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HomeMy WebLinkAbout2673 De- ~TATt ~o~?,~o oF H~TM CERTIFiCATE OF DEATH 15324'7 ; eo~~s • ¦URGU OF VITAL iTATIfT1q ~TAT< FIL[ N0. l~s.? FLO$IDA ord rAe4 BIR7M NO. REGtiTNAR•f NO. ' p ~ o p~ r I r 1. ?LAC[ Oi KATN CODi M0. t- YfYA~ R[f10~NCt M~y ti~- l~/WNwwAtra• RrY1~r MHn ~vwu+I i e:.eus.a ~ ~TM .^a ~~il Saint Lucie 66-02 Florida Saint Lucie ee P1.c.~ • l e y~t- 6. bTl. TOlA1tl.0i1 LOCATION t. K MJ1CE Os OfATN t. qTT. TO*N.OR LOCATIW~ r. K RESIOE~iCE NeOSt INSIOE CITT IIMITSI ~ {MSlpE CITY LIMITSt . r~,.. Ft. Pierce ~sUC wop Fort Pierce-Port St.Iucie ,~sD No~_ r I. M?rE OF Uf ~ it ~~it~l, /it sbat ~frn~) t. STREET ~OqtESS ~ uaT~TUTau ~~T~ ~ Ft.Pierce Hemorial Hos ital ?75 5andia TJrive 3.IIAM[0? I7nt ~liqlt Lyf W1TE Voat~ DR/ Yea c~iy,°r`. «~~.:.r~ FLORENCF M. DAI3IELS «:7M Fehruary 4, 1967 S. SiX ~~IOA OR MCE 7. YAAREO NEYE~ MAlA1C0 DATE Oi ~1ATN 9~GE 11a NYI ~f UM[II I TW tM0[i N 1AS. lYf 1~~t1 XwW D+w Bwn Yi._ ~ s. Felnale White rnoowcoiJ orvo~cco I~.Sreh 22~ 1898 ~ plal~l~ IOa. YSUAIOCCIM~Tp~(Qirtliwlyw~tlnt IOS.KINOOi~uSUtSSORWOtlSTIIT 11. WTWa~CE(St~ft~r/M~ywda~Er/) !2. tlr+7b~OSrw?7COU~n~rt : .i~r ~"'~b~~~,"~``."'~`~•`~"~ None Grand Rapids,Nichigan United States ~ i Dl~tk lek 13. iA?N[II'S WYE 1~. YOTMEII'S YAIOEM MAME % O~ } i ~~p..~~~.~ K : ~ 16. SOCUL S[CUS~T1f N0. 17. IM ~ sIWMriRt .SNrqa ' ??5 ~~a~- Drive ~ _ - e a t Iuneral 1~. CAVK K 0~1TN [61fa N1/ Ms eswt ysr list ~r (s). ~a~ (c).j IMT[nvnL ~ETwE[~ i d 1 t t~ ~ IART L DE~TM wAS C~YSEO /Y: ObSET AMD OEATN .u.e r~1. wreouTC ewsc c.) ~ D~-- c?. e.._ t3lfe~t• CNLKiw,f pI. .isa cs. ;u~ r. ~ ca~ Ar . _rj es~2sr~~~ Heart DiseasC _ Years 1 u e. 7 .ee.r c..u ~ . reslstr~~ K~w lk rNn- pyE TO (ci ~StAiw i2 2 l~is~ aMar lut. pOU~ f- O ~MT 11. OTKA S~CNilCM1f OONOtip~6 GouTlWY~YK TO OU1N ~11f IqT RMtEp 10 M iERrwt pYAY tO~D~~+Ow GMw M/~Ni 1(al . trA5 AUTO?SY . NEIKONMED . c~r e~~ee ~ or D~fer• sstlaa ~w~ Q~ Ih~ ~[su~u[ ?~q? rutMr ottu~RCO. (Eata a.nue ynjrr~ la Pat !~r Hrt ll yirrs f~) ~cuocNT wK~oc HorK~oc disyest- u ? ~ ? . cloa of p~ T~~E os Nw~ Nwt~. D~~. Yer Ded~. V uUY11Y t- w. `q R ~ ~ 20/. wWr OCCYR11EO mr. RlltE OF uUU1n I.. ia r raal ~e~r. 201 pTY. TOIn~.OR LOGttIW~ OOUN7T STATE riNKE AT a IqT MN4E ~ /pR. I~1MI. Mstd. i~tt NII•. dtJ . MORX AT 1pp11K 21. !~tt~el~d tM d~wd /~om ~Zg• 2 9~s . to FCb. ~i~ 19 7 ~nd !ut s~~ A,~ ~lir~ on F' Cb. ~ Dr~tA ocev~nd ~r m on tM d~t~ ~t~ad ~bo?~; ~nd to tM 6~st of mr /cno~ld/~, l~om th~ uua~~ ~t~t~d. •11 1N~s jj~ ~p~TYR[ •re to D• (~rr~lt/k) 17b AoDRE55 ?It. OATE5~6NEo °~•p~•c• • Ber?iard D. Ross M.D. Port St.Lucie Shopping Ctr. 2-7-67 •terrate. 23~. W~aa.UUUMM. 2b WTE 2k. ?UYEOittYETE11tOnCR[~ATO(!Y . ?3f- LOCAiION(GY~.lwa.M~oa~(J) (S7Nt~ ncroru (tiyrrih~ rial 2- -6 Ft.Pierce Cemete St.Lucie Countq,Florida , Y. S.l612 zs. ~u~c~ a~Er*o~ : swN~T~~cyate~eral Home OATE REtO. ~7 IOGI REC. 26- REGISTRAR'S 516MATUR[ ~ "".1°6b Jack J. Moore Ft.Pierce,Fla. 2-8-6? Anna Lee Denison, d.r. ~~~~r!t/!'•':~„ - - - - -:~La' ~ - - - . , ~ ~ -hdr~y-~~'~t~ii=•.f6"~bi. a. true and corred oopy of tF?e locsl y0 R ;'~~.8egistrat's reootd` ~'f.~.~~ i~n~ the St. Lucie Coi~nty Htafth Depart- L~j ~ . ' _ ittsnt;a7- ~e?t'Pil~~bn~: ~ U y~~ , , ~ ' . lF _ ; ' llfofwl vnless ralsed ~al of the St. tucie ~ ; - .ry.'. • T.~'\~~!ti ~~Oilt~1 ~AQOfT~f1[fM 1K AffIXOd.) C - `,\d:!~",~1~ j :'.~~~t. . , ~ V ~j~ ~ ~ ~/`~'y~ y ~ ~ ~ J J~.~: ••'r i~~' ~ N. Q MILLfR~ M. D. ~ - ~ ~c,~? off~? e~ ~~~n.. 153 4 CCERK"~~`' ='OtT~ ~ ~ : ~ _ ~~R~~~T COUR7' - ~ • o.a oepuryr troc.~ ae~unsr d, . . .i i ~ooK~64 ~~~E~s7o ' ~'"~`y'~ " ~ <>as'` 3 .,x~='*~- : ~ _ . . . . . . - .~sS= ~ -~~x.- p~' `T^d~' a _ I ~ ..3