ARIZONA STATE DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
STATE FILE NO. 9865
REGISTRAR'S NO. 4212
PLACE OF DEATH AND AL RESIDENCE
1. PLACE OF DEATH: (a) County Maricopa, (b) Length of Stay: In this town 54 Years; in Arizona 54 Years. (c)City or Town: Phoenix, In City Limits (d) Full name of Hospital or Institution St. Joseph Hospital;
2. USUAL RESIDENCE (a) State Arizona (b) County: Maricopa (c) City or Town Phoenix (d)Street Address 1515 E Rovey (e) Is residence on a farm No
PERSON DATA
3. Name of Deceased TROY E WELCH
4. Sex: MALE
5. Color or Race: WHITE
6. (a)Married, never married, widowed, or divorced Married (b) Name of husband or wife: Grace (c) Age of husband or wife, if alive blank yrs.
7. Date of Birth 08-28-1882
8. Age 82
9. (a) Usual Occupation Self Employed (b)Kind of Business or Industry MFG. CO
10. Birthplace MISS
11. Citizen of What Country USA
12. Was Deceased Ever in US armed Forces no
13. Social Security No. 526-03-0992
14.(a) Father Name: Cooper Franklin WELCH (b) Father's Birthplace: MISS.
15. (a) Mother Maiden Name: Dora Price (b) Mother's Birthplace: MISS.
16.(a) Informant's Signature: RL Leach, Records of A.L. Moore & Sons(b) Address Phoenix, Ariz.
17.Date of Death OCTOBER 20, 1964
CAUSE OF DEATH
18. Disease or Condition Directly Leading to Death: (a) Cancer of Colon due to (b) blank due to (c) blank Other Significant Conditions Severe Heart Disease Interval Between onset and death A few months.
OPERATIONS, AUTOPSY
19. (a) Date of Operation blank (b) Major finding of Operation blank
20.Autopsy Yes
21. I hereby certified that I attended the deceased, from Janary 1957 and to October 20,1964, That I last saw the deceased alive on October 20,1964, and that death occurred at 3:25am, from causes on the date stated above.
22. (a) Signature Kenneth E Johnson (b) Address 444 West Osborn Phoenix (c) Date Signed 10/20/64
DEATH DUE TO EXTERNAL VIOLENCE
23. Blank
CORNER'S CERTIFICATION
24.Blank
FUNERAL DIRECTOR AND REGISTRAR
25. (a) Burial, Cremation or Removal BURIAL (b) Date OCT. 23, 1964 (c) Place: Greenwood Cemetery (d) Location, Phoenix AZ
26. (a) Date Rec. by local Reg. 10/21/1964 (b) Registrar's Signature Beulah Johnson
27. (a) Funeral Director's Signature A.L. MOORE Jr. (b) Address Phoenix AZ
28. (a) Embalmer's Signature John T Young (b) Embalmer's Cert. No 300
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
STATE FILE NO. 9865
REGISTRAR'S NO. 4212
PLACE OF DEATH AND AL RESIDENCE
1. PLACE OF DEATH: (a) County Maricopa, (b) Length of Stay: In this town 54 Years; in Arizona 54 Years. (c)City or Town: Phoenix, In City Limits (d) Full name of Hospital or Institution St. Joseph Hospital;
2. USUAL RESIDENCE (a) State Arizona (b) County: Maricopa (c) City or Town Phoenix (d)Street Address 1515 E Rovey (e) Is residence on a farm No
PERSON DATA
3. Name of Deceased TROY E WELCH
4. Sex: MALE
5. Color or Race: WHITE
6. (a)Married, never married, widowed, or divorced Married (b) Name of husband or wife: Grace (c) Age of husband or wife, if alive blank yrs.
7. Date of Birth 08-28-1882
8. Age 82
9. (a) Usual Occupation Self Employed (b)Kind of Business or Industry MFG. CO
10. Birthplace MISS
11. Citizen of What Country USA
12. Was Deceased Ever in US armed Forces no
13. Social Security No. 526-03-0992
14.(a) Father Name: Cooper Franklin WELCH (b) Father's Birthplace: MISS.
15. (a) Mother Maiden Name: Dora Price (b) Mother's Birthplace: MISS.
16.(a) Informant's Signature: RL Leach, Records of A.L. Moore & Sons(b) Address Phoenix, Ariz.
17.Date of Death OCTOBER 20, 1964
CAUSE OF DEATH
18. Disease or Condition Directly Leading to Death: (a) Cancer of Colon due to (b) blank due to (c) blank Other Significant Conditions Severe Heart Disease Interval Between onset and death A few months.
OPERATIONS, AUTOPSY
19. (a) Date of Operation blank (b) Major finding of Operation blank
20.Autopsy Yes
21. I hereby certified that I attended the deceased, from Janary 1957 and to October 20,1964, That I last saw the deceased alive on October 20,1964, and that death occurred at 3:25am, from causes on the date stated above.
