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Home My WebLink About0609 ~ 1 r ~ ~~~~zliir ~~~~~cli ~?.111I2i~u ~~P~IIf~1 ~et~ ~II'~IltFlt~ / ~ . r: ~l: ~ ~ ? . 1" ylL T~„+`De- ~TAtt ~OARO o. Na.,~TM CERTIFICATE OF DEATH co~n~ • •UR[AU OF VITAL ITATIfT1C• fTAT[ FIL[ NO._..__~._.__. ~ ,•R•~ r~~- FLORIDX ord .Aen OIpTM NO R[GIiT1~AR-f NO e a~ r u c s d 2 VfYA~ II~NO[Mi[ w?.+. r+ww:,r r~.+r 1 r~+..~~~w~., R..~..p. ?.!~..r...«.., ~ r~ r 1 IKAC~ O/ M[A'fN COD[ NO, A COUMTV ~ S?AT( ^ CO~MTV •na r111 ~ ? nj P$l~ _$~ach !1 - ~ D e y 1~ c e A ~ S H J~., l~ ~ - ~ - _ . 11f pe~- A. CITY TOWN.OR IiJC~THJN C S PLACF Of p[~TM ~C ~17Y. TpWN OR I~X~TI(~/1 ~ [ fS N(SI(~f~/~f •~tlint ipS~Df CITY IIYITSi ~ 'MS~:H CITY IiMITS+ r„e. West_PaLn BRach .ts(~I ~i~l Port_ St~__Lucie ~ Yfs[~ ~~C; - - - - - I. ti~yF Os l! not is ~lwpwd. Ive ~nrer sd~rra~ ~ IfMGYH ns ~ / 5T11EET ~noAt55 ' pti ~ NOS~iT~L OR STAY t11 1~ 1 INSTITUT~ON ~t~ Nar~y's_ .HospiLaZ _ - . Sanc! a _Drive ~~5 ~.J , 1 ~ , _ _ _ . _4~4---- ~ _ - - - J III~M[ ~I fYrH .V~ddle l.wt - - 1~ ~ATf .IfoetM I~a~ -1'ro~ "r~.`a o`.`o MARIE MAC B!~tID~ !~:,M Feb. 14 1965 - - - - - S 4F7( 6 COION O~ RACf ~ M~RR~ED ~ hEYfR u~PRi[U? e 0~~) Of BtNTM 9 AGf ~~1» ~t~r1 If V+~Otp ~~[~M ~f VM~E111/ rYt~_ _ + r ~.~y j ? n I !aX ~~•irLf#da~' .Vt+t4 (iew Nr`-r.V~. • r y t e r~lC ^1li~r~ wioowcoU DIVOt+CEbC A ril ~l, _ C7~ ~ ' P d a t n l y . ~ ----p- - - - ---1- ` - 1 _ - - IOa uw~i oCCU?eY~oN i(lu~ tind o/r~0~llont I~A RIMDO~ ~'vS~MESSOR IMOC,STN~ 11 ~iM7Ni~?CF i.'Ydr o~ fer~t/q [oun~~~- - ~IZ UT~lfb Of Mw~t GWh~11r• . t t h p~ r fr p~wod oJ o ~s/ hJ~. ~ve~ i/ rrtvrd~ ~ `~ouae~~e Owm Hoa~e Icnra U~A bl~ek InY ~j F~TMU S MAYE ~1 MOTnEN S MAi(~fN N~MF or tYp.~rltsr Samuel &~rry Dor n~ia Wallace IS 1Y~5 O(C(~SED EVE11 IN U S A~MEO i011CE5~ 16 SOCIAL SfCU11iTY NO I7 IM/ORM~KT • Y~YN MA ~ ~ ` I Yr, r. ~JrwJ J/ ~r~. I~~r w r iYa a/ rnw~ _ ' - No ~o•,~., p ?un~?al CAl1K SI ~tATN ~Iiwf~ ewJ~ awt a~ru pn l~v Jnr 1~~, !~1. ae/ itl ~ . iNTfNYAL SETWFFM dl~retOt •~RT 1 L~E~TM W~SCAUSEOlY I/~~~ y,~ ~ ~ 1~ OMSET AMD DEATH a u~ t f l l • IMYIp1ATE CAUS[ . ".r/ r" ~ ~~Y~M^" ~'w{ ~ ` ~ ' ~ i lh• e~r- _ ~"'1 ~ t 1 f 1 e~ t• (~~w{wy, i~ M~, OVE TO (E1 ~ ry •!tn tA• ic?k~ /w r t~ ~ - - • l _ J. t o e• 1 ~Aa?~ c~x~~~• , . ~ r• 1~ t r~ r t~ rq4r• R l~iy taru i~M ~+E TO (t) . •1tRfn 7~ . ~ ' - . J._. ~ ?A~7 ~I OT~EII S/GMKIGYT COpdTqMS COM111l~{JTlllfr TO OUM RJT M01 RFUTL TD TML R~Y~rNI DREASE COMpitOM 4iKN IM ?Mi I~el WAS AUTO?`Y AOU~• •f r . . ?(RFORMEU~ t~ r d~ s t b ~S ~ N L„~,,,,,~ ~'}4e-a.-~^?-( V E 5? Mo m o r D~ f o r• IY. l IG~ IOA DESCRirf HOW ~NJUR? OCC~RIIED ~ F.~nf[r eN4r~ eJ ~~Ju~~ iR 1'trf 7 0~ Part 11 oJ l7rn~ 1A + ¦ak7~~ ~w) ~ ACCIOEl1T SUKIOE MO~eK10t dl~po~i- V Q ~ ? tton ot - - Xk' TIME Of Hour AIowM. Oq, }'ra Eod~. ~ ~~uu~r w. 7S V ~ ~ ZO/ IMJUIIY OCCUIIRED Z(k ?UCE OF INJUIIV /t. M o~ sMW AoAw. C~f~ TO'~'M OII LOCAT~Oh COUkT~ ST~YE M11tlL AT ~ Nl7T M~HILE ~ /~rrh. t~cro~~. rr.r~t. o~ler ~ilN . rrr.; IrURK AT WOAR 2~ ! aft~nd~d th~ d~c~wssd from ~T. . ~o ~ . ~ -1. _~l.~ - - snJ 1~~~ w.r ~~~~l~re on _ Z ~ L ~ n ~ . - [3Nth oeeurr+d ~t _ ip:~ - A~_ . m on fh~ d~N ~f~t~d ~bor~. •nd ro th~ 6~~~ ol mr ~nowl~d/~. Irom rhr c~ua~ ~~~tsci ~11 1t0~• jj~ MiMATYR[ ((Xp~reorlUlt~ ' l3D ~00~[55~ 22r U~7ES~GMEO ar• to D• p~ ~~¦o~•~• • G-~~ H.D. ~ West PaLa Beach Florida 2 1~f ~5 aecurste. 23~ twer~iw, 2b o t 2k +~~~lMEf[NYO~C~(r~TCpr 23d ~oC+~T~oti ~('v~. forti. or ro~ntr: (til'stri u t.tiprc 1 / / 9~'a/ ~ ~ ~s /~O/ ~ _ ' ~'.9. f814 fU11E11A1 1 C 011 S ~T E r~,~11~i5 S~t` ~ ~ 2S' OAiE RFCD !Y LOC~I ~eEG IS~R~R 551GNaTU~E fl•?. to66 i• I'.8 1 I fii~:.'tF':EY C'r:::';I~Y ':trE A~sOVE ~ H~~ r1 T;t??E AP~;1~.;u:~HE^T ~U~'Y 0'. <<i'r, :tEGISTTtAit'S ;tF.~C;tI~ UN FiI.~ ii~ THI: ~FFICE ( Not valid unless the seal of tr2e YaLr. Beach County Health Depar?me.nt is affixed) ~Ei:^.'IF~~:ii ~(::'Y ~ ; . ~ C . L. n~bac~, ~K. . _ Lucal Etegistr,~ , ~ureau of. V i~ ~ Statis#,i cs : ebruarv 21~, i965 West P~1.~a~ Aaac~?w ~'lorici~ R'J ~ D 6,P~ ) ~EC ~,a~~N: F1t_~,E,~~. ~.=,w;-~i ' : ~a,} i~~ ~ ti _ 9;~9 ,~5 4'~`,! 9 AM N, _ : .v ~'~ERK . ~ F~~?C,:_ • ` ,:'tir..~C~U~:~Y, . ? . L ~ - - . rLCRIDI~ ~ ~ ~ .