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HomeMy WebLinkAbout1430 in~. e~- sr~T~ eowRO oF Ncw~rH CERTIFICATE OF DEATH 164~13 eo~es a BURGU OF VITAL fTATI/T1C• STATt Flli NO. 1~,~,1 FLDAIDA ord •he~ BtRTH NO. REGI6TRAR•S NO. 5 properl~ e:eeuled rUC[ O! OUTN CODE NO. t YSVA~ R[!IY[MC~(~awrler.dlG.d l)wawe..+: R.dwW...~a.~..w) and ~111 ~~TM STAiE d. COUMTY P,.«a St Luci ~~n -o ~ Florida St. Lucie ~q P~~~ A. CITY. TOMtN.OR LOCATqN t. K KACE Oi OfATN t. CITY. TOIYN,OR IOCATqM t. ~S RfS~DEKCE ~~AfA~ IM$1~[ CITY <IMITSi IMSI~( CITr LIYIt$/ r,,.. Ft. Pierce ~ES(~ ?b? Ft. Pierce ~S ?u~wE Oi t!f wY is ~M~ild. pe Nruf ~Ilra~) : STRFE7 ADDnESS 14T~TYTq~1 4409 Metz ar Rd. ~ Ft. Pierce Mem. Hos . 9 3 Nwwc o? i'L~t A/iNrr L.~e a. w-c Alo~r? ar f~u ~'y~"~"~'~ JOHN N EB December 13, 1967 S. SEX ~ COL011 OII ~AtE MAi111ED ~ MEYER MAIINKO? OATE OF ~INTN 9. AGE KMi ~~a~ Mtta t~ `MS t.,r eddtn~ Ywi4 b~. Hwn N.+. r ~ z c• M W r~oowco avoncco March 2 8~ 18 9 5 7 2 p1~1o1~ ~~«~w~Tqw(Ciuti~~yeMlfn~ fOD.KMDOFWSUIESSORWDtISTRY ».s~A~Na~~alsr.rr..p.ryanrsr.y) 12-GT12aOFKWTCGIKntrr •1tA y~r- ~rria~awfy~vorRia/hp.er~~l/rrt"vN) ~~p~p~ Re air & Paintin Auto Bod Sho Rome New York USA ~latk lak FA7NF115 ~uYE 1~. MOTNE1l'S MAIpEN NAYE er ~~...r,e.. Carl Englebrecht Regina Schmidt _ 16 socu~ s[CU~~n 17. ~NS9 a s~auT ~c - Atl.ru . 0 86-28-7425 a ~~n, rC Ft. Pierce Florida Fwnei~l CAYK 0/ O[ATN (6~ftr Mf/ pr t~ws ~i~t (A). sat (t).) tMTENV~I BET1~t[EM OMSET ANp OEATM dir~etor ?.~T~ asTMw~swnco~r: v ~ * •u~t tll• IMNEDIATE CAYSE ( ~ t\• t~t- Q tlfle~t• C~wliti~u.i/~wl. •1te tA• rircl ~~rt ?u~ p ~ ~ TO _ ~ 1 e e• 1 ~Dott c~sat t~alst~~~ K~tia/ f~t r~frr- 04E TO flia/ c~rK luf. I~OU~ ~A a f? ~ fMT 11. OTf(~ 51GMflt47ff CyNDfTIC.K CGNiRMNpC TO T11~ MOT R[URD i0 TM( 1G~IML Qlf(AY Cp1pITIpN WYOI {N ?Mt 1(~) . W ~S AUTOFSY . tf RFORMF D t~r d~~tA ~ ? r1~ er Oefor• ~ ~ ~ YES? ~.OL+T t~b~\ O[SCA~fE MOM INIURY OCCURREO. (E~lt~ 7~of4~t ~/taftV/ PVf I M Ptlf I/ ~/ifenll/.) •~kle; ~A~ ~ ACCIOEMi SIlICIp( IqMK10C 411POS1~ W ~ ? ? L10A O~ V ~ 20C: 71ME Oi NNr A(~wf~, D~I. Ytr fed ~ uUU~r n. - G A. w. - . . W ~ 20/. MUUIIr OCCUIIREO mt. ?LAU OF uUURY (t. ia M~erl,lest, 20f CITr. TOMtM.OII IOCAT1pM COUNTY ST~TE vrM4E AT ~ wr wNwt ~ Ndar. u.ra..l<« aN.. e~c.) IMOIIK AT 1MORK 21. ! ~u~nd~d fA~ d~cNNd /rom. ~ ~ ~ , to - r •nd b~t a~~•~i~ ~li?~ on ~ ' , D~~tA occu~~~d ~t m on ~h~ d~t~ st~c~d ~bor~; ~nd to th~ b~st o! m~ ino.rbd/~, Jrom tA~ uus~a st~t~d. •Il lt~~• jj~ HCNAT ' , b J •l• t0 D• ~~Np« M f4 ( 22L ADONESS ~ ?2t. DA7E SIGttED eo~pl~t• ~ - / ~i~. V--'7~t~- ~ •CCYta[~. ~~~~~iqM. j~ pATf 23t tiAME OF CEMET[Ar OR CREMATORY 23d. IOCATYMI (GSt/.lorfL. M CNtat~) (Stefel R[rqru lS t~//1 x ova~. 1 -67 Woodlawn Cemeter Peekskill, N.Y. Y. S. iAlY ~ ~ 5 S T Ss~ 25. WTE RECD. ~1/ IOCAL REG. 26. REWSTRAA'S StGNATURE Ae~.1968 - ~ lY • 7th St. ~ ~ . . .Pierce Fla. ~ a-?-tv~ ;ti.~ti..~ .'./~`J : ~ he~e!~i~ce~+fy" tFii3• to br ~ true anct correct copy o# the l.oca! ST~ LUCA~l~ RECORDED ' Regisha~'s~ r~e~prd on tile-jn'the St. lucie County Health Depart- r,E~.~OUp1TY, F~A~~ rr?Bnf'dt f~lt~~Piette,-FlQrida:~+ - ' • ~ ~ii~ ~n ~ . . . - ~~(YVaming: Not valid-unleu raised seat of the St. Lucie l~+ * _ Counly~ Health Department is affixed.) ~68 V~~1 ~ FEB t3 ~1 10:21 . . . ' , ~ •~N: .Q: MILLER, M. D. . %.•',Q~nty Health Officer & loca) Registrar - _ . ' j , CIERK^C~RC~jjT CO ~~„~„ot~_ . . . ; , P, . ~-t , ~RT p~q~ Deputy Loca) Registror c~. - B 1 "!U ~A~ 14~5 r _ _ ~ ~ ~ ~ ~.;t ~ ~ y