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HomeMy WebLinkAbout0315 ' ' c70.?-.~... . . , ; ~ ~ • _..-...«:a~aKi~.?~:.' ~ : . ? r~'\~:tr'=j','. .~..5.::"~~~T.'T:=" :i~ a'rw'~...~ ?v a t~i. ~~~~a •o~~o n~ Hu~t~+ CER7IFICATE Of= L~EATH ~~~0~ ` • •U11tAU Or YITAL RATI/T1C~ ~ KATt IIIR NO.____.____ 1 ~•a•~ ~ ~LOAIDlI , ~ •r~ .~~w n~ NA ~o1~T«~~ • ~~O , pf~p~fl~ ' 1. ~t~tt 0/ ~~A~N COO[ NO. Z. Y~UAI ~I[~IOtMCtl~Iw~IM~rINwI /l~•.r.r.~w 11.ww.~~.r..~µ~u~w1 •fNYI~~ ~~i~ ` . ~ ST 1 COUNII . ~~loridA droWard M ~~•e•~ Bv~wqvd ~ C~t~,tOwM.dllOC~1qN t. 15 KAC? w M~TN C~ir.iowM,oO ~oC~T1oM ~~S~dsCt ' •~\~At IMSIO( GtY lIM1TS1 iw:~p( CITt UMIf~i tu•. ~011 W o e~ resp NoD NOllywa4d rts n0~,_ ; ~ I. N\MI Oi ~ryMf~A~M/~fr~~YlMfNf~IIr1~~ Si~ffT AOfMtS~ _ ~ wc~snr~i os S. w. ~~1~ 5'~• INSTITYTION ~,r~l ~ 6546 S. W. 22nd 5t. _r~ _ -~s~-~ ~ ] M~Nt O/ 1'MM A/INft Luf ~ATE MwN d~ Y~N ' ~tttA{[~ ' ~ inn N ar.n Jemes Frenc is Lan 0[ATN ~N~ s 9 ~ Stf i COIOR OII IIACE 7. MAI1111E0 ~ N[Y[A MA11111[D O• OAT~ OF ~IIIiN ! A4( 1/~ /Itl1 I~ tl~ot~ 1 vU~ t 1?~Of~ H Mf. ~ IYf ?NfN~/1 MW4 aw /Iwn MM. ~',a • ~ t t• Male Wh1 t~ Mnoorrcop avo~ccn Jul 1H 1911 55 ~ " . 11 ~lOl~ 10~:-USY~I OCCU~~TIOM (rw~ ti~Js/tN! M~t 1~. kN100i WS1M[SS011 ~MOUSTII~ 11. ~111TMR~C[ (.S1Nt ~?~rtN~ tNU1f~/1 t~t1t(J10~ ~Mf EOIRt~t/ s1tA Irr4~w~Ns/ta~l~Ihk.Kt~1/~Nbtll ....aa Pe master Laundr 9raokl n N. Y. U. 5. A. 11~tt ~11~ 1~. ?ATN[AS MWC 1~. MOTME~'S M~IO[N MAM[ ' ~ ~n•••~~•~ Unobtainable Unobteinable ~t. socua sccu~~rr No 17. MI~~wMAIIT ~~IOMATYA[ ~u"" y46 S. W. 'l2 nd S t. i 116-12-066 1Zcl;.~ 1Q~•L Holl Wond f lorida ~ ~ ~ ; Run~t~l 1~. MYt~ ~I ~[ATN ~li~ft~~d/~NeMN?t?IIMr ~ lt).) t1rtt~V~l NTI~[[N d 1 te ~ ~ART 1. OE~TN wAS t~YS(D tr~ 1 q O~KEL A~D D[ATM ~ ,¦v~t ttl• IMMt01AT[ CAY7[ /~/GV'~t_ 1.~.?~..i~ ~ 1.v3 v FL~cie.dw - ~ - / ~ tA• t~r- i ~ tttle~l• s ~1~ f1rsIHM~~.1/~~I. OY~TO(~1 C~7:~w%Nv f'/~?~t-..O~fr~~t~!ot~f . . l*. ~u..,.M „ r - ' ~ . i ~ .