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Home My WebLink About1021 2Als A~- STATt wwia on Ns~u,r~ CERTIFICATE OF DE~.7'"!~„~a~ ~o..: . •uRCnu or vnr~c.~ ~rwtnsrtd ~ strwss ~~,t ?ea '•aa1 r•`_ FLOHIDR ord ~~~n BIRTH NO. prop~~lf REGISTRAA•S NO. ~.2 ti~CYtfd ~TM OtATN CCOC NO. Z. YfYAL R[SIOtMCt(f4+rr~rrtirl. //iW:~fr: R~:/.~MNw ~sd r112 ~ STATE ' OOYUTY s. y]ac~d ~ ucie 66-12 rlorida St. L~icie i¦ *~r- 0. tm.?Owt. Wt lOCA7qN e. 6 rIACE Os DEATM e. GTr.TOMM.OQ IOCATION t. a R[S~DENCE a~t~sf uK~OE CITII uMR51 INS~OE C~TI u~IT51 ~ r~l.. F Yierc ,rrs~ No? Ft. Yierce res~ No? 1. ~++~i~o~u~ir~ ae (!/~r i~w~ir~t. It~r.hser.Ura.) a~[wcrn os I. sT~cT ~oo~css OM A i11RMl sT~ w u U N th SL. ' U~(rs. 0 r[. 1' th JL. ~sD NoC~ ~~~e /1/i/pr lwrt o~TE MwN ps Y~ar Mattfe ido e ~TM 1 7 y$ i S. SEX i. COIOR OR AACE 7' MARQ[D O MEME11 YARRIED i. OATE OF MRTN AGE 1tY1 i{!4'~Ew t YGR {IKOQ S~ NK. 1 Jrt Obt~[q1 x..w D.w ~twn Y:., t e• Female \e ro ~noa.coQD orvoRUO Aiarch 1 ltftfU y } ~i~lw'lir- IOt, tKWLOOCW~TpM (04tliN~lwrllae Im.KItW0iM/SilESS0~IM0YST11Y 11. NIITMrIACE(tSTYtP 3 .t c! wi,y s~r y wrtiy 1~Jr. sew 4 ntire~) /~i~I~s ow~tr~) ti ana~ as nur oW~ntrt ~ '•'~•°t Do:~estic House Work Geo ia U.S.A. ~l~ek la4 13, iATNE4'S w~ME ~ 1~. YOTIIEIIY MMOEM NAItE •r = ~ t~D~~r1t~r W lliam H in Kannie Unk. ~ ` ui w~ED..r.~..::.~ souu sca,~mr w. r~. s aawrwei Daniel Heath tJo No e " N t et ~ 1~n.r •1 1~. ewuss o? otwTN J&ua ~ ws aw pe. tiailYr e•). te). a! c~).j iwrutvw sErrrcEM llr~ete~ ~MTL OE/1TNNASCWSEpw: ' p1~i~yrpp~{TM ` ¦r~t tll• w~~TE ~N~ (~1 e1~ e~r- titie~ta ~ ~ ` ~ ~ ; ~it? t\• u~ 1 o e • 1 ~Dw~ cpwe (iL ~ r•a~=~*~~ ~,o <<~ Carcinoma 5i moid Colon .1se~n ~a z tri+~ nrai r~.t. . iOV ~ s s f- O ?MT iL OTIiA SK1i1GCff OOIIDRqR[ GWIqYIMC i0 OUTN ~Yf Iq~ ~OA7ED TO 7ME i[RIIMY 01SIAY CnId71011 GMO~ M MRt 1(y . YrAS At7TOKT t . t~t d~~tA ?E1IFORYEOT ; er 6thr• ~ ~ ~ • • • 1fE5? Np 3 ¦atie~ ~ ~~Nr wKiuc Nowrcwc ocsuiuc Mow ~wu~roceuartFO. (bt~to ¦rwe NWwt ~ Pirt J~r Pet Ayiras uJ •aPo.~- ~ ~ O O as e[ ~ aDc. TtrE OF I/w~ a(w~ti. De?. Ys~? ' ~Od~. INJIIRY a. p D• W . ~ 20/. 6UYIIY OCCY11RE0 Id[. rlACf OF INJURY (t. iR M~MY! ~O~II. JD/. CITY.1G1t11. 011 IIOCATION ~ C01111TY STATE ~ wNnc ~T ~ wr wN~t ~ le~.1~r..ncer. NEcs ay.. aa) ~ 1/ORK AT MOIIK ~ ~ , • i 2~- l~[bnd~dtMd~owa~d/rom 1- 1~eC. ro 6 Jan. ~l~ ~ndJa~twti hj~ ~Ji~~on ' ONtA oeeurr~d ~t m on tlw d~t~ at~t~d ~bo?~; ~nd ro eM Mat o/ ~ RnorNdN. lrom th~ uuses ~t~t~d_ ~11 it~R• ~ ~Q~Ty~ se 1. (aq?nr a rrk) tte. ~co+~ss ue, wTC s~o ~ °°¦p'•t• k :tartin G. Gonld :l.D. 10 Ave. A Fort Pierce 9 Jan. 8 •etr~~t~. 21~. MAnat.taEiuipu. 13A. OATE 2k. MYEOfCErETE11YORCAENATOR~ L'~!_ LDCATqN(GV~.fass.~?c~wiWl') (.~dt) RiMOr1l (S ei/~1 Bn 1-12- $ Pine i;rove Ft. Pierce rla ~ S.+612 21. fUNENAI DYIE OR'S SKMATYR£ AOOrtESS ?S. DATE RECO. ~Y lAtAl REG_ 2i. ItEGISTJGR'S SlGr1!?TURE R~~.1s66 +rs r-- a Charles N. Stone Ft Pierce Fla. 1-i2- 8 Anna Le De ' ~ . FtLEO AND RECORQED ~ i her~t~r~cL'~ttf~ thi~"to tis a m~e ar~d correct copy o# tfie tacsl ST, LUCIE COUN?Y. FLA. ~ Rcgi~tra's Teoord oo~fiie_in the St. luc~e Coimty li~ahh Depart. RECORD VERIFIED , - 152i83 ~ ~mirp: Not v~slW~unl4s! reised seal of the St. lucie t . c~,,, -~~h. ~;s aff;X~a 6t JAN 25 PN 3• 22 ' ~ ~ • ~ ~ - M ' ~ Z! , . - ~ = = ~ : 'N.. Q MILIfR, M D. i ~ : ~ = ROGER POITRk3 = . ` ; ~ ~°u"!~' Hea~tf' O~tce' 3~ ~oca! Reqistr°r CLERK CIRCUIT COURT ~ f; ~ , • - ~ , . ; % ~ ~ //93-~1~~I P~~ ~ ~ • ~ [SiMr ~ • Deputy Louf Re9imar ~ . ~ , . ~ ~ s~x~ts4 ~1ozo ~ < _ - _ - _ _ - t,.:- ~ `