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HomeMy WebLinkAbout1768 D~ 145385 ~ (Fee for thi:. certificatc, sl. 00) . ~ ; This is .CQ~`Ft`rtijx.th~t;~t#iis is a true copy of the original record which is on file_in;the:'Pcn:ii~yi~Qa~l~epirtment oi Health. in accordance with Act 6b:' ~~~1.f.:'~3{~4_i,~ a~~;rQ.~reH by the General Assembly, Juae ,29. 1953. ~ ' i~~~ -~~q~`~r~ ~ Q 8 v s- 7 ~ ~ N CO eoox o . ~ ~ ° ~a,~~,o~~4~- ~ _~,l ~ , No. ~ . ~ ,o ' '66 MAY I 7 PM ~ : I q ~ - .7,; ~'~~1y ~ i-+ ~ - _ ~ ~ ~ . ~c . 2~~~~ 145385 ~ ~ C. L. wilbar, Jr. . . D. R~CER PCITRAS. ~L~~ ~ ' ti-•~•~ !T. LWCIE COUNTY. T d ~o~at R.o. oo~woNwE„i~ of ?cMNmv~u? !'LO!i1DA N°• S~"S ~ IO~ VITAL tTATIfTIq FIM Mw CBitTIFICATE OF DSATA a.~. u. ~.ucc oF oun~ : uwn~ ~cwocMCC u.....~ ww. w~..uww.: r..w.... w c.,,.p, a.. , a sw~ ~.wb Gts. {Kw T e. L~yu ~f ~tq 1~ lA s. Glp. MrwM • iULI MAYE lM T I~ AwIW v~ NrMt nw) W~M AI/erw bw d Mp3/1TAl ' ~r IN3TITUTION~~~r • ~ ` Is ?4c~ d OwlA IwMM Yrs1~iM1{t~ bi N~N 1~11~ y u.~ai h 11riMM~ M• ib~t ~ 1rM ~ ? YM IN Q Y~ Q M~ e.~ F NAYE OF t ( ) (lad) 4. DATE (YNO) (p~) (Yrr ~ _ DECEAfED . OF ~ ~ ~ O (T!M M Nlel) O[ATN iEX f. MCE YAN/IIEO~?NEVE11W1R111EDO OATE Oi ~IIITN l1~ (1~ rr~ II~~N?ll~ NwMi~Mn. w~oowfo O Olvw~cca O w.w o~a ~+..r. iww. ~ - 10. f LL NAME Oi i/011 11 tl (AI~ ~M M 1L CITIZEN pF W!{AT OOU~' 111f / 1). i 'i MAME 1. YOT/I[!1'S rAlOE11 NAM[ 13. US(!AL ATION M ntlnp li. ~Mlal ~wMy Mw. I 1 T ~ ~ ¦1i~11< neN w~nmr•a ~crscc~ l~. CAUSE Of TM [Ewhr 1 MN nrM rM IIM IM (a~. a(t)~ OwtE~ A110 ?AqT 1. ONtA n~ swnM ~1: ~ . . . IMYfOIATE CAU~E ...~i~[fii~.i~[. ~ . L~l.. - - _ . Gw11Uw. N ~d~' DUE TO ~iM t~ rw~ ~~r» _ . _ _ _ _ - - - . - - - - t.? .+.uM u. ..a.+r ~H sar« 4d. DUETO - ~ - - - - : t i~T 11. HE11 i1GN1i1CAM? DITION3 (~tnM~tJ~~ M fA M~t irt ?MNN b tM Me~lwl ~N i~ ?~r{ 1(~)J lf. YrAS AYTOIir KRi011MED t ~ r« M. ~ ACCIDEMT SUICIOE M0111• IO~. DE/CRI~E MOW IM~t?!Ir OOCURRE lOs. TIa~ Mw?. Y~.M. pM. Yw CIO[ d O O ~•!r [_s.T. lOr. ~IN,lURY OCCt11111E0 40~. M.ACf Oi IM~AMIY (e~,. tOf. C1T11, ~O~OU~1. 70YIfMS111~ OOYMri =TAfE MIINN ~t Md wMM ~w. fvw. hdr1. ~M~M. M~.) wrt O al....t 11. 1 Aereb~ eenifq ~Jbt 1 oruulel tAe o~ove nowel leeeo~el s~l t~st le~t~ oeewrsl ~t t... B. S. T.. /~ow tbe toaiea a~l os t~e !ou iwte sbove. ' - !!a i1G__ M.D. ~r D. . DAT[ iNMtO ~ ~U111AL prCRE~A 1011 Q DATE EOi ~T T[M L ON (!r. Mn., Tq. ~ ) q1~) 11EIIOVAL Q ~ ~ DATE RtCI'O •Y 23. 11 OIiTNAII°{ 0 tOR r~~~i ¦ V VI~~ • V so~145 566'~~ . - . _ ~ r~.~ 8 _ - ~ ~~r