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. zei. D~- ~TAT[ eowwo aR Mu~TM CERTIFICATE OF DEATH ~
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l•aa1 FL08IDA I~
, ord ~\~n BIRTH NO. R[G16TRAR•S NO. ~i~
proy~rl~ 1. q/1tt 01 OiATN COD[ N0. Z YtYI?~ R[f1oO~Ct(~~^~wrM1i.~- U"w''r"'~ R°'~"MNw•'i'w"'~
e:tcut~d ~ ~TM a STATE ' . OOYM~':
.°a ."1 St. Lucie 66-02 Florida St. Lucie
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rii.. Ft.Pierce ,res~ Nop Port St. Lucie ~ res Mo ~
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Ft. Pieree l~emorial Hos ital 16~t~ :Sar_enateCourt ~
~ a. ~unc oF .v+~a~ Lvt DATE x..u? Y~ ~
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~ A ~ c~n~ Nove~ber 10, 196b
S. SEIt o0tAl1 oR ~ACE 7-.y~RR~ED ~ MEVERrWt~EO wTE oF MnTN 9- ~~~f) x..w D.w xw~n~ X'~r. ?
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O ?AAT IL OT1f~ SKIi1G11i CGIp1f016 CO~101RwG 70 QIT11 ~Yf MOT IIOAIED 10 iME TWI~L ORf?fE Cq~1110M 6rY0~ M ~AtT 1(a) MUS AUTOiSY
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l11 1 Nu ?2a fICMATY~t (Dr/ra ~r ttNr) A0011E55 ??t. DATE S~GNEO
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~~•alie• • Bernard D. Ross M.D. Port St. Iucie S!~op ino Ctr. 11-1 -~b
•e tn~at~. 23~. OuaY. QfiunOr 230. OATE Z)c. ~E OF CcMETERT OR C1IEWTOAY ZIt. LOCATqM (Cif1. fws. M asiW!)
~ur~.~~ 11-1 -bb Ft.Pierce Cenete Ft. Pierce Florida-
v. s. ~si~ tt_ fw~c~ -s s~c~uru7atesA°P~l~ral Home ss. are ~cca ~r wu~ ts_ ~~sra,u~~s s~c~uTURc
a...1oes Jack J. k.oore Ft.Pierce Fla. 11-15-66 Anna Lee Denison d.r. "
` ~ " j = " FILED AND RECORDED
1~1~e~et~y'taitify.th ,to tie a tru~ and correet copY of the Loat ST. LUCIE COUNTY.
- jtegistrat's r~d.•~iie in ~fie St. lucie Camty Heahh De~ars- RE ORO VERtFIED~~
~ mait at foif Pis+!ie:. Etorids. ~ :
Y' ~ 152~34
(Waqniripi Nbtvelid unless roFsed seal of the St. tucie i
. - -,,c~,; ~ ~M '6T JAN 20
_ . . , _ 7 ~i . AN I I : 31
` ~ ~ 'N. Q M1l1fR, M. D. _ , -
_ . .
- - . : • , . : ~ • ' : County Health Officer b Lxal Reqistrar ~iOGE R r OITRAS '
~ ~ ~ ' ' ~ ' ~ CLERK CIRCUfT COUFtT ;
t "~?4~,.~(v`7 ~ f
p~~ ~ Deputy loul Re~istrar ~ , ~ ~
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- BooK 164 P~~E .785 ~
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