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HomeMy WebLinkAbout0012 . Cx ~ ~ ~V~J~iIV v ; ~ - - . i _ . T.~IARYLAtlf~ STATL DEPAGTMCrlT OF ISEAl.TH - ~ ^ _ i, ~ ca ' ~ Dhrisi~w STATIST' 1l rFS~aARQI AND RKORD=. 301 ~1/. P.^..:STiw STREET, f3A1.TiMORE 1. MARYLANO t' ~ rc~ . , . ;aIC~AL EXACA1S~ci~'S C~::'ii~:~: : O~ [)CAYH C~ ~-1 p ~ - . C~ C~ LACC U_Il:7t - r.--~~ 2. Vsv~u. rL:.I:~LNCL ~~~Mr~ Eece~w/ Aved. ~ iosw~t.w. boH~c~ O~an ~dw~uouj ~ CO'v" I ! ~ ~ O ~ ~I SiAll ~ a b COIR!!Y ~ . .q• ~ MAAYLAbD ~l . ' _ r~/(~ ~M i . GTY Ui 10':lN i•! cu's.~~ a~:r~••.at~ 1.-.~,. . i. t(:.GiM Oi STAY IN 1~ ~ ~ r: I 02 i0\Yd (il corc~.~ +.e t.- 3: ~~~l aad o~~~ ~c~.~~' tawe~ ~ , ~ !'S A ~.,jM'?swJ y ! . ~ ~ ° ~ 1~ a$ 0 /J ' ~ l~d ~ E /QC•~ ~ ,!S~~' ! , ~ O ~ - NA•~[ Of HO Al l~' 'rtVi10.~ ce.~ ioyre~•, y-.. ~.<N ~[MW ~i ',::.lt wDDf11ti ~ IS tESF~iNtE ~ 'a ~''~~~.~,L~IuQ ON A tAR~1~ ! o r~ fi`~ S'r ~j OJH'~ ~J9 P~ ~ 'i 9~ !7 ~/QP0~7r ns 0 ti~o ~ ~ ~ ..o.u w. r... - ; W ~ a: ic OF ~•~u •~.dda ~•w DATt a ECEN3E0 n Of 19 L?~j ~ . a Ir:e c. onwq _~L! ~ '/pf)/~ ~~~j~1IT - DEATH J/LlLp. 2~~ ~7~ t ' v - i f"i > ~o~os o~ ~?~t ,.,,,~EO ~VIR MAItl(D UA.1~ O! N[TN 9. wGE ~I. r~an.lf UNDti l TEAR !i lA~~it ]I NtS__ c~ M 1 ~Lt ` H••~1) ~llew!M~ Wif ~ Moaet ~ M:~. M~ a O ~ t ~ I W I WDOW[~ ~ D~YOlCEO OuL/Q~ I~ ~ O fn. ' . F i i~ O ` USUAI OGCLiAiION (Giw ?.w~ d~vl , 10~ [DO Of WW~[SS OR IWUS)lY ~1 ~SCiWiACE ~SV•~ a bn,y~ te..~M) I 12. CIi12tN O~ WMAT COlA~1T[n ~ ti U p • dr.y ~oM werriy tib. ~•e~ .1 rM:wQ ~ ~ ~ ~ ° a us~e G~ue Home Neu Ca,o#,lQ, ~Yeru (i~runorr.~dt~ Canada ; . a ~ J. /AiHER'S HAAitf - U. MOMF~~f MIUD[N NAlY4 ~ ~ :d a ~ ~ ; ~lvluc Q. ~vd~eLlnui /~re?ci.e ~Cx~d~e.l,li~rr ~ F y ~~d. WAS D[CEASED EYE! W U_S_ AlME fORC[1t ~ 16. SOCIAI SECU~tIf NO. INfnRMANT Addrw , ~ Y ~p w~.1~wa1 NIq~~~ ar«d+!NO1Mn~c~) n_ ~^;"""`7 H((/JQQ/~ FU/K I.(.Q/Z(~1 F~CQ~ ~ ~z. p r /F'O . , ~ -'IFOft~ :XIY<.LL W C3 o j 1/. CAUSi Ot P~iM ~E..tir ~.I~.~w~~,.,. v« 4.. ~a iei. .~a : . .