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HomeMy WebLinkAbout0432 e t~~. be- fTATC iOARD OI MF:.~~ CERTIFICATE OR DEATH .~65666 ~ ~o~~• ' •URGU OF VIYA6 RATIfTIC~ fTAT[ FIL[ N0. 1ea•~ FLORIDA - ord wAea BIRtH NO. REGI~TIIAR•f NO. ptep~rl7 1. ?U1Ct 0/ KAfM GOO[ NO. L YfWtL 1KN0[MCtl~wn~rwdlN~/. I1wMrw: RrrwwWw+~/..w:M) :~a`:~ii 0011TM Saint Lucie _p~j Florida "01NTM Saint Lucie e• ~l.e.~ 1 s CITtl. TOIIII. OR IOtAT10N t. K rIAC[ Oi OEATN t. C~TY. TOI~IN.OR IOCAT~ON t. K RESIDENCE ..a..~ Fort Pierae ~~r u~,n~ ~~*Y ~~y~~ r11•. res(~ w[] Fort Pierce rc nu f. tuYE OF (IJfM h Myifd, ~f~t Wset MhtM) f. STREET AOpIIESS - ~ T~,~ 1508 Citrus Avenue 1508 Citrus Avenue 3- ~u?rt o~ itrM Alltffe L~t 1_ oAtE JYwu~ Dq Yra n,~ M~r.,~ ~T~ March 23 1968 S. SEX ~ OOLOR OR ~ACE 7. `~tARKO ~ IIEYEJI ~W~YO DATE OF W1TN AGE (la }s~q 1~ U~O[~ 1 ~W1 1A0[22~ NK. ¦ r t t• M C.BII• rnooMCO avo~etto riarch 16 ~ 189~F r~t~?t~f~?1 r~.u. ar. e.... x:.. 4 y i• ~ e 1~ ~a. usu.~ occw~T~ ca~ y.r~ rwe WDe. Ku~o as wswcss oR wousTRr 11_ ~TNn,?cE (st~te w A+W~ ~wt) t. anra a.wr oou++*n .sca twww«tyw.tia/Mr..«.l~.~tlrrn F'armer Dair New York U.S.A. ~laek lwk ~ATN[11'S w?rE t4. woTNEt'S iutDEM ~u?rt Augustus Anderson Mary Gustafson ~ socu?a sccu~~rr ¦o. n s wwruu attra. 22-07-03? 1508 C~trws Ave. Ft. Pierce. Florida ~ r~n.~.1 1~. td?YS[ N KnTN (il~tn MI/ Nw cswr li~e ~r t.). ~a~ ~at.) ~ ' urtcRy~L Kt~tM = dtr~et~! ~A~TlOEATNMAfCAY![O~e rlti~ ~~1 ~T .~.e rii• wreoun e~ust ~l?~ V~J 11 /Vl:<.~ c~• e•~- ' i tltfe~t• Gi~1if4~a.i/q~. D11E TO ~ - ~lt~ t~• r~ir~ /w~ ?u~ q 1 • e • 1 ~b~se tnw r~aistr~r +t~ti+~~ t4 r~1rr- pyC Tp (t) t~iiy aax l . •itelw 7i = AOUIf •t- O ?MT 11. p'IIQ Tpp(~"~ p~ i[I1y~w11 pprpTprC~rpMry~tK~ .IYASAYTOKI' ~ C ~ / ~ ~ ~ rcieso~wc-w/ a..s~ res? wS~ or ~~h~. = ocsuuc Mon NuwtroccuRUO. ts.raw~rw~ yi~/w~ fs P+~.t Jr Pwt!! irrs N.) •~t~~s ~~7 ~ ACC~OENT 511K10[ NpYK10E y a1~~~~f- u ? 0 ? ci~a IGc. 7wf os Hwr XwN, Dq, Ye~r ?~a ~ uuu~r ~ ~ S W = 201- MUYIIY OCCYRRED 7Ot. MJ1CE Oi WUII~ (t. i~ ~r ~f w~t, M~. TOMM. OR IOCAT10i1 OOUNTY STATE ~ MM~LE AT ~ wT rrMa[ ~ M+~. Nu.+~. x,sa. yk. ap.. ue.) ~ MOIIK AT MOIIK • I~ff~n tM I~ewa~d /~o~ , to nd I~at w h~~ ~Iir~ on t oce~rnd on eh• d•r• •r•~.a •bo,r, • to fM Mat o/ m~ ~ JW/~. /roa~ ~A~ uus~s ~t~t~d. ?ll ft~~s f/ YIK •r• t• 1• ~ !Yk) OW1ES5 ` ~2t.0ATESK.ME~ ee~11~t• • - ~ ~_~.-Z 6~~~,,, '~f~-Y •tcYNt~. GEYAr10R Z'!S DATE 23[. NAM UMET[~YORCNEMATOIIY Z3/. LOCATION(GSf~.fM~.MHYSf/) (S(~ft) - 11IrOr+K l3ytci/~1 ~ ~.s.+s,~ 2~. ~a'~ ~~~5 Pierce~ ~eme0. e~R Ft ~P`~e~ce~St~., Lucie Fla. s S, !/'S~~ ~ •r ' a...iosa ' ~ ~ -.Z-~ - ~ ~ \ . ; , FILED AND RECORDED ' . . ST. LUCIE COU~:7Y. FI.A. ~ / c-- ' : r c ' . i here?,~l,certif~i this ~tD, bet a trus snd correct oopy of the Local . Reg~rars'rqCq~~ fifi in the St. Lutie County Health Depart- ~~S6fjs ~~f ~t..wr? Pre~~'~p~'~_~ ~ '68 P~'~t`~R 29 ~M I I: 4 : .=~:(VI/aming: (Vot.va~dvnla~s raised seal of the St. Lucie , . Cowity .H~sltti ~epsrtment is affixed.) ' 1!' _ s : : : : ~ i ; ` j - . . . 1 ( yi'•N: _D.. MiIIER, M. D. CL~RK .C1RCUtT•COURT . 4Caunty Health Officer b total Reqistrar ~ : C: ; •g ; ' `3 - /~-O ~ ~p'~ ~.I n - - F ~ ~ Q p~ ~ D~puty Locai ReQirnsr ~ , - , . ~ , - ~ ~ ~4 ~ V~~' ~5~" ' - € ~ai,,~._