STATE FILE NO.:  65-017324
 1.  PLACE OF DEATH:  a. COUNTY:  Brevard
                      b. CITY, TOWN, OR LOCATION:  Melbourne
                      c. IS PLACE OF DEATH INSIDE CITY LIMITS?:  Yes
                      d. NAME OF HOSPITAL OR INSTITUTION:  Brevard Hospital
                         (If not in hospital, give street address)
                      e. LENGTH OF STAY IN 1b:  [blank]
 2.  USUAL RESIDENCE:  a. STATE:  Florida
                       b. COUNTY:  Brevard
                       c. CITY, TOWN OR LOCATION:  West Melbourne
                       d. STREET ADDRESS:  26 Carolina Street NW
                       e. IS RESIDENCE INSIDE CITY LIMITS?:  Yes
                          ON A FARM?:  [blank]
 3.  NAME OF DECEASED:  Marion I PANCAKE
 4.  DATE OF DEATH:  April 25, 1965
 5.  SEX:  Male
 6.  COLOR OR RACE:  white
 7.  MARRIED
 8.  DATE OF BIRTH:  Aug 6, 1877
 9.  AGE IN YEARS:  87
10a. USUAL OCCUPATION:  Test Board Man
10b. KIND OF BUSINESS OR INDUSTRY:  Telephone
11.  BIRTHPLACE:  Noble County, Ind.
12.  CITIZEN OF WHAT COUNTRY?:  USA
13.  FATHER'S NAME:  Newton I. Pancake
14.  MOTHER'S MAIDEN NAME:  UNKNOWN
15.  WAS DECEASED EVER IN U.S. ARMED FORCES?:  no
16.  SOCIAL SECURITY NO.:  307 09 0381
17.  INFORMANT'S SIGNATURE AND ADDRESS:  Effie L. Pancake, 26 Carolina St NW Melbourne Fl
[Cause of death is omitted]
23a. BURIAL, CREMATION, REMOVAL:  Rem-Burial
23b. DATE:  Apr 28 1965
23c. NAME OF CEMETERY OR CREMATORY:  Citizens Cemetery
23d. LOCATION:  Rochester, Fulton, Indiana
24.  FUNERAL DIRECTOR'S SIGNATURE AND ADDRESS:  [unreadable] Melbourne, Fla.
25.  DATE RECD. BY LOCAL REG.:  April 26, 1965
26.  REGISTRAR'S SIGNATURE:  Rose Marie Seabolt

STATE FILE NO.:  83-042383
 1.  DECEASED-NAME:  EFFIE THOMAS PANCAKE
 2.  SEX:  Female
 3.  DATE OF DEATH:  MAY 11, 1983
 4.  RACE:  White
 5.  AGE:  81
 6.  DATE OF BIRTH:  Oct. 18, 1901
 7a. COUNTY OF DEATH:  Brevard
 7b. CITY, TOWN, OR LOCATION OF DEATH:  Melbourne
 7c. HOSPITAL OR OTHER INSTITUTION:  Holmes Regional Medical Center
 7d. IF HOSP. OR INST.:  Inpatient
 8.  STATE OF BIRTH:  Indiana
 9.  CITIZEN OF WHAT COUNTRY:  U.S.A.
10.  MARRIED, NEVER MARRIED, WIDOWED, DIVORCED:  Widowed
11.  SURVIVING SPOUSE:  None
12.  SOCIAL SECURITY NUMBER:  313-10-4366
13a. USUAL OCCUPATION:  Salesperson
13b. KIND OF BUSINESS OR INDUSTRY:  Retail Sales
14a. RESIDENCE-STATE:  Florida
14b. COUNTY:  Brevard
14c. CITY, TOWN, OR LOCATION:  West Melbourne
14d. STREET AND NUMBER:  26 Carolina Street NW
14e. INSIDE CITY LIMITS:  Yes
15.  FATHER-NAME:  John W. Thomas
16.  MOTHER-MAIDEN NAME:  Laura Daugherty
17a. INFORMANT-NAME:  Mr. George Redding
17b. MAILING ADDRESS:  1770 Rodes Blvd., West Melbourne, Fla 32901
18a. BURIAL, CREMATION, REMOVAL, OTHER:  Removal-Burial
18b. CEMETERY OR CREMATORY:  Citizens Cemetery
18c. LOCATION:  Fulton, Indiana
19a. FUNERAL DIRECTOR-SIGNATURE:  [illegible]
19b. FUNERAL HOME-NAME AND ADDRESS:
     Brownlie & Maxwell Funeral Home, 1010 E. Palmetto Ave., Melbourne, Fla 32901
23a. REGISTRAR-SIGNATURE:  [illegible]
26b. DATE RECEIVED BY REGISTRAR:  May 13, 1983
[Cause of death is omitted.]