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HomeMy WebLinkAbout2514 ~ ~ i 1. ~ 1 6~- ffA~r .a~o oF Nsn~„~ CERTIFICATE OF DEATH ~'7~J~J ~ es~~s • ~U11tAY OI YITAL fTA~'f/TtCf tTATt /ll.t ~ 1~«~1 ~~e- 1''Ti~a~n~ sri s\~n ~ a + yrb?~~lY ~ .:tieuc•~ ~aAes rr ~s,?T++ coat Nn. . wwL I~~cwett••..,.....r. e u~ ~ s.t/r~p,~..r+.y»> , I a~t • i 1 y ~u+~t~r r. sT~T~E 1• ~l~e~i ~ ~ il 6, aTr. *ow~.0it c. iS ?LACE Of ATII e. t~rr. roWN.oe e.oc.~ra~ f. r~~sat iwsioc c~Tr u~irn 'rq~ tm uw~ts j ff' YES ~+p? ~ ~ . ~ ~M (!f tNt f~ A~p4r1, /iy ~ttNf ~dlru~tl STREE7 ADD11E55 ' ~ . FWl~l1AL 04 j . , 1MST~IUYN'N ; ! i NAMi O?• /Yrn Mi/ilt L/W 1. DATE XwW D~ er ~ ~[C[*ft~ ~ ~ ~T~ye pfOff ~TA . OEATM i . ~ . SEX , 6 C4lOR OII 11ACE ~ yARIIiED ~MFYERM~RIII[OQ' ~Tf C?F ~if1Tk y~M~~_ i~ ~ ~6E (1M /t~?! M IMI@el t ~ ~ trf Oit~/at) MwM. G~. iww Y(w, r i t t• }~lt,~ W:ppWED~} DIV011CEb Q ' *It ipl i ~1~ VSU~L OCGUMTqN (G~et linQ oJrc ort Iortt !OG KiMDOF f~.,5~ME550Q iNGU57RY ~ 11~ ~1 'TNM.ACE (3fatt ar fottt~ rNtrtrt) . CfflSpl pF ~MT Cn1Mfl~t1 ~ •1tT. *~r- I~rie/n~a~t0/~ratin/h/r,~r~niJ~~tbrd~ ~ f~v~nt E 8Il ~11SU ' I 11iIIY ~AY rA7HFR S MAAE 1? w07HEA~5 MAIpEX NAME + 6 f N~ f £dwin Harde i: . iS W~S DEC[?SEC [VFi~ IN U S ARK(p FO#CES~ 16 SOCtA~ ~[Va1TY MO 1) IMF~IIM { Mt/Y wt N~~~~ : lYr~. Y. ~r rwd~ylfsl (l/ /~M r~r (1y1 f/ Knr-~ j. NO 2 ~ _ .Idhr~~ c ~t . i 1tA,?al '0 C~VS[ O? ~tA1M jEnlrr o•~Jy ont ~auae {~tr Nnr /m re~. N~. anI (c!.~ 1lRrJtVRL KTw[EI1 ~ ~~~1Ct07 f~RTI GEATMWx5UU5[DAY- + a~r u~o ourM ~ j ¦Yi 11 ~ iMMi0i4Tt Cxl~if 1~) __~~'~`''~l'd(~` ~z`1"~.!~ 4.---' i. _ . ___."____v._- ~aa . tltle~e• c.nlittm~,i/~n~, OUf tu ~ei _~~~y'145CI~I'Otl~ A8c'i,Y'~ C~15E3~B i, •Stl th• 4A~cA ~ol~ nH o 1• C 4 1 a_c~r tar~e (al, ~ •t~~r +'~:~nl r~?s us[r~• ' . vr10Un 97 2 r~"~~- :aia !aN DlE TO r~' --R~- - ~ ~011'f i f- O P~ST if OTI~~ SKi4(f~CA~T CQMDITI'105 COMTp ~JllNC IC I~~C~TYI b~lT pqT R(U7LD TO (NE TE~Y11M1 DlSEASE COMqT10N GIY'Eh IM M11i 1(f) S A h t~r ~~~th = rEMSO~r[Dt • r ti r f o r• Y - - rts ut~ i +'a ~ 2tY~ C,i9CAfEl ~.Ow ~NJVAY OCC~RRFG (Eefrr aalsr~ o en us iy P~rt ! a Psrt e'tM lt.3 YO~ih~ ~nj ~ 11CC~f~tNT SUtC'nE Hn4~Clil ~ 1!