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HomeMy WebLinkAbout2321 r . ' . ~l ' 7 - 16491'7 e~~. ~~„~p a M~,,~,~ CERTIFICATE OF DEATH ~ ••••r ` ~u~uu or vn~ st~?n~r~ca S'TA7[ ~u No. ' •1 FLOaIDA ~ •1 TI! !!O. R 1 1UR' ~f~~~rl~ •a~e~t~~ 1• ~ COU ri F DEATH coos no. U.B~ L RESIDENCE ~~..~a..M+~ ~~t. a 41- w rd Ind ia . 1~ CITY lU ..uw ..n.w n.w. n,u. suw.) G IENGiH Oi o CAY clt ~rr~ ws+w ~tw. w*. aos+?L~ iiAY ib Y4 Mw) OR r~~~~ Ver B• Ft La erdale Wll HAME OF ~u w b Mw~ • 4ruatlr. ~w n+.w Mrw ~e trwtl~! STtEET ~r ..+L d~• "NSi~niT~a°+ 14th ve.dc isL St t ~ 4C0 S D v~e Blvd. NAME OF s t!'tnt) \ IriW~) a lL~t) l QJ1tE t~Iwl1 iDa) (=~rr1 DECEASED O~iA1M ~ u ~ 1 19 5 S_ ~ oTTO E~ Lia:< ~p( COLOR OR tACE 7. MARl1E0, NEIIER M1?tRlE4, f. CAif Of ~1tTN t• ACE~y r n~a ~~w r~s~a~ ~+r+ wiuovvEO. DIYOlCEO ~~ctipt ~ ti'~ ~ • - < < • '-Male '~'r~ite Narried ~!~rch 1 ~~8 ~ _ `t ~l~f~l~ 1~ ~~~~U~A?ION~OIw t1M d~1 1M~. KIM~ OF WSINES! O~ IN- I1. NtTNM.ACE tww ~ tr.~a w+es? IL CIiREN OF WlIAT 1 •~s~ ~+.s..n.~ aa...~r..~..~~ ~usttr couKtar~ ns ctor~.,ntomol at~te nlant ~o~ rd Mar l~nn J~A ~Iset fat Il. iA?N~'S NAME 1~ MO7TIER't MAIDEN NA11E •r eT~~~ritte John Link i~, w~ ~o t{N O. s.~?e~EC wRCES~ ~a. socu~ sECURin n. INfORMMl1'f SlGNAiW! 3. N. Ya tes l?M. R Mtirw) lU M t1w wr R rw M~enfnl NO. AOD~S ^ ~ r~.•~al i~. CAUSE OF DEATH MEDICAL CERTIFIC/1TION ~*~K ~ . i ~:s =y~ ~y~ i• OISEASE OR CONOIiION pn4ye ¦~~t tf~• fR ~!or (~1. lN. DIiFCTIr LEAOIN6 t0 DEATH'~~) ~ t 1 S 1 JI,iQQC11 TM s~• s~r- ~ ~e) ~~:s•••• r Coronar ~ieart Disease 3everal Yr: •f sl tf~ ~!W ~*~t aMw lbriiJ awiti~wa: i/ a~. /i~*~QYE t0 W w~it oI ~ 1••• l w~ ~ 7w+t J~ sir a tA~ aMw esw (~I Mat- O~ r~ ~ t r ar ~Aw~i~. ~ lt +w~ f~ ~p'Mr~'iw/ °s~ Ld- ' ~ t!s •it~iw Tf W~iw~s~ iw~+R D~1~ 1~ t n t~~e~ a[- ~wyie~ei~* v?i~411.OTH~SiGNiFICANTCONDIT10Nf 3. ' c•r e••s~ Cw/ieiw. erwenL.e:.~ w t~ ~tA i~t w~e b ~t1 •r l~f~r• *drt~! b Jiaeare w' e~~litww i~t~ ~ It~. DATE OF OIftA- Hf. MAJOR flNDIMGS OF OfElAiION ~ ~ na+ ~ s ~ '''z .e? e._. •t , ~rttt sea~. irew?b> ~a.~us~ i~s. tu?c~ os ~wuRtt c.w~~•~•s tia (c.ISroaiaw~ ( , ~rr w~1 ila. wcCtoo~t nr~. aa4ei. Mn~. i~ Ws. Mal II f~.4 aw ~1?~~ "'p ~ su~c~ot ~ CR1 ~V ~ 21L. TIME I~~J ~Dvl ti~ul ~9.~? i{~. HIJU~Y OCCIIR~D ~ ~ ~ OF ~w~u ~T ~sr wwu n-• fV i~ O INJU~Y ~ ~o~a ? ~t re[ ? ~ ~ ~ 1 ~ ~t. 1 lltnby astiJy t/wt t nuswded tlle dcceased /ro~n~~a :OlZ~j'e eA~ ~ ~a+~ t!u dceeotcd 1 i~••• aUvt on~-~_ 1~ ard fl~at d~ath oeeurred et._l l: QO~~w o~w tAt oawa o~d ow uls dol~'Muled abw~t. •r• s• 1• p~. 81GNATURE 1D~s?M K tlW) ~~u ce~>l~t• ~ M • - - 24. t U R 1 A L, CREMA- I~D. DATE 2k. NAME OF CEMETEt1! OR CtFlAA?ORY lld. LOC~IQIOM fr~a w~trl l~) t~oN. ~orw~. ~~,nn m v 1 1 1 Noll w d M~n ria i H 21 wood Qla DATE ~EC'D ~T LOCAL lfGlST~/1t'S S16NAt1itE 1f. iUNHAL pIRECTOI'i tIGNATYRE ~ ~ Y.:.isoe 8-15-55 ~lizabeth N. ~omer J. W. Yates, Ft. :'terce rle. ~ ~ ~ ; ~ ~z..n! x~ '~~t ,L :``..Y~a:a~~~~~G„~~~~(~, ~ . • • the above to be .a true and cot ~ R~~eiy of ~ , ~,~j lieYeby G~rtify % ~~e~tecal R~~i~trar's re~ordVe o Beach, FloYidal'~ ,~C,'puntjr''Heal t~ 'OePa r tenen t at ~ ~ . ~.~ialid unless the raised seal of the Indian River ~ ~'~ttis••is•'~'~Q artment is affixed• ~ Cout~ ty, ~6~1 th DeP ~ _ . - ~~~7_ ~ Local Registrai ~ County Hea1th Dir., ~ , 7~ ~ /y~ 02 /a~t~t- ' ~ ~ R 1, t0 f'Ati"t2314 Deputy e4istrar ~ BO~K . ~ ~ _ _ - ' _ ~ ~