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Husband: Ewell Gain Yates
Birth /Chris: ... 1893 at
Death /Burial: ••. 1976 at
Wife: Nellie A
Birth /Chris: at ...
Death /Burial: at ...
Children:
1. Yates, Sampson W - Birth /Chris:... 1914 at
2. Yates, Eugene E - Birth /Chris:... 1917 at ...
3. Yates, Floyd J - Birth /Chris:... 1918 at ...
4. Yates, Living - at ...
5. Yates, Melvin Earl - Birth /Chris:... 1922 at.
6. Yates, Living - at ...
7. Yates, Living - at ...
State of Florida, 0 Department of Health and Rehabilitative Services 0 Division, of ,Heolth.
Buriai Femit No....2.k ......... : FY
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BURIAL-TR
Full name of
..7 ..................................................... —..
Place of death- .. .. ........ f�-d�Y44;'ez . ................ Florida ................
(City) (County)
/ ........................
Date of death ........... ...... color ...... ............. Sex...../," ............ Agc��.? ..............
Method of disposal... (Whet .� W�14, cremat ....... i .... ........... (Cemetery ................
i'7�on, transportation, storage,
.............. State ..... ...................... ........... ........... .........
certificutp.al ath huving been filed as required by the laws of this State, permission ib hereby given
M zlil�-1t4,e-6 .......... License No ....... A:1 .. 2,:;,Z -• ............................... ....................7 ..........
(Funeral Director or person acting an such)
to dispose of b ?lq- of said deceased U.......... above stated.
Date issued...-,.... -- ----- e Signature......... ...... - ... ............
(Registrar)
C'METERY OR CREMATORY AUTHORIVeSHALL FML OUT SPACE BELOW
r lla%u 44-151-01 �-77i��
Body was...,.- .... on ......... ..... . . in..... (C
Mato whether 4womwW46 burled ometery or Crematory
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11 - -1 � 3.1.��X.-.-'�'
Place... , .!?� .:? ..... 1?; �& L , ,-r,. e ....... .... : .
ei person In charge)
This permit must be endorsed by the Sexton (or by the Funeral Director where there is no sexton) and re-
turned within 10 days to the Registrar of the district in which the burial takes place.
YATES, Ewell Gain
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