HomeMy WebLinkAbout0095 rws. e._ ~rwn w~uen or Nrw~Tx CERTIFICATE OF DEATH ,
eere• a ~Uf1tAU Oi' Y1TAL fTA'1'tiTiCt ~~/C~.
l.~.l FLOSIDA
a.n•n s~ r N. ~ ~
op•r1~ nwc[ or ~?n~ coc~ No. 2. uwAt 11w~IC[(~..+rr.ww.d, r/I,waw..rr wnlww.M~..~+++..+.+) ~
..~os.a s. oou~TV sT~~ 1d8 cou«n 5t. I,uC.~.e ,
.e .iYi
• p2re•a ,
lO p~r- d. CtT1~. TCri~+I.OR ~AC~7qw t. 13 rI.ACL OI DfATM t. GTr. 70M11.OR LOCATI011 1. 1! ItCSt0E11tC
l~e~nt IlfSlfl[ CtTY' UMtTS/ nt MSIOL UMITYt '
tll~. YE3 NO? rICTCd Y[! MO
NAME f7F ~qn,rtl.~.eNr.t.N~+.a«r.tlrw) mrcct~oo~ss ,
MOSMTAI OII '
n~srirura~ ~ t 1 Fernit1d1r1s
s. w?M~ w Mr,.e i iv~ut. iw wn ~u.,a n.r Yeo
NEWTON WE.TSTFNE ~TMOctober 30, t qb5
. SEX OpL011 OR MCE 7. MAR11K0 ~NEYEII MAlIR1i0 .~n ~~IR7N AGE ( ~ rMM/ r M~ 1~fM UMOf11I~ MS-
lYf 0 ) ~1wW D~M Bwn MI..
• ~ 1 t. male white w,oo,.to awRCCO March b, 1891 l~
y 1. i a 1~ IOt. USUAL OCCU1'A71DN (OM[ RI7~ 0/YOIR j011t 1~. RIND Of ~USIf1ESS OR INDIISTRY i si~rNrucf (Sr.a r? ~?..yr a.~r.~) t. ert~ w r+u~r en~nen
•itl+ p~~- frrfMltpoN ~oor froh , 1/rdhrl)
..~.~c p~`~ ~is~~utax Wholesale Pennsylvania U.S.A.
Dl~ak l~IL ~j, ~A7NE~'S MAME I. MOT?1ER'S MAIDEN NAME
or
~,r••~~eir iJnavailable Betty Del 11~Po
WAS DECEASEb EV[11 IN V. 1 AlIMCO ~011CC3/ I6. 9pC1A~ SECURITI' Iq. IMrORMA s s~au~rvwt CJS C . d S ene
I Yr. Y. M Y~YIN~1 ~l/ YM. wM wI p~M/~ ~ Y~~M)
no 221-09-9125 A.a... 3 t 3 Fernan , .
Ean~~al I!. CAYS[ O? O~ATN (blk0 eMt/ o~s ~w~t pnllwt/br (a1, (b1. ~w1 (tl.) INp~T[REjV~A!L1 ~E7MrEEM
i .L ~ • OGTN
eir•ecor ?AqTI. DEATM~ASCAU3CD~Y: SCju1C - Arterinsclerosis
¦u~t fll• tMMIpu11'i GUlt
tA• a~r-
eirie.c. ee~wuas.,~/.*r, ouc ro (s)
•!te tAs ~?kA ~ww ria~ b ~
1 • o • 1 .Eer~ awe
r~si~ttar ~4 r~• pyE TO (e)
•1tAin ?9 ~I~ J~. . W A
Ao u r r ? C'- ~ ?AIIT II. OT~Ot SK~YIGMT OO~DRqM'3 QOMT1pRJfi~4 TD OGTM N!f IqT REUi[D TO TN! f[R~ctM~t qAAR C'f~1~01710N 41Y[M M MMT I(~1 KR/O1tML0T
H
N~ d1~th ~
e~ O~fO~• 2Qp. pExR1~E MOW IMIURV OCCV11RE0. (Ytllft~ feUY~t 1/h1Jtt?p PIf I M POf II ~JYA 1f.)
¦akfA~ •nr ACCtDEM7 SUiC10E lqMIC10H
d1~p0~1- Q ~
tion o! TIf~E OF Horr Mwu~, D~I. Ysa
sod~. ~ ~KJU11r w.
S D•
W
~ XU/. IIUURY OCtUMED 20r. PIACE OF IMJVRY (t. hl M~AM~t Aeiwt, m/. CI'TY. TOM1M. OR LOGTKNI COUMTY STATE
WNII[ A7 0 raT vniKt ~ fp*~ I~ar. xrret. eDse~ etq., .te>
iY011K AT N~ORR
~ I~tt~eed~d th~ d~aaNd /nm , to = 7~d end 1s~t ~ew ti,~ ~lir~ on
Wath ooourrsd at m on tM det~ ~t~Nd ~Dw~; ~nd ro tM iwst d atr knowNdf+. lrorrn th~ o~uw ~tat~d.
~ii ie•¦• ?L. ses~uru~
s~• so e. (~nK o. wts) 22b. ApDRESS t~. w~rE sia~o
~~•D'•e• • ~ D 802 No. 7th. St.,Ft.Pierce 11/3/65
aLCYTIt~. ~ ~MU ~~~T~ MAMEOFCEMETERYMtCREMATORY Z]I. LQCATIOM(Gl'f/,lNn{,MCIYfIf~r) (St~lt)
R[rovNt (SprtiJ/1
Ft rce Crainatorium Ft.Pieree, Florida
Y. 9. / al~ TI, iUN!RAL bl OR'3 SKNATURE R 2S. DATE RECG. ~Y LOCAL IICG. . ~1EGISTMR'S EIGMA7URE
R...ieea Zuther E. Kramer Ft.Piercc, Flori a 11-4--65 Anna I.ee Dcsz~.taon, d~r.
I hereby c;eritfy this b be a frue and wrrrct copy of the loca:
Regi~tra~'s reQorr~, on file In the St. Lucia County He.ilth Depart- }
mern at'Forf-Perce, Florida.
~ ~.(I~Vamjngz No? valid unle~s roistd sc,l tha St. L~cia
' • Counfy Heallh Department is affix@d.~
r'~ ~ ~ N. D. MtLL~R, M. a.
. County Health Officer d~ Locel Rc9lstrar
4~ ~ 1~'r ~
_ib t, r _f Q_~ ~ -aZ~~
Llafe Depvty local Regiatrar ~ r
; FIL- ~CORDED
•
Jc~~~~ ?OOK
• .
• . ~iUl7 ' ~ A~~9 ~O ~ OJ
FzOCL;>~~:~;~,~~
5T. LJCIE COIJNTy,RK
FLORlDA
EOOK ~e~1 ~
O~LAUGNUN AND O~LAUGHLIN. ATTOFtNEYS AT LAW. FORT PIERCE, Fy.OFtlDA