Walter Edward VIRT Death Certificate
STATE OF FLORIDA
OFFICE OF VITAL STATISTICS
CERTIFIED COPY
CERTIFICATE OF DEATH
FLORIDA
STATE BOARD OF HEALTH
BUREAU OF VITAL STATISTICS
BIRTH NO. [blank]
STATE FILE NO.: 20719
REGISTRAR'S NO.: [blank]
SEP 1955
1. PLACE OF DEATH:
a. COUNTY: Broward CODE NO.: 16-11
b. CITY OR TOWN: Ft. Lauderdale
c. LENGTH OF STAY: 3 yrs.
d. FULL NAME OF HOSPITAL OR INSTITUTION: Broward General Hospital
2. USUAL RESIDENCE:
a. STATE: Florida
b. COUNTY: Broward
c. CITY OR TOWN: Ft. Lauderdale
d. STREET ADDRESS: 109 S. Victoria Park Road
3. NAME OF DECEASED: Walter Edward Virt
4. DATE OF DEATH: July 30 1955
5. SEX: Male
6. COLOR OR RACE: White
7. MARRIED...: Married
8. DATE OF BIRTH: August 19, 1882
9. AGE: 72
10a. USUAL OCCUPATION: Conductor
10b. KIND OF BUSINESS OR INDUSTRY: Penn. R. R.
11. BIRTHPLACE: Paragon, Indiana
12. CITIZEN OF WHAT COUNTRY? US
13. FATHER'S NAME: John Virt
14. MOTHER'S MAIDEN NAME: Margaret Payton
15. WAS DECEASED EVER IN U.S. ARMED FORCES? No
16. SOCIAL SECURITY NO.: [blank]
17. INFORMANT'S SIGNATURE: Isabel F. Virt
ADDRESS: 109 S. Victoria Park Rd., Ft. Lauderdale, Florida
[section blank]
22. I hereby certify that I attended the deceased from [blank], 1953, to July 30, 1955, that I last saw the deceased alive on 30 July, 1955, and that death occurred at 7:30 a.m., from the causes and on the date stated above.
22a. SIGNATURE: Walter J. Glenn, M.D.
23b. ADDRESS: Ft. Lauderdale, Florida
23c. DATE SIGNED: 8-1-55
24a. BURIAL, CREMATION, REMOVAL: Cremation
24b. DATE: Aug 4, 1955
24c. NAME OF CEMETERY OR CREMATORY: Grove Park Crematorium
24d. LOCATION: Miami, Florida
DATE REC'D BY LOCAL REG.: 8-1-55
REGISTRAR'S SIGNATURE: Leatrice Rhodes, Dep.
25. FUNERAL DIRECTOR'S SIGNATURE: Phil H. Fairchild
ADDRESS: FAIRCHILD FUNERAL HOME
Ft. Lauderdale, Florida
Transcription by John C. Hepner, 1998