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HomeMy WebLinkAbout2496 ~ L ~ - - - - - - _ ~ . t ~ - - - - - - . - - . . - - - - ~ 145'75'7 ; ~ ~ 3T1tI~ OF OOLUMBU I~$AL1H DBPA~'1'b[EN~ o. ~ ; ~~1r BUREAU OF VITAI. STAIZ.STICS : . ~•CBRTIFICAT ~ OF DBATH 540864 ~ oso~. ~nsi+cs cww. a.e....r u w4e.w.: ..ra.» • ~ . ~ ~ =lTDf~ • ~ e'!'A2'i . 1. COOIRY MIM~ ~i~iwio~. ' e. C1TY pf wYid~ wpnq IirM~. ~riN ~UfAL ri pv~ N~Wiv) BORTITAL OR . OR • ' lICBl7T07'10ti ~ ~ ~ TO'A!1 ~ i.6TRSSl' (I Mrti~)~ ~ IY H08TIT~L t! W j ADD a it/1~, ; ^ AIIS OF l ) d. 1[1iii~) a(Lrt) t DA~TF'i (Nwe!) ) rr) DI~~CSA~BE~' ' ~ DSA78 ~ , /t~ ! A AAC6 1. NARRISD, NSYSR MARAISD. t DAZS 01 EIt18 AlIE: 7+w ~fwtV D~r H~ . WIDOi~D. DIYO~C~D~ ) O ~ ~ riv r~,. ~r~ n rw x caw. r:a .«k Ns- ~Ixn or avs~li=se tr ~1~. stRre t~•~••~ ; : ~;~ei~s d wlci~s ~li ~?w il ! • W/ : o wan o~v.rra t s~~ u. x~s or drovs : • ~ - x nB ~u?max 1 ` ~ ~v??- • ~ O~/~-.~ t!. NA3 DSCSA~D SYBR & ARMED flCES! lOCIAL B~CUriITY Na ll~ IN RlfAN't .1~ (Yr. r. w .~kae~~) lIt ' ~r dw ~t Mrvia) - i Ifb. ~ELA'1'ED TO 1:.• LCAi. CER CJ1Ti0 u~m.w .e.m~ ' t. Nc wh aM e~~w OK li~ I~r Si). ~d (s) Mntr un wns TIHAL DI8YA8E OR (70ND1- . ~ ~ TION TR~CSDINO Di1?H i. AN'~4`SDSYT CAU8S8 ''I ' KoeOii corht+r. it ror. ir~t DUS TO (D). ~/i.~a~I`• I~ . ! , ~iw a W e~w~ (~1 ~4~ IM cf~re la~. DY[ TO (e) ~ ~ ~ t ti OTNSR RiaN1FICANT OOICDTi[09I8 i . _ I/. C~e~deior eaw~s~ta~ ts tM d~t\ !M ~et ' / ; t ~el~ted N t?t diwa~! er ~o~ditiow siri~ dMt?. ' (Ir~l~ nPoet eI P~p~ef ~tLi~ ~ atw ~i dMtY}. ~ { ~ ' ?fON 1 N th. AUTO~ t A / ?BY 1INDIN00 , ~ ~ ; t ' Ii0 0 ~ {J[.~/ LI~ /ji Y. / • ~ y• !k. AOCIDE.~T7' (9Y~f) llE. TLACS OF INJL'RY (~s-. i ae ~Ds~s fle, tCCI'Y. TO~Y2f. O~ 'I~O~IJi~ (~.b~t7) b) t 801CIUB ?~w, tara~, lsebrr, ~wet„ efp bY~_, HOIdIC1D8 ata) i~ . > 1 tl T1MB p[o~t?) (Dyr)~ (Ywr) (Sar) l1~. 1\JITRY 00(.'URRtD !IL HOR DID iNlU1lY OOCfTB! f OY M'Yie ~t~ Ket 1\JL'AY ~ork ~ ~t wwt ~ 2~. I kercby cc?ti/y tAnt J atte~uled tAe deceosed jrmw ~1 . 19 , l~ r. tiod fert atr , ~.~1~_ativs ow , 18.~. and lAa~ dtaek oecrrred el iw., hom eJ1e oorad.pd_.ow tAs datc ata~ed ; eboc~e. - . . BI 'IIS lib. ADDA~d * ffe. D~Ti alaN=D i • • ~ 1[. D. ~ ~ ~ ti I ~ B4'H DA7'E k. NA?1S OP CB~[ RY OR iBl~! .~i/; , ~M ) (tu1+) t; f AT10:1 - ' ` • ~ , ? ' HkMOYA6 ` , ' a : j ` ~r .i li ~ l3~. U~.tert~teri ~ !S~ U 'DEAT q , : • ' wDDaI~ i ' . ltetrtot~aw I?~~ T ~f~. t-•: J~/'/- ~ '.,'t y~`~~ ! l ~a~~J...~.. _ ` ~ 'i lt~~.~>f~.cY¢`~G" ltis ' ~ . s • ~ Date Zssded . r. , • ~ ~.•NOT Y LI-~ ;W TE~~. ~~S_ED "SEAL I ' - ~ ~~?Rl 2 5 ~ . 1~ : : w~ t' ~ . ' -'r_,~, /i • ~ ` THIS SIS TO CERTIFY that ttie above'is a?~true and~`~iti5crieo'~~;fy r'oductfon i F ~ of the original certificate ,filed ~ith the Vita1-~Rec~,~" o fice of the E ~ District of Columbia Depertment of Pub ' Heal. h. I ~ ~ ~ , . ~ I ar F. von Ahn, Chief E r ~ ~ Vital Records Unit ; ! . - - - _._r___________ _ . _ ~.~_-rae~. tt.-~-w ii S i t P . ~ " € i t F11~~0 ANp RECQROEO ; 8T. ~U~IE COUNTY~ FLA. ~ ~ RECORD VERIFIED ~ ` `fh . ; ~r" "d' ` '~io JUN I P~I 2: 48 ~ ` 145`75`7 ~ n0:~:_ ~ OITRAS ~ / ` CLERK CIRCUIT COURT 800K~~~ ~ ~ ' - - ( ~ ~ ~.=r.~~~ ~ ~ ~