/ J ~ E~s.3~s1- • r ~ ~ Rii ~ at ~ ~1 ~ ~ 20t TI?~E Of Nabr .~fnnlA. ltor. }'rrt~ ~ ~ IMJliRY a. A. . ~ ~ p. ~ 2~Y CNJUilY p~:CU11RfD X}t ?L~CF Of '~MJUI!Y ~f. D. ~n OtiCd! A~.r~~. IO/ Ci7Y. 70Wk.O!! LO[ATpM C1plJ11T'f ~TATE ~ ~ MMiL[ AY ^ ppT ~YN~if G Jarm. lutccry. ~trrr! r.~tt 6±E1 , eftJ . 1?bRK AT WOR.t ~ 21. ~~tt~nd~d th~ d~cs~~~d lrom A,~~. t- . ro ._S~11r18 ,2~ trtdlast Nr h,~ ~l~trh;~*la1~A .~1 _ 1 ql~i5 ~ D~rtA accurnd ~t _,p_~~__ m ort thr dsq ~NNd ~Aov~; and to tM boat oI ~!t ' }~f'11~rlNStai~/. ~ ~l I f t~ri jj~. f/YMAT41li . ' •T~ 4• i• (lkp.•r or rktie 2?L ~OORESS ,~;'y~t ,.r.•...3 . .'*TL fINILC ~i " ~ . • _ 'r .~•~r?e., ~ Alva D. CJrr I~f. D , F'G. f'ierce Fla. s>~ ~ i 23a ~LL, tl~rAttp~. 2~p O~TE • Z3c M~?tf O~ CfME1EpY pR tREM~Tp!!Y 23d. LOC1lT , ~ I ~ 1~ravu ls jr~ ,IMf~.,Iw~t~ t _ 1 r # Buria~' 6 2 ~ Hillcresi Memorial G . ~'~.:P~er~d-~ - ' : s.=eta t4 ru+~~~~ a s swti.ru,~c yate~9°R~'fineral Hone 25 DIiTE 11ftD iY WCAL REG. Id. RE8 . p' 11CMA `1~ . 4;~ ~ Asr.iaee , - - i " Jose h~. Yateg Ft. Pierce Floria fi~-23-~5 Anna ~ . ~ ~ . • ' : 1~}~~ ~i~is 4a be a true and correcr copy af the loca! ec ' ~ i rti, ~ i s jr e~'s ~ ~o~ fi le in t fie S t. ~u~ie C. o v n ry N ea l t h D o p e n- : t:"•''' _ r.~?t ~ at fv~t ,P~. ~~or~da. F~ ~ E ~ A ~ ~ (~Na+~t~i~Qt ~v~raltrf unlesa raise~ se3} ef t',_ ;t. luc~e )r,l ~ ND Iq~CO1R~~0 ' . , fot~r ligatth Dtp~rtment is a4fixe.~.) ~C~OK ~ _ ~ ~ . ' _ • ~ - , . , ~ ~~S ~ ~ _ c ~ l N. 0. M,iLER, h~. ~3. ~ tIU ~ ; i` ~ • County Nealth C7fficer & Local Re9istrar ~ f j~ ; ' ` tif...~ ~ . R -i j ~ ~~'~'`i~.`~1~..._ - .,s~L,~ . Q ~ ~.+,",~ST. R ''vt i~nqS c~ ~ , ~U~?E ; COUNTYRK p~. D~rty tacal Re~stn~ Ci.rr. Fl.pRtpq ' ; - - - ~ . . - ~ I. - - j