STATE FILE NO.:  94-031561
 1.  DECEDENT'S NAME:  Gale Joseph Pankake
 2.  SEX:  male
 3.  DATE OF DEATH:  March 3, 1994
 4.  SOCIAL SECURITY NUMBER:  471-40-7462
 5a. AGE-Last Birthday:  55
 6.  DATE OF BIRTH:  April 4, 1938
 7.  BIRTHPLACE:  Litchfield, Minnesota
 8.  WAS DECEDENT EVER IN US ARMED FORCES?:  Yes
 9a. PLACE OF DEATH:  Hospital, Inpatient
 9b. INSIDE CITY LIMITS?:  Yes
 9c. FACILITY NAME:  University Medical Center
 9d. CITY, TOWN, OR LOCATION OF DEATH:  Jacksonville
 9e. COUNTY OF DEATH:  Duval
10a. DECEDENT'S USUAL OCCUPATION:  Underwater Sound System Technician
10b. KIND OF BUSINESS/INDUSTRY:  Military
11.  MARITAL STATUS:  Married
12.  SURVIVING SPOUSE (If wife, give maiden name):  Lois Elaine Bollman
13a. RESIDENCE - STATE:  Georgia
13b. COUNTY:  Camden
13c. CITY, TOWN, OR LOCATION:  Woodbine
13d. STREET AND NUMBER:  1471 Sadler Cove Drive
13e. INSIDE CITY LIMITS:  No
13f. ZIPCODE:  31569
14.  WAS DECEDENT OF HISPANIC OR HAITIAN ORIGIN?  no
15.  RACE:  white
16.  DECEDENT'S EDUCATION (Specify only highest grade completed):  12
17.  FATHER'S NAME:  Leslie John Pankake
18.  MOTHER'S NAME:  Edith Hess
19a. INFORMANT'S NAME:  Lois Elaine Pankake
19b. MAILING ADDRESS:  1471 Sadler Cove Dr.  Woodbine, GA 31569
20a. METHOD OF DISPOSITION:  Removal from State
20b. PLACE OF DISPOSITION:  Plantation Gardens
20c. LOCATION:  Summerville, SC
21a. SIGNATURE OF FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH:  James M. Dekle
21b. LICENSE NUMBER:  1333
21c. NAME AND ADDRESS OF FACILITY:  Dekle-Wainwright Funeral Home
                                    P.O. Box 677  Kingsland, GA 31548
25c. DATE REGISTERED:  March 9, 1994