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HomeMy WebLinkAbout0531 Tsl. ~,rwT~ wn~a or Nsw~TM CERTIFlCATEOF DEATH ~~(~~2 ~~3q33 - °p••s • • .~ey?u oR v~w~ srwrmcs srwn ~u No. '•j'1 r'°- FLOBIDA s~d v?~~ SIRtH N• G AR•f NO. pr~p~tlf 1. ~LI?Ct N~tATN COD[ N0. i YWA~ wi't~1~QICt(~aw d:.r'~r~. tr:MnN/~.~:..iNl •:.euc.a •ad •111 ~ ~TMS~1"~i ++LLL`lH LC~2 • STA~E ~ 7 ` . D~ ~l~e~~ • W ' . 1 n r~t~ 1. GTy. T0~1M.011 LOCAiION t. K M.ACE 0/ DEATI a di1/.10~N.OR WtALQM f. K 11E510ElltE ~ rii.. ••••¦s Fort Pierce ~il~ O F ~ ~O ~ ~ N06i1T111 O~ ~~Mf It ~N~~. ~if N/~I[ ~/d/M~ s, 1i11C7N OF fTwEEY' AOOwE~ ' ON A iA~Yf i sTr~u "'~T'T'"101 D.O.A. Ft.Pi rce Mem ~ ~?.r sp~ ~ruw z.~r ~ x..u ~ Da rN. ~ JOH!~T BAILEY JR. ~TMOCT: 26 1 61 soc t caar w ~.u 7. ~p ~~vae~uuwco ~ wTC os ~arrN ~ ~thr~s.r x..w n.. r«. x~ • i:. Male Ne~ro ,noo,.cop ono~cm Dec. 15th. 1900 b0 . a i.l ~ lo.. uw+~ oaur~noM to~r tW y.wt a.. to~. Kwo os wswcssw wous*~r 11. w~Tw~~a (arw w~nr. a..~?r) 1 araw as.wr aaunR?r .i c~ ~•r_ yw•~W ~lk. u+~ 1/~~r1D aun .•¦••a ~`~t.a~`iorer u~ Railroad CheraW So. Carolina U.S.~. O1~e1c iwk U. sATN[I!'S IMME 1 IqTMR'i lW0EJ1 ~Y?Mt . . . s,,::.~e.r ~ John Bailey Unknoxn . ~s. w~s oca.sco cvu~ M u. s~co w~ccsr - . soc~u sccw~m so: n. n~ s s~~ Adel Baile fr~. ..d....? w....:......~...,~...:~i Y ~ ~es W W~ I 718-05-5691 •ur... 00 Carver t. t. erce a. ran.r.l cnvsc o~ w?rN (~fw.:.h... o...s ~e. tbs1~ c.j. t~). os (d.) ucrcievaa ~~w air•ee•? ~~ura oc~rnar~suustu~r: " oasETruiootutM .~.s r~~. w~~~ ~ w I~rocardial I~nfarction t ca. e•~- ~ - •itYe,tl• ~~itiw.fr/i~eap/. OIIE TO - . 1 o C• l ~Dw c~iaa (i). .~•ai•e••r r~ o~« r'~ar. ouc ro t~~ ; . i s aa ¦:s ~ ?~T k a~a ~rra~a oo~wms m~nrtra ~o aum ~ ~w rmaim so rrc tamwk asusc co¦ana ana n r~n qy . w~s ~uTOrsr aours at- ~ ?E~sqeMEp~ • c~r d~~t~ s or ~~f~r• r tOr. ~ 0[SGt~E ~+0~ rYWltt OCCW~tE0. (bbrs ¦.r.rs yiys.s is Firt Ir Pirt 1! ytr~a t~J t~0 Q , ¦alci~s ~a~ ~ AQC~OEIIT SY1p0E NOM~CI~ ~ at~p~si- trJ O ? ? - t s~ t ~ 7At. ~wE os , l/w? X~t~ Dq. Yerr a~. ru~p~r ~ S ~ IQi. Yt7YllY OOCY~RW mt. RACE Of YIAfRY (t. / i~ Y~t waf. mJ- d17. TOrR O~ tACAT10M OOY/ITY STATE 1MILt 11T O 110T r11111I ~ /t ~MI. ~Ortd. dt.~ 110RK ~TlOIIK - - ' r.ea,~s.d ~e. i.«...afro~. never saW ~.m ~ ve .~a ~ w.. ~ D~~eA ooeurs+d ~t SbOUti • a p~ tly d~f~ ~t~bd ~bo~~: •,.d ro en. s..e oI aU. tno..bdp. /rom th~ uus~s ~t~fM. ?11 lt~as ' ~r• se 1• ?2a fiCM11TY11[ (lMMeeMNHt) 1L. ~001KSS Ilt. GtTcSKNEO ~,.:1.~. a trrilliam H. 1Keyer, M.D. ~ 708 S. 6th. St.,Ft.Pierce 10-30-61 t aeecr~t~. =y ~wK.t~[iunor. t~. O~TE ?3C- MAMEOfCEYETERYORCREYATpIY 7i1. WCwT~ON(Ci(~.twrs.r~wat~) (~tel ~ ~irlsa'~'' 11 5-61 Pine Grove Cemetery For~.,.~i~rce Florida ; Y. S. ~61~ 2~. fY1~E~uL OME 'S SIWTWK ADORESS 2S. WTE RfC0. ~Y WCAL R~G. M~ 11EC1STIwl'S TYRE . a...~9as ~~a~ R. Gibson, Ft. Pierce 11-1-61 Anna Lee Denison, d.r. , , • \ \ . tr ~ _ • - ~`c =4 ~ ~y ~ ~ ~ FIt,ED ANO RECORDED r0i~ttds.reoortt d~iib'i~t ths St. lucte Coimry Hsahh Dapar~ ST. LUCIE COUNTY. FIA. mient at Fart Pierqs:;Np~a~• RCC RD V~RIFiED NVami~. Nof iialid unless relsed seal of the St. Lucie ~ 0+~ 0 , ~ ~ : c~r, r;~r+? ~ ~ ,~~a.~ '61 n ~J I 2 PM 3 : 3 7 ; ~ _ ~ . ' . N. Q MIL1fR, M. D. -~'~~--~'~pC~C~~ .i ' . , ~ ' ' ~ CouMy Heshfi Officer i~ tocel Reqistru L F'017 R ~ S " ~ CLERK CIRCUIT COURT _f - tn-(o1 ~ ~ ~ p,~ Dcputy Lou! Re~imar d, . r. - ~ ~164 ~ 5~9 ~ . ~ ~ ~ _ ~ _ r ~ ~z,~~ ~ ~ . - - - - - - - _