Pelkey, Gerald TRANSPORTATION OF CORPSE AlwayBsla kr Ink
ite With
BUREAU OF STATE OF DELAWARE
VITAL STATISTICS
CERTIFICATE OF DEATH
BIRTH NO. BOARD OF HEALTH STATE FILE NO.
I P.PLACE
OF DEATH 2.USUT CADENCE(Where deceased lived.If' titution:residence(before admission)
v b.COUNTY
Swindon Wilts, ngland
b.CITY,TOWN,OR LOCATION c.CITY,TOWN,OR LOCATION
c.NAME OF (If not hospital,give street address) d.STREET ADDRESS
HOSPITAL OR
INSTITUTION
d.IS PLACE OF DEATH INSIDE CITY LIMITS? e.LENGTH OF STAY IN 1 b e.IS RESIDENCE INSIDE CITY LIMITS? f.IS RESIDENCE ON A FARM?
YES❑ NO❑ YES❑ NO❑ YES 0 NO 0
lJJ 9.NAME OF
SED Graf Middle Last ' 4.DATE -Month Day Year
DECEI D DEATH
(Type or Print/- Gerald appsey Pelkey April 10. 1959
Li-
5.SEX 6.COLOR OR RACE 7. B.DATE OF BIRTH 9.AGE(In IF UNDER 1 YEAR IF UNDER 24 HRS.
Married Never Married❑ last birthday)
Q Male
e White
.ii..+l e � Months Days Hours Mln.
Hil{L1 YrL1 L N Widowed❑ Divorced❑ Nov 20,t 1920 39 •
d 10a.USUAL OCCUPATION(Give kind of work done 10b.KIND OF BUSINESS OR INDUSTRY Il.BIRTHPLACE(Stdle or foreign country) 12.CITIZEN OF
O W during most of working life,even it retired) WHAT COUNTRY?
U O
< U. 13.FATHER'S NAME 14.MOTHER'S MAIDEN NAME
-IQ LU
15.WAS DECEASED EVER IN U.S.ARMED FORCES? 1 16.SOCIAL SECURITY NO. 17.INFORMANT Address
U.l (Yea or unknown) (i/fyes,give war or dates -_.__ ._.
V ~ 18. CAUSEJ_ OF DEATH Interval s.tw..n
Q (Enter only y on.Der pee lino for(a),(b),or(e.) Onset and Dents
I- O
Ee J PART I. DEATH WAS CAUSED BY:
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fnW IMMEDIATE CAUSE(a).............der r..aI.G.tion.....my ..Y.ed....l,.d ............................................................................................................................................................................................................................._
zH Conditions,H any.)
I- Q Deities 9ayo tb..to DUE TO(b).................................................................
t,J above came (a).
IT
the undder-
Zlying eerie 1..4. DUE TC(c).........................................................................................................................................................................................................................................................................................................................................................
O H
PART II. OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART I(a). 19.AUTOPSY?
Z w z
O J d YES JN,NO❑
I" < aU, 20a.ACCIDENT SUICIDE HOMICIDE J 20b.DESCRIBE CIRCUMSTANCES SURROUNDING OCCURRENCE OF INJURY.(Eater naNu of niur.Y in FAET S ar PA5Z LI e5-Nari0J--_ _--_-------_-..--
-..._ Q _ Q__ Cl _
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LT
O O .1 20c.TIME OF Hour Mon. Day Yr.
LL U INJURY
Z P.m.
w 20d.INJURY OCCURRED 20e.PLACE OF INJURY(e.g., in r about home, 20f.CITY,TOWN,OR LOCATION COUNTY STATE
WHILE AT NOT WHILE farm,factory,street,office bldg.,etc.)
1 WORK AT WORK E]
21. I hereby certify that I attended the deceased from , 19 ,to , 19 ,that I last saw the deceased
alive on , 19 ,and that death occurred 2015 P m.,from the causes and on the date stated above.
22a. SIGNATURE 22b. ADDRESS • 22c.DATE SIGNED
William U. Hubbard Capt USAF MD RAF Burderop Wilts, England 10 April 1959
23a BURIAL, CREMA- 23b. DATE 23c NAME OF CEMETERY OR CREMATORY 23d. LOCATION(City,town,or county) (State)
TION, REMOVAL (Specify)
DATE REC'D BY LOCAL REGI ZS SIGNATURE 24. FUNERAL DIRECTOR ADDRESS
17 Apr 59 REG. ,��,t f xayes Incorporated., Dover, Delaware
THIS CERTIFICATE MUTT BE FILED WITH THE LOCAL REGISTRAR WITHIN 72 HOURS AFTER DEATH AND BEFORE
INTER1MNT OR OTHER DISPOSAL OF THE BODY
\:b v.', ,,y
VPE tATIYOk BOARD OF HEALTH OR REGISTRAR
/ This od is eingg,'transported ommon Carrier.
\.` s Pe iit ith,iabbve Certi to must be presented to Baggage Agent and delivered with body at destination.
� ' 17 April 1959 , 19
eirmission4 here gra d to remove for burial at - , the body
i f ' erald..D....' e�y. , above described, if prepared in accordance with the laws of this State.
4'� f ontagious or comfit- ' able, state narni of person who is authorized to accompany the b y.
'''' ',.,___-Z.„,,,z..1 7.- • ..... -4-,-.-0--).---f______,.......
s Health Officer or Registrar
Detach boy portion at this perforation an hand to passen r in charge, to be delivered to the undertaker at destination. If burial is made•
in this State the sexton or other person superintendi g must send thi permit and certificate to the local Registrar in ten days.