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HomeMy WebLinkAbout1715 ::s.~?.~r.. ..-.r'_ ~ -~4 _ _ _ ^4 . _ _ ~ ' " .i J~• ~ ~ .~J . . _ ~ ~~u _ ~i Tl+ls .T~TS .o~RO o' Nsn~rn CERTIFtCATE OR DEATH ~y~ eo~~s ~ ~UAtl1U 0I VITAL fTATIfT1Cf RATi fllt NO. ?.s.i ~.o- . FLOAIDA~ nca~sT~~?p•s Ho. ord sA~e a1RT NO. p~op~f1~ C Y NO. 2. YWAI II~sIC~NC[l~'~I+wMbw1 !!waw.w~ Rrd~wW..~~w~) ea~tYt~d ~NOY K~~ STATE S. COUNTI/ snd s1~ 1 'G~ 7 FLOR I DA COLL t ER e. P~~e.e t. K RES~DINCE tn ~~t- ~ C~TV_ TOWN.ON IOCATqN t. ~S ?l~tt Oi DEATN t. pTY. TOWN.OA lOC1tT10N iNS~OE C~T1f 1:r1~S1 .•e•ae NAPLES rnS~oE tiT~t tt~~TSt rji~. resQ~ wo? (V PLES res ia_QT_ N11M( OF 11J ~w! fw ~a~iMl. /iN NreN WIreH) ' . . R. SY11EE7:ADDRESS Mp5?IT~L OII ~NS~~TU1wN NAPLES COMMUN 1 TY HOSP t TAt 891 I 3TH ST. ~ NORTH 3 NnMS o~ itrN Vlt/I~ -tWt ~ OATf NMr~ Dq 1Qo ' «p~~~y HENR 1 M. PETROGNAN 1 ~TM JUNE 20, I 96? S S[X 6 CQIOq OR MtE ~ M~UIR~ED ~ M[Y[11 MARII~EO ~TE OF ~t11TM 9 ~6E ~r1 i N"~~ U~O[a t~ ~ lyt Ai?tM~~1 X.,w ww X.w x... r r t a• MALE WN I TE ~noowEO? avo~cco AU6. 20~ I 898 68 ' p 1~ f ~ 1~ ~a. ~A~ W CU~ATqN ( Cut ti~~ rcN! H1t 10~. KIND Oi lUSu~ESS 0~ 1NW5T11Y 11. ~IRTHK~CE (Sl~ft A/Nt y~ tO~~K~/~ ~ «T~ ~~T •itA t~rt~~~wtyrati~/hJe.nrsiJrNurll ••*•p• BUTLER Ec CkAUFFEUR HOME CAR~ NYERES~ FRANCE U S A ll~et fak f~TMEl1'S ~u?ME ' MOTMER'S MAIDEM NAwE ESTELLA NOEVELLI e~p~•r~a•* DOM I N 1 UE PETROGNAN 1 16 sotut sECU~iTr rq. 17. ~N~o~r s ~~o~u?TWK A~treu s 1t 89) 13TH ST. y0. ~~IAPLES~ FLA. I I 2-01- 4058 X:(! 2.eP.u~e..c-~ ~-?`7"1 ~~'t ie e~vat er ~snTk (~n esti •u c•.x n~ h. ~e?...~ u J ortcRVa~ arrccN /un~~~l . ON~E ~O N dlrlCt~t ~AllT1 pEATNM~SCAUS[O~Y~ ~ IMMCWAT[ UIfSC - - - - - - ~ .nst rtl. - - - ~ tA• e~~- tltit~t• A~Iittnu.+l~*/. put TO l01 - •lte tA• r~k? I~re ru~ !o - 1~). /(p I r~61~tr?t ~ tAt ~~k~- Dt,E TO (H_i~! r~.