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HomeMy WebLinkAbout0236 s Tnis !e- BTATE eowao OF HEALTfI CERTIFICATE OF DEATH coaes a BURGU OF VITAL RATIlTiC~ fTAT[ FIL[ NO.~~~_ ~.a•l FLORIDA o~d •sea BIRTN NO. REGI6TRAR•i NO. etecuted 1. rUC[ Oi O[ATN COOC NO. Z- YfYAL R[SIO[MCZI*M~Mr~iti~- /!iwMJw~: RrJ~MWrMw~iMI •nd •311 ~NT~ St . Lucie STATE A. COt1MT1/ (ob-0~5 Florida St. L~:c~e E• P1~ce0 ln y~r- A. CITI.TOWM.ORIOCATqN t. 6 KACE Os OEATN t. QTY.TOMM.OR LOCATIOM , t. 6 RES~OEMCE •~n~nt ~ t . Pierce ~~M~rn r't . P~erce ~NS~o[ 4~TY ~~~~rS~ file. rE5{:J u0? 1'ES~ n0~_ 1. ~uME OF (1/rf is ~Myitd, ~ia ~tr[t! ~I~rea) _ LVA I. STII[ET AODRESS "°S"T"°", Pierce i~ie~orial :.osp. ~02 41st St., u~sTiTUTaw r t . 3 KwYt os flrrt ~li,Ws L~at ~ wTE 1Nwt1 Ms Sin ~~u?~~o Otha Gaie uear °i ~ i p~i~) OfATN ~ I I... ~ I J C3'J S. SEX 6 CO1011 O~ MCE YARA~EO N[YEII MAR~~ED • OATE OF ttRTN AGE /t~r1 ~i u~oc~ 1 rUU ~ta t~ ~rK_ _ ~~;le ;fii te ~ 7/5!2~ r~a~?w.r~ x..w n.. x.,. r r? s. rneoweo ~ avaeeco y 1 a 1 a 1~ 10~. YSU~I COCWATqu (Ciet tiR~ ~/ewY fpt IOD. KthDOi WS{ME550111N01lST11Y It. tIRTM?LACE ($~ft M fMti/R CNt~fr~l 12- Gt~iO~ Oi r~MT OOUwnlii . ¦lte y~r- t..i,yswHsati¦st~/r.mRlJntvM) ~ '•Tel~er Su ervisor `~est Viryinia iln~ted ~tates Dlaet isk ~j_ iATM[R'S N~?tE ~ 1~. YOTNER'S MA1pEN IIAME - .~.arcus Gear T~:eresa "-!cGee t~y~~rf Nr ~ 16. SOCIAI SECUMTII N0. q. IN/011 t HCMATYR[ Alfrtu 23~--30-1r3 Betty J. Gear 402 N. 41st St., Ft. P_e:ce, .~l.a. FYA~f~l 1~. CAYft 01 O[ATN [t:~t~? M!/ qt eawr prr li~e~.r /A). u! ld.~ IMTENYAt ~E.TWC[h d 1 r~ e t O ~ ?~~T ~ OCATN Mu5 CA~S[ 0 ~Y- OttSET~p DGTN .~.s tii• ' ~MY[W~1TE CAYSE m~;l ti=nl P i r~ JL17'1BS St1CiQ@ri tA• e~t- . t 1 t 1 c. t•' " G~tilwu. i/ •ar. DuE ro (1) r1tA L\f 1[~K~ ~Mt fu~ fI ~ I 1 O C~ 1 ~t twar r~sistrar x~/ t'k r~~- q;~ TO (d ~ l~iR~ dut lut. • 1 t n 1 e 73 0 ~MT 11. OiME11 S~GafIWT CO~OIi~S COM11p~111uK TO OG~TN ~ NpT IIt1A7[0 TO M TUtrNLL 06(AY COMOITOM GY[N N?Mi 1(~) . MRS IIUTOKY ~ Aour• af- F tERiORrE01 cer d•scn ~ ' ! or ee[ore _ ~s ? ~ ( ~rrw.?b? aoe asc.Ryt Mar uuu~r otcu~R[u (Earn arrrr yuja.~ 4 Pwt f r Pa.t !I yirrn ~t.) a~klAs •o~ ~ ~CtOENT SUICIDE NpY1C10E ~ioe~`er ~ ~ ~ ~ two car collison ~ 20t TirE OF H~rr J~Inf?. Ih~. Yt~r Dod~. ~ u~luAt W 6: 30 a. 1/ 12/68 s Zo~ iwu~r xcu~co 20r. ?UCE Os ~WU~r i~ w?~a[ ~eu. m/ c~Tr. towM. o~ wuTa++ cou~n STATE WNIIE AT O MOT NMIIE ~A• N[lMI. Il~[d, o/k~ dN•. dt.) ~ ~.K AT WIIK ~ Oran e Avenue Ft.~Pierce St. Lucie Fla. 2~ !~tt~nd~d th~ d~c~~a~d /rom T1PV@r , to •nd b~t w~ ~li•~ on D~~th occur~~d ~t on tM d~t~ it~t~d ~Ao~~; ~nd to tM Mat ol mr kno..Nd/~. lrom tM uus~a aut~d. to`l~` ~-RIONATYII[ (IKprtMfi! ) ADDIIESS • ?2t. WTEStG~c[O O°`r~'~• + /'Y ~~fiit- ount Courthouse 1 16/68 ~ •CCYNI~. ZJa Wmat. Ucr~rp~. 2]D DATE I3! NAME OF CC Ffik~~ OR ~TOAY 23/. tOGT~ON (GVI. psR. ~r twu~tp (ST~tt~ •~-~.i`~~`~h~ 1/15/~L '.'~e ce Ce~eter ~ Ft. Pierc:~ : la. Y. S. fei2 Z~ ~p~?l ECTOII StIGN T ADpl1ESS • 2S. DATE 11[CD. ~1/ LOG?l RE6. REGISTA/111'S 51GMATYRE d. . ~`ates ~>>cral ::c:ae ~ w~..~oes ~f?: ?~t. Pie~ce, ~ia. 1' I~- 6~ a r.. .s, . ~ , x ~ 1 ~ ~ . , K i hereby certify•t~i"s;t~pe.s_trve ~na correcr coPy of rhe t.oca~ FILED Ap~D RECORDED Registrar~s~ recou~to~'file J~1~tlie St. lucie C~unty Health Depart- ~ ment at•~prf iPierce; F,la~db~ Sj. LUCIE CQU~~TY, FLA. ~ . F;~.C(1~P :~=Rr~~Eo •":(uNarning: Not valid un~~ss raised seal of the St. lucie ~ Count~t Health: D~panment is affixed.) 163636 ~ - ~ ~N: .D: MILLER, M. D. +68 J~?t! . I 8 P~ Z I ~ c 'i t ~ •Courity Health Officer ~ local Registrar ~-~/~a~-c-l-~-~~ ~ - . : . .01'F,.,$ ~ _ ~ = ~ 1 ~ , , . •~w ~ CL~RK CIRCUIT COURT ~ p~f~ Depury loul Ragist~ar d•r-- ~ ~ ~ d00K PAGE a _ _ ~ - s1~ _ _ ~ _ _