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HomeMy WebLinkAbout2476 . ~ 159291' ~L~ a~to -R~cQROEo ~UCIE COUNTY. FLA. •n' ~`C1~~ VEP.tFIEC 1592.91 ~s~ 1~~'~ 2 ~ QM ~Z : ~9 i~ t? ,~OtTR :s CLERK CIRCUIT COURT oHio os~wrm~errr o~ H~?~TM'L'~t~ 1 , w. o~,.. oMS~a+ o~ v~rw~ nw~nsncs `1`sf~ ~ tr.. ti~w~ 1?v. Dit CERTIRICATE OF DEATH ~wu's No ' 1. F DEAT S ESID NCE ` re dae 1~ iwu~tYt~oe: n.- de~e betea aMis~iow) ` y z O 2 iTATE D/ul0 a. aow,n Ld.PA /b • an. vu ot ?ouiwN tawrn a st~r ~N atr. vtu+?aE. o~ ~ou?TroN l/. ~s -c I( 1/ ~li G a k~t ~ a.~.~... 33 4 89 uLa,~sv ~2~? NOSMTAt O~ u+sriturww ~3~y /~/s~f ; 7~a . _ ~s w~ae a oEwm ua~oE an uMim ~s e~oE~ ~us~oE air iuuns 13 ~ESIOENCE ON A fAW1 Kp r[s !7 uo - rES ftY ao " NAME OF Fint ~1~dk l+~t ~?rE ~r ~u tniE~o~~i f~/EL i~v4SGiv~l o~rn G~ E 7 ~ 3. tE1t OOtO~ OR U1CE 7. 11Ala~ l1EYER MA~RIEO OATE OF NtiM Ai6E /Is f~~ N~ 1 Yw 11 ~dir 2~ Nn. l~N ii.ti/q1 IM~ntb D~~~ H~r.i Mrs. w' w~oowEO O avoRCCO 15~ 9a 73 ~ ~ 10~. YfYA~ OOQI~Al10M ( i~e ~ r Ne IN. RIlIY Of W31NEii O~ INOYSTtY I1. ~itTUKACE IStih ~r /~rn~~ 1!. pTIZEN Of ~ N~IIA. ~w N~M/n/1 O l~M, _ W QS~QJW_ M?MAu S NitYf Z ~~arnn.~ ~ ta. rw~rs N~ u. rwn~rs wuou+ wwE = m~ R~~ ° ~~l:,Q.~, ~ is. wAS OECEwSEO EvEe uf Y. s. AM1EO roetEit 1~. sOtu?? sEaul~~lr NO. ~7. 1 FORMANT'S NAME Address O fYu~ON wb~w~ fIJ K~. pre ~ M l~t~r ~rrrire) I~~O(~' 34a3 UJm ~~-,i~ ~;r,,g s~~ V W'G11 ~ Q,(CP ~ 0_ ~ 1~. A SE F ~ IE~ • 7~~~ r~+~ f„ • s• iNTElVAI tE7WEEN otwrn wns t~unEO sr~ a+s~r ~wo oEwn~ W uu~wAtE cwusE a~. ~G~]~t C ~pcv~~ 7~v~y F-~/~i.r -t. > • ~ Gw/iwei. i/ ~t OYE 10 1~1 ` OY O~t ? i N ~~"O ~l0 t/ ~t f Sc~G - , r ~ k ~a ( j I}i~~ =c~ne Itt. OIIE 1'O Isl `(ZY D N 2 v"~ rl D S! /~v p r/ f ; _ ~ M~n Y. ~nti f~w~nert tMrrw~ C~nnMrM t~ wn ~n Nr „urs~ ti n~ tinw M~wa CMwnw p~n n?u~ d~! ~ l~. WAS AUi0I3y / n / 1 ?ERfOwEO ~ S ?J/ ~ h~ S~~S M e/% ~v S ~ I rES O no I ~ ~ 70~. AOdoENT ~YICIOE IIOYICME 10i. OEiCRRE 1101M IMIYIY OOOIt~~. Ils~er wm • apry n lrI 1~r P~.I ll ar~ !t./ ~ ~ O O D ~ S n ~~ir~ .H. : . . ~ - ~ ~ 70% INIYA OOQ1vED Q I 70~. ~ ACE Of IMIYlY s.. i~ at I IOf. d1f. VILIKrE. O[ IOCATION OOUNTY. SiATE YYNIIE AT !!OT MMIIE y ~~~1. ihrN. ~~n i//s.. ds.) WO~ ~ AT rMO~ ~ ii. ~.avrd e~. ~r.wd h.- /uf iw diri 2 DM~I~ ~t~~rrn/ ~f J~.~ Aj`? w M tIr l~r~ N~/ is 1: ~l I~ Ii~ ial hndrlp. M~ ~k ruui rt~t~I. s~~ n.. IGt~ATtJRE (vrp.. w r~.1 rn. ~oo~u m. DA1E SIGNEO ~1~~/ ~ yyv z~.. z i~ ~ c.~ T~ e. w n n t, t' a~ u. ~~~,J' W01.Klrltf/N~v E~ n E w? T a rr I i A toc DT~oH n(G~ h r. ~00. . or co~~O c~1 ~ . ( \.JUwC.~RM,Q~ C ~ 71e Of E11~M~1E! Iuc. uo.l 2i. Np1EfAt OI S SIGNAtYtE Wc. Mo.) l~•~n A~ So~o A ~ l.~wl~n A~~ 3(~0 ~ u~ hw ~wo ~o~ss ~:T~~ no.l lam ~s~~rE! . ~ ^ ~i~~ A har~ --'700 l~ . ~ru:t a~,t - L aZa~ui~, 0 4ujo . n. a?n ~co w s~ ~ cw~c eECO sr ~o. sw-~c~ : siceuTUe~ ~ y fY~~i1iT~AR c~ > • : - 'f'. '~..1-\1~: > ~ ~~L~ I HERE9Y GERTlFY THAT THE A80VE IS AN = X ,CT ~ ~ ~ i r, i..", COPY OF TME RECORD WHICH IS ON FlLE :1 TNF: ~ - l ~;;t , . ' - - ~ - . - • ' ' DEPARTMENT OF HEALTH. CLEVELAND. !C ~ - _ . . . i ~ ~ .ij a - ~ ~ . . ' ' WITNE55 MY HAND AND SEAL AS I.OCAL RE ~ . ' ' : . r-. • ~V , . : ~ ' , OF VITAI. STATISTICS : ~ . l: i~ , ; ~ ~ . . , I~1 ~ • . . ~;_J4~~ I_ . . ~ JUa -s i98a ^ . ? RtGlfi"tRAR '',*•..a'' . _ `,~i _ - a~~16? P,~24 ~6 ~ ~ T~,~~ ~ - ' ~ . - ° ~a -