22. (a) Signature Kenneth E Johnson (b) Address 444 West Osborn Phoenix (c) Date Signed 10/20/64
DEATH DUE TO EXTERNAL VIOLENCE
23. Blank
CORNER'S CERTIFICATION
24.Blank
FUNERAL DIRECTOR AND REGISTRAR
25. (a) Burial, Cremation or Removal BURIAL (b) Date OCT. 23, 1964 (c) Place: Greenwood Cemetery (d) Location, Phoenix AZ
26. (a) Date Rec. by local Reg. 10/21/1964 (b) Registrar's Signature Beulah Johnson
27. (a) Funeral Director's Signature A.L. MOORE Jr. (b) Address Phoenix AZ
28. (a) Embalmer's Signature John T Young (b) Embalmer's Cert. No 300
ARIZONA STATE DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
STATE FILE NO. 9865
REGISTRAR'S NO. 4212
PLACE OF DEATH AND AL RESIDENCE
1. PLACE OF DEATH: (a) County Maricopa, (b) Length of Stay: In this town 54 Years; in Arizona 54 Years. (c)City or Town: Phoenix, In City Limits (d) Full name of Hospital or Institution St. Joseph Hospital;
2. USUAL RESIDENCE (a) State Arizona (b) County: Maricopa (c) City or Town Phoenix (d)Street Address 1515 E Rovey (e) Is residence on a farm No
PERSON DATA
3. Name of Deceased TROY E WELCH
4. Sex: MALE
5. Color or Race: WHITE
6. (a)Married, never married, widowed, or divorced Married (b) Name of husband or wife: Grace (c) Age of husband or wife, if alive blank yrs.
7. Date of Birth 08-28-1882
8. Age 82
9. (a) Usual Occupation Self Employed (b)Kind of Business or Industry MFG. CO
10. Birthplace MISS
11. Citizen of What Country USA
12. Was Deceased Ever in US armed Forces no
13. Social Security No. 526-03-0992
14.(a) Father Name: Cooper Franklin WELCH (b) Father's Birthplace: MISS.
15. (a) Mother Maiden Name: Dora Price (b) Mother's Birthplace: MISS.
16.(a) Informant's Signature: RL Leach, Records of A.L. Moore & Sons(b) Address Phoenix, Ariz.
17.Date of Death OCTOBER 20, 1964
CAUSE OF DEATH
18. Disease or Condition Directly Leading to Death: (a) Cancer of Colon due to (b) blank due to (c) blank Other Significant Conditions Severe Heart Disease Interval Between onset and death A few months.
OPERATIONS, AUTOPSY
19. (a) Date of Operation blank (b) Major finding of Operation blank
20.Autopsy Yes
21. I hereby certified that I attended the deceased, from Janary 1957 and to October 20,1964, That I last saw the deceased alive on October 20,1964, and that death occurred at 3:25am, from causes on the date stated above.
22. (a) Signature Kenneth E Johnson (b) Address 444 West Osborn Phoenix (c) Date Signed 10/20/64
DEATH DUE TO EXTERNAL VIOLENCE
23. Blank
CORNER'S CERTIFICATION
24.Blank
FUNERAL DIRECTOR AND REGISTRAR
25. (a) Burial, Cremation or Removal BURIAL (b) Date OCT. 23, 1964 (c) Place: Greenwood Cemetery (d) Location, Phoenix AZ
26. (a) Date Rec. by local Reg. 10/21/1964 (b) Registrar's Signature Beulah Johnson
27. (a) Funeral Director's Signature A.L. MOORE Jr. (b) Address Phoenix AZ
28. (a) Embalmer's Signature John T Young (b) Embalmer's Cert. No 300
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
STATE FILE NO. 9865
REGISTRAR'S NO. 4212
PLACE OF DEATH AND AL RESIDENCE
1. PLACE OF DEATH: (a) County Maricopa, (b) Length of Stay: In this town 54 Years; in Arizona 54 Years. (c)City or Town: Phoenix, In City Limits (d) Full name of Hospital or Institution St. Joseph Hospital;
2. USUAL RESIDENCE (a) State Arizona (b) County: Maricopa (c) City or Town Phoenix (d)Street Address 1515 E Rovey (e) Is residence on a farm No
PERSON DATA
3. Name of Deceased TROY E WELCH
4. Sex: MALE
5. Color or Race: WHITE
6. (a)Married, never married, widowed, or divorced Married (b) Name of husband or wife: Grace (c) Age of husband or wife, if alive blank yrs.
7. Date of Birth 08-28-1882
8. Age 82
9. (a) Usual Occupation Self Employed (b)Kind of Business or Industry MFG. CO
10. Birthplace MISS
11. Citizen of What Country USA
12. Was Deceased Ever in US armed Forces no
13. Social Security No. 526-03-0992
14.(a) Father Name: Cooper Franklin WELCH (b) Father's Birthplace: MISS.
15. (a) Mother Maiden Name: Dora Price (b) Mother's Birthplace: MISS.
16.(a) Informant's Signature: RL Leach, Records of A.L. Moore & Sons(b) Address Phoenix, Ariz.
17.Date of Death OCTOBER 20, 1964
CAUSE OF DEATH
18. Disease or Condition Directly Leading to Death: (a) Cancer of Colon due to (b) blank due to (c) blank Other Significant Conditions Severe Heart Disease Interval Between onset and death A few months.
OPERATIONS, AUTOPSY
19. (a) Date of Operation blank (b) Major finding of Operation blank
20.Autopsy Yes
21. I hereby certified that I attended the deceased, from Janary 1957 and to October 20,1964, That I last saw the deceased alive on October 20,1964, and that death occurred at 3:25am, from causes on the date stated above.
22. (a) Signature Kenneth E Johnson (b) Address 444 West Osborn Phoenix (c) Date Signed 10/20/64
DEATH DUE TO EXTERNAL VIOLENCE
23. Blank
CORNER'S CERTIFICATION
24.Blank
FUNERAL DIRECTOR AND REGISTRAR
25. (a) Burial, Cremation or Removal BURIAL (b) Date OCT. 23, 1964 (c) Place: Greenwood Cemetery (d) Location, Phoenix AZ
26. (a) Date Rec. by local Reg. 10/21/1964 (b) Registrar's Signature Beulah Johnson
27. (a) Funeral Director's Signature A.L. MOORE Jr. (b) Address Phoenix AZ
28. (a) Embalmer's Signature John T Young (b) Embalmer's Cert. No 300
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