar�5peclly)
� 8p. PUCE OF pEATH — GOUNTY 9c. dTY OR TOWN pl ovU1G� tllr Ilmita, 9��e 9,1. N�ME OF pl no� In IwsO���l, O�+e ebnl �EOnW
O pr¢Inct numDep MOSPITAL OR
; Cameron Harlin ei
m lO.BIRiMPUCE�CItY��451aia lI.CITIZENOFWMAi 12.WASDECEDENTEVEH
� wbmlpntoanlry) COUNTRYi U.S AqMEDPORCESi
L JaYES ❑NO
a IS.OECEDENT'SEDUC�TION(MlpneslpuaecompbroCl 1W.USUAIOCCUVAiION
= Gnaee�Olt� $ Collepep��or5�� �nenllrW) �,.di�l
O 11�AESIOENGE—STATE 110.CAUNTY
`o Zndiana Gibson
� 1JO.STREETAD�RESSpImnl,plrebCLLlon)
aRt.i aoX iais
1B. FATMER'S NAME
K Geor e Blanton
0
f Xla. SIGNFTURE OF INFOHMANT iOE. MAILING I
j�JYES ❑NO
Q(M�RRIED ❑NEVERMARq1E0IN.SURVIVIHGSPOUSEpIVib,QMi
ow�oowen ❑orvoaeeo Betty Sullivan
n0 0l work Oon� O�rinp mo�l ol +oA1n0 Ilt�. Do no1 1BD. KIND OF BUSINI
cllY Ilmlta. eMw
Hazleton
1 ]�.INSIDE CITY LIM
OYES Y]NO
Sarah Noe
)qMANT �Strsal �nE NumDm p Rvnl Rouis Numpp, GIr p Town, SI�1�, Lp
21.MANNEROFOEAiM I1�.DATEOFINJUHY �20.TIMEOFINJURY u�,INJURYATWORK7�270.DE5CNIBEHOWINJUflYOCCURREO
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� •°w • 27E.N�ME FPTTENOINGPNYSICIAN(Typ<O�OdN)
" Dr. `���� Ebersole
25. MAILING I.ODRE55 OF CERiIFIER (iype or Pnn11
Valle Ba tist Medical Center Box 2588 E
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cbry. alllt� i11. LOCATION (Slrwl �M Humar Ep Roul Poul� Nunbw.Gll a io..n. Sui
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j z6c.LOCATION—Cltyo�TOwqSUte
Q Hazleton, Indiana
� 36�. NnME ANO ADORE55 OF FUNERAL HOME
H Cox Fluieral Hcme 37.2 E.
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� I'�iEBY CERTIFY this to be a true ar�� correct
e. of the ori�nal �eath recorrl of�
THOMAS N. BLANTON
as filed in the Bureau_of Vital Statistics of
the City of Harlingen, Texas.
Issued: 1-16-90 • �,
CL(i`zf
, C Regis ar
STATEOFTEXAS
a t.NnMEOFDECEA5E0 (��Firal
u
q �
a IPAGE S�. WAS TNEDECEI
y MISPANICORIGIN7
q Caucasian ❑
- B.SOCIAlSEGURITYNUMBEfl
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R B0. PLACE OF DE�TN - CAUNT
; Cameron
m t0. B�RTMPUCE (Clly �nE Sl�1e
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Bc. CiTY OR TOWN (II outelG� clly Ilmlte, plve pd. N�ME OF pl ia� I� �o�pll�l. piv� sirnl �GU����� 9�.INSIDE CITY IIMIT57
Dwclncl �amMq HOSPITALOq
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= Gr�aea(Q12) p Colloqe(I�orS+)
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O 17a. RESIDENCE - STATE
rotlrsEl
17D. CAUNTY
pwiooweo ❑orvoRCeo � BettV SUllivan
_ _____-____- _-____- __-_-____" _
Z 110. STREET ADDRES$ (II mr�l, plvs bcatlon) . . "-
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o Rt.l Box 191B �
8 1B. F�THER'S NAME 1G. MOTMEN'S MAIDEN NAME '
� George Blanton Sarah Noe"
1�- �0a. SIGNATUPE OF INFORMANT . i00. MAILING AODRESS OF INFORM�NT (Strsl �nE Nvrtil
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e°-¢ iJO.NAME FRTTENpINGPNYSICIAN(i�peapilnp
" Dr. ����� Ebersole
25. MAILING �DDRE55 OF GEflTIFIER (rypa o� Prinp
AiYlORK1 � 13a. DESCHIBE
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ON AT M.
Valle Ba tist Medical Center Box 2588 Flner en De t. }iar]
2W.METHODOFOISPOSITION�iIBuelal pGem�UOn �Remov�11rom5uu 2fiD.PUCEOF01SPO51T10N(Hamso�eem
3❑DOnation OOma� ISVeUIyI I.O.O. F. Cemetery
� 26c.LOCA710N-G�ya�TOwn,SUte 26E.DATEOFDISPOSITION 2Ba.5�GNATUNE01
¢ Hazleton, Indiana 12 12 89 8onald:H�
� 261. NnME ANU �DDRESS OF FUNERAL HOME
N Cox FWeral Home 322 E. Ta lor Harlin en Texas 78550
� 2]�.FEGISiMP'SFILENO. 210.DAiEREC'OBYLOCALFEGISTRAF 27c.SIGNATUREOFLOCALREGI
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