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HomeMy WebLinkAbout1624 ~ CERTIFICATE OF DEATH 148'7~Og ~ ~ F L O 8 I D 1~ 'Twn r~u ~ s~R~ No. 1• a OuWCin 1fOF DEATH CO~s 1~w. s~8~~ R~1DtNC! Iw~r+~w.~w~~ dswu..: CIiT W wi~+i~ osp.i. .v..:. D., - w~... L~!!': Il~u~. wW fUi~Ll oR su?r u~. ww o~ mwN ~ ~ a. wu ~uwE oF ~u... ~ w~.~ aw~...a..a.~.~... ~ ww.u m~ ar a~•~. ,..~w . ! i~"~~'wORIAL HOSPITAL ~°0~ 2 02 A~'FF D ~ ~ NAME OF a A9eai) ti. (1[ii~) a(L~q . ~ DI1Ti pleat~l (Daf) lYre) ~ DECews~ T1~JDIb PICKET': ~?n~ 2 ~ i. SfX OOIOR Ol RACf 7. W1W ED, NEtlER YAtRIEp, OJ1Ti Of ~IpN 1. AGE a~~ ~ rw r u~n ~r ~ ~ F.I~JILE COL. '+nDO1M~D'~~?~~`°" JAN. 21~ 18 ~ a~..~.. a... ~o. 1 ~ ~w. ~au~ oocur~nowa~. u.. .r iK. an~ oF wsN+QSS oe~t T r~anu~wc~ rwr. ..R+~,. ~s ww?r ir ~eYis wt i wtl~ 1Yti w~ Y wU~MI F~nir~Y a~wt N. tw~ts ?w~t w?rt~ ^ - ~ ~ ~ `t w~?s occ~?sEO iN u. s.~m ~oacESr i~. socu~ sccuemr n. iruowrwrs s~aL?n~ . a.~.~.~.+....~ urn..a»..«.n...c...w~ qp, ~fiAR LF.HlI1EL uE a~ c~?tuE of oEwn~ M&DlCAL CaR77~IC11Z70N ,wt~v,,...~n,,,sa ~ ~ ~y ~ 1. DISEASE OR CONDITION ~ py~ ~ ~TM ~ ~ re ~ Ge (~I. (y. D!~[CTLr 1FADINQ TO DiAiH'ta ; O aM ~ •a wNrtc~r cnusES j ~ ~ W~w~t~i ipi~M. YrriJii awittiw~. E~ w. Ii~MWE TO , ~11t~ Y ~Mf~ ~N~t. ~N fI~ ~ {wN OiW (S) ~ff~ , ~ M ssI tA~ ~a~s~iy ~s~ Mrt. Wi TO e ~ ~at~wll.OTHEiS16NINCANtCONDRIONS ~ aswi JMei. Cwditiw~ aweriMtiy b tA~ J~st~ iat rt ~ nrl~trJ t1 t~ ~i~e~aw e~iit~i~s ' ~ Na DAiE OF Ol~E~1~- HM. MAJO~ HNDtli6f OF OrERAt10N AIIiOKYi 4 ...0 ~ (~'~M~MSI 1~i1 216. ILACE OF iN.IURT (at. b s~sws 210 (C1iY O~ T01MN (OOYNTY) ; i 21a. ~euoar M~.. m*. uet.p. wK i~ MY.. Ma) yf ~1. ~=Ua~W , ~ ~ure~o~ ` t- W fid. Tl~ lY~rq Wvi ir~u) iBs~I 2t~. tWYlY CL;~!!tliD ~ ~ INJYtY R ~~~~r ~er~uu ' ~o~[ ? ~T twa ? ~ ; ~ a I Aenby urci/y eJ~at 1 nus~ds~d tlks deeearsd /~oa~ ^,1D~2, eo 9 , l~Y~. tboe I tat ao+r t1~. ds«assd ~ ~ W alive o~~~_ !D and tl~at deatll oa~ansd a! s~ tll~ oawa aed ow tks dal~ atoetd abovs. ~ t7~. SIGNATURB (D~seM R tlW) t)?. ~ p,A~~~Ep ! i ~ ~ iw. ~ U R 1 A L, CtEMM 2~0. DATE 21c. NAME Of CBIETE~ O~ C~HiATOIT WC~ATIdN (CW. 1r~~. w aoV) d1~MI I na+. ~ V cawr» ~ n ~ ,i ~ a?~ ~o nr ~oc~ ~~sr~s s~s~u?rueE s wNr~ a~crors s~auTU~ r?oo~s . 2-18- 2 JINITA RICHA!~DSON d.r. A.T. S'!'ONE FT. PIERCS FLA ~ , _ . . - - - ~ - - -T-- ~ he*eby aA~fy, ihi~ to b. . true «~d corr.et copy oi the toca~ FILEO ANO RECORD p~ ~ ~ ' lipatnt'.s Moq?d "a?.fili in 1h~ St. tuw Cainty H~ahh Depsrt -61'• LUCIE COUNTY, F~,A, ~I rt~t~at ~Fo~? airg~„FioNda. RECORD VERIFIEO i i Not-wKd-vnl~ss nised wal of tl» St. tud~ --'~~~.C~'' ' ~ o.~ ~ ~-~.a.~ ,66 SEP 26 1 ; ~s_ ~ _ -PI~ Z; 2r . . . ~u a Nuuat, M. a t~y~p , ` • ^ r~"' ZowMr .Hsalth Officsr 3 toc+l Rpistrar= ROGER ~g `VO - i ; POITRAS : t : - ~_t ~ ~ ; ' ..t~ , CLERK CIRCUiT COURT ; ~ _ ~ ~ . . j D~t D~pwr Local iEspatrar d. r. - ~ i ~ . , . . s I ~ I ` f ~ /S3 ~Z v ; 0 ~R ~ ~ I' , ~E00~~ ~ -~~J ~ ' . . I . _ :r~k v- ~ x x ~ ; _ _ - - - - - - - ~ ~ ~ ~ < p~~.i ?5;=; _