| Name | Eugene Addis Provence |
|---|---|
| Sex | male |
| Birth Date | January 6, 1921 |
| Death Date | August 15, 1983 |
| Age at Death | 62 years, 7 months, 9 days old |
| Birth Place | California |
| Death Place | San Mateo County, California |
| Mother's Maiden Name | Greenslade |
| Social Security Number | 556-16-6933 |