| Name |
Theodore Roosevelt Provost |
| Sex |
male |
| Birth Date |
October 10, 1905 |
| Death Date |
April 27, 1982 |
| Age at Death |
76 years, 6 months, 17 days old |
| Birth Place |
Louisiana |
| Death Place |
San Francisco County, California |
| Mother's Maiden Name |
Ellis |
| Social Security Number |
546-06-4522 |