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HomeMy WebLinkAbout2211 t• .T~Ta .o~,~o o. Hw~,x CERTIFICA7E OF DEATH 1~g~3 °O ~UII~I?V OR YITAL RAT1fTtt~ *TATt r{Lt Iq_ ~LOnta~ •r ~ N . ~g~ •rl~ 1 KAtt N ~tArM • a • t~~ • GOIlMTII COOt l10. YWAt ~tIKAOt t IV~ ~+~~1 Mwd II iwiww: ~Ynw ~~1 ~w •ili • S?~rE • ~pywn tae~~ Ct__ lnriw Flerid~ ta ~~r- C~1r. tOrM. oil LOG?T+O~ e. K K~CE Oi OEATr ~ e. C~1r. TOw11.0~ WC~T~OM If ~0[~[E .t na~oc an ~w~m ~sia[ cm ~w~ra • res p MtY[ • ~ ~ t/1 ~M i~ ~M/Yd. ~t ~6N[ Nb~N) t S?~E[T AOORESS Npl~ITAI OA - . INST~1UTqM ? ~ 11A~It N ri~1 /1/Wk L~M ~ oATE ~fwM pp Ywr ~ di • °~'T" 1 1 6 7 MAllAI[O ~ I~Y[R MARRKOC ~T[ 0~ M~TN ! AiE 1/~ Mt~ I I~O 1 YfM ~t~ ~ 1~/ MrMIM) Yr~ O~ /~w Yb. • ~ ~ e • +nooaEO aw~eco 6. ~ 1 • 1~_ IM uwnL oCM~~D~ IOw t~d y~.t Nia lOS Rwo aF ~uS~udl wOUSr~r 11 M~n~~tt Isr~ ~r 1MHp esr~t.f) ! crosi ar ~wt t~aerY? . f r- I~riy rM ~!I rM1My h~. rrw y?~fIrNJ Nat. USA ~l~ k 1 I~TM[RS ~u?rE ~ YO?NER S YAIOEII NAr. ~ t~~ •f1l~r ~r 1 ~AS OECt~7t0 EtlER 1~1 Y S. Aw11[O + lOCUt ![CVMTr Ip 1 t t1~IMTY~~OBg I T~. Y. ~ rlawv II! ~r- M~ ~r ~ M~~ d rrw~f Zi --1 L ada Ave Ft. f'ierce Fl<3. I~e ra 1 ~wYM N MATM (6tien ~~r e~r~r ~er Nr /r (~1. l~). a~I Irl.~ IMTE~rAI ~~td ~lr et~~ ?~~T~ tY~rMKLSCAYSEOfr~ ORf[TMOO[ATI ~ n,. '•'K~'n ~ --l~rfl.C8rd1$1_SII~~t'ction du~_ ~_A1~ioaclerotic_ _ 11 houra i~r Coronary Thromboais ~ ' .l~ ~ ~•;/r"~M a,c ~o li,inertensinn and ArL_QI'~4fi~4I'4~1~ bQ$~~ .Dl@e8;•e ---11 . t ~ 1 • • ~ 1 .b.. ew.e ~ ?~s •trar ~r~1 ~ 1/t~I aw Irt. out 10 (e) •ft 1• if ~ ~~nTe rn~s~wsa~rtOUwroa - ~ af- GOIR~RR f0 Ot~n~ ~ Ipf IIMtp ~O M 10wM? D~lufE Od~M~~~ CMa wlMt ~(~1 A t~r ~~~t\ - /EIIPO~nEp .r... rESp wD u~ ~ ~ ax~~c Mor ruu~r occuRaco ti~a .rrr~ Nral~~t b Prr J r/w /I yYn~ i~ i ~ccac~r wK~a ~KUc ~t• •~t- O al• •t ~r Twt os Hwr ~/wM. YM - t~~ . ~ ~ww~r • ~ . ? ~ 1M1Y111 OG VRII[D bt ~IAC[ Of NUU~~ (f. I. h1 M MMf MfY. ~J.~ CIT~_ TOwll OII IOCAT1011 OOIIqT1 STATE AM4i ~T ~ NOT ri1KE ~ 1r A. A~tfM~. ~rNf. ~ct N/I.. dt.) ' ~OR~I AT ~ORR . ~ tl I~fanOW tJb d~ow~~+I /rom y~p~• f~ 9~L? ~ 9~ b~t w~ ~~~li?~ on ~L_ f DwfA oooun~/ ~f u~ on tM 1~N ~t~Hd ~?w~: ~nd fo tM M~t o/ ay lne~Nr/~. /ronf tM uuw ~t~N1 ?11 ft~~• u - •r• t• ?ta M~w?Tw~t (/AMrer ~r Nrk~ ?!D ~ooR[ss ttc. wTE sK~EO - ` ~ P St Lucie Sho in 1 6 - •ee Ht~. Ll~ ~U~Y. ~Yqi 2~ OAtE 2]r MAIlC Oi CEMETERY OR CA[YATd1~ 2N IOtATIDM (C~.IMw. qs~t/) ~~~1 IIE~OUY. 14~ett71 . ~ ~ ~ ISI~ Z{. NIE OR S SIGII~ YA[ M~ 2S WT[ A[CD ~Y LOC4l 11CG - REG~Si~ll-S SIG~A l• .l~s• n~ hh. St. ~ F~Q ~:J;{~e[e6'y~rt~-#y-thts ro be a tru~ snd•oorrocY oopy of ths Locst LUC~ R~ D: OU R~gistrar's remc5!'o- {:'e in the St. luci~ County Heatth Dep~ert- RECORp . • ~nt ~t; ~rr' Q~.-re_ F~orscie. 15 ~ERIFI~p ; - ~ (YVarninQ; t~ot k-~=;~ unless rai:ed seal of the St. lucie ~l 49~3 , ' CQunt'/ 1•:ealth DEpartment is affi,:ed.) ~ 2' 3 ~ ~ '~I~-'~~ ~ ~ . 41~j~~ , . _ N. D. MILLER, M. . . ~ ` ~ , . _'ii . . ~ ~ ~ : : . ~r --Couaty H~alth Officer b Loca) Registrar C~RK CI~CUIT C4S . ~ r ~ " ~ . i~ ~ ~~.,~~/;!~flS.:Lb'V ~.~~~.7.~ ~ . 1'~/~w~+.~ ~ D~r ` Depwy t,ocal ae~istrar d,r ~ ! . , . ~ ' ~ Bo~K165 Pac~2207 ~ . . _ - - - - - ~~..s„~ ~ f,-.~~, ~ ~a W.~~:a, I j w s i r~ - ,c ~`•~=w , V t - i ~u~~