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HomeMy WebLinkAbout1020 , S~~ 8~~ CERTIFICATE OF DEATH ,~8 te 1rlie Na Bureau o1 Vital Statistics ~ F L O S I D A 5~i ~'s Ne- o (y Qount~ ~~~~-C~.. n~striet rt _ o~ IISOAL 8ffiD~II~C~ 01 D~ t~~ tv ss~t. } ~ ~ cb) oo~z ~ - ~-e-~- ~ cwrtee nam.. aot ntm~b.r) rrecinec x . (c) dbl~ow~nr~._~ pb ar le) Ctb oe .t ~ A~• Town Ii ~ t+i afV ot o~rn ~s t~ Nwr aR Dospttal oc ` td) Ste+sat Ne_ _-$n 6 7[,. I a!k. (It not 1a hwpttal or f~tipttloeti wrlt~ street aumber ar looWon) (e) Qtlsen a! !Yil~M~n 7i~~ . (e) LenEth ot +tq: 7a Lorpttai ar 7~s ae ao At p1ao~ at ~ ~ n~ ~ (~d4' wLsth~e monUU ac dt~s) i. ~7JIl. NAI~ G~' , s w~t ..s.r.p, ~ s cs~ soct.i ~an c~c~ox • . nam...~ x ao. vs0s~~~wn n~r L~ ~IA~t.I i. O~lor Qe C~ Y d ge.a v~..,.~. v s~- ~~aert~4t~tI ffi~ R Sho~fe. marebd. wldow+d oe ' ~ • _ # •(a) It mirrf~d, wJdo~wd ae dlroeo~q, LnsD~nd at (or) I Ld a~w bwu. tlts~ • aod ' wil~ tLat deatt~ ooe~ae+~Q an f~ dat~ aod Swr ~d aboN. D~eatloa ~(b) /1p o[ htrb~nQ oe wih4 i[ « 7. BJrth dat~ o! ~ ' - • (montW (d~l) (7sa~') L M: Yws YmtLr D~1~ I! 3aw1 tLaa ao~ dp ~w ~o M • 6 z : ~ " ~,.a a ~ ~ ~ ~ ~.~•~.,,~s~.~~, i~. mama=s a ~r„iae soa~.: ~ ~ . ffie~~ . ~i 1~. (Gtw dat~ at oparation) sL~ oot ti• li Yalden ~ ~ ~ 76. B1tth ~ 3t. I! deatit wY do~ to ~oW~aal puw~ SR m t~ followfoj: ~ IR IaEoem~nri (a) (Probab~) A4ddmL ad~. bomlrl8~ (~!}y1 it W • 3- (b) Date at ooaateo~ (c) wher~ dId fat~as oatia! ~ 17. B~afs1. tfan - (Ct#f ~ (~b) tStatt) 11 (y Da 9 tT (b) Did iqi~ oocta fn ar abwt Lom~. m faxm, 3a fod~lrial ptaar ia yublfo ~t~e.~ s u' s~r'1 4~dfifi~ VD~ ot r1.os) ~ u(y Wht1s at wac (e) ad ia. n~.l z ~ ~ _ , /1.~..~,,.w =s. s~sn. i Loc+1 &~Stru (s) - te Si~oaS,~.3t~ ~ - - _ _ . I ~ F~l.EO ANO RECOROED ' ! ~~Y ~~Y ~~_m E» • ~ ~PY ~ ~ ~ ST. LUCIE COUNTY. ~~,q, ~ ' Re~'st~""s rot~b~°^, fil° 1^ tt'° St. ~"`ie ~°"r'ty H~'hi' ~°P'rt' R~CORD V~RIFIED me~t ~t fat Pi~p.~f~d+. . :~QM~ili~ {lof vali~ unl~u nlsed seal af the St. lucie ~ 1~ ,~8,? c~-y o.~~? n~~.~ 6l JAN 25 PM 3: 2 2 _ ; = . . - tt 0. MILLER, M. D. , , _ ~ • . 1 : H..nr~ o~,~ ~ r~~w ~o~ER POITR~g I ~ - ; l ; CLERK CIRCUIT COURT ' ' ~ C1--~d~~.,•'~. - ~ • ~ . ~p~l,; . ~ ~ ~ . - . p~puty L+au! Rpishar e~ . r . a~K164 P~~0~9 . ~ - _ - ~ . : . - _ - ~ ~ 5:~.~,~ ; , _ _ ~ : ~r=`'~~~ "j` ; ° ~ f"~' xi;=