STATE FILE NO.:  68-017590
 1.  PLACE OF DEATH:  a. COUNTY:  Lee
                      b. CITY, TOWN, OR LOCATION:  Fort Myers
                      c. IS PLACE OF DEATH INSIDE CITY LIMITS?:  Yes
                      d. NAME OF HOSPITAL OR INSTITUTION:  Lee Memorial Hosptial
 2.  USUAL RESIDENCE:  a. STATE:  Florida
                       b. COUNTY:  Lee
                       c. CITY, TOWN OR LOCATION:  Fort Myers
                       d. STREET ADDRESS:  4135 Manning Drive
                       e. IS RESIDENCE INSIDE CITY LIMITS?:  Yes
 3.  NAME OF DECEASED:  RALPH   ADRIAN   PANCAKE
 4.  DATE OF DEATH:  March 22, 1968
 5.  SEX:  Male
 6.  COLOR OR RACE:  Caucasian
 7.  MARRIED
 8.  DATE OF BIRTH:  Feb. 19, 1891
 9.  AGE IN YEARS:  77
10a. USUAL OCCUPATION:  Shoe Maker, Retired
10b. KIND OF BUSINESS OR INDUSTRY:  Shoe
11.  BIRTHPLACE:  Dundas, Ohio
12.  CITIZEN OF WHAT COUNTRY?:  U. S. A.
13.  FATHER'S NAME:  Henry Pancake
14.  MOTHER'S MAIDEN NAME:  Effie Blaine
16.  SOCIAL SECURITY NO.:  340-28-2135
17.  INFORMANT'S SIGNATURE AND ADDRESS:  Mrs R A Pancake  4135 Manning Drive
                                                          Fort Myers, Florida
[Cause of death is omitted]
23a. BURIAL, CREMATION, REMOVAL:  Burial
23b. DATE:  3-25-68
23c. NAME OF CEMETERY OR CREMATORY:  Memorial Gardens
23d. LOCATION:  Fort Myers, Florida
24.  FUNERAL DIRECTOR'S SIGNATURE AND ADDRESS:  Philip Kiser
                                                Harvey Funeral Home, Ft. Myers, Fla.
25.  DATE RECD. BY LOCAL REG.:  March 25, 1968

STATE FILE NO.:  76-044847
 1.  DECEASED-NAME:  EMMA BLANCHE PANCAKE
 2.  SEX:  FEMALE
 3.  DATE OF DEATH:  JUNE 20, 1976
 4.  RACE:  WHITE
 5.  AGE:  83
 6.  DATE OF BIRTH:  June 24, 1892
 7a. COUNTY OF DEATH:  Lee
 7b. CITY, TOWN, OR LOCATION OF DEATH:  Fort Myers
 7c. INSIDE CITY LIMITS?  Yes
 7d. HOSPITAL OR OTHER INSTITUTION:  Lee Memorial Hospital
 8.  STATE OF BIRTH:  Iowa
 9.  CITIZEN OF WHAT COUNTRY:  U. S. A.
10.  MARRIED, NEVER MARRIED, WIDOWED, DIVORCED:  Widowed
11.  SURVIVING SPOUSE:  [blank]
12.  SOCIAL SECURITY NUMBER:  340-28-2135
13a. USUAL OCCUPATION:  Housewife
13b. KIND OF BUSINESS OR INDUSTRY:  Own Home
14a. RESIDENCE-STATE:  Florida
14b. COUNTY:  Lee
14c. CITY, TOWN, OR LOCATION:  Fort Myers
14d. INSIDE CITY LIMITS:  Yes
14e. STREET AND NUMBER:  4135 Manning Drive
15.  FATHER-NAME:  August Baur
16.  MOTHER-MAIDEN NAME:  Gertrude Bice
17a. INFORMANT-NAME:  Mrs. Dolores E. Allen
17b. MAILING ADDRESS:  2427 E. Mall Dr., Ft. Myers, Florida 33901
[Cause of death is omitted.]
24a. BURIAL, CREMATION, REMOVAL:  Burial
24b. CEMETERY OR CREMATORY:  Memorial Gardens Cemetery
24c. LOCATION:  Lee County, Florida
24d. DATE:  June 22, 1976
25a. FUNERAL HOME-NAME AND ADDRESS:
     Harvey Funeral Home, 1600 Colonial Blvd., Ft. Myers, Fl  33901
25b. FUNERAL DIRECTOR-SIGNATURE:  H. Richard Neal
26a. REGISTRAR-SISNATURE:  Dorothy E. Gaylor, Dep Reg
26b. DATE RECEIVED BY LOCAL REGISTRAR:  June 21, 1976