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HomeMy WebLinkAbout2178 rn» e.- ~rwT~ wwRO oF w~w~rn CERTIFICATE OF DEATH 164g2p eo~es • ~U11[AU OF VITAL fTATtfTlq RAT[ IIL[ NQ l•s•l FLOSIDA erd ~A~n SIRTH NO. RE016T11AR•! NO. prep~rl~ 2- YLY~t ~[N~tMC[(w~w.M~.1e..~ 1/..r:wa~~ t~.rwrrM/~.~i.w:w) eateut~~ ~ KA~ COD[ NO. STATE C'OU11T11 ..e •ui St• LuCi@ 66-12 FlOrids St LuCle 0~ ~l~e~~ CITt. T01M.0~ LOCA7qM e. 6~U Oi OEAiN e. CITY. TOfM.011 IACATION e. K RESIDEMCE 1• ~fr- NKIp( (Iry LIYITSI •~~~~t M510E CITt IIMIT51 rsi.. Fort Pierce .~s~ ~a? Fort Pi rce Kural •~s0 ~Q f. NAY( OF (/Jwd 1~ Mqthl. NN sErM MdsM1 LEIIGTM Of f. STII[ET ADOIIESS ON A iMYI NOSMTAI OA STAY M 1? ~S D "'~"T""0" Fort Pie e M 1 7~Mt F1rM NiYe Lrt 1. d?TE a/wd1 Dq Yea i~~,• ~ iiarie So ie Gau el °EATM 1 1 60 S- SEI[ ~ OO1011 OII RACE ~ NARII~D ~ IEYf~ MAR~tO ~ OATE Oi M117M !~6E 1/~ /tr~ i Y~0[11 tW 1/~0[R t~ MS. r i e• Female White ~noowco0 Jan. 28 18" 8 t~ 8 ~ x..w n... w.... xr.. +l•i•i~ 10~. V511AlOCriMAT~ON(QYtli~/~/rwtM~t ~oe.Rwnas~?sMCSSOa~ousr~r ~arwt~cclsrewp.sM+aa.nr) ~ c~ruaa.¦uoa~rmn. •itA ~~r- fviq~wtNw~thMl~h.~wlJrdirM ~ .....e HouseWife ittenbe Germa u•~• • /1~ek /wt 1~. i~TMEw~S MAYE 1~. MOTNEII'S MAIOEN I~AME ~s.•••~~•~ Christo he Hemi er Unavailable IS- MRS DEC[ASEO CMEA 1M U. i AwMtO FOACES/ K. SOCML SEC1MITr IO- 17. s M~~T~~ J.W.Ystes ' ~r+....•..lwd u1~».«......w+.r......! NO Afiu~ I~n~r~l 1~. iAYit N KATN I67Htr til/ w[ lMM /t~ q~t/r Is). q). d I~).) ~wi[~r~~ ~~rEtN /AIIT 1. OE~TM R~S CAYSEO ~Y- ~gy$~TM ai••`~•• ,rrcou,n u?ux ca GanP.rene of .~.e ru• c~. e.r- ~,r,~.~. ~,r,,~,.~fA,, ~ ro~~~ Thrombosis left femoral artery Days ~ .~ee .~i~a r.+'r'(.~ l • e • 1 ~ r~si~tr~r /tMI nur l4t. ouE TO (d ~ • t t 1~ 1 a 7~ ~ fMT 11. 01~ SK~1[M~ Cd~OR~Od ~Mt ~O OU/M ~IR MOf ~[M1E~ 10 M TdNMI 06fAtE CO141~011 GIrEw O?MT 1(~I .~IAS AIYTO~SY ~ s~rr• •t- ~ ...s. 3 Gangrene of Small Intestine, severe arterio-sclerosis n,a ,,,p ~ •r ?~f~r• ~ i 2os ocsc~wc ~ wn~r oocwao. tawe. w.r.r~ MM!¦?~ Pwt ~r Pire ll ~lY.w u.) •~t~~s ~w7 r ~?ttroEAT SY~c~oE Md+~dOE l1~/~~t- a~ ? ? ? ~ l~a •f ~ Twc OF Nwr J1/~wt~. IN/. Ye~ ~ •N~• ~ wu~~ iw. , o ~ IO/ IM/Ullt OCIVRREO KACE Or IIIA111r (t. 1~ ~t wf1t. 7DI CRr. TORM. Ow IOGT~OM COVMTr S~A MMRE AT ~ IIDT tillll[ ~ ~I• af?td. M[t N~1-. dt.) M1011K l17 ~IIOIIR ~ Y ~ ! ~et~nd~d tJb d~eNNllrorn12 2 ~ . tot~~l ~nd h~t w~ A~'~O1 ~li~~ o ~ ~ DwtA occurnd ~t ~1= y•I~. s~ on tM d~b ~t~t~d ~60?~: ~nd to fA~ 6Nt o/ a+~ lno~NdN. /~om tA~ uu»~ ~t~t~d. •I1 f t~~• ~1M~TY1t[ (Drntt M t1Ne) ?b I10011ES5 tlt. WTE SK11ED u• t• N G ~..~~.e. • J.}1.Hatsche M.ll. 516 Ave. A Ft.Yierce ~'la. 1=l-60 ~ •ee~r~t~. j]~. MYE Of CEYET[Rt OA CREMATOII~ 2.lr. touTq~ (Cr~. tws. r ewi~! (~r~) weti. tat~arqR Z]S wtE ror~ l Ot~~/I~ ~rema~ion 1-6-60 I3elra Cremato wa llelra heach Florida s. te is t~. s s~uunMC eooRCSS a. wTC ~cco_ n iccµ ~a. s. RccaTiu~~s siw.v~c ~ss• Josenh W_ Yates, F ~.?j srce, F3a. 1-11-60 ~nna Lae Lenison d. r. ~ ~ ~ ~ ~ ~ ~ ~ Ft~EO AND RECORDED' - ~ , . ~~~E ~OUNTY. F~a. -~648~~ i hpr4bry,~ ~ce~ti~y~~tbis ~to be a true •nd correct copy o~ fhe Locsl gT. L ~ t; Re~jsl~rs,~ecord_on file_in ths St. luci~ County H~altfi Oepert- ~ _ au me~t'at Potr'Piert~. Florida; . -j • . , ~ .(VNarning:.Not va1id V~~~s ratsed seal of the '68 FEB 29 P~1 0 ~ ~ ~ : Cpunfr H~aNb ~Depa~tment is aHixed.) _ r- _ - . . - ~ ~ N. MIItER, AA. D. . . , ; , ~ ~ ! i~ t. S ' ~ J.' =~..County Health Officer b Loul Rpithar cpK.CIRCl1t7 COURT - CL_ • ~ . . . . . ~ • - ~ - 1;l~;~ ~ . ` . p~puty Lotal Rpisbar . ~ oa. d . ~ ~ ~ ~ BOOK~~O P~CE2~~', ~ - - - - ' - _ ` _ ~ ~ - -