State File No.:  68-008050
 1.  Place of Death:  a. County:  Collier
                      b. City, Town or Location:  Naples
                      c. Name of Hospital or Institution:  D.O.A. Naples Community Hosp.
 2.  Usual Residence:  a. State:  Indiana
                       b. County:  Knox
                       c. City, Town, or Location:  Wheatland
                       d. Street Address:  Rt.# 2
                       e. Is Residence inside City Limits?:  No
 3.  Name of Deceased:  FLOYD ARTHUR PANKAKE
 4.  Date of Death:  February 14, 1968
 5.  Sex:  Male
 6.  Color or Race:  White
 7.  Married
 8.  Date of Birth:  Feb. 1, 1905
 9.  Age in Years:  63
10a. Usual Occupation:  Lineman
10b. Kind of Business or Industry:  Light Company
11.  Birthplace:  Indiana
12.  Citizen of What Country?:  U.S.A.
13.  Father's Name:  Leroy Pankake
14.  Mother's Maiden Name:  Minnie Warner
16.  Social Security No.:  303-01-6355
17.  Informant's Signature and Address:  Mrs. Hester Pankake, Rt.# 2 Wheatland, Indiana
[Cause of death is omitted]
23a. Burial, Cremation, Removal:  Removal
23b. Date:  Feb. 14, 1968
23c. Name of Cemetery or Creamatory:  Hamlin Chapel Cemetery
23d. Location:  Knox County, Indiana
24.  Funeral Director's Signature and Address:  Earl H. Hodges, Hodges Funeral Chapel,
                                                Naples, Florida
25.  Date Received by Local Reg.:  Feb. 14, 1968