HomeMy WebLinkAbout2769 .
~-;~~l1De- ~TATt sOARD OI HiALTM CERTIFICATE OF DEATH ~L6S~Q~
„ eo~~s • ~URGU OF YITAL fTATifT1C~ fTAT[ ?ILt M0. M
1~~•' FLOHIDA
}~roperl~ B~RTH NO. RtQ1~TRAR•S NO. ~
ea~eut~d 1. ~IAG~ 0? O[AiN GOD[ NO. 2. YWAt A[MKNC[t~wlr~r~tAMf. tl:.u:~.a~s: t~.I..wW~e~/.wi~.)
.°a .~11 001NT1 St. IuCia bfi-02 ~~A~ Flarid~ ~~N~ St. Lucie
e. *i.o.a
ln p~f- A. CITr. 7pRN.O11 I,OC~71pN t. 6 rUICE OF OEATI l. GTr. T01~N.OII IOCA t. K RESIpENCE
•~s~~t IMS10E CITY UMITSI IMSiDE CITY 11M17S1 -s
r,i.. Ft. Pierce ,~s~ ~+00 Ft. Pierce - rural r~s „o
I. NAME OF Ih~ b~r. I~ Wfd ~N?tN) t. STREET AOOIIESS "
NOSMTAI OR , "
'"sT'T~Tp" Ft.Pierce I~.eaorial ~:os ~tal 606 Ceconut ~renue
3. ~u?~t OF I'frN NWle Lat a?TE MNt~ Dy Yea
«v~~«"N~•q THERGI~[ HARVEY I.EE oc:TN Deceraber 28, 1966 -
S. Sf7I i. OO1011 O! IUIQ 7. MAR111E0 ~ MEYEII YM~~OQ DATE Oi NIITM 9. A6E K~?! s IMOEII 1 tW t~OEa t~ MS. ~
~ fYt birtWll X..Y• D~s~ Nwn N:u. •
x~~ e. ISaIe k'hite moarco ? a~ro~ecca
~ 1~i ~l ~ 10~. uiu~l OCtu?~Tqw (Oire ti~1 yw~! Iwe 100. Ku~00F WS~NfSS011 u~OUST~11 11. N11TNR?CE (~te ~ I~wtM~ aa~tr!) 1. anaw OF ~nui aowrnnr ~
~it? 1~~~ twiy~tNnntialhk.eKnllrtNrep
•~w~et Stey ard Ford 7ndust ilerr Ha e e e
ll~ek l~k ~3. i~TNER'S M1WE I~. MOTNEw'S YAIOEM I1~ME
er
Patrick Lee Una a" a e
i6 socu~ sccuam No. n. a~ s ao,un?u Ara". River Park
Ol,l.-12- Sf 4 F~rances Lea b08 Coco:
ti2t Avenue Port t Lu ' e la
~YA~ttl 1~. CAYit N~tATN (~lYA ~ Ms tuw p fiat/ir (0). u~1 (t).~ IwTE~VAI ~ETwE[M
al ~~lt~T ~AIIT L OEATN MAS CAYSEO /r: OKfET AMO OEATN
rli. - ~~~cou?TC wKC ca Vantricular Tac c a ~ ~s
e~r~e.e. c.s~'rr..a.i/..r. ouE To p1
.ica c~• .a:~ wr,u~ r• 1
l• e. 1 ~e c~we (i). t
reafscr~r ~ r~- q;E 70 (d
•ithfa Y f/iy npr l~t. ! .
\our• • l- ~ fNIT u. Ot~E11 SKwIt111(r CapilOKS OO~I1wq~rtrr, i0 OutN wrt Not It[Ul[o i0 M iurw~l OtS6?Y Cao1q116nEw n~ tMi ~(U . M~5 AUTOKY
t~t df~tA ~ tE11fO1~MED1
•r s•t.r. ~ ~ VES? Mo~ ~
aat~.s ~ m' ~ 2D6. ocsuuc ~orr wu~r ocw~uo. (F~ra,.rrrr yiw~a.~ P.n t r art u yia~ ~t)
ACCIDENT Sy1Gp[ NpY1CIQ
ils~~~t- t~ ? ? ?
lOd •r TIMf 0~ //N? A(Mf~. ~f/. YHI - .
MUUIIY A.
O D• ~ -
u
~ 20/. 1NJY111! OCCYRREO 7De. rt.ACE OF bUU111/ (t. i~ v Nwt ~eat. 20% CITr. TOM1i. OII lOG1T10M COUNTY StATE
MNM.E AT ~ IqT MNKE ~ /p~. Ndr/. rtr~N. sAtt AI~/.. de.)
MO~K AT MORK
ti. J~ft~ndM/ fM I~oMNd/roa~ ilever . to ~nd l~~t w~ A~r ~lir~ on ~ 2 zE~
' a.re oo¢~rrM.r 9• A h;"'
~ m on tA~ d~t~ ~t~t~d ~bw~: ~nd to tM 6~st o/ a?~ ~m~/~dj~. /rom th~ uuwa at~t
?l] ite~a ~ ~Q~TV~
•r• t0 1• Z~MnMlYltJ ?lb AODhESS llr. DATES~GMED
~o•,i•e• ~ Francis J. Carbenara,M.D. 503 Ho. 7 St. 1-9-67 _
•te~~~t~. ~_~~T~ ~ p~TE Z~t. N~MEOFCEYETEIIYOIICREMATOU~ jy. 1OG710N(G~f~.lw~.wtMtsfp (StYt!
K t~//1
~°u`ri~` 12_3a66 Hi~lcrest riea~. Gardens St. Lu cie Cc~wit~:, Flot ida
Y.S.~612 Z~_ NuEiUIOMlECT011 SSWNA
T~tl.' $~~I' ODIC 2S. DATE R[CO_ ~Y IOCAL REG. ~GKTRAII'S SKNATURE
A•..~asa Jack J. t~,eore ~~pierce,Fla. i-11-67 A.nna Lee Denisen, 6.r.
, _
e .
• . • ~ -
1 hec~ tar?'~y? .this fd bs a true and corrett copy of tt~e Loat F I L F D~: N D R E C 0 R D E D
. Registtars teooid: ori~ file M 1fie St. Lucie Coi~nty H~~hh Depsrt- e T ; r~ ~1 T v F l_
: me~t it Fort Piee~w: f1a~d+• .
:
ti Nof val'~id untess rdsed seal of the St. LuGie ^ i
- ~`'~~~Coue~t~r 1is~lkh D~pKt~r~ant is atfixed.) -16Jr~Q~
~ ' : : ; • 'C8 ~ 4 F~~1 ~ ' y9
~ ~ . ~ ~ N, Q MILLER, M. D. '
. ~ . _ County Heaitfi Office? d~ Locst Reqistr~r ;l~=-~G~O`[-~c-C.~-~
. . - - , , .
~ \ -F:
l-1 :L.- [e~l . t~: r 4`~F i ~ i~~,., il~~UtT COURT
p~t~ Deputy loul Repistru a r,
~ aooKl~f ~ ~~~E~~~57
~ ~X, - _ _ - - ~ - - .
. ~ _ ' . . ~