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HomeMy WebLinkAbout0713 ! k ~ ~ i ~ ~ r ; p~~. 0~- ~'1'AT[ ~OMD w?„uu..9, CERTi~'1CATE OF DEATH ' ~a••• • eu~uv w v~r.LL RAT1t77C~ KATt F~~t Mo. F , FLOdIDR ~ •rd rA~n 7 NO 11 ir11A • M. p r~~~ r 1 f I??ARt ~I atArM COOt MO. t. Y~tlAL IItMf[4Gi (~w. Ma..t l..~r ~r...pw~.. A...irr ~..~.rM) «a~e~t+d ~ ~«rir • i7A1'f A Co~yr7r ' ~•a •~ll St. Lucie 6b-025 ~`lorida St. Lucie ,t.~.~ - - ~ ~ o. ~.r- e. c,rY. ro~. on ioc.T~au ~ a•ua a oc~rM ~ c~TV ro~r~. ~e wc~rioa n~'i'f's'ia~+cf •~~~at IIK~OE l!r1T'Sl ll~yl CITY LIMITSt ~ r,,.. Ft. Pierce .ESL~ ~.00 Fort Pierc~ n;~ „o? ~1+1M1 tlF ~ IJ Iw IN~It~1, ~fn ~trMf ~d?p~) ~ IEMOTN OC lTIF[I7 AOORES7 OM A FAIlMI ~ Mpf?1TAl O~i • ~ ~L 3TAt IM QD ' 111ST1TUTiON ~y ? ~ C1 ; D~ fr..r .~IS~1r. I.w 1~Tt Llwy Dw Y~s (11'W K/?ht) 1yi ~ ~ n C4~M , SEx 1 E tq.011 G# 11ACE 7 MAR*~ED M(\t~ M~RRKD ~n d~~ 1 Ai[ Ih1 Nsri •~JI~Q 1+If/~ YIYf11 I~i. ~ ~ ~~1 ~ X.w. P~. /?ww Yi.. r t t• I/IpCfYIED dV'ORCED . s 1~ 1) 10~ USUAI OCCWATK~ ~Cf~ ttwf ~/.ea1 fn~t RI~OOf ~US~M[%C~ ~~OItSTR~ 11 ~MIT'1tRAGI f dr n Anl/~ owt~+?~~ I Ctri7q1 ~IM~ OOt/rT~rl NI ~ • 1 t M p~ r- trrpfy rrf M~wtfw h/t. wrw if rdtrdl V - •iR~r.t D fl S ~a~Q l, d 1, i~ • V~J~~. ~ Y( ae t 1 ~ Y I. ~af~1(~ ! ~1AM[ t1 ~qirwi 't r~+OtM RAYt sr ~ 1~raLor~ Sca°i~i - V ; D' 1 w~S 0[[E~![D EVFR M u 1 kqYfO fVRCIS' T}T lOG:ll fFC~R~7Y Iq 17 f itiMll ~Ona~d C Q~~~•y~j ~/r w. w~ r.irrwl M. N~ Mr p~aw N wwwl • H~Ci.li.fi.i 1 ~ h~~UY ~ _ _ - _ - ~ n..~ x t 6R.rK e1 atArli ~E.+.•.+h ..r e.~+. Ne+ eiw. cst. (el..s~ t~i ~ nrr vM. ~['TVaN ~ ' PI~[? AMD DUTN •f>oeto? ?AqT! OE~THN'ASCAVS[OF/~ + ~M~toc4rc c~uxc i~) ,~iQ...^~_~~~C.I.1lS.+.L'II - - _ . - - - ¦rat fl1• c?• e~r- t t t f e~ t• ctiadlfll~~. 1/ n~s. Wi[ TC (1) ~ - - •!tY tl• NKi ~re ru~ q ~ - - 1 • s • 1 ~dw~ r~sw r• f~lrar ~ . ~ ~ t/1~ n~u t~et Ovf TO (t) - •tt?ts 71 - i~~r• a~~ ~ ?AAT 1! crK.R s+cwrwr a~o~ra~w cr~nrw,~~ ro au~ wn ~m w,.