~ ~_~wi ~ 11 s~~ J i •ItAlo i~ i lfi~~ r~rie (W. ~ O IAI1T 11 OT14~ SIGMfIC4Nf CONOfi101if CdNTAqIJTYK ~O D[ATN ~R 1bT RE O TO tNE iFRMiti~l DISEAS[ C~1~inOM G111[N W~MT 1(~) . WAS OKY ~o~r~ ~t- F, ?ER NED~ t~~ d~~t\ s YES? MO~ ~ or Otfot• r~ 1 ~ 20D. OESCNilE M01N UUUIIy OC.CURRED (6~1~r w~fr?t ~/~wjrr~ 1 t I a Pe?t !1 oJitw l~-) •~Ll~s ~*y ~ ACCiDCNT wK~a NOMICIDE ~ ~ dl~~0a!- v ? ? ? tien ot ~?~~E Oi ibrr MoRt~. lNf. )'ta - ?Aa~• ~ INJUA7 A. _ p 0. w. ~ 20~ IM)U11Y OCCU~~fD ~?lAC[ Oi ~NlUll~ w. i~ N cMrf Aenp. 10/ C1T~. TOWN. Olt LOCAiNM CqUNT~ ST~T( w~ac ~T ~ ~t wMnt U N?w. l.ra,~, u.u~. •p1~• eIN , d~.l . WOIIY Ar wo11K tt ' - . •nd /ut Nw Aim •:ir~ on ~ 1~ff~od~d A~d~c~~~~d om . fo D~~th oc rnd ~t _ ' ~ _~i~,s- ~n on lM a~t~ ~t~t~d ~bor~: ~nd to fM M~r al r+~f k~M'I~dN. IfOll1 fA~l~YN! ~~~tld. ~ • , A I ~ 1 t~~? jj~ f!Ol4l wt (/N/?[~ N f~l~) 2?1. AODRESS ~ ?2t. WTE SIGNEO •r• te D• • G'~.20?~i co~}l~t• ~ •eerrat~. ~~t ~~T~ jk. NANE Oi CEMETEII~ OR CREM~TOAY 23f. IOCATqN (CY?, f«rw, ~r e~ti~t/? (S1'~t~+ ~ RtY0Yl1l 1~1p[n//1 / BUR 1 AL ~~Z ~ NAPIES MEMOR 1 GARDENS CO I ER COt1NTY ~ F~OR I DA ~d~~ 2~ fU ' Al MAE O^II ATURE ~DDRE55 25 ~E RfCO. !Y IOCAI REG . R TMR:S ~IGMATY~t • te•.~Yea t!`j t-w~ NAPLES~ FLA !~-ti ~ /~JG ~ ~ CERTIFIED COPY I hereby certify the above to be a true and correct copy of the record on file in the Collier County Health DepartAent at Naples, Collier County, Florida. (Not valid unless the seal of the Collier County Health Department is affixed) `,p~ I ll Q f;ci~~~ .~f fr v .;;,.fi . '~Y• O'( ~ ~,~t~a..p , . ~ . REGIST R OF VITAL STATISTICS ..j•% 1 ' • ~y s~ . 1 " z • ~r' ~ COLLIER COUN'PY FLORIDA v - ~.s : .q ~a. i_.. .a - ~ i ~ • ' , r • ' t r . ~ . ~ ~ v~ " • I 1~ . / ~ / ^S` t? ~~i ' r+-~, ; ay ; ,~„a..,) ~ J' y-' ~ ~ z _ . _ ~ ' YS l;y~t f- q~.. ~ y, = i ~ • S h '7•. . ~ ,i . ` '..11 ~ ' t ) ~ . ~ F1~E0 ANd RECORD~D- ,,~ST. WCi~ CQ NTY. FL,A. ~ RECORD V~Rt~lEO ~ ' .~-a~~ ' '61 AUG a ~ ~2:38 - dGOR ! FA6f ~71,5 i:Ov~R FOITRAS CL~RK GtRCUiT COURT ~ : . - ~R~ _ ,K