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HomeMy WebLinkAbout1511 ~ . t•~• .~+r~,~ .w~wr a. CERTIFK:A'i'L~ OF DEATH ~ ~?t~ -.t ,..,~c • su~u+nu ar nr~ r?wtwr~a frATt rurs tw.- 9ti~1 r~.- lLOIYD?~ - i. .a~a w? .snr.l coo~ ~ea~ rwn. ~e c......~u.r.i a~.r.... r..w.+w..~r.W •a~~~t~~ a, o01M~Tr . a lTS1i OD1111tr ~111 ~l~e~t ~ t• ~If~ C?TY. T63~M.0~ LOCA t. 1! ~LAQ OIF 0[AYM t. CfPr. 1VY11.Q~ LACw21011 f. 1{ •~s~st nrfr0[ Ctri LrYR!? ~lIY[ ~tTy L~yR1r r u.. res ~o ra iurc t1/ na w.r+r. r+~+ ~r.r .Yan1 m~ccT ~ao~cfs MOl~IT~I OR 1~Ti~1R10iM ~ n.r eaw. t,.~r an ~u.~ ~ rw ~ ~Y/~ K 1Ki~t~ ~ATM . 9[II ool.OR oll ~AR 7. MAlllq[b p M[vGl rA~11rCD CATI OV Mw'fif ! ML (1~ /wI ~ M i~/ N'~IM?1 D~w ww Y/r. ~ r 1 t • ~p py,~~~ ~ t a t¦ t~ Io~ usuK octu~~n~ou~OM. tl.~ y w.~ ~r.r t0e K rw w~ss o~ Ma,sr~r n~enwti~ c o~.~ aaae?t) t a+~+ w wrr o~er~ • f t~ r- ~??h f rw1 ~l so ty~. wN y rAi~L1 ¦~~~~t ~ ei.•t ~wt FAT1~R f IM~1[ t rorM[e r ar ~rt .r iy~~vfltst a ~ tt~ fif 1 11115 DECEAlED ErER M Y 1 AIIM~D ~011CEf+ ?t ax~ ~cv~m ~+o. n ~+w? Bi~'old H. BamM I 1'r. M, ~r r!Jrwi l!/ wr. A wr w~~ ~ wrw~) ~ A~M/ wa.e •i ew~ M wrn (au. ~w... ~w. ~n ,r tu, t~~...+ ~rurw~ ~c~ ti? ?A~T 1. Ot~TN 1A'i CAUy[D W 01~T A~ OUf11 ¦¦~t ttl• w~KOUTi CAUac ~•1 ~'QQ ~ ~ ~T! t~s ssr- si:i~~e~. c~,rw+w. ir~y~~.r. ax ro cAl (~rmiC [Ir3.e$=X it1La~~ t~~ _ ~1c~ 1•• a 1 d+rt e~iw (i)~ f~ f i s t r~ r ~~~I !M rsh+• ONi TO c' ~ f~rf~y nwe 1Mr. ( ~ • 1 t S t A 7f ?AftT M. OfiM ~ii1~ACJNR 00~1DrT1CJId q~ifA{ 10 f~A7N II!? 1~? O4A/tD ro fM[ 1l7NIIML 01ltAl[ COI~If1011 lMOI ?~r~• ~ ~ ~V ~ • . ~~IMONM[Of ~•r ~s.ts ~'ST'd~'il C r t - • ' ro Nhr• ~e 20b fl[lc~Mt ?q~r ruvRr otC~ar1[o. (ilera w~tw. ytiW~1U M l.lr~ iA~'tld,•• • •~t1~t ~ta~ ACCKIEMT lU1C10[ MOM~[70E . 4•..t ' . ~l~~i~l' U ti~¦ •t - _ _ ?~dy. ~~c 7tNE OF ifwr Af~?. An. YMr _ ` - ~+uu*r w. ~ ZO/ nNUll? OCYUMKD ~t tLACE OF lKJURY (r. i~ V~A~at M+rr. ~ CIT1'. YL~N. O~ IOUTDII ~ GbIJ • ST1rTi pM1L[ AT ~ ~U~ wM11.E ~ ~~1. JKN~f. RrMI. ~[t My~ ~ ~ `f•. wMR AT 1MOIIK . . ' . 21 !~~»n~/ tA~ d~o+~wl /row~ ~__.L{~a_. T~ .~e _ ~t~ 1~~ INQ w~ Al~ ~liti o?~ Owrh amrrr~I ~t w~n fM d~t~ ~t~t~f ~Mv~: an/ fo th~ i~et o/ r~f tne~INN. /e~orn t1?~ e~wN ~f~tsl ~11 iN~s ~ M~~~ ar• t• y~ (UM?k o~ fYlr) AD011t13 ?~e. OAT[ SNAED e.~~l~t• ~ ~ R4i K ~ ti ~ laa~raN. ~~K. I j}~ MAM[ OF CtMEiE0.Y OU C~RtMATq1'I Z7/ I.QCATIOM (CY/. fMn. M Mr~) (Ad~) rOrK l9 1 ~uria~ -1 ~'L M~ra~ C+~t~r~ r r, i.+01I H. N ~ SKNA UN[ a pATE I~tO ~Y LQCA611iB- . IKi~S~A~~f f1iKA7U ~~e• ton 1d Ba1rr 1"L. Pisrce, ~la. ~ 9-17-b5 I~riaa Iw~ Dwi.~oa, d. r. ; 1 hore~iy certify this tp be e true and co~ect copy of tfie Local l~~~ ~ RegistroAs record on fil~ in the St. Luc~e County Health Depart- ~~,.a • 1 D~w,,,,,~ a~r~;~ merTt z~t Fort Pie::e. ~iprida. E~'~1°"~°~~~ " " ~ (Warninry: TVpf=V~I1G Uf'~B.°S ra:se~ se~l of the St. l~cie ^ I~q ~y~ COV(~~~~SItF: L~L '.t n:'~ affixed.) ~ OL1 L.i. ~YI ~ { lJr~ ~~1a~ ~ ~ N. U. i,+. ~ Z, h! . : . ' Cou~ty itealth Cii._s: & Loc31 Re~istrar ~0~~~ "''Ll~i t;,~~$,, ~L~R~ ' . s~. ~uc~~ ~~ovr~tv, . ~i~R~~~, • ~ -7 ~ ~ ~ ° .1 ~ ~ r~r ~Il.i"' ..a. • D~}~ Deptrty loce! Registrar~ ~ ~r ~ ~ B~oK 129 312 ~