Loading...
HomeMy WebLinkAbout0496 * ~ t > > - !'TATr ,r Nr,u.t„ ~ERTiFiCA'T~ `7~ G~A''~N c;, ne ~ a RU11[Att Yt!AI~. /?'A'RfYtCif ~ S~~ i R''' "~Y!t 1?IL.! M~1.~~~ le`a] ord t,. \ p ? o , : i - ~ 1rs..~.~r... e < e ; : r ~ 1 /iKeR ~f: COD~ MO. ~ ~ wtN ( Irk Y +WI f/~YW ~IiMw I.M. ~rr+ywf~) s~~i , ~ - MUNT1 f7Atr CYfYNTY~. e e ~ _ g¢-.~i3rlre ~ ~J~yi{~ri da _ _ W<~..~.~,,~~ 1 ~ - C~TV. tOMrh O? ~MATIOM c. N MLAC[ 0/ prA M c. C~TV. tOr?M, Olf 1qCAT10M R*lfRt+lCt ~ ~~s~ac cm uwiTr :~+~nc : rr Ur~rs+ t ~ i e. res Np ~ S~L. . Mif~ MAME C/ ~/f t~ fN ~~Ifd. ~t ~h~ef N(nMt lTREtT ADDQplf Nq~?ITAL O~ tMST11'tIT~OM r~ f~k A/1M(r Lwt i t OATt tA !Y+ Yrer ( 77'~ ~r~/nfNl ~ ~ I OE~Tn A 1965 S[a 6 COIOR OR RAtf 7 flAT[ 0! ~t11TM ~ S A6[ i* b~ 1*t rMMMLD ~MEVEIINARM~C00 . ~ - . - y 1, ( 7M D6t±1~t) r~L Iwr rl?n XM. M r~ c~ MfIOUMEa[.] pv011C[0 ~ • p~~ ~ r If1~ USUALOCCU*1T10111~t1~1o/cwtMfll IOD RIhDOF~uS~f~ES30111XD~1S~IIY tt IITNIh,AC[(1~M~ ~rr L~ r i t• e.- Irri~/ ~Melf oJ teNNA/ b/e. ntf~ iJ rHir¢dl N+r~ csti.nr t Cifti[N 7~ r~ti t~:arTlhr n~r- if.~i.~, bl~~ ~ 1nY 13 ?ATHE~ S MAME ~ ~ I-' M TM[R'! MR~pEM MAME ' ~t ~~Ca 1~~M ~ ~ 170? Q A~T~dd~ t W 3 OEC[A340 IYER iN U S. AQYf f~DfICES~ I 90CtAL StCu11~TY p0 11 ~ ~j~ g Hamri~k iYw. r wwfr~..J ~ ll/ ~r. ar w o Mw N.rr:,d .V- _ A/N~N , 11 CA1MR ~I ~tA1'N fiWtr ~wf/ p~t iye~N ppr ffwt r,,.,,. c.~. ~e~..~ t=i.i i RVM !R'A[tM 0?ra:.o+ t~RT~ pEATNWASGUS(D~Y~ y, . 01K['AROOtATM nu. • ~ i • IMM[DI~Tt CAUS[ (~1 _ .Y.~~.i1~ hGm~.~..7`4L~4, ~a114~. u.~d~te~tl.i~ed - - T - ta. (DOA st h~~~~tial) ~ir ..c. (1?nb~iM.. 1/ e~I. puf To tD~ - ' . . +it~ th• r41tA ~OMr ri~ _ - - a, t o c s 1 t~tu (al, ~1'~ . , ' L/ •~s~ o -~r ~~tNe~ Mr rsln- _ ' . t~j~ t~r~e l~ef. D~e ro (c, _.Q~J.1~•_~ - - - - - - - - - - - N ~ t 1 ' i 7 ! ~ _ _ _ . . _ _ _ _ ROV ~ f- ?ART !i Oi~tll S!¢MfKANT Cp+at~OMb fXJKTRIr,Jtn» f0 DutN K(T 1qt R[LAT[~ Tp ry~( }4~I~Ml dlU7E COIIOIitd~ I 1 ' ' !'i ~tD1 t~t .xth ' _.~_~~•i~'"~ l or s'ors ~p auNik Npw iN~u~r otcu~RCO IT~fn ~~fqlf 0/f+lfnr~ M f"~/; /~I., ~II(f111 1~.1 n1T!: ; ~n~ ACttO~KT SU7C~DE MOMrCipF . d~rv 31- - ~ _"..er _ ~ ~ _ • 9 O r o f ~ - - . bodt yy~~ TIMC O~ i/OV/ M~N~, 1H~. YIO "4'} ~ ~ ~MJUFY n~. _ . • w~_ _ y, n~. ~i. / r?.!; ~ IMILIRY OCGU~RED ~e ~IACE Of ~tUURY p. M a~Iw~Aowr, ~J Ci7r. TUwM. O~ L(KaT~O? . SY~tE tMN~I[ A't M07 WNrIF /u+n, /~ct~r~. ii~Mt. o~ltr hlk., ite.) MO~R L~ ~T MV11K ~ , pL r~-i. d ~tNnd~d tA~ dw~~wd /rom _ _~ti.~ ~ ~ri.lL_,~ . to ___L~.~i~ ~nd i~et wr ti!~ •!(r~ sn _._i~i.a~t D+~th aoeurr~d at ~ 1 L~i.~,+~_ m on th~ dat~ ~t~tW aawr te M~ bqt o! eny Artyrhlh. /roen 1~~ c~vN~ ~hNd. il: 1ts~s -J~ tte s~s~wws tv.rr~ o. rn~.~ ~2A ~D611E~U3 Nfi. 9rV~Rth 3t. o~ rt sw~o .r. o ~e -e~F •c~ ? ~ x Fort pi.~rce F~~• ~~2~'-fi ~e ^ v •t~ . ~Y~t~ ~ D~T[ 2k M~ME Of CEMETE~Y G11 GREMI1T011Y LOC?i16N (CU~, fNrt1.11 tNlflf~) Rtrw+~s ( ~p,r~lr, ~Pierce Cemeter~ F't. Pierce, .Iuci~s lr'~.a. P. 9 0 p{ ~UM RA 0'A S SICMATU~~°~eP~ H~Q js 6l7E IIECD. !Y LOCAL lIF6 . II[61fT11AR~~ S~~ ~ Re~ tDSS f~ Q"~ ~ . i ; i_fu~r'bby c+e~i#y"tliis to be a frue r~nd corrert raopy of th,e Locel ~ Registrar's ~e~drt~ an file in the St. l.ucie County Heaith Depart- oe ~ ment at ~¢tt,Pie~oe;_F!orida. • ~'t 1~t'EC . 1 RD~D - (W3rnin~: tsot ralid un!ess ra;sed saal cf the St. I.utia (~~K Coui~t~ Fiealth Department is affix@d.) ~~~~~y , : . ' i "~l ~ : . . . . N. D. MtIL~Q. r~n. ~ 2 ~l PM 1 : y 7 ~ . , , . , • Covr?ty he3trh Ot#;cer ~ Loea! Regiatrar , , . ~ RG'~~';< i ~ ~:r,,, r• ~~~t5` ~-~ciE Cout~7Y,~K DoM [k~wty local Rvqistrar ~ 0~ I D A ~ C~•r. goo~ 1~i1 49a