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HomeMy WebLinkAbout0748 - D~_ .~r~~c wiueo oR Mu~TM CERTlFICATE OF DEATH •<< • eueuu w v~w~ rrwm~nc~ srwTS M~s H~1~~~~~ ~ ~~:p` F L 4 8I D 1t -'~'°''"'°'r- 81 T NO. ' REOIaT11AR•S NO. ~roasrlf 1. ?U?CS er KI?TN Z~DDi ii8. t YsYAi ~[!!liM6llwshrl,e~rlferd l!.-~yewq.,• ~.:~..w.+.w~,w:..t •a!luted ~ 4 ~A~ ~ad •1~2 S•t j~~C.?. 1~ ~l~e~A ' • 1• ~~t- C~TI. TO~IM. d1 LOCATiON t. 15 rIACE Oi 0[ATN t. M1/. TOM11.011 lOG?i10N e. K 11ESIOtNtE ••,••s Ft. P1eY~0e ~s6d uiap • wsioc aTr uM~rn r~t.. 1fFS MO ~urt Os (7wM b~M~tht. M~ ~eraf Wre~) ST~ER ~oo~tSs MOS?I~LL OII "'n'T"T'°" 1110 Easter Avenue Ot~Ctws~[O NWIe Lqt oAtE llNN Da~ Yea tnv.«s•+r~ $EY!'DUR ~ORRES`T MOtIVT ~?TM Jtu~e 7 19&6 S. 5[X ~ OpIOA OA RACE 7. yN1RKD ~ KY[A MAIIAI[0 O~TE Oi NtTM I16E (1~ /tY1 ~ YWdI l YW tlrOFd 2~ MS. - f r 1 t• I'1p~ ~7.~ ~~~u~~ Y~.W Mw N«n Ya ~oorco o~va+~ao Nov. 7 1889 76 ~ ~'•'•l, ~a ~au~ occ~..~ ~o~.. ti.~d...~ s... 1a. RMOOF MJS4~S50~ MIOIISTwY u. .uT~ ~s.r.. •f N ~~r, J(a.1y VQ1 ~k ~iLi6:1.~ M~ owant) t. tmia or rw~T aoiea~» ¦•...t 1 Indiana U5A 11~tt 1~k 13. iAT~(11'S N~ME 1~. ypTMER'S IUiOEN NAYE . u,~.,.,~}..~p~ 1~~~~ ~~~~~r~t~r ~ ~t 1-Cai-Yl~i itl(~i i[[ 1. SOCrtI S[CYRITY i10. 17. ~ SI~IIATYA[ .4flrw r ~ 312-12-396 I~rs. Seymau~ Mant Ft. Pieroe, Flarida I~rw~r~l 1~. Cwva[ ~I KwTN (ata ~ ws caw /er ti~r /r p). p). d(d.) IMTE~VAL ~E7N[E~ i ~lr~et~r ~AIITL OEIITNNI~SG1{I![O~: pEATN ~ wrcou?.c cwsc w ~~YY Thron~bosis °MSi~CU""~e .r•s tsi• t~• e~r- .ia~~~e~. d.sWr.'.i/s.~. ouc ro p) ~ ..~k? wr a s - I • e • 1 ~t ntiar~~). f~ji~trar +~~I f4 ~altr- 04E TO (e1 ' 1 •ft~le ~a l~• 1 ~~r~• ~ ?II~T 11. 01~f11 SIGiK'MI OO~pi~0~6 OORMRK 10 Ot~TN wR NW IIp~tFO i0 M 7G1MMl O~Utt COIOt10~1 GIM~ M Mllf 1(V . IMAS AIffOKY ~ N! ~~~t? ` tEIKORMED/ ~ •f i~hN V ' TES? ND ¦a4f~~ ~eC~OEMt SuKwE ~~CtoE oESC~ME ~wM? ruu~roCC~RREO. (blWa ~~tve yyjar~ f~ Art !~r Rrt ll ykriw ~~J ~ ~iq~at- ~ ~ - . ti~• •t v i ~ ~ mr. TwE os /br? XW~. Dq. Yar t ?~a~. wu~r t S I- n. F = m1. wJU~r ottu~MC~ IOr. ?ut[ as auu~r k. I•. w r~wt y~r. ml. CrtY. tor~. Ou lou?TqM OODUTY sT~TE ~ MMRt AT ~ MDT NMRE ~ M;. Na++/. IfiHf. ~~[t AiN» dl•) j MO~R AT fO~K i ~ 21. J~tt~ndN tM dra~Nd frorn m~ . ~o •nd /ut wr h,~ ~/i~~ en Never 4 ' D~tA oceurnd ~t 12: ;{Q P ~n on tM d~t~ ~t~tW ~bo?~; ~nd to fM bs~t of m~ 1no~r~idh. Irom th~ uua~ ~t~~M. ` e• ~ 72. s~auTw~s (uh?n «Nrtr~ tm ~no~[ss tic. wtc sK~co • ~..~~.c. a H. C. PScDiel~d M.D. Ft. Pieroe F1a. 6-9-66 ; ' •!tY/~1~. ~ jk. ~M[OFC[METEIIYClICIIEMATO1111 IIi. W[ATqll(Gl(I.fw~'~.MCM~1 (S[dtI [ IICr01Ml ( ' 1 ~ Remava~`"~ 6-10-66 Mil2er ~emet j s.~ s i a t~. sw~c~ oa s sK+ur~.r~ '~1 HaRIe ~ j,~ ~ arc ~ca ~r iccw~ iua_ tc. •~RS ruet ~ ; ~••.,~as Jadc J. Moar~e Ft. Pie 6-9-66 ~ ` 3 i - ~ r 1 ~ ,a ! - ^ ~ w (llfl////I~~,. n • ; , ~,y r i ~ i.~. 7. ~h~~t~i~it• certify fhb to be a trus snd corr~cf copy ot the t~ocal -r"v ~ c O ; ' ~ c~ ; `,Q is~rar~d on fib in the St. tut~e County Health Oepart- ~ l : ~~`,«r-? ; G ~ #r~ r P~er~ce. Fbrida. c~ ~'st Z ' ~ ~~'~~r~ 4~a~f~p: Not valid unteu nikd seai of the Si. tucie ~ J ~ ~«.f j .c.:i.L C7--: ~O~ : ; - -a~ ;Q:~ _ : r Cqunry Health ~epartment is sffixed.) e c ~~"A"' 2~ ; n C m ~ ~~t'~t_ rZi ~ "~v: R~ y~ 77Zn l ; - f°,_ ~ --i`• : `yyr_ ' ~l`s;Y,~~ ~"~r fw - . ~ ~ .*r={~ sy~, ~ h,:~ . N. D. MILLER. M. D. c;' o rn= ~ O E ~1~~~s1~:;-•~ t:'.~ co~y ~nh off~ a ~r ~ ~ ~ o.=,~ : ~ ~+:s'--:~ , ~ a. - . E" ~ ; ~ ~ W° ~v r ' ~o h ~ ~ ~ j ~~~:,rr i r~Y~iSL:~~`~~~~ ~ - D~ ` D~puty Local Rpi:trat r I ! ~ ~ 6QOK 154 148 ~ ~ ~ . x .~,:~".*a°~.~~, ~ _ _