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FIlEO AND RECORDED j
ST:-LUCIE COUNTY: FLA.
~ RECpR(` VM RIFIE
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CLERK CIRCUIT COURT
OH10 DEl~ARTMENT OR HEALTH 15~9`76
~ p;~ DIVId10N O!~ VITAL sTATISTICS ye~ E;k ~
~ p~;~ ~602 CERTIFICATE OF DEATH ~s~'~ ~
~~o EATH c~ ~ e~«r .a~i
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t: . Ai 1 nd n~,~ Fla~ida oouNn erce
Q• nn, w~uae. oe ~ourwN I t. IENGTM Oi STA~ IN 1~ atr, vut~a[, oe ?ourw~
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c, R 2 vks . Ft . Pierce
1. NAME Of II~ Mf 1~ M1jN/~ M t~1lff1JJ~1. Lne un~~ ~tlreu~ I. fTlHi AOO~ESS
~ o "~T"'"O1 H ct ital 1 1 Yost~ite Ct .
~ is w?ae of orw ~ws~oE an iurim ~s ~oe+ae i~oe atr iuurrr I~. If lESIDEHCE ON A fAWi
rES ~ wo ~ rES ¦ uo ¦ res O r+o !
u' s AM O Fint ' k Iart 1. DATE '-3oeKh Da1 Yqt
T °r~~a
~~i Harold S. ~tunysn ourn 1-3 1967
n~ c s.
~z oo~o~ o~ e~cE wunEU MevE~ wun~ a?rE of aern ~ n. n aw. ,,w u r.~.:~ M..
Mele ( Whi+e wioow~ O av~ott~ 11-1-89 Mrw.~1 ~y..~~,1 n.~, H...,' rw.,.
f"' • ~j 10~. YSUAI OOQRATION /Gir~ li~1 v~r! /~r~ 10~. [I?10 Of MKINEii O! INDUST!? 11. ~Ilt1YlACE fSa1~ N/nril~ 12. dTIZB1 Of
~ y ~ ~?iN ~w d wii1M lih. N« i1 rM'w~d1 r~ 11 0011Ni~11T
Salesman Cin°c~nnati, Ohi~ ~
V •Q, Z Retired
03 O f~n+~rs ww[ u. ron~rs wuDa+ wur~
~ Z Yilbnr Keen ~unYan ~?nnie Herris
~ u. wwt o[ttwsEO EvEe ~rt u. s. ~wEO ?o~s~r u. soq~t s[cunir Nc,. u. INFORMAWT'S NAME Address
O (Yu. M. ~r esh~n~ !~l r~. t~ r' IIO J~ru nrria) I 289-O1 119? ADflB ~11[1~T8A
Mrs. u
~ 1~. A SE F DEATH [ ~ • ~ ~sr ~s~it ~tr ~ . (r . INiEdAt ~E1wFH1
a?et o~?rn wns uuuo ~r~ I a+s~ w+o orwn~
W _ _ cwus~ r., Medullsry ~ralqsia
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W a.1:u.... ouE To a, Pulmonar3? $~boli~
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,,;.s~~,.,, ouE To r~, Mpocardisl Infarction
Z ~ r~er u. on~~ a~aaaur cwMne.~ ce~TnNn~s n wn ~~r ~w twra~ r~ v~ i~n~~~a asusi ca~«i~ a~n t~n del H. WAS AUtOKr
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~ ~ IOe. AOGOB~T Su1C10E /10MIC1DE OESCtI~E I~Ow IN~I~Y O~IKED_ IE1fM 1dM1 IlJaf~ 1D PMf I M PI?f II lftlR It.1
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' ~ ]Od. IHIYlY OOQltlE~ 10~. ~LACE OF 1!W!Y (a s.. i~ ~Mit L~at. 201. dTY. VILIAGE. Ot LOCATION OOUNTt. STATE
a I /r~. /~rt~ry. itrttl. ~Ett ~llj.. Hs.) I
~ WOlK AT ~ Ai MIOK~E ~
~ 21. 1~tadd tie Jirr~r • ~ h- iur bi~ dir~ ~
D~~t1 ~t~and ~t a ~~s t~e /~te it~t~! ir ~sl t~ tk irrt ~J h~lrJ~t. /r~w tbt ~~a~n u~tt/. ~
~ rt.. SIGNATIlRE ID~.r~. prts) m. nooe[ss Ylc. DATE SIGNED ~
g S. Dale ~avenacrai`t, DO ~ Lynchbura, ~hio ~1-6-67 ±
z~_ wn~u, ceEx~- na. owrc rk. n~wE of t~rEer o~ te~ruTw: iouno++ (c~. co..o. or co~~ (s~ae~) ~
T~a+. ~ u,~ Greenlatirn Ce~. Milford, ~hie =
Buris I 1-6-67
2!_ NAME Of EII~AWE! luc. No.) ( 1S. FUNERAI DIlECTO['S i1GNATYlE luc. Mo.) ~
John H. Svane 6312A Jehn C~ Craver 2661
26. wNEtAt Hw IuA l~oolESS (sTeEET No.j (011?) (~A?E)
~ Cravsr Funeral Home Inc. 529 Main St.~ Milford Ohi•
-r. o~~ eEC~ a b. ~c~sTwrs susw?rueE a?rE ~co n m. ws-eEC~sT~wrs s~c.w?TUe~
> 1`-~`-~~ IDarlene Woodmaneee I ws-.~~sr.~?e I }
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