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HomeMy WebLinkAbout1279 t~,, .T~T~ .o,u~o „r „s~?~t„ CERTiF[CATE OF DEATH i~ 3•~ !~3 eo~es ~ AYRt/1Y O!' YIYAL fTATIfTiC~ fTATt FIL! NO. " l.s.l FLOHIDA erd •A~• H, R ~TRAR•~ NO. ~U2 prop~?17 1 KAtt 0/ KATN GODt NQ Z. YLYAL w[N~[NC~(/Mfrr~M6wi flbraw~Ir+: R~iiwriM/w~~irrt~ . e:~ert~d ~ •ed ¦111 STA7E ~da ~.OOYI(Tr S~r• I.L3C~d oi~s~~ Se ~~e . C1T~f. TOIIIM.OR IAC~TqII t. IS ~lACE Of OfATN C. CtTY. TOI/N.OII tOfJ1T10N s. 15 RESIOfNCE •~e~~t IMS10E Cm uMITSt 1MSIOE C1Tr UNITSf t U~. TES MO ? E TES MD ILLME OF (lI Mf !R ~N~IbT. /ie abW ~fbtM) STREfT ADORESS IpSIiTAL OR AST~TYTIWr ~ S~. 3. w~~[ oI i'M~ X1rQe Lwt 1. wTE N.wU Dq Yw '~T?~~' H R3~;~iT Z•~:NZ ~?TM I~iar ch S s ~ 96b . HY COlO~ OII RACE 7' MARIItO NEYERMMRIEPO OAiE Of WTN ~~~f) Ywrw OM~ 1/wn Yi~. 1:. wooxEOO orvoa«n Dec. 22 1895 7~ p]~ f a37 ~ ysy~l pp~y~ATqK (pyr tlslq/wr! /~t 100. KwOOF WSINESSOR w011STRT 11. WRWUICE (.9dt R Jktl/w owMi/j 1. a11tFM Oi ~W1T QOWI1Ri . i e??~ IwIM ~wt N wWI bN. an Y ~etfrN) aanan Institut Australia Nat. USA ?l~et 1~k 1 ?~7Mt~'S WI N. YOTMEIIS ~uUOEM /MME •r ' c~p~.nt~~ ~ M111C ptlnl 8 iS. w.s occusco nc~ w u. s, urco ~o~as~ It sxuu scar~mr +a. n_ a s~ow?w~c EliZSbet i~~riZ ~/w ~w ?.rFrwl U/ w~. w~r w rr Y~ rwrl 11 So. bt . t. . erce, a. E~~...~ « e.u•i w*N ta~....r,..r nr.. yn u.rr N~.... ee~.~ . :tr.: E:• u~ru~w.cT.r~ ?~~T ? ourN r~s uusco ~r: ``~Ne :~sCT mo oun~ diit°•' w~ca~?,~ w~sc ca Occlusion ,ti~. r:i• t?. s.r- . ~ : , ' ~ ~ cftie~t• ~ ~ ~l • •ltA :a• Ctistif4R~~~~a~ ~ ` -.~ti ' ~l7t~ ~IN~y p ~ _ • 1 • a ? 1 ~bwr caue (i1• - . - .~RSSa ar ~wV 4t r~/e?- Obt TO (t) ' - .scets ~7 Z l~in1 awt bM. ' ; ~ ' : • " r.o~.. . r- o ru~T a o~ mwanrr memaa oowrwirtws ro ourn wrt wr aumm~ ~o n~ turww oKUSC aora~ uio~ ~fK• i. • r~s tu )c~MEOt r - c.r e~.t1 !S . - ~ If[2 IiDO or l~te?• Y ~ . •~tl~~ •ay ~ ~~ACC10(MT SWC10[ MOMKIOF 20A.useRac~ruwroCCUR~o. (b~nw.ewry~J..~bl~lir I~1ff~NJ:.t- ~ . dl~p~~!- V 0 ? ~ ' ~~4~ st ~ LO~. nrt os N~a? XMN. Diqr. Ye~r "!r~ ruu~~ ~.n. ~,~':.t: :t... n. I 20f. MUYR~ O~WIM[O 10e. RACE Oi IMJUIIY (t. h M~D~rt M~t. ?D/• MY. TONII.O~ LOCAiIOM 001iM1'Y STATE r111LE AT O 110T MNR.t ~ /~KI. ~dtd. ~~Gt EilII., dt.) • M011lt AT bORK 2L I etNa~l HM d~owwd /rproti _~~0. A~' . to ~~5~ ~nd fut w~ dir~ on D~wtA oot~rn/ ~1 m on tM d~b ~t~t~d ~bo~~: ~nd to tM eu! o/ a~ ~no~l~dt~. hom tA~ e~u~ ~t~t~d. t I 3 ! t~a • ?La. N~i1~TY~t (~M/?ut MlYIs) 72A. ADDIIESS l~t. OA7E SIGIIEO •r. t• 1~ ~~~LL f D H o~.~nin M.D. Ft.Piercc,Fla. o0 ~ •c t~e ~ N. ~y. j~- ~YE OF CEMETEQY Oll CREYATOIIY Zy. ~,pq?Tqq (Ah. uvs. r ar~h) (8w1 `s y Beach ~i~m P~ark Lantana Florida ~ r. s.Ieia rw~~ o~ s s~ ~~s. 'lth. St. ~ ts. a.rc ~ca. ~r wck ~o. t~. ~aisrw-s s~cw?TUu ~.•.,~se ~ton K. Baird, Ft. Pierce Fla. 3-9-66 Anna Lee Denison, d.r. . . ,t ~ . , . FI~ED ~,NO RECORDED _ _ ~~e~ L hR~ebl?-y~lifY-this to be a true and tornct oopy of the loul - ~ Q~ROOK ; ~ . Registrarf'!a~oord_on file in the St. lutie Gounty Heaith Oepa~t- : , nwnt ~t f~A p~. Florida. , ~ ~ f~AR 2 ~ • (Wuninq~Not w~id unless raised sea! of the St. ~ucis ~ 9. 36 . . . f~ntj? Hesith Department it sffixed.) j • - . t . j ~ ROGcF. i U ~ '~U , I 1 N. D. MILLER, M. D. t;t%: . CIERK - ` Co~rnty Health Officer d~ local Rs~irnu S T. LU C i E C 0 U tJ T Y, ~ • ~ ~ FLORIOA '~'-'jrj _(o(o ~ . ts ` )~i s ~ - p~ psNuty Loc~t Reqistnr ~ _ . 80dK 141 r/ ~ f ;~s ~ ' ~ _ ~ € ~ r-L~.,s- ~ ~ ,-.~~-~~`"~,^.4 _ . . ~