STATE FILE NO.:  72-016877
 1.  DECEASED-NAME:  General Washington Pancake
 2.  SEX:  Male
 3.  DATE OF DEATH:  March 11, 1972
 4.  RACE:  White
 5.  AGE:  59
 6.  DATE OF BIRTH:  Dec. 7, 1912
 7a. COUNTY OF DEATH:  Broward
 7b. CITY, TOWN, OR LOCATION OF DEATH:  Hollywood
 7c. INSIDE CITY LIMITS?  yes
 7d. HOSPITAL OR OTHER INSTITUTION:  Memorial Hospital
 8.  STATE OF BIRTH:  Ohio
 9.  CITIZEN OF WHAT COUNTRY:  U.S.A.
10.  MARRIED, NEVER MARRIED, WIDOWED, DIVORCED:  Divorced
11.  SURVIVING SPOUSE:  None
12.  SOCIAL SECURITY NUMBER:  unknown
13a. USUAL OCCUPATION:  Welder
13b. KIND OF BUSINESS OR INDUSTRY:  Construction
14a. RESIDENCE-STATE:  Oregon
14b. COUNTY:  Lane
14c. CITY, TOWN, OR LOCATION:  Eugene
14d. INSIDE CITY LIMITS:  yes
14e. STREET AND NUMBER:  Clearlake Rd, Rt. 1, Box 992
15.  FATHER-NAME:  Henry Pancake
16.  MOTHER-MAIDEN NAME:  Emma Keeney
17a. INFORMANT-NAME:  Charles White
17b. MAILING ADDRESS:  Rt. 1, Box 992, Clearlake Rd., Eugene, Oregon
[Cause of death is omitted.]
24a. BURIAL, CREMATION, REMOVAL:  Removal
24b. CEMETERY OR CREMATORY:  [blank]
24c. LOCATION:  Eugene, Oregon
24d. DATE:  March 12, 1972
25a. FUNERAL HOME-NAME AND ADDRESS:
     Wadlingtom, Brown & Cooper, 140 S. Dixie, Hollywood, Fla.
25b. FUNERAL DIRECTOR-SIGNATURE:  Arnold D. Brown Jr.
26a. REGISTRAR-SIGNATURE:  Frances [illegible] Dep Reg
26b. DATE RECEIVED BY LOCAL REGISTRAR:  March 11, 1972