Loading...
HomeMy WebLinkAbout2165 ~ ~ ~ _ . r f - ~ !'~.~~(~1).~ Tni~ rT~TE eo,?ao or HtALTTi C~RTIFICATE OF DEATH ~ ~~•t• • •u~~.,u oF v~r~~ rr~nmcs p L O 8I ~ A rswn ?i~.t tso. ~.i,~ re~- ~r~ •b~n y R A ' ~ r~~~ r 1~ t 1ViG~ ss ~tw7w c00 [ NO. L YMML ~fMfMOi Mr.~ ~r.i U w~a..~: h./~r M~. +rM.i~ •~~~Y~i~ C~UMTY Y'flTf COIlRTY .~13 Indian Riv~r _ x ~lc~rida St . Lucif ~1~~~~ C~rr t6MIN.OM l!?CATk7M c~S iL~Ct OI OSATIi c. C~TY. 10~IfIt.OR LOCATDM f. ~1NYt IMS~O[ UT7 Ur~l7~ IMNOt C?17 LIMIr71 r~i.. Indian Kav~~r C~~ ~nt Yrsp +b$7 F t. Pierc~ .rsL~ roB 1. 1uMt Of ~ tJ v( iw ?wpM~f. /ip iuwr Ndrwi 77~I[LT ~0011qi n~r i ra« Pe t e r s R~~a <j , R t. 4~ Box bOb ~ ru?~ ~i sr,a ~uwt. t«i 1. awrc l~f.,1~ r..r ~iys~No„ui `':1' ~e,L ~i:I,LS FlAI'Li:R.`~U:~ o°u~rM July 22~ 19ci5 . SEx ~ CDl01t C11 IIAGL ~ IRaRl11[D ~ NEVf~ YARR~ED 'dRR O~ lfwTN ~ A~[ (h /rI1 1 M~ 1/~~11 ~ 1~1! !Y[l~R1 Y~~M+ D~ awrr Yv. r. i c. Ma 1 e ~N~:i t~' ~ wtoowcr~C~J GvORCID ~ullc? , 19G5 ~ , r 1~l ~ 1 J Ia1 USUAI OCCUTAT~OM 'Ctlc ttR~ a7 aKt~k~VOD KiMOJ4' ~~i~MESS tNtXi5T11'! 11 ~~IIT?W~I/~L[ ~~~[t p Mt~ pMt~!!~) qT~ r'~MT COIARR'f1 •it? psr- Isrty mwf sJrptiy:iJr,err~ i; r~r~I~ j~ ~OllCja, ~.~J./~. i2anc~~er :.~tt :e flaok 1et 1~. f?7N(~ S MI~M[ t1 MOTM[I1'S rAlp(M IurF tri~~rlt~r Yulce _r+c~~L11ErSU:t J~jlie L..dt71~z 1 Y+Ii{ OICUSLO [Y[~ MI U 3. A~w~O ?OMCts~ }8 SpCU~ stCU~s7r ?q 17' ~ M~AY I 1'~. a~. ~~wt+rw~ 1// W?~r w. ~ i~Mr N~rw' 1'1 O A~{Itsl p F t t' L S t{ C1 }C O . IY~?~! II ~~Yt[ •I K17M ~t_'~(~r rwl/ Me cssw' ya~ (int f+ ~n~. ~w! ial ~ / ~ • O~OtY AMO G~ATb !ir•at~r r.~* , oc.rN w•s c~rsco ~v S'. J~?~•~ C~ `~~~f 7'~f,] IY4C:Ji~TC CAl'$C •IQ~{ ~lit _ _ . ' ' . ' . _ t6• a~t- ttfl~~t• ('chlKw+u.11s*~' ~ •!tY th~ Y14? /sN .~y ta Ddf TO i~~ v - - - - - - - ~ 1• e• 1 dar rnu (~i~ - - - r~sl~trar a'~:~+i t4 rni~~- ~t TO f~ •!t?!