Loading...
HomeMy WebLinkAbout1709 ;ht~ De- QTAT[ BJnRD ap HtAL7f! CEF2TIFICATE OF DEA7H cor+s a py)RCAU OR V11'AI, tTq71CfIC/ ~7A7[ RILS N0.- ~~~t r~ ~ legel Te~- FLOAIBA ord •hen BIR7H NO. properl~ REQISTRAR•e NO. ~J, eaecutad i. fLAC[ 0/ OUTN GODE NO. 2. YiUAt N[fID[NCL(Ma...f.r~yh~/ I/:...~i~..w: Q~.s.ruWu,,.6.i~,w) end •ill a' ~~N~ s. STA7E D. WUMYY ~e yl~c~d Sn y~Y- D. CiTY, TOWM.OR A ION , t, IS ?LACE OF DEA M c. LITI', TOWM.OR IOCA?~pM t. IS RESIDEnCE ¦in~nt IMStpE CITY LIMii;t Ik510E CITY 11MIT57 tll~. { YES NO ? 1!. NAMC pF ~(f pp{ ~?p~y~~~ ~ i~*tsf ~l6rtar) f. STREE7 f~DD#ESS YES n0 N0571TA1 OA iNSnT~TbN F d 3. NAM[ OF fY/I[ q!l6~:t Lw! I. OATE Mo~tA Dar Yt6~ nccuaco ~Tr~`~•n,r'~r> ''~`c HE.T~tiESSY o°E''`T" December 2 1905 S[% 6. COL011 OII MCE FIARNIED ~ NEVER MARRIEO ? 8~ ~TE OF lIN7M 9. AGf (!R ~tai~ ~F UkDER 1 YGq ~hpER:~ pK, JaU Ob[1da/) a/wuJ. P.~+ N.wn Xiw. " ~ 1 c. lf W wiooweo ? DtVOftCED Feb. 1 1 g9 ~2 p 1~ 1 n 1 ~ IW. USU~L OCCtiPATpN {(]/mt ki4( OJ~00/k Loqt 10~. KINU OF dUSINES50R IMOUSTRY i i. HRTN?Li1CE (8yatt 0~ /ottlpe ppuRlf/j !2. CTTIIfN CIF M/W1T CYJUKTRYf t h p~ r- QurtnO iwat o/ eorkinl hJ., at~ t/ rphred) Me Auto;nohile Dublin Ireland USA Dl~ek ink ~3. fA7HEA'S MAME 1~. NOTNER'S MAIDEM NAME Of tr?s~r1 t~r Patrick Henness Miars Ba al. 15. W~S DfCEASED EVE11 IM U, i ARMED FORCE37 16. SOCIAI SEWRITY NO, 17. IMIO { MGMATVIK Kathl.een L. [~iCIL"1CS8~7 I YM. Y. w' ~w?VIN{1 l/~ ~w1. YeI~ V~I P~OY/ 1/ M~~YI Yes WW I 0-0 -l+1~82 A~+~«~ Ft. Pierce a. Fun~ i~ 1 1! 6AUSi oI p[ATN (Esttr ~wl/ owt csrx ysr ti~s /n~ (a), (C). awf (t).~ fNT'EAYAt BE7N'EEN d 1 ~ t: t O ~ ?AR7 1, DCATM WIlS C~USEO 9Yr qtS(T~-~~y?- DEATH ¦u~L fll• IMMEDIATE CAUSE (t) ~nrl~'y lA1C'mc~~ 1~ ocardial Infarction f10ur.r9 tt~• C~~- tifia~t• c,,,au,,,,,,,~.p,,, ) WE TO {D)__ulC~, Hemorrhage -~astro Intestinal 14 Days •lth th• bAitA Daas ~iaf !o I . 1 o t• 1 oDovt tauu S ~ , rugistrar t,~~~ ~¢~~i r~' ~ o~c To c~~ Eso, h_ a~e~LUlcerations ~ ° i our ~n ~ f~ ~ fART II. OTlill ~IGIIIFIGNf COIIpiKMS CpMTttlKRIhG TO OfATN pJf hpt RCLAtCp TO TME TGYt1~tl pt5[ASC GpMly f1p11 G(yrj~ N1 ryyti ~ ,.'WilS RUTOASy f' . WtwEbi ~er des~p ~ Adeno Carcinoma of Amp~.21a of Vater or Defo?• ~ ~ • r~kin` •nr ~CCiDfMT SUIC~DE NOY~tIDC DESCR~BE µOW itUV11Y OtCURRED. (E*+(n A~fv.tt OJM}ttr~ f~ Pvt ! ov Pq! l•~/J1t+e lI~) . dispo~l- w ? ? ? . . cion of - Dod~. TIME Of HnYr MonlA, DaY~ i'su . ' 1+UURY s. w n. w. . r• = ~ 20d. vuu~r otcu~RE~ 2Ct. ?UCE OF INJURY (t. 0., rn or .nout Aops, 2DJ CIYY. TOtYN, OR IOGTqN CvU?f[~" • $YATE wK;u ~t Q ?aT wH~u Q k~m~lutorr. urad~ o~t« Mlp.. uc.) ~ . WOIIK AT WORK - • , . : ~ . _ 21. J~tt~nd~d tb~ d~cv~~~d /~om ~ 9 3 , to ~ 2~ ,_~nd l~~t ur hi~ elir~ od 1'~~~-QS` D~ath xeu~r~d it 827011't g i F~. M_ m on fh~ d~CS star~d ~bow; ~nd to th~ bsat ol m~' knowt~a(/~, /rom rh~ a~uur~ ~tatsd. ?11 lt~l• f10KATYR~ ~a a~ (DeP«<o~lU4) 22D. ADDRESS 21c. DATESIGMEO ~~¦rl•~• . J.H. Batsche,M.J. 906 Delar:are Ave. 12_B_6 ~CC4rai~, ~~p~~~ ~pEM11TI0N, j3Q. DATC L3C. NAME O~' CEMETERY OR CNEMATGNY T~. L(KATION (Glt/, ~p1of{, pI COYq!/) (bYdY) ~`"~'ti~~"`'' 12-6-6~ HiZlcrast Mem. Gdns. r^t. v.s.t61~ jy, fUNERAIOtR oa sswruruRe Pierce F7.orida _ D~E ~ t~ 25. OATE RECD. BY LOGAL REC. 26. N£GISTRAR'S SIGNATURE x•~.iG56 Milton W. ~~ird A`t,~'ierce,F`la, 1~-9-65 Anna Lee Jenisan d.r. _ ~ ~ I heveby~ urtify,'this to be a true and cosr~ct capy af the loca ~rrrt ~ Resgistra~a rq4ord pn fik in the St. Lucie County Henlth ~epart• r~ ~ a~~ ' - • rtio~ri. ~t~ ~ taPtp~ce; ~Florida. r = ~ ~ J~', R:`~~ irig: Nof vafid un(ess ra~sed se,i =t tha 5t. tucie ~ r'`~ V' '"'~``-~°COV~7tj/" Health Department ;s 3ffixgd.) r L~ ° ~ , ~ . ' , .~z ~ f ` ; N. D. MILL~R, M. D. ~ ~ ' t7 ,Caunty Nealth Officer & l:xa! ite~istrar D~~, y,ti_ , ~ ~ : ~ ~ .~l • C~ c~ c~ ' L -4 t't _ i~-C~ O fTl ~ ~4*.i.r..r ~ -w~ ~wr~r~~ ` j ~ \ ! 1 e C~_ ~ Y 7 ~ 1 1 ~~r• J~. ~ ~ . Date Deputy local Reglstror d, ~ ~ BOGK