STATE FILE NO.: 24115
1. PLACE OF DEATH: a. COUNTY: Dade
b. CITY OR TOWN: Miami
c. LENGTH OF STAY (in this place): 1 month
d. FULL NAME OF HOSPITAL OR INSTITUTION: Jennings Nursing Home
2. USUAL RESIDENCE: a. STATE: Florida
b. COUNTY: Dade
c. CITY OR TOWN: Rural
d. STREET ADDRESS: 10515 N. E. 3 Ave
3. NAME OF DECEASED: Grace E. Pancake
4. DATE OF DEATH: Oct 2 1953
5. SEX: Female
6. COLOR OR RACE: White
7. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED: Never married
8. DATE OF BIRTH: Sept 27 1876
9. AGE IN YEARS: 77
10a. USUAL OCCUPATION: Housewife
10b. KIND OF BUSINESS OR INDUSTRY: Own home
11. BIRTHPLACE: Noble, Co. Md. [Grace was born in Noble Co., Indiana]
12. CITIZEN OF WHAT COUNTRY?: USA
13. FATHER'S NAME: Joseph Pancake
14. MOTHER'S MAIDEN NAME: Olive Peck
15. WAS DECEASED EVER IN U. S. ARMED FORCES?: No
16. SOCIAL SECURITY NO.: [blank]
17. INFORMANT'S SIGNATURE: R. E. Wixson
ADDRESS: 206 S. W. 8 St. Miami, Fla.
[Cause of death is omitted]
24a. BURIAL, CREMATION, REMOVAL: Burial
24b. DATE: 10-5-53
24c. NAME OF CEMETERY OR CREMATORY: Flagler
24d. LOCATION: Miami, Fla.
25. FUNERAL DIRECTOR'S SIGNATURE AND ADDRESS: R. E. Wixson, King Funeral Home.
DATE RECD. BY LOCAL REG.: 10-5-53
REGISTRAR'S SIGNATURE: T E Cato MD
STATE FILE NO.: 57-025073
1. PLACE OF DEATH: a. COUNTY: Dade
b. CITY, TOWN, OR LOCATION: Hialeah
c. IS PLACE OF DEATH INSIDE CITY LIMITS?: Yes
d. NAME OF HOSPITAL OR INSTITUTION: Hialeah Convalescent Home
195 West 27 St.
e. LENGTH OF STAY IN 1b: 10 days
2. USUAL RESIDENCE: a. STATE: Florida
b. COUNTY: Broward
c. CITY, TOWN OR LOCATION: Hollywood
d. STREET ADDRESS: 1636 Madison Street
e. IS RESIDENCE INSIDE CITY LIMITS?: Yes
ON A FARM?: No
3. NAME OF DECEASED: Hiram Kenneth Pancake
4. DATE OF DEATH: August 5, 1957
5. SEX: Male
6. COLOR OR RACE: White
7. MARRIED
8. DATE OF BIRTH: July 12, 1892
9. AGE IN YEARS: 65
10a. USUAL OCCUPATION: Real Estate Broker
10b. KIND OF BUSINESS OR INDUSTRY: Self Employed
11. BIRTHPLACE: West Virginia
12. CITIZEN OF WHAT COUNTRY?: USA
13. FATHER'S NAME: [?]an Pancake
14. MOTHER'S MAIDEN NAME: Alice Krammer
15. WAS DECEASED EVER IN U. S. ARMED FORCES?: No
16. SOCIAL SECURITY NO.: [blank]
17. INFORMANT'S SIGNATURE AND ADDRESS: Norene Pancake, 1636 Madison St. Hollywood, Fla.
[Cause of death is omitted]
23a. BURIAL, CREMATION, REMOVAL: Removal
23b. DATE: 8/6/57
23c. NAME OF CEMETERY OR CREMATORY: [blank]
23d. LOCATION: Hollywood, Florida
24. FUNERAL DIRECTOR'S SIGNATURE AND ADDRESS: Carl [?] Slade, Carl [?] Slade Funeral Home
Hialeah
25. DATE RECD. BY LOCAL REG.: 8-6-57
STATE FILE NO.: 64-049221
1. PLACE OF DEATH: a. COUNTY: Dade
b. CITY, TOWN, OR LOCATION: Rural
c. IS PLACE OF DEATH INSIDE CITY LIMITS?: No
d. NAME OF HOSPITAL OR INSTITUTION: North Shore Hospital
e. LENGTH OF STAY IN 1b: 13 hrs
2. USUAL RESIDENCE: a. STATE: Florida
b. COUNTY: Broward
c. CITY, TOWN OR LOCATION: Hallandale
d. STREET ADDRESS: 400 Northeast 7 Street
e. IS RESIDENCE INSIDE CITY LIMITS?: Yes
ON A FARM?: No
3. NAME OF DECEASED: Noreen (AKA Norene) Pancake
4. DATE OF DEATH: November 17 1964
5. SEX: female
6. COLOR OR RACE: white
7. WIDOWED [box checked]
8. DATE OF BIRTH: May 10, 1895
9. AGE IN YEARS: 69
10a. USUAL OCCUPATION: housekeeper
10b. KIND OF BUSINESS OR INDUSTRY: hotel
11. BIRTHPLACE: Ohio
12. CITIZEN OF WHAT COUNTRY?: USA
13. FATHER'S NAME: John H. Holland
14. MOTHER'S MAIDEN NAME: Clara Young
15. WAS DECEASED EVER IN U. S. ARMED FORCES?: no
16. SOCIAL SECURITY NO.: 265 42 6657
17. INFORMANT'S SIGNATURE: F. B. Hunter by phone
Address: Paul Neuman 927 Baughman, Akron, Ohio
[Cause of death is omitted]
23a. BURIAL, CREMATION, REMOVAL: removal
23b. DATE: Nov 17, 1964
23c. NAME OF CEMETERY OR CREMATORY: Hollywood Memorial Gds
23d. LOCATION: Hollywood Florida
24. FUNERAL DIRECTOR'S SIGNATURE AND ADDRESS: Frederick B Hunter
Fred Hunter Funeral Home Hollywood Fla
25. DATE RECD. BY LOCAL REG.: NOV 20 1964
26. REGISTRAR'S SIGNATURE: Ethel L[illegible]
Updated July 22, 2005