• Ti f~in~ r~~at lN1. ~ - ~ -~_i-~- - - ~ ?a~T tl O'~ S1CM~RAMT COKwTIbA CO~R'~KF1'i CY~'v R!' 11CT ?£lA'YC f0 '1A RIriN41 DOlA7i[ CO~YITUM Q1401 M MRl ~(~l ~U ~sai e • f - ~ ?'[RFOIIM[CT t~r d~?tA ~ •r ~~fer• ~s~ b - r~. j~ 1 : a ~-----~~~T~1`ut~ ;:flCll~tk ti11111 ~MJURY (Xr~~i1~fC (EMfrr wefllr~ ~!ipra•/ IR VPl ( p I°i~i fl ~f Yr+R l~ ) •~t~e~ in~ ~ ~CC~DtM SL+C r.{ '~pYKIC{ j ~1 L • lt~~o~t- ~ G ~ ,.7 ~'r "CK 8 t1~• ef - ----~-r---- - Moi~. ~ Rk t~wE Gr Ne.r N_~ie, l~ar. Y~or ~ JIU~.'I s. p~ ~ +r. ~ ~ 20/ ~NJU11T dCf ED 20r ?LACI OI :~UU~Y (t { Iw or ~f l~swa, 1SiJ CiTY. TCR~. 011 IOCATIO~ COL~MT~ YT~Tt yrprtt ~T M0T +MNKE ~ hdort. af~ ~r, o~ri Ni~~j t~ i P W~DIIK AT WCl1~( V ~I~' ~ • I PI~C~ ~r, ~ ~•/Q / • 1 ~tt~wMl fh~ d~c~ud ltom ~ - • tu ~nr la~f w+~ ti T •lir~ un oeawr~~ ~r ~ m on rh• d~t~ ~Nt~d Rba..~: •nd fo tM D.~c oI m~ ?rq.1~p, /.om tl~~ wu~ ~Nted ( 11 ? ; t . N YA[ {fx~rtt a u - - ZiD a70~E35 ~ ~ . 2?t. dAT[ f / ~ , ?r• te /L e~e~lst• ! II !j1'1..0 7 ~O ' aeea~r.t•. ~~4. ~~Tf ik~ M~YC Of :E~ETE~Y Jq CRLwAT01lY 23I L0..Ai1D?I (~M(.l11/A. r['M/wl/; f3~1 ; ,i'~"'~' ;-~~-~5 I~t. Ni~ic~ .:ei~~~•~ , ~ Y~erc~~, 5L :.uc~e~t~ 1.~. ~ i!)12 j FU ~4 DI 3 1 URf ? SS 1 ~ DllTj RLLD •7 IQCLL ~EG 26 FlE61ST11AN S S~iMaT1lIIE ~al l~ ~`UTik~: _ i /J ~.r•. ieee - 'r . Pic~rcF~ r ? . 6- G.~ ~O?QttLfve - 1 ~ ; t-,erebT ~ertif~ th~ e~ove t~ b~ true ~n~ corr~ct c~p~r o.' the . Local ~agl.~trer' ~ rGCOrd on f i in the Tr~dien River County Health Y Gepar~~nt at Vt: o H~ach, F`lori~a. " ~ C.] O C ~ '~'iis ~not re~lld unle+~~ th~ rais~ eal thc ;ndia ~?i~ex~ C~aunty o a~ d ~ ~ EiealtFL~'~3epertmesnt le affixcrd. 1 ~ ~ ~o ounty lth~ ffic~ , LQC~ 8e~istPar ~ 2. ~s d`+~ . ~r: . ' J . ~ 7 j z~ ` J~ G~orgsa JoF, Depu A letras ~ ~ or~ u~h ~ _ ; ~ i ~ G~ • ti' . t~ ~ ~ ~ ``~13t1 . ' aaoK . _ . -