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HomeMy WebLinkAbout1920 i ~:.-a~~s ~....y :ei. ti._ ~rr~YS ro~ ar wrn~.~ CERTIFICATE OF DEATH ; ,?~(L eo... . ~u~~?u ~or vtr~ rrwrme~ t~rwtt~ ~tu no - ~.~.1 ~L08IDl~ era .e.n t~ r+ . R y r o p. r 1 r L vw~~ u~~tNe[ l in.. w..r w.t u r.rw+...: K.+r.u. M~...r.r,.i..) •Y~eat~d i. KwC[ e~ ~tA~f/ COD[ NO. and •ill ~ ~A~ e. D• ~ 1 a c ~ d D. CtTY. TowM. OR tACAT10N c. iS rL~CE OF rn e. cm. tOMM. 011 LOG1TqM e. ~S RESioEUCE in p~r- ~?a~eL tNSIOE CITY LIMIT31 IIeS10( pTY UMITSI fil~. ~ ~ ~ 1. IuMf oF (1/wrt i~ ?M~~t. Ire ab~M Mlrrr) I. STREE7 AOOfeE33 MOS?ITAL Oll 11i3TITIfT10M ~ 7. NAMS e~ I'lrrt Nk/G Lrt 4. OATE Xwd~ D~f Ysv ~[CiAft~ ~ ~~P~ p DGTIi S. SEX 8. COlO~ Qw RACE 7' MARRIED Q NEVEII MAk/1KD ? DATE OF NRTX A6E (h ln?~ tMOtR 1 TUR N~EER 2J MlS. lpf OktR/e1) Xw+M Dy. Aw+~ Mir. ¦ t 1 t• ~ N11ppMEp ? dVdtttD p 1 a1 n 1~ ia. usu~~ xcur,~no~ (aar rtnt yw.~ i... 100. KIMD OF tUS111ESS OR MIDUSTIIY i~. r~Rrnnacx caw w ~e..M. a.,np I. Cl~I~A Gr *iN~ ~1R~'t sseA y•r- lr.iw~.«eyw.t+~tnR.Mr•1/.ftirop ¦an~at ~ ll~ek !nk ~ATME1l'S NAYE I~. MOTMER'S MAtOEN IIAME ~ or t~p~~rft~r IS- NAS OECEASED EVC11 IN U- S ARMED f~ORRST 16. SOCUL SECURITY MO. 17. 11110AMA S M~NATV~ John Hansen ( fw. r. .w~,.r.d Ul 1~. ww w. ~ IW~ y ~ww1 ~1i6tN Tan~Tal I!. CAYf[ O/ O~ATM ~b1Msr Ai~ M~r es~ur pa llnt/M {D). {d.J 11fTCRVi1L ~E7MEEN 011SET MW OEAYN 41?~CtOf ?AIITL DEATMw~3GUSED~: iMrEDWTE WUSE (a) ¦~~C tfl• es• e~r- , •itDe'C6• r ~u~•fJ~~• ~ ro (6) ~ ~i~ ~ 1 o e a 1 afdb~ t1t rwder- rs6l~trar !r!w/ e~rx l~e. OVE TO (a) ~ 1 t I11 n 7~ ~ /ART 11. 071E1t S~GIS1CJUrt COIIOftq~O OOMTItl~lTlMC 10 OGT~ w!i I~Cf ~A7[D TO M TERtl~WL Otltl1~ ~lOlTqll a1r01 N1 /MT 1(~1 KRI011ME0~ Your• •C- F, c~r e~.th ~ • TES Q MO ? or n• tor• i j~, pEy~Rt~E ItOM ~}VUIlY OCCURRED. (St~ftr w~tWf ~Jh~/~ h1 Pb! I R Pdf /11/YH~ !f.) dl~pesl'n7 ~ ACCIOEMt SUKIOE MOMK7GC tson ef ~ ~ ~ ~ mt. TIME O~ H~rr NMrA. Dq. Ye~ OOd~. ~ IIVURY f~. ~ a s. ~ 20~. IMJVIIY OCCU1lRE0 mt. tLACE Of nWhY (I. hl a ODwt istM. m/. CtTY. T~D1111. OR IOCATIOM COUIfTY 3TATE ~ waK.c ~T ~ woT Mme.c ~ IRn.lae~v. r.sa..p~ar ers~.~ ~a.) 1MORK AT iKMI( 21. I~tNnd*d th~ d+wr~r~dlrom ~t~r~'h jy ~,Q~~_. to y~~2t - 2~~ ~ 965 ~+~d lut +NS Aj~ rlfr~ on Dwth ooournd ~t m on eh~ d~n ~t~t~d ~bar~: ~nd to tM bwt oI eq k~hdN. troa~ tM wu~ ~t~t~d. ~1 i s t.~. 7Z.. s~ow?TV~c •(DMMa ~r N/k) 120. ADORE35 : IIZt. wi~ swnco •r• so . ae~}l~t• ~ p~ gQ N. t,h. $t, Ft. ~erc 8 6 ilEU~at~. ~T~. kAME Oi CEMETERY OR CREM~ITORY ~3l. LOCAYIOM (GTfl.lw*• ~ f'~~ll ~ ~~K csv.~+m ' ~,+013 2~. fUf1EML M E OR'3 SlGNAT1IRL+~atidpllESt,~ CI'~ HODIC a. DATE 71ECD. ~Y 4.OCAl. RE6. . REC Q'S S: ATU~ . . ~ , G.`S I' LL[1 s...,,ae W Yates Ft.Pierce Fla. 10-1-b Anna ~i.ee: Ikni.son : d.r; - ~ . _ - ~ ~ ` ` ~ . ~ ~ pe~! ,this to bs a irue and wrr~ct oopy of the lxa: ~ . ~ ~ . . . . •Re~~a`~+s°,•t~eW~rd .Dp fib in tfia St. Lucie County He,~ltfi Oapart- ' h.~'me~? .44 ~'Fldr~e; ~laride. a~i'"' . . / . ~ c.n ~y1/a~ing: Nat Yaf1d unless roised se,l =f the St. lucie o r-- " ; - ` CpNh~ ~F~e+tlth Department is atfixedJ ~ ~ ~ rn - ` . . ` :e • ' r ri ~ , . . _ . ~ • ~ N. D. M{tL~R, M. 0. .f.~ c : . - 1 , ' • Cw~nty Health Officer ~ loeat Repiatrar r w -b . - , ~~;1 1 ~ ;1 ~ ~ ~ ~ ~ / ..J ~ ~ ~7 ` ..Lt:-r ~.~«~~~6,5~ ~ tiC~ -r~ ,h ty~~~ ~ n ~~~.+~.,,~-~r.~....~r.~ ~ peputy l.ocal Reg+strsr d C- O • i• , ~ r-, ~ ~ .--a ~c ~ orn ~ y, .c~n o c~ J ~ gooK 1~i0 ~.~1 ' j