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Mitchell, Metta May,r r File # ,>e'` Permit #, -( ;. •-1 Fu !i s F, roily hhor,es: DRUID CHAPEL BELCHER CHAPEL CTR# Name : M F T T I T C[+GLL- Age: I I/ Address: eeZ4 W 17y) Legat addAns: 4!?z4 mo to 1 FL. -7/ 1 city? V8 Date: -;:SUM• day, 19@ 9 M. f:,; r41 ?) rJ FL A Place of death: L.19 / Date of bi, thejPwu 2 1 I OO Soci.af- Sec. 072-?-3 if? 6 Birthplace: Kam- Fi)RE;,& Ti __F_'LLjNJ®IS Citizen ob: "-4 FatheA's name jjA-1?,i?5 MI T CjjELL_ MotheA's maiden name: LICEE C-LL V SMJ 1 74 INeveh maAAi.ed Here from: (? N Occupation: C) ARL&Oo J , (9CUTWE Sex: M GF Race: S- Q. Since b (??1 ??VV•C' d [ Mititany: tj4kE" # Years here more on the j Church membership (attended): Memberships: hack _ more F1 on the Sur ived by: f G? ?© , SrouW s name: b e uu back e, give 6uU maiden name ? I more n OD the In Uh111aYLt: .J? ?? ?I ? ? D ???(C ?O ? e /) ' v C back ? ? M• ? C ?r},2n?on,?Fn-\,ED. C UU?TTYY?VV£cQ f? ?--G J 03 Doc tors: YS M-4 &I M M. t?. 1135 LAkF C Ll?JC?M??T, F?. 3?`y?l ( ) DOA ( ) OP/Emeh. Rm. ( ) Npatient Posit: yes/No ReSehAed to Medieat ExamineA? Yeas/No Retie,Aed by: RI e\ • F.D. 4 9_1 Date: )4 8