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	FILING . date JAN 0 7 1988	CERTIFICATE OF DEATH STATE OF MISSISSIPPI			STATE FILE NUMBER	123-	
DECEASED	1 NAME First Middla Last Joseph Seuzeneau Blanchard		2 SE? male		3a. HOUR OF DEATH 10:45 a*	3b DATE OF DEATH (Month. Day Yaari Ceceiriber 21, 1987	
	4 RACE (Sp*nty Wh<ta Black.	Sa AGE AT LAST J ONLY IF UNDER t YEAR 1 ONLY IF UN0ER 1 DAY		6 DATE OF BIRTH (Month Day Yaar)			7a COUNTY OF DEATH
	White	bklnU*i -b M0S | 5c 0ArS |So M0URS ' M(NS / / Yaars 1 1 1 		,	1 1		March 6, 1910			Hancock
If death occurred in an institution, see HANDBOOK, regarding complelion of RESIDENCE items
For RESIDENCE Hams ?nl#f actual location ol hom? rathar than mailing add'ass
PARENTS
INFORMANT
DISPOSITION
Bay Saint Louis
8. STATE OF BIRTH
Mississippi
?HoEeT m^-Nurrsing?Center
9 CITIZEN OF WHAT COUNTRY
U.S.A.
13. ORIGIN OR DESCENT (Specify Carman. Cuban. Atro-Amarican. Maiican. ale.)
: an
<6a RESIDENCE STATE
Mississippi
0 MARRIEO NEVER MARRIED. WIDOWEO tJIVORCED (Spacilyi
married
70 IF IN HOSP OR INST SPECIFY INPT . OUTPT EMEft. RM OR DOA
14 SOCIAL SECURITY NUMBER
433-03-0440
16b COUNTY
Hancock
17 father ? name
11 SURVIVING SPOUSE (If W'fa g>vt maidan namal
Mary Sbisa
12 WAS DECEASED EVER IN U.S ARMED FORCES'* I'll O' No)	Q
IS* USUAL OCCUPATION IKiM o< wort Oona	\Ysb KIND OF BUSINESS OR INDUSTRY
most Ol working Mat	j
salesman	Unavailable
16c CITY OR TOWN
Bay Saint Louis
Oneziphore
Blanchard
160 INSIDE CITY UMITS (Sp*cil> Yat or No)
yes________________
16s STREET AND NUMBER OR RURAL LOCATION
400 N. Beach Boulevard
ie mother-name
Fust
Lucie
Ann Seuzeneau
19a INFORM ANT ?NAME (Typ* o* Pr.ntl
Mrs. Mar.v S. BalncharcL
20a BURIAL. CREMATION. REMOVAL (Specify)
20b CEMETERY. CREMATORY-NAME
19b MAILING ADDRESS (Siraat and numbar o< rouia and bo? numMi Cny or town Stata. 21P codai
117 Vacation Lane Waveland, Ms.
20c LOCATION (C?ty and Statal
Bn rial
Gardens of Memory [Bay St. LouJ^S,
21 b FUNERAL HOME-NAME AND MISSISSIPPI I 0 NUMBER
Edmond Fahey Funeral Hone
21c MAILING ADDRESS (Straal and nLmba
22a PERSON WHO PRONOUNCED DEATH ?NAME AND TITLE (Typ# or print)
Harold -Stiglet, Medical Examiner
3^ P.O. Box 3^8 5av St. 'Louis, Ms. 39520
town yStaj
PRONOUNCEMENT
22b PRONOUNCED DEAD (Month Day Y?*
on December 21, 198?
22c PRONOUNCED DEAD (Hour]
atII:45 a
CERTIFIER
Mississippi Stat* Board of Haalth
Form No 511 Ravisad 6 182
23a. CERTIFIER ?NAME (Typa or print)
Bertin Chevis, M. D.
23b MAILING ADDRESS (Sltaat and numb*' o< rouia and bo? numbar Cily O' town. Slata. ZIP codai
P. O. Drawer W, Bay Saint Louis, MS 39520
i
This saclion
10	ba com | plalad by physician
11	NOT a coronar
or mad leal ?aamintr
124a To tha bast ol my knowladga Oaalh occunad dua lo tha causas slalad
SIGNATURE I
'fLdLa. CMjllvO
I ?4b DATE SIGNED (Month. Day. Yaari
I
I- 4-T?
24c STATE LICENSE NUMBER
folt
| 24d. NAME OF ATTENOING PHYSICIAN IF OTHER THAN CERTIFIER (Typa or print)
T his sact?on to ba com pialad by coronai or
madical
atammai
ONLY
|24a On tha basis ol aiammation and'Of mvasligation. in my opinion daath occunad . dua lo tha cauias ?taiad W
(SIGNATURE ~
|24l TITLE
I
I 24g DATE SIGNED (Month Day Yaari
CAUSE OF DEATH
Conditions, it any. which gava naa lo immadiata causa stating th* undarlying
25 PART | i IMMEDIATE CAUSE (tntar on* causa only) DEATH 1 CAUSED i
causa last
{
C/4ii&<'oeesfiirLATd/&/ Anzts
DUE TO OR AS A CONSEQUENCE OF (Enlai on* causa only)
(?r UoALASTbW.fi -	-rUMo/t
DUE TO. OR AS A CONSEQUENCE OF (Entar ona causa only).
!<?)
hnianral batwaan onsat |and daath
26 PART II: OTHER SIGNIFICANT CONDITIONS ?Conditions contributing to daath but not raiatad to causa givan m PART i (si
21 AUTOPSY (Yas or Not
28 WAS CASE REFERRED TO MEDICAL EXAMINER OR CORONER?5 (Yas or Noi
h	*	29a ACCtDENT. SUlCIOE. HOMICIDE. PENDING	|29b	DATE OF INJURY	1 29c	HOUR OF INJURY j 29d DESCRIBE HOW OR BY WHAT MEANS INJURY OCCURRED
d?alh	* INVESTIGATION. OR UNOETERMINEO	.	IMonth. Day. Yaar)	I
NOT ? (Sp+cityt_________________________________________________________________________I___________________m |_______________________________________________________________^
dua to - ?
natural i 29# 'NJURY AT WORK | 291 PLACE OF INJURY (Spacity Horn* Farm. Slraal. caus*s	I	Factory. OHica building. ate.)
29g LOCATION St>aat or ibula numMi
Cily or town
THIS IS TO CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT COPY OF THE CERTIFICATE ON FILE IN THIS OFFICE.
GlUj &. (Wl MS
January 8, 1988
David Lohritch STATE REGISTRAR
am
mm