Court of OrdinaryI

pobb CountyMari etta, Ga.

lpPlication of Mrs. Clyde Croy to be appointed Guardian of andfor Jesse Whitlock and his estate.

II Jesse Whitlock do hereby acknowledge due and legal not ice on

~he application of .Mrs. Clyde Croy to be appointed mY guardianra.iving all further not ice and service and consent to thehear ing •

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STATE OF GEORGIA,

CmJNTY OFICobb.

BEF~RE the undersigned attesting officer, personally came WILLIAM

H. BENSO!i,M. D.,who, after being duly sworn, says, under oath, that he isa licensed physician in the State of Georgia; that, on October 3, 197~),

he was a Iphysician member to examine JESSE ViJHITLOCKin a hearing in

the cour1 of Ordinary,Cobb County,Georgia,on a petition seeking to have

JESSE WHiTLOCK, a mentally ill pex'son,hospitalized (Chapter 88-5 of theCode of Georgia) that the examining committe unanimously determined

Jesse whltlock to be mentally ill,requiring hospitallzation;but thati

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at that hearing,the question of whether he needed a guardian for h:Lm-

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solf,or lor his property was pot presented to the EXAMINING COMMITTE;that, in the opinion of this deponent, ,TESSE '\YHITLOCKis mentally ill,

mentall:y"Iincompetent, to the extent that he is incapable of managing his

property~or estate;that he needs a guardian of and for his property,

and thatlhis mental condition is such, a guardian for him and his estate

would belproper and authorized under the law pertaining to such matters

and conditions;that this affidavit is made to support a petition for

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guardianship of'and for the estate of Jesse V'lhitlock,oJ.'"'his person,oY>

both.

Sworn tOjand subscribed tobefore me on this the 9th

I

day of October,1972o

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/~Ji;./(, r _- . r)

(I.cD~ - .) ,f.~z%-'- /')/~' <

lUbliC, 'State o~ Georgia,County of Cobb.

STATE OF GEORGIA

COUN~Y OP COBB

nary M: ~: I>'

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"0 i::r':~a!~.:fO':

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offi

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I~1M-

.0I •..•

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of Octooer, 1972.

to and subscribed before me this

I do solemnly swear that I will well and truly perform all the duties

requlired of me as Guardian of JESSE WHITLOCK to the best of my ability, and will

ly account to my Ward for his estate. SO HELP ME GOD.

o...•

(Y01lI)

Stalo File NOh' ._

om,. "0. \ WliH'D:~mCA1~OF DEA~_. ~u8todian'B~~ _

1. NAME OF (Fit,,!) (Middle) (LM!) 12. DATE (Month) (D.ay)DECEASED I h OF 1 1~ 74(T~,'<orPrint) .]ie,sse 1.tJ itlock : Durn -:;- I

rpIXis OF DEATH (Clnty) i ---·----\-4-.-U-S-\-rA.-L-RES--i-D-E-N-C-E-l\-V-·h,~;o decoased lived. If institution: re"'d~:,c-;: ;;'~t~r" adml,",j~

Cobt , I Stalfreorg1~ Counly~oQb ---'1City or Towr. J In Cil Li~-I LEIKfTHOF -.-- -. In City Limit. LF.riGT~j oF'--M • t t Yos)p No [J STAY lin ihb placo) . Yoa 0 lJo.-p STAY lm th19 pbcomarle a . ' ~lty"r Harietta -

N;;~~;~tr(~~~r-Ii-'f-i-o-s-p-i-t-a-l-'---'----'-I~-~i~~F"'-!."~~;;~~;;:;;;;~~:=:----cc==c.5. SEX I G. IUiCI: 17. J;JIni'HPLACE (Stllte or foreign C'oun!ry)1 CITIZEN OF W1iAT!15. IS RESIDENCE ON FARM? liG. BURIAl. [8 DATE~'I Can G\eorgfua COUij'41!ri Y 0 '1 r~~ REMOVAL [J 1-16-n~

I' - U :.JA I os , 0 7>,. cnEMATION [JII. DATE OF BIR'IH uJI9' AGE (In y"o."')IIF UNDER 1 YEAH IIF UNDER 24 HRS. -!TA.~E- OYC:£M£TEn-y-- ----·Ii.O-c:Ji.nOinCItyo7't~'ml) i(;OuDt~(S1ato)hut birthdllY Month. I DAY" Houra I Mm. .t tt <> C c b r- (~,9-12-1933 40 I Gresham Cemeb:;l"'Y !lJaru:8 U.3 ,.), U<A.

