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~ iei•• o._ ,T~n sowKO ur Ms,~,,~ CERTIFICATE OF DEATH
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erd •p~n SIRT NO. A~i A• NO.
pTOp~~l~ 1. rtAt~ OF BrAY71 COD[ ti0. 2. VfYAL R[b1O[NC[(AM/.w~.NlirJ. !/hN(wiwu R~i/~wWw+~oiw~)
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Sn peY- E. CITY. TDWlI.OR LDGTIOII t. 1S ?LAtE Of DEATM e. CITY. TOWN.OR LOCArpN r. 1$ RES7bEMCE
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MAME OF (IJf~f fw ?Mpiht, ~(wt KttM ~lhatj t. LENGTN Os t. STREET ADORESS pM A?ARMI
1i05~ITAt OR STAY ~N ib YE3 ? !10 u
IItSTITUTqM r.
3. ~u?w~[ O~ Fb~t AlWts Lsx 1. o~TE Mewt! Da~ Ysa
E:dmund None G raham °E"7" - 2- 1 6
, S. SEX 6. COIOR 011 RACE 7. ~ S. DATE OF l1RTM 9. AfnE (Iw ~tVf T~ INwER 24 Me5•
NARIIIED NEYER MARRIEO ? ~ lyt Af+lAf~?) X..~Y Dew lfti+ Xiw.
? 1 L• i:i y11DOWED ? dVORCED V u 1 ~ ZS
g1a1n1] USURIOCCUtA7ph(QbrNn[eJevo?Rtowt IOD,KiNDO£lUSINESSGRIN~VSTRY 1!. ~IRTN?LACE(Sr~ftor/onipnco~wtrt) I. pnxFMafwiMTCi7u~fTR~t
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blaak Snk ~3. iA7HER'S NAME 11. MOTMER'S MAIDEN IIAME
or
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1S~ WAS DECEASED EVER IM U. S. ARMED iO11CE57 16. SOCIAL SfCURIT' NO, 17. iM/ORMA ~~1YM11':YM[ M~ • O._tL D• Q~hB~I
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Ynneral 1t. CAUf[ Or C(ATN (1i1~1n M~i/ n~s esras Da I(wr Jar (E). an/ (c).) INTERV~L EE7WEEM
?~RT 1. OEATN M114 WUSED f'I: ONSE7 AND CEATN
.use~rs~.i. IMME0IATE GUSE Hodkin~~isease f+
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•ithln T3 71~*/ cadu lul.
O lART II. OTNEN S~GmF7UM CA11dT1d15 OOf(T1a~VTihG TC 7EATH ~{!T NRT REU6TED TO Tt1E TE1tYIWLL OtlEAlL C01IOfT~11 6~ ~If4 . WAS AUTOFSY
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ter daat6 ~
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or b~for• ~ 2pE. DESCRisE NOW iNJURY OCCURREO. (Enltr ftatvr~ oJlttf~ry b P9~?! I q 1! oJ4rw~ l1.) ~
¦~kina cny ~ ACC~DEMT SUICIpE NpMIC10E , _ '
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on of ~ T~ME o~ No~r M~t?, b+t. Ysa
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~.2Qd. IFUURY OtCUARED 20t. rLACE OF fNi:1RY (t. M p/ CAOttI AOn1e, 20/. CI7Y, TpWN, OR IOCATION '-.QDUNTt. ~ STA7E
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woaK 11Y WORK
~ 21. I~tt~nd~d tM d~w~wd from . ro l~~r • end /~~t ~w il1'r~ on r• ~
~ D~ath oceorr~d ~f m on th~ d~t~ ~t~tsd abwr, and to th~ bwt at m,~ kisosHcl~~. hom eh~ uuMa at~•+d.
~ ?11 1 t~~• ~~~aMU1TMR[ (p~prr~ or t~k) 22p. A~DA£SS 2?t. DATE SIGNED
ars to bs
( _ ~e.rles. , RiGhard F. S - -
~ aeeur~t~. ~y~T~ 7~. MAME OF CEMETERY OR CREMATOR• 23t. LOG1TqN (Ctif/, fava, a eor~!/)
REMOYA6 (Spt[IJ~`. ~
V. 9. #b12 FUnER OR'S 51G TU AODRESS ZS. DATE ~ECD. sY OCAL REG. 26. REG~ RAR'S SIGNATU
as,. ieae Jose h~d. Yste Ft. Pierre -r6
, • . FILED A~~:D RECORDED
hereby o~rttfy this to be a true end torr~et copy of the laca: R~{~---h 0 ~ K
Registrs~s "record, o~ file fn thc St. lucie County Hzilth Depart- _~~c~_~~~'~~
meM st Fnrt Pienoe, Flor1da.
(Wami~g: Nat valid unfess raixd uxI ~f the St. Lucie ~~5 Q~~ ~ s PM 3:' 3
County PTealtfi De~artment is affixed.)
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n _ ! t , . ~ ti~i
- ; ~ N. D. MtIL~R, M. a. R G y; i.:.;~:;, r Lt ~ K
. County Ne~lth Officer 8. local iteqIstrar S T. L U C I E~: 0 lJ,ti' T Y,
- ~ ~ ~LORIDA
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~ ~ p~}e pepvty Local Registra~ d,
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