•rr. c.vwi .aiwuri i N z ~ ?Ati.4DEAM WAS CAUSED ~T, ~y ~ ) y~r d ~ a~31S[~ Ati7 O:A7N ' O i . IASM[DIATE CAI:SE 1~1 _~~i~~ ,7~I~/~ / r~~I7 t f H H M i ~ : . . . . _ , ` . DUE TO ' ~ ' - • H / ~ ~a.A:~~ /~~f'ERrosc~~t. i~< <•'R~Div I~S+~d~t j Y~ts. f r-~ - n:~.:,.» :~:.a.e. wa. - - _ - _ , _ ~ _ y~ q ~y OUE.iO~ t G, ~ i . I~)t ws.s 'H~ .s~rro ;.f ` ~ ~.i W H ~ . 4.r_ - :kl i - _ ~ _ ~ r - . --r - - - - - - ~ ~AtT k_ OTXER Si(LNiKII^'-i CONQIii~NS~COtiTRtiUi~ttf, i0 CIA~H Eill N01 tFtA1ED 70 fH( TEtMlHAI OISlASE COWI110N GIV[N W tAtf Ij~; /9_ WAS /lUtO: SY H ~ - ~ . - - f tttrowt~~ s ' • . I ~i ; ~ Z ~ A ,4 _r'- . . ~ 7ES Q- NO ~ t H ~ir - - - - - . ~ ~ N J^+. Ex~ERH/?L CAUSf WAS 1 20b DfSCtltf HOW YISCilY OCCUt[A. ;f.w ~a.w~ o1.+~vr iMf 1 w?art N ef ~h.+-~i.~ ~ ~ ~t, w Q7. ~ r c~.u~t* i7 a cor+ruwip+G G7 • t• . c;. a ~ r CAUSE OF OfA7M.- • . : • ~ C. H Q~ ~ ZO4 TIi~~ OF +?INt'~ y Me:~A. Dar. T~.r ~ 20d. ~N~uiT lkClltif0 1M. ?tAC E O F W i I R Y ( l b+~. lir~. 2 q. i G~+1 w q~n l ( Co u w ry) I i h!~; ~ ~ ~H • w,.r _s.:..- - ~ a ~ wha, Na wAd• Maon.w..~~en:c•e~dv..rc.f - , H C~ s.< ^ . 19 !M ~oci i ] al .eet ^ ~ . ~ ~~y 2L I,eetttlT tF.at 1 lo~f cfi:,r!~_ of ~h~ tC'T. 1'>• eIMCf~bc::.bn+.•. held an AutopsY ~ lnspeUion ~Sn~wy and m my ep.mon i ~ . ~ i . ~ti:•:rdlad i~„n 17.~t~r..: cau•.cs ~.~.~d••nF ~ i '.u~cWe a. Flomicide Un~;Mc.mmOa~net ~ : ~ , ~ CMNF MEpCAI flfAtitWFt U ~ ~ ' 1C7VRl ASS1SiAM MIMCAt (IA~Ul~'2 : PlLTE SiGtJ£*} . ~7 ~ CI .RA7URC ^ M O. ~ ~ . Ct!A'tINEA'S I- ~ I~/~~~! otnrtr M~~O~! ~ ~ ~ a x ~ `~HA::E:irrel ~/~iY/~~ ~ ~~7~ ~ Addr~+sl ory. k..q~ ~ e~l~ ~ '.-3 E-+ ~ :li~ilA!, r~i4tAfWN.~ :7s OAtE IHI~fOf : 2ic. NAr."[ c)f [[•.tftf r O! CtlMAT0~1 ~ i1d. IOCAiiON;C.~~. a r<u~:.r! IS•~r~' ~I • r'1 ~EFMU~A ' ~i)~ y c~~~ ~wte 25~ ~~i~' I~aiiu.cJci. Cemc.te~t~, `Neru Ccr~#,[e, r1'au fyuut.~mi.ch~ ~uitada : ~ IlM[tAl D1~ECi0~ A~MFS1 - RFC'D !T ~[GIST~At I 7~l.. tI(ifSpA~'. SiGrUllli( ~~en l~uirn•~ ~ ~vne, Tvv.~vR, ~fsvwlru+ol - - - - I o,?.~ ~J~~N 2 6 '1967 :~~~''?`~v ~s~• : . - - - - ~ F~l.E~ AND RECORDED~ ~ ST. LUCIE COUNTY. FLA: ~ p~CORD YERIrIEQ ,sl N~ _s PN 13 2g 16 . ; ~:o.:: ~ ~-o~-r~~s - CIERK CIRCUIT COURT i. a~o+c169 Pn~ ~.2 ~ ; a _ - - ~ : ~ - _ _ - - ..1