~~n ro rw~ nx.~..~ anuw wK.rr~ s~r V~~1 ~S U~C1"lY r R~OR~et Dt t~r d~~th ~S 7[i[~ MO~ • r ~ ~ f e r • ~ ~G ~ Dcsc~~9E MOM +o.:,,~r acu~~co (6+dn ~dr+r ?J~ar/ fr f'ar~ t ar Pwr ll y irea t~ ) ~etlN~ abJ ACCIJ(MT SiIK104 MC1YK1~ '•!/~sil - ~ • r 1qc T:wc v~ Ns~r A.rw4, Dw. Y.. - ~d1 • ~ iwul~r r. ~ ~d NUURY OCCliR7VED IQr ?tAf[ lX M.IURY II. M M s"~YJ ~o7iY. CfT~. TQ~MN. UII tOCAf~ON - CDI:MII' ST~7L •M~lt AT r1 wryT vYkf~E f'J lr~w. A~t+il. K+df, a~+.rt dti1.. dc.~~~W tl10Ak ~1• WO~rK ~ ii i~tf~n~d fh~ d~cw~sp Irorr~ __o1ty.~_~Za.SL~ , fo p1'. ~~,1~_.,~ ~nd /~~t u+ h~•lir~ on ~.~:11 - Dw~t~ ocewrree! ~e ~t p ar en t h~ d~t~ ~e~trd ~60.~: ~nd to t14~ 1~r o! m~ ~»arHilM. /.onn rAw wu~+a ~t~t~f d t 1 1 ¢ ~ ~ a - . '7~.+`"~- ~ ..Y._ - ?Z~ friwlTllF~ ~[1Mrts mr tYtt) ZIG auD#[SS Z?s, MYE SeFqEO •r• to lt .••?=,L• a . s~ M Ft tisrce Fla. 2"c 6' .cerr.e.. t'3~c R~~i. dRrwr~Dw ~ 2'~ pnTt lk KAM( OF tCVEiEIt~ f?I~ C!1EM~7G+r Zy IVC~Tipp (GY~. tNr~. ~r eveyt?j r (Mtr) IIrOtlLI ~ V~K1(~~ 1 < • y/ T~ ~___.i~~~,~ F_~iic e Cetnet~~1__ x't. Pierce' ~~~'lor-i~ . 7. 1. I9:Z j( It:h4RA: Jt 5 SK'.M 7UR[ Q~ -Y `~OPRliSnel'~1 NOIG@ 2S MTt ilECO ~Y t.UC4: ~~6 ~26. ACGtSTR~~3 ia. E i li , . ,~sa ,;Oq Y "t Pie re Fla. ~ --22-E ! 1~nr1a i.odt`1?@ri1~or~, d.r:~ , i,hsfab~'~ectify this to be a true and cor;ect c~py of the I.ocaf Regis~rer'i _record on fi!e in the St. lucis Counry Heaith D~art- _ ' . s ~r~{ AtlFort.Pi~:ce F!orida. 1 ' (Watning; I~c' va~io un'ess raised seii of th~ St. lucie ~ FI~ y(A(1~(~QC~~~4K i~ C . Caur~ty He''r`+ 7e~artment ;s 3ffixed.) - ~ " N. D. Mill`-,^, T.'1. D. } ~ 1Y . ~ ~ , ~ 65 ~ 1' Counry Health Off;cer G tocal Re~istr~r ~ : . :r~. ~`S.- ~a-1 ~ G~ ~~~i i6a_it~~~ :~~OG~R FG= ~ ~Sf+~J. CL~RK Dtt! Deput~r Local Rec,~isSr~r d~,• ~ UCIE COUNTY, ~ ~~aRi~a g~~K~~t7 ~ ~.~i.?~_~ ' -