Walter Edward VIRT Death Certificate

STATE OF FLORIDA

OFFICE OF VITAL STATISTICS

CERTIFIED COPY

CERTIFICATE OF DEATH

FLORIDA

STATE BOARD OF HEALTH

BUREAU OF VITAL STATISTICS

BIRTH NO. [blank]

STATE FILE NO.: 20719

REGISTRAR'S NO.: [blank]

SEP 1955

1. PLACE OF DEATH:

a. COUNTY: Broward CODE NO.: 16-11

b. CITY OR TOWN: Ft. Lauderdale

c. LENGTH OF STAY: 3 yrs.

d. FULL NAME OF HOSPITAL OR INSTITUTION: Broward General Hospital

2. USUAL RESIDENCE:

a. STATE: Florida

b. COUNTY: Broward

c. CITY OR TOWN: Ft. Lauderdale

d. STREET ADDRESS: 109 S. Victoria Park Road

3. NAME OF DECEASED: Walter Edward Virt

4. DATE OF DEATH: July 30 1955

5. SEX: Male

6. COLOR OR RACE: White

7. MARRIED...: Married

8. DATE OF BIRTH: August 19, 1882

9. AGE: 72

10a. USUAL OCCUPATION: Conductor

10b. KIND OF BUSINESS OR INDUSTRY: Penn. R. R.

11. BIRTHPLACE: Paragon, Indiana

12. CITIZEN OF WHAT COUNTRY? US

13. FATHER'S NAME: John Virt

14. MOTHER'S MAIDEN NAME: Margaret Payton

15. WAS DECEASED EVER IN U.S. ARMED FORCES? No

16. SOCIAL SECURITY NO.: [blank]

17. INFORMANT'S SIGNATURE: Isabel F. Virt

ADDRESS: 109 S. Victoria Park Rd., Ft. Lauderdale, Florida

[section blank]

22. I hereby certify that I attended the deceased from [blank], 1953, to July 30, 1955, that I last saw the deceased alive on 30 July, 1955, and that death occurred at 7:30 a.m., from the causes and on the date stated above.

22a. SIGNATURE: Walter J. Glenn, M.D.

23b. ADDRESS: Ft. Lauderdale, Florida

23c. DATE SIGNED: 8-1-55

24a. BURIAL, CREMATION, REMOVAL: Cremation

24b. DATE: Aug 4, 1955

24c. NAME OF CEMETERY OR CREMATORY: Grove Park Crematorium

24d. LOCATION: Miami, Florida

DATE REC'D BY LOCAL REG.: 8-1-55

REGISTRAR'S SIGNATURE: Leatrice Rhodes, Dep.

25. FUNERAL DIRECTOR'S SIGNATURE: Phil H. Fairchild

ADDRESS: FAIRCHILD FUNERAL HOME

Ft. Lauderdale, Florida