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MARRIAGE DATE PLACE •. _

HARR lED TIMES. OTHER WIFE'S NAME _DEATH DATE PLACE---- ----------------\o.'HERE BUR lED----------------------PLACES OF RESIDENCE _

OCCUPATION MILITARY SER VICE _

HIS FATHER'S NAME , _

HIS MOTHER'S NAME _

BIRTH DATE Cq 179~ PLACE AJc,- .,PLEASE LIST OTHER MARRIAGES FOR HUSBAND OR WIFE ON NEW. SHEET. ,MARRIED TIMES. OTIIER HUSBAND'S NAME! '

DEATH DATE I"3t,D,7o? PLACE Ey.~}.v~ (~ 1tL-7.

WHERE' BUR IEDV Cepd ~~ C-e.,,-v--vj-~--.'-.•••~-f-i'-v-'./-,..k.--C-e-.-~....--;-. ~~---PLACES OF RESIDENCE ------------OCCUPATION IF OTHER TIJAN HOUSEWIFEHER FATHER'S NAME p~1"<1('" fZ~f -t;-(!-/l-?-. -?-O!--~{-eJ)----C,,-.-G.-)j-----HER MOTHER'S NAME v .

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WIFE'S FULL HAlDEN NAME

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OCCUPATION r·~ tlILITARY SERVICE f;1V2- OCCUPATION IF OTUERTHAN HOUSEWJFE

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PERSON FURNISHING THIS DATA__ ~~~ __ I_~_' ._c~,._~__ ~l-~S~b~f~(~I _

ADDRESS ----=r£.:L- t".••.-"_. __ 'L.•..I.J_( .••••_Sf _CITY Ic.w;sbv{:" . STATE PA· ZIP J7<6s 7

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;'.> 7540 HAWKINS RD

; . ;,':" ;,. LUTHER, HI 49656' .... ;.,>. :.' (616) 829 3912

'. ~·.·::'H~SBAND~S tal. NAME ~ •.p'" S~.J X~e.eJl Sit-

. ; ADDRESS~ IIJ~;W/~DS <:;:r: ~r1~ Ha ~l..OL .. "BIRTH DA~'1t llilq PLACE STE:\f.rowki. CAT'I\UJeA ,CT"1 Ale" :' MARRIAGE DIED&:. 1814f Il& PLACE Au f!.tA'~tJ t..E.a: '-1"1 A L

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. PLACES OF _IDENCE_· .•.... _OCCUPATIO.~r~~~ MILITARY SE~VICE

.:HIS·.FATHEI'S lAME WILUAr\ 'J~~~t..1:~@.~-S-e.-----­HIS MOTHER. lAME ADOAc.:.,N~ ~A~C~S He. t1A~tJ

aYE cHILDREN'S FULL NAME. USE MONTH, DAY,

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PLEASE CHECK YOUR ANCESTRAL LINE.JOHN FAYETTE NEWT-- --HENRY WILEY ED

JAMES C.B .---K--_- GE-O-RG-E--

WIFE'S 'FULL MAIDEN NAME Lou,~ V~ w,,~

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. PERSON ' •••• ING THIS DATA 'RtJ:! 5rl1!tr1A0 :r~A(j.("Jfl..: ...ADDRESS .CITY STATE ZIP

, TELEPHONE NUMBER( ) ----. -----

.. FAMILY ca.- 110---