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HomeMy WebLinkAbout0232 • + ~ t i . t ~ r T.i. R~rrti ~anwo or Mw.~rx CE1~T1F1CATE OF DEATH 9 • wK~~ a~ rrr~a, irr~?n~~ rr~?Tr n~.~ Mo. t~~~~ ?LOiIDA - _ _ •N sl~~¦ ~ ~f ~ r~~e r 1~ . MM1i~ ~t/MRilrt ( ~a.. awr+r rr r.r.e~r.w ~~r~i~ww ~M~.+yrr.i..1 •~~~~t~~ 1 R~ K MA1M GODt MO. y~ r 111 ~r s. fTAT[ R(~y1{Tli ~a ~I~ts~ ~ . f r rf• Gt~r. TO~w. d1 LoCAT1011 r. A~l~C[ Or O[A7N e. dri. 101~. M LOC4Tqi1 e! 1~ •Neft ~ 1M~Ot C ~ 1M11T~i NA10~ UM~TS1 ttl~. ~ti In HQb~ WYiiY 1'[i MD? MM[ OI (~1 wt b M/~~(, /irr aYMI ~fi'N) IIMCTM d' 1. fT11[[7 AOOM1[E! 0~ A/AIW1 Iq~MT~I OII wstnrv.~o. D.O.A. l~t. Pisrce M~t. a':~.~:~ . F.O.Box 122 r~:? ~op ) Mn~ M l~r ~NrO. 1..~1 ~ o~rt H.rr D~r ~ ~ Gea e Raleigh F~rguaon,Jr ~?Y» May l~th. 1~?f~ . f[lt 6 r~Ow Ow ~1Gi 3 YAMEO 1KY[R IM~RIO MTL 01 M/~TN ! 1i[ Ih M~~ O 1 M~ IM. 4 1"lale ~1~ TQ r~so~rm rrartcc OCt• 19~ 19~1 r••+~• ~•w r~. D • f t • f 1~i~C 1 y 10~ ulu+u.0.'CUr~71w~ (Wrr Nd ywi?i M.r 1~. R~ioo?Mr~M~f t~1 w0ulTlt~ 11. ~nlTMRAti (S'eti r M+Y* wr~nii txttelBM rR i1MY 0o?s~rl?rr •fill (Et~I Mw~IRh,~*H~R~'~ ~ao~c ~ Cafeteria Jacltson~ille, Fl~. U.S.A. l~~ik t~~ I. F~1M[I1 S 11AME T MOTN[1t S YA~O[M MAwI ~r?~•?~~•~ Geo e A. ~'~ea~ on Sr. I.~ola T lor ~ r~s oea~?x. c+R~ w u s,u~[e rawc.rr »~ocu~i seeuee~rr ro t~a+~ s MwR ri3t~.t1~ b. erguson 11'r. r. i~~w1 Uf p. wr w. r~iw rw+~ Yee w.~l. 2 26 -10- 8 1 P.~.$ox o e a. ~ rw••, •i 1~ sAi~[ M/sA?M ~.+..+r w. e.~w ~r.. p~u. t+?..+~ ~ ~~wu. rr*r~~ ~ I t t a f t~/ ?~~T QC~YM t~wS G?1rJ~[ O ~ . AID D~ATM ~wr~ rt~. w~~n ~At'o~r~C,Occlueion_tirit,h .Infarction - - - ~?te__ t!• e~r- j tlffe~t• ~ u .sc~ cs. twr~r~.~/.~r. ax ~u c?~ __~9t4~3ii'~C_ ~~Q~'4t~~ he3ii'~ ~~6~,~4 . . ~.--_~:.•r. 3~7r~• ± 1 . ~ . ~ .~~i.r a..~~•u . _ r • t s t r ~ r ~d4y' x'uYs• . . . . . . ' - .~iMS. 7s ~ 1~ e.a.~ a.r. ax ra ~ct ~ ~=~-'~..__._..r_~.~`' IMT N. thrrt .~N1qG~Mf CO~Offfr/ OrR~RrN l0 QAff~ q/T 1~4f PR~1E! ~O rp[ ftsrlMl DiUJ! CA~OItiOM µ 1y ^ ~1 \~~r• •f' ~ 1~MCIr1[M ~ i~f Q~~i! K • - •t ~ef~r• Y - - ~ ~a ~ OtlC~tiE n0~ wtxJ~r etcv~~eED (Lstn s~rrr~ of ~;rr~ i~ Fart yi. p,err 1! y frn~a 1fJ . •~~~ri •~7 ~ ACC~~OCIIT SuKW[ MoMK10[ . _ . i1~~o~~t- U U , ~ y~• •f - ------;y - ~H'. ~ nr TiY( OI Nwr ~/titt. lYet. _ , V IItMlRY f. . ' ~ ~ p w. llrt ~a~W~~ oe~uR~tD ~~lAC[ aI w/u~t (e ~ V r~wt iiwr. ~1/. t~n. mwb. oM toc~rroh Oatr7r s1e'r[ MMil.E AT Q MDT rMLI ~ A~~. ~1. K?Nf. ~pt ~4•. ik.) ' . . MOIIK R7 ~K 21 ! ~trsnMf tAa I~cra~+~/ /row~ j1 Ot lg~f7 , to ~l~ 1 ~wJ /a~e h ~ ah.s ~n dwrF ooo~rer/ ~r a~n 1M rrh ~f~t~d a1or~: ~nI to rM iw~ W ~ne.+b1~. h~w rM uu~ ~e~t~I 1 ~ts. u~wwtwl~ {n.p.. r ew.f ~ ~ooleess Lts. aT[ sK++eo •r• N , v K .•ti r~t r~ie ~ F . -i t-f~ •c~rr•e~. L3. ~,w?. a[w~ncw. t~ wTC t3r ware or arctt~r ae eRCr~ro~r LN ~ouTa~ tCV~. arw, a eswt~l (~r) II[ra~~r. ('~~np~ _ 5 s,j~ Cairettr_,~r _ Nobe ~aund Martin, FZo: id~ Y. t. 4 817 j~. N+~E~AL 01i 4 SKK~ ~OpRESS ES Oaf~ IFfCO. ~r t~7C~at RLG 26 REGKTqA~ ! SKr~ ~ a•.. isne -EO I :~e s ! - i hereby crrt~fY this to ~t a true anr! corr~ct copy of the Locel " Rep~~s~er~ rec~rrl fite i~ the St. Lucie County H~elth p~part ~ rrtent at Fort P~ :-e F'~?~J3. ~ . (Warnirn: ?..o* =s.;.::~ un:~ss ra;sed s+~a! or the St. Lu~ie IN. ~ . ~ Coimry F;e3•rh De~ertment is sffixed.) [«~;~4f ~Ry s ' ~ N. Q. MillFR, M. 1'wf ~ B ~ I ~ , County He~ith Off;cer & latal Rec,~istrar _ ~ . ~,E.i~ i~~~TR~a.~, ~L~R~C ' .:r ~ o.. ~'~r ~ • - - s..~ ~ . ~ ~~~ul~„y„' ~ ~ ~1~ T it'.. ir~+1 , Q~1~ t)sputr locei Registrar a•~ ~!L k('~iK 1 h ~ ~~D