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HomeMy WebLinkAbout0497 7Als D~- ~TATi •owno or Hsw~.,,+ CERTIFICATE OF DEATH 165"715 ' a••: ~uauu or v~rw~ ~rr~n~mu lTATt EI{.[ N0. ~ ~ , i.6.i FLO~IDA , ~ ~ iord .Aen BIRTM NO. Rt61aTRAR•6 NO. . prep~rl~ 1. KACC OF KATM COD[ NO. 2. YfYAI R[S10[MCtl~i.+~.r.~M.L Il:w.w...: t..r....Nr..i+w:.+) e:~euttA STATE 0. OOYNT~ ~ s~ ~'"~t. Lucie /~-D ° Florida St. Lucie ~ 0. C(ill. TOUIM.OQ WtATqN t. K KACE O~ OEATM t. dT1/. TOrM.011 IOCAT1011 t_ K RES~O[qCE fa p~~- ..a•.e irs~oc cm uriTS~ i~ rr ur~rn r,l.. Ft.Pierce ~~h ~w? Ft. Pierce . ~o I. IuMf OF (1/ wr! h~M~iNt. /iu Mruf MIreN) STREET ADOIIESS ~ T~~ 1224 Ave. B 1224 Ave. B NAM[ 01 Fh~l AIf1/Is lyt d1TE XMfI Dq YtY rnv p+.n LEONIDAS CARTER SMITA o~TMMarch 21, 1968 ~ S. SCX i. CO1011 OR I~ACE 7. ~u?~lRiEO Ia ~EVE~ MA1lRqD GIITE OF N~TN ACE (l~ K~q li Wn f rUm wota t~ w~s. ~ • /YI Mf~/~!1 Y..u. WN Ywn Ni.. r ~ a s. M Ca[Li rnoowco O wvoieae NOV . 2 8 18 82 8 5 . p1 ~f w1 ~ 10~. USU~LL OCCW~Tq~ (QiK tid~/w?! fMt IOS. Ku~DOF WSU~ESSOR ~DIlSTtt/ 11. WiWLACE (57~fe ~r/Wey~ tw~b/) 1. tmt~ aF iw?T OOwr~n ~ •1tA y~r- ~wia~~adNw~li nk.t~t~1/?efirM .•••p~ Car en~er Buildin Monticello, Georqia USA ~ ?laelc lat 13. FA7M[II'S NAYE 11. MOTMER'S YAWE111uME ~ Or ' e,,..~,~.~ John Smith Carrie ; C] ic. socu~ sccu~m No. w a s~ow?TUwc.. , eu.ra , ' U ~ ` ~ ?65-14-032 A~y~~- ~ ti Ft. Pierce Fla. ~ • IYI~~r~l I~. QAYK ~I KATM ~~/1~ M~I M/ qYN~ 11[ (~1. ~A< (t~.~ IhTE11VAl ~ET~ [[N ' U A t t t0 ? ~?IIT L OtATN MAS CAY![0 ~e ~ j /'7 ~ 0! ~D TM WrEOUTE C~ust p1 _~"'V t~ 1/V •u~t tfl• ~ ~ ~ - ! ea• e~r- ; x tlfie~se Ciditi~u.i/p~. pyE TO ~ ~ . i ~ ~ 1 N t A• ~?id ~pe ?u'~ q T i y,~ 1• e~ 1 ~Dett r~sat (i1. ; ra r~a t~ t r~ ~ at~tiy f~?t rw/er- Dti[ TO (t) ~ ~ slcnan 7s z tlis/ nut luf. - ` O ?MT fl. 0~1i1 M1~fIW1? CO~~OIi101S 00~71MRMG TO OGTN RR IbT A[UiCO TO TM[ iGYYMI OIYAf[ 00101/1011 iIYLM YI ~MT 1(~I . MAS AUTO~SY ~ ~ \eu~• ~f- ~ ?ERFORM(Di ~ c~r d~at~ ~ tE5? MOe/ •r s.ror. ~ = tD+. t t00. asuuc Morr wu~r ottuaaEO. (E~ta ~wv~ yhJw~ is Prt P~t 11 y irrn t~J ~ t ••ktwj ~ ~C~ocNr w~t~oc ~w~.K~oc • ~ dlsoest- u ? ? ? ti~w et ~ '~d'~ ZDt TWE OF Nwr 11(~(~, !N?. Ye~? ~ uuu~r ~ o s- _:0/. wJ411r OCCU1111EO '~