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HomeMy WebLinkAbout1074 Teis De- 6TAT[ eowno oF ~ts~?LTM CERTIFICATE OF DEATH 1s40`70 eo~es • YUR[AU OF VITAL tTATItTICf fTATt Fli.t NO. y l~a.l FLOBIDA ord rAen BIRTH NO. RE61iTRAR•! NO. properlr ti~eut~d 1. ?tAC[ Oi CiATN GOD[ NO. 2. Y~t1Al R[NOtNt[l~a.nMWM~iwt LwwMr: Rr~twwWNJ~~ri~w) and •l~l ~~~~S1]~I?t uCle 1/_~Oas- STATE A. OOYNTY ~p« "loric?a Saint I.ucie s• y~•e.a _ ln y~r- 0. dTr.TOwKdIIOC~TqM c. K KACE Of OEATM t. dTr.TOYrM,ql tOCAT10N t. K RES~DENCf UISIDE CITt UMITSI INSiDE CITY UYIiS/ ffl~*t :'OIt P1G'rCC rESL.'] tq? i Ol't Pierce yEg . ~q I. tUyE OF (IJtw! i~ ~wyifd. Iirt ~httt ~Ilrt~) STIIEET ADDIIESS Iq5lITAL OII ' {NST~TYTqN ~ r.; ~ ti 1~~03 SOUth 8th Str2et ~u?MC or tt.r alurte lvf OATE ~«r~ ar 1~a ~~vu« p?~.p LECPOL.~ I-~'a~!'n ~ r.1T =.SE oE"TMJa;~ 3_O ? i.:r~ S_ SEY COL.011 OR RACE 7. YARRIEO ~ NEYEIIYARAf[C OATE OF ~lRTN 9- A6E (l1 K~?1 i U~Gp 1 ~W 1FOEdN WK. ' ~ M?W~/~ M~Y~ Mw Mwn Xi+_ r~ s c• '.'~le '.;'i:; ±e Mnoowco0 wvo~cco ~:ov. ? 5~ 137~ y: *1 ~lYl ~ la. ~~ATIWI (Ci~t tf~1 ~Jr~rk fpr 1~. 1(IIfDOi WS~M[SSOR ~MOYS?RY 11. ~MTN~?ACE ($dt R~tl/R [Nt11b1) IZ. qTttEM pf RIYT QOUNIfiI . ¦ate P~r- Is~iy~wtNwriia~h/r.newiJrftbd) Lr.~tcc: 5;.~.;;e_ ¦~p~pL FrOC3:1C't2021 ~'jO~::e- .e«,ir.~ i:c,"LC+11T:E uer~:n T' ~ ~ . ll~tk lak, ~j_ ~AT11EIl'S ltAM[ 1~- MOTNftY YAIO[M IUYE Ot e~,...,~.. ['nav :~?.~'~Ie Unavailable 16. SOGUI SCCYR1T11 MO. 17. ~NI~ ~ tICMATYRt Af~rtM OLl Cl J.. Z F C 1. ~ ` O~il-IO-77e ::ar~e S4 ^:arie Ft. Pierce rlo~~c?a ~ rYO~r~I 1~. CnYf~ 01 O[ATM ~Ewtt? ~wll w awt pn ne ~ sa/(c).~ ~ _ IhT(IIYAI ~ETMf[fN : A1~~CtOr ?.eT~ oc•TNr~suuxo~r: ""o ~ : •r~t lll• INMEDIATL CMKE r~y~ ~ t\• e~r- . ~1~ ~ ~I;1~ eifie•e• G.tK~.a.~l~*r. oue ro (N -C1?t~1~4,-~- `~fi -1`L~'~'~t-C~/ ~ ¦it~ t1• r~it? prt ru~ N~ ~ . 1• e• 1 ~ea cnu ti). ? ~ r~alstr~r at~tiy u1r r~4~- o4t To (d ~ ~ •itelo 7Z l~iy n~x lwf. ~ 1oYr • a[- ~ ?MT n. Oil~! SKwi~UUfl CppiOMf CONfRRII}wG 10 M RI~ IDi IK41CD TO M 1LfruYt OtSGS[ C011W M~YT 1(U . MAS AUTOKY c~r d•?N ~ ~ J . 1 RF wcor s ' , fs NO ? or D~ r• ~ mp. pE RyE ~Ow y~r p~CUaRE tEstn wdwr MNr~ i~ Pvt I Prt ll y i~~=11.) .•~s¦s •w~ ~ ACCIDEN~ w ~Kioe il~ie~i- v 0 ? ? e - tiOf •f p~ TIME Oi HN? A(Mf~. /AI. Y~Y - 20 I' ~Od~. V ~NJYwY • ~ f~_ • W ~ 20t. IMJURY OCCUMED mt. ttACE Oi oUUl1~ /t. i~ M dN~t Aear. mJ. pTY. TOMII.OII IOCAtqll OOYNTY STATE MM~LE AT ~ NOT Mn~KE ~ ~M~, af~td, o/kt Ot[/., dc.) i w'J~K AT MIORK ? • 2~ _!~~and~d tM d~c~~s~d /ro , to d bat w~ A~~i~~ on D~~th oee~?nd~t m pn fA~ d t •t~t~d ~bor~; d fo tA~ bwt o/ my kno~rl~d/~. eA~ uua~s ~t~t~d. ~ •11 ft~~a ~ fICNATYII /y(e) / 22b. ADDII[ S 2:t. WTES~GMEO •r• to 1• I / eo~pl~t• ~ / [ L ~ / ~ •eerr~t~. ~ 23~. Witu~. UE i TE 23c. h~rE Oi C[r NY O REr~TOR 23f. LOC#T (GY/.lwcw. ~r c~r~) (Stdr~ Rcroru.l•' n 1 /l ~ ~ _~~_~y P~erc.. Ce:..e:.erf :or Pierce, :3orid~ ` Y. S. i612 2~ ~ERA~I DIRECTOA 5 SIf.N4TUllky~~4~i. ~,WO~€~s~::e r~ _ i:oY: 25. DATE RECO. ~Y IOCAL ~EG. 26 615TMQ'S S UNE ' a~,.~oe~ lc. -~t P~erce ~Ior~ a f- 1 j-b ~ , o..k..ts~~t~~Z~.. . ~ „ , E ti~- " FILED AND RECORDEO . ; i~ereb~y certify this to be ~ true ana correct copy of the Locat ST. IUCIE COUNTY. FLA. ; ~ Registrar's lecord on file in the St. lucie County Health Depart= {-1 C Q R~ ~!E R I FI E D l ~°m~ent at Fort Pieae, Florida. 1640'70 ~ ; ~ . (VI/arning: Nof ~alid unless roised seal of the St. lucie 5 ~`O ; Q 3 ~ • Covnty Nealth Oepartment is affixed.) '68 f EB • ~ , ~ ; - . ~ . " ! ~ . ' N. D. MILIER. M. D. ~ _ . Counry Health Officer b local Registrar ! : ~ ~ i'• ~ ~01'i P ~ S ` CLERK CIRCUIT COURT ~ l~'-, ~O 3~ ~ L~~`r Y r~ 5.av~- l f Date Deputy Loca) Registrar d.~. _ i I ~ - OR ~ _ BOOK17~ PAGE1071 .R~~.:l . ~ . - « . _ . _ . . _ . .-F.~.'4"J` ~Sr`` Y - I i~- . y~ . y~ x a-.:c}. r, ='.s* . ~~~3,~v t; M~,="~ t}' ~ . . . ....~;="::::i