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HomeMy WebLinkAbout2202 rn?s Ds- ~7AT[ ~OARD o~ Nut~ CERTIFICATE OF DEATH /~/~lo G eo~•s • oUR[AU OF YITAL fTAT1~71C• s'TAtt FIL[ NG. ~aa~l r~~_ FLOSIDA p ~ - ' otd •hsn g~q7H NO. Rt ii"fRA NO. ~i 7 p r o p~ r 1~ I. ~LACQ 0? Y~ATN COD[ HO. 2. 1~WAl ~KM~6MCt l A?~ Iw~dli~t. f/4~d:lr~w: Rsi/w~ 1Iw~ ~iw) •[~CYt~d ~pUNTY •"a •111 ST. LUCIE bfi-02 ~ 57A~ FIARTDA 5T. LOCIE 0• yl~c~e ln j)f~- O. CIYY. 1'OMN.OiI LACATpM ~ IS ILACE OF OEATH t. CITT. TOWN.OR LOCATIOM t. IS RESiAEMCE ¦aO~Ot INSIDE C!~ITY L~MITSi IMSIDE ITY L~MITST r~i.. FT. PI~CE YE51a po? FT. ?IEHCE rES ~o NAME OF ((f wN iw AMpit~i. ~be iNtU Nfl~tnl STREET ADORESS NSTITU7qN~ O1 E1R~NCHO DRIVE 1 FIRANCHO DRIVE 3. ~u?MC o~ • /'Y„t NWt~ L..t a~TC Ma~u1 Ds/ Ycm p~.r«e> WII,LIAM HOYT CURTIS o°c~YH December 17, 1965 S. iEX 6. CO1011 001 RACE MIIRRIED NEYEIt MMRIED ?~~TE OF {iR7N 9. A6E (!t~ }tY1 r u+ou i ruui ~pE~l t! NIS. 1s~ We/) y~f,~ pow Nwn Xiw, r r t c. I~: W w~oow¢n avoecco APRIL 1893 plriply IO~.USUIeIUCCUPATiOM(CJf~[k~w10/WMk~t I~.KIN06fWSINESS0111M0UST11Y 11.~IRTIIPLACE(L~IftM~Y?rl/~ONirlt+~l I.CRt3710~~nMTWUNPlt17 r1tA p~r- /artw/ a~af oJ~vakiw/h/~, urw IJ?jfGd1 USA .•~•p~ REST & HO'1°EL ASHVILI,~ N. C. YlaOk 1Rk ~3. fATMER'S MAME 1~- M0T11E11'S YAIOEII NANE or eyD...se.r i8 Ettg Dalton 1 MIAS DECEASED EVER IM U. S. AIIM[D lORC[51 1. SOC1A1 9ELUPITT M0. 17• IMIa • ~1~MATYAL e ~ a l Yr. r, r rti6+~~ U! s+. N« wr w/rn d rrirl 263~_ gL~ ~ $ ALdstq ~ Pierce, OZ"1 a Fun~i~l 1~. CAYS[ O~ KAl'R (E~e? ~wJ/ o~1t nwr D~'? liwr Jnt (s), t~l. ont (cl.j . 1ltTERVAI sETMEEM d1T~etof ~~pTl. DE~TMMIISCAVSfD~Y~ Q~T~KD~1~ TN IMMED0.~TE CAUSE Corona~ Thrombosis _ ~v (Y ¦u~t f11• tee e.r- ~ cst~erc• Coa~uto~u.t/+*r. ax To (G) A~"~CI'].05CZCY't7513_ _ 10 yT. ~ rlth C!~• 1pAit? /Nf r(~ f~ ~ 1 e C • 1 ~Daoe [r~ (i)• ~ ~t~ef~1 W rw/rr- ~ r~si~tr~r 1~iM hrq ta~t WE TO (r) • 1 tD i p 7~ ~ ?A~T 11. OTYrtYI SIiMIfICIWT OdMCMTqM3l70M1l~VTYIG TO OGTN ~Ift MDT R[SA7LD TO TN[ 1UIMaM1. OWA4[ COMWT1iD1~ G1YE~~ M M1101 I(a) - MAS AU~O?SY lour• •1'- tERFONMCDt ~ a..cn S Diabetes 2~k11itia ~S~ or e~tor• ~ t 20D. DESCFI~E M01M IKJUR7 OCGUIIRED. (E~I(t~ w~faut ~IfRJury hi Pnt IO? PKl IIOJIIt~ (f.) ¦aklw{ ~Ay ~ ALCIDENT SUICiDf NOMKIOE ~ ( ti~p~~i- t~ ? ? ? ~ t~~w •C TIME OF 1`lo~v NoMA. D~t, Ysd ~ ?sa7• ~ nuuRr . s. ' o n..~. ~ i IiUE1~Y OCCUIIR[D ZOr. ?UCE OF WUR'Y (t. Iw a~t bf~c. ZJJ ClTY. TViMM.011 LOCATIOM WU~TY S7~TE wH~~c ~T ~ iar wN~~ ~ 1~~. f~ar, ~.:a. o~[u aq., dc.) , YlOIIK AT MIOIIK 1954 _.~d 1.,~ h~~ •lir~ on ~ ~ 21. I ~tt~nd~d tb~ d~we»d /rom ~o '2~ ~ Aim ' D~~tA oca~rr~d ~t =~~A m rn th~ deN rt~t~d rbors; ~nd to t14o bs~t oI m7 knovl~d/~. Irom th~ wuwo st~t~d. i ~11 iter~ UYNAriRf (DeyrnatNk) ?2D. ~DDRE55 22c. ~TES~GMED , •r• to D• I / i ~o.B~•:. ~ M. F. Watkins M. D. Ft. Piercc, F1.a. 12 22 65 , ~ iECYf ~L~. ~YATIp1. Z~D. 6ATE r3t. MAME OF tEMETERI' pR CREMATORY LQCATpM (C1f~, 1qPR. M CQ~H1l~) ~ ~~~n~n~ ~ 2~~~5 Ft. Pierce, Florida ~ Hillcrest r~tn. Gdns. ~ Y. S. t619 j4. fUMERAL~I T~OR ~S 31GNATUIIE ~ ~ 2S. OATE RECO. [Y LOGAI REG. RfG~T~~~s SlGMATURE ; a...,oea Miltan W. Baird ~`t. F'ierca, F'l.a. 12-22-65 Anna Lee Denison, d. r. ' ' " ' ~ ~ILED ~.NG aECORD~.D I . I hereby ~rti~y this to be a~ tn?e •~d caricr ~py of the lxa: ReQiatrars record on fib In tfie 5!. Lutis County Heilth Oe~art- _ ~ ~'mMt at Fort Pieroe, F{orida. - ~ ' , ' i %y 1~ . r .h ; ~ ~b5 ~~1 I 4 : ~1 Y ~ - . (YVami~g: Not vatid unle..s raised scil the 5t. lucie Zg i • . County Health Department is 3ffiK@d.) 't _ " i - J~- ~t . , ' N. D. MILL.R, M. 0. f ~ , G . . . , _ , : : , Rr: , • ~ ~U ' ~ ~ ri.l~lir I f, . • Cewnty Health Clffiter ~ Lotal Reyistrar , ~=LOr,{G~ i - ~ -~v~_ ~ ~ 0 R pi» l~ep~ty local Re~istrar d, , BOOK ~W ~