10. MARRIED 0 NEVER ~ARRIED ar 111Marriod or Widowed Gi"" Ii;""o ;){Sp-OU30 17. EMD-!U-~.•ER.~SS!GNATUHt>; I LlCF.NSCN6~--WIDOWED r1 DIVORCED 0 - - - - - - - (::-./;. { ".L-.- / 1 CO C'SEPJiliATED 01 (.' [~~",// ,..--j r:t/l_. _._ -- . / 1

11; USUAL OCCUPAT!ON {tGIVO!dnd of work .IKIND OF' BU-S-I~-~ESS--O-n----- 18. 1<10R1'ICIAN --------------donoduringlnoztofwo ltinglile, ovenifrolirod)INDUSTRV B l d R ", Dc· ••.•al Homea {er an ,eece I' U .";J. •

12:Vi-'l-A-S-D-E--C-E-AS-E-D-E-V-E--R~!N-U-.-s-.-A-m-JJ-E-D-F-O-R-C-ES-?----\S-O-C-lAr.--S-E-C-tful'l'YrlQ I~Monr'fcIAl'I'S ADDRESS(Yon, DO,or UnboW'nrU yoo. give Wl!.I or dateD 01 sorvice) . ;-". ' .•.• O' J.t I) ~~a in c: t "I 0.0. d "t- ,...(' K G aI '.. ';"'.- -!/I:: /,.-<; ~:l: ;-- \ [ l'l~ ~.:. . "u, . ' JL) .•n,•..•..• ' 0

~ - 11'-"" -~'S NAME I '" .-:j " .. - - . 20. I~OIUllilliT I!olalb""hi

Jim ~hit~ock Mrs Clyd Crey Si8tor

14. MO~;e7;~~Ntrren --121•~~~~f:~~:~~ao -----=-----.-----;••.•.;.M;;;;"===c;;;~~=-:;;-;~~~O"',.....,...,...,,,...,....,,~~-

22. CAUSE OF DEATH [Entdr only one C'au!J.Opor.lino for la). (b), /lnd (c).] PLEASE PillNT jlN"I,~~VA.~,BE1'W£EHDO NOr WRITE IN nilS SPACEPART I. DEArn WAS CAUSED BY: (II ! J ,:> P ~(; .C '; 01'''''''1 A•. D DEArn 1. IIMMEDIATE CII!USE (a) / 1'<' ('6£) t1/1"-It/I~1t..•...Y\ .J..)' IJL.~. u /:->< C . "-- ':"'(- .--------- ....,,---c-=-- _

/ 2. 13. I ~

;'n /l,,; 0-177" J .•• :,.,"1 ' ,'. A·~l("·) I" Conditions, I.! a.ny.~ DUEITO (b) L LJ../..;/.().0... '/,f"r.1 1,S2<.. "',.,'f.-),1,. , ~) 'J __ . 1 . ., which gAve rise to I) '.) . , 5. 16.=: abOYO clu13t> (3), /:' 0 . \r~(\ . ,) /)":".J _1.'.~ stating tho undor- L-~i2.(&('(1...1C-<,J»__r_J!.,..·"\ rc/ LI"<l4<f- (;7,:'>l'~ lying caus •• last. DUE TO (c) _ - '.- ... , '- __ ._1 . .

~ PART II. OlAor ciQJiliicant conditions C'ontribulincr to dea1h but nol roi."ied to Iho 'tonnincldfsoiUJe condflio';-glve,", i;p-;rt-rTa1-' I 23:-i\UTOPSY?~ \ - . y~~J:L~~

, 24. ACCIDENT 0 IPLf\CE ?F INJURY (0.1.7 •• in or aDout I INJU;rnR"Y-O~r;C;rC"U"'R"R"'E;;:D"-------.---- /._ I.: . 'C/.~ SUICIDE 0 home, 1<11."" factory. clroot. Whilo at Worle [J 25. I hereby cerhfy that. I a!tendod tho docoaJJod frOIn.... ~_c ......L _~ HOMICIDE 0 oUice bl~g., e~ !i~~._~~i!~_at ..~~~:!:.i:J19 . to I_-~Jc~ ~ 19 , that I last "IlW tho dacau.d

~ (CIIT-On-TOWN) (COUN11YTTSTATE) I TIME (Mon!h) (D,.y) (Yoar) (Hour). /.- ;'(/ rId I .. ). ',~ I OF ahvo "'L.-.----:-z;:;:~.._. "~ . 19 .. -- ..... and thatINJURY doath occurrod st (£ II',·-n r:",., from tho caU£;09 llnd on tho dilto fitatod llbovtt.

HOW DID INJURY OCClJ~? ---------. -ZG-:--SIGN}\1'URt··., ' .. r=::----,---------.-- ..~--- 'Vogr';';-';l-TitfC;I' A' /' ( , /'--.\1.1 /" "~1 rr __ .~ ,~f~f.{ __ :·..•.....:..../k l~.i.::..t_/},·,: .•.?'j II~~ _

21. DATE REC'D BY L07~128. ~STRAR'S SIGNATURE I ADDRESS I ,', I DATE SIGrlE.'DREG/ ?L/ ,/ " .. -<1,1" ./ <? ' .. j' I ,,;,!~ / -0) r- "-. /()../ C Y~L</L/ .__~-)I21-'-.o_..I ...f'·' C:'T<: , __ . ~~_~!....~./.,' . _ADM 5.3 (12-1~56) I ,) (;Qorv" Deportn:cnl oT~lT.;alth

Vtt..11 RO(-Ofds Se(;,.'ito

STATE OF GEORGIA.

C01JNTY Oft' COBB

COpy OF THE FACTS OF DE!\TH 0i'; 1"11'·R T[.! THT,s Uti'F"Cr<:"

S)~AL

DATF ISSUED ,J;\i\1 ... i ,J j