~a,ii::~i:. - - f~Rl~t~~f ? l~iq t~rR I~N. 01![ TO (fl~-- •11A/w 71 a z - - .wA^AUTOK~ j: 11~1~?• ~ ~ ?ART 11 OI11lA SfC4fK411(A1101TqMf CONfwqllllM~ fp OI~TN M/l ID7 R[lARO t0 TII[ RM111M1 OISfA![ C01~/I~~ON fi1R11 M~Mt 1(~) KAlpAMEO~ • a..~~ ~ res0 No8 •r s•t•r• , tos. ax~nc Now u~iu~roccu~aco (t.~ra ¦.rrr. •/i.~..~ is P.rt 1~. P.a 11 yre¦ u.) .•tt~~ ~ ~caaNr wK~ot xoMK~a as.~..~- ~ O O O - - tl~w •t 1~~ . 20t T~yE Oi Jhrr Al~~t~. M/. )iN . s f ~ iN~uer w. . ~ y p. w. = 20t. ~a~u~r oeeu~~eo 20e. rue[ or uuu~r le N dakf ~s~t. 7DJ CITY, TO+MN, 011 LOCAiqll e~+u~Tr ST~TE ~ ~ MNK[ AT ~ rqT 1MNIlE ~ N~~. hNM1. Mrrd. Mrt Wp.. Me.) ~ MIO~K 117 NOIIK ~ 21. !~~eH«.r~d tA~ dsc~~s~d /IQ1b . f~ •ndl~sl a~r h,m ~ on ~~~'~a L y D~~tA oceur~~d ~f a .___~r+~ on th~ d~H ~t~f~d ~Do~e; ~nd to fA~ b~st o/ m~ Ano.bdp. !ro?n fh~ e~u~~i ~t~t~d. •f• t0`~~• ~f10NATY11[ (I ptt N fMJt) 22A ~DDIIESS / 22t. WTC S~GMLO } / i ~..~i.~. • /f ~K~~ 77 /Y1.~ ~E~cQ,,~ 7~ ~ 9 r~c L ' 27~ NrMn. U(MUqN. 2]6 OAi[ 27[ MAME OF CfMETUY 011 C11[YATOIIY 2]d LOCATpN (('~I. f~rs. N f~r~Q! I Sl~ftl /~f0 / 11~ r; t 1 tipn//1 • 5 ~s'~ ur .1 ~l 1 1 1967 Noll wood Memo G~rd~ns Hall wdod Floride .s.~e~s t-•r auc~o~ S1G A0011ESS gpyd ~ 9 ---wrc ~uo. ~r ia.~ ~cc. ~sT ~ s s~c~ Tu~c n ~ ~••.~~ss Ho1lyWOOd~ •u•H~o29, /~G ' tii N : r . ~ - c~ - cn r ~ . ' m ~ t= CLRTIFI~D COPY " ? ~c~D c° ~ a~ J I hereby aertify the above to be a true and Qorreat oopy ~t~ the ~ ::~~m W Regietrar e record on file in the broWard County Health D~gartment t-?z~ Fort Lauderdale~ Florida. o = ~~~~o ~ ~ ~ - - 'z'' ~ ~ ~ o~m i ~ (Warnings. ,Not ,v~lid unleae rsiaed seal oP the Broward Cw~?ty H~lth D v ' - - ~e~~t~~ment is affixed. ) - . , j ; , , . . ` _ . ~ ~r. i~ ; r . ~ y; ~ • - ' ^ .i ~s ~ ~ ~ - ' ' ' ~.o ~ ~i/ i - ~ ~ ' . c~ ll? r ~ , , . . ' . ~ ` ~ ~ ; County Health 0 ioer and Looal Regiatrar ~ ~ : .y•_t~--~°?-~; - ; . ~ - . , ~ , : . - • 0 R Q~.e:cZ~ ~ ! ~ _ ~ BOOK~7o PACE .3 uty Lo 1 Registrar ~ . _ - ~ ~ '-~,~F~ _ _ r. ~ ~ `