Loading...
HomeMy WebLinkAbout0449 i YICROFILI 1~]t0 ` Legibility ot writing, typing ~ or printing nnsatiaiactory in ; thia document for microfilming . ~ ~l 151'~ ' ~ CE~t'IIEIm ABSTRACT OF DEA'IH CERT1FICATE S ~ ~~C~ . GEORGIA ~EPARTMENT OF PUBLIC HEALTH F~~^ VITAL RECOROS SERVICE . ~r,• l.Xf . , cvCV atqodi~a's Na t1 0 ) ) ~ ~ w DECBASm ~ - ~ ~ ~ • • /W~ Cw1~ ~ Ta Ife Q a!A li tW pLo~) ~ YM~ Q AY;~Yt~) ~ K I1as~ e~ ~Y et a s~ M~ ~1~ K ONff[~) ~'~1 ~ ~ ~ ~~i ~ ~ T.. p u. ~ aaovru. p wtw?na~ D~ Idt ~~II~ nsl~ Heas l6~. ~ ~ ~ WIDO ~ UlDi DO ~ O ~ - +•w U80 OC AIIOl1IGi~~ ~at d~.' f w~q ib. t~~s H n1ie~A) U1ItT M. ~ WASD ~U.S. ( Yss. ~udo~ew~~lH rs. 9~~ w~r w dtlM M Nnio~) ~ ~ FA ~ ~ ~ ~ ~ ~ . i x ' 69~i t!~ ~'a~~s ~fl~s ; . ! ~ CAU~ OF DEIIffi [FaLs ed= oa~ aua~ p~s IfM fes (a). (b).-a~d (e).] !LlJLdE Pl1lR AL j PJI~T 4 DD0~1AiE ~~i O1QLi Alm DLRfI f Conditiw~. iE DDL Z~O (b) ~ O wsicb qap sL~~~ J " G abo.~ eaaw s). t statiaq t~ V ~T~9 uoM Iad. DUE TO (e2 ~ PAHf Q M dWti sN te t6~ Ni~l 9~tia 1(a) ? F w TM Q lfe Q ~ ACCIDIIR ? (~.4.• i~ er abe~l ~ StnCwt O tie.a fa~a. l.euel..tr..t, vI~W at wed~ D =`••'a7 ~«fiis tw i.a..d~d u. d.c~...a fi~ HOl~CIDL OI~~ ~4~ ~1 a w~ 1! - 1! - ttitl t Msl s~w t?~ d~ew~ w (CtTY Ol WN) ( ) !L) I ) (Da7) wr) ) : ~ O! ~N . - 1f - - a~d tVf i ~Qn dNfti OOCrtlM~ r ~-r ~l~ ~ qr~N Yd M~ aiN /Mt~ abOt~. ~ aow aro - - ~ ~ ~ d.-~ ar ~~II~r ~ .f DA~~~ ~ D ~I ~ . ~ 1. S • FILEO AND RECORDED ~ ~ ~ State of Georgia ST. l.UClE COUNTY. FLA; ; . RECORD VERIFIED ~ . ,~t ~ ,~+,..i.-~ ~ _ . l' ~c~ ~ h " ~ ' ~ . : ' .~~o! 151`795 ~ ;~,,.y~~:~,~ ~ _ - A ' ~ y~.:~ ,,f~"~"'~i 4• ~~t ~,~j i~ PM ~:os. ; ~ y"~`'~~~' e~r,'~ei tify that the foregoiug is a true and correct abstract ' y ~ ; f`-..~?,~ ~ _ . • ~ ~ , • ~ ; =,f ~ ?~~ctis o~ death as ahowa on permanent record of deatb on /~-f • - 3 , . .i . Y~~~~ "~''CYiis oYfice. - ~a~LR i~0lT ~S ~ LERK CIRCUIT COURT ~ . ' ; " ~~,i~~" - - ~ :z.:~~~•.,,.;,:~,. . - si~a ~ ~ < <.;;;,,~,~•~~,.~~; _s : . Cus of ital Statistics Records - ~ ~ , ~~+~!,~~t','~-'' , ~ s~AI.'~'. _ ~ , -~ate Issued ~1 ~ ~ • T ~ ~-5 ~ 17 a~ 164 P~E 44'7 - _