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\'.S.,~12
R.Y.19~~
aTATF. BOARD OF HKALTH
IlURIlAU 01" VITAL .r,\TI~C.
O.k.
SIRTH NO
I P\ACI!~" Dl:A TH
.. Ce'..i'.lY
Lucie
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HOSI"TAL OPt
..STITUTIO~ 2407
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Hvusewife
:J rATHER S NAME
lOa
James Duff
15 "AS DHfASl:D f\'fR IN U 5 AR'4fD fOR([S'
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CERTIFICATE OF DEATH
.f' I "AfI[ flLPl; NO,___ ----
J. LOR D A RI:OI....P.Ml.. NO, A8
....0. z UWAL n~IMMC:. (W.l......I<t~.~h.... I!I.uh"".""-. ._~~hl_.J""''''''''''~~
. STATl ~ COUNTy
~loridB St. Lucie
c CIT.... TOW". 0" lCX'ATIO~
,. I~ RESIO(NC(
I~SIL)( flTV L\:1~S'
':. S [J ","8
Jt t. 1LJ pee
4 ST~HT A('DRfSS
O~ A FAR'4'
:[50 HOD
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2-iO', 'l'a!r.arind Dr.
.\11441, L.lI 14 D;)f
in~ Hita ,Tohnsc.n t CVTH A
7 .......R~IEO rxHE't'(R t.U"RI~OO . O-'H ~ liilH--- ~-i(;'E (.I~ rte~'
ISJI b"/14., I
...1 oo...f 0 0 Dl>QRCW ~b 1902 ___ b5
ir.. )(INDOf tuSIHESS OR IN()USTRY 11 aJ~THt't.ACE (!';tolt 0' forllg't (0-:';.1\"1)
12
Dr.
M.../l
fur }-t~'
. Ow n_.J..LfL me
New York
14 ",",OTHER. S ,,""'IO(N MAWE
U.S.A.
;j . Y .
N 55-10-57
lilc,",uK 0,. HATH (A'.I" orU,'" co"..~, Ii", fo' (.1. (b). .,4 (d,)
PART' DEATH WAS CAUSl:D IY,
INWEOIAT[ CAUSE (.) -.C a V.A. ..u~_~_
}<'re drike I<r ink
11 l"f'ORtU>:T II IIQ"ATUaIlDav i ct J os e}.h Johns on
5 .w''''2407T&marfiiCf Dr. I<t .~erc~-----na.
INTERVAL BETWHk
ONSET AND DEATH
C..4i1lmu. if..,. } [)'Jf TO (6) _Ii Y 1- e t't e ns 1 on
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PART 11 QUtEa: ~HlfKlo(l ~OCTt()fId COf'fTlltlkrTl~ TO DlATH IVT NOT ~{LAn!) TO THi: n'UIIMl DtSOSl (('frrkOtT)()", GI't[Jit IN 'MT 1(4)
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WAS AUTOPSY
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YfSO ",,0
20'> DfSCRIBf HOW '''WRY OCCURRED
(1<:"", "G/lI." ojlrlj!Jr. h, J'/Z" I or Po" 11 oj i~I'" 14 )
204 I~JURY OCCURRfO
:~~l~ AT [l ='t...~~~Lf 0
COUNTY
STATE
~_ .nd ;.., '.M' ;.."t:.. .live on _A'f)r___ 2_Q~.5..1_
.nd to ,,.. b~.' of my Ino_,.d,_. 110m the c.au... .t.ted
llli4, :2 ~~;~ 7-
Fla.
l2.
21 ue . .
I .."anQed tha dec..,.d 110m ______.__}., w_____. te
D..th occu"ed.t __~ OO__J_!_ll . _____ m on the d.t. ".teo. .bov.
IIQNATUltI (/><g,a or /lI/,)
I UJ, ADDRESS
M .1. lot. i'iel'Ce,
N......E or C(I.4E'T(RY OR CR!t,,(AYORY 2M LOCATIO__ (('II,. (nil. or to\l,'II,)
(St"',)
John
D. l rcwnin..;,
ZlI> DAl[ 23<
I ierce I Fla.
Z'6 REGIS'(RAR-S SIG",-...TUR(
2Jq BVRlal. c.JII:[""'~.
Rf"OVll (.'ipu1f,l
_~ri&- __,,4-~7-57
21 fusfRAl DIRECTOR S StGNATUR[
;,:ilton ~~. i:a.ird
AODRESS
Hillcrest
23 OAT!: R[eD
5-~4-57
Anna Lee Duniscn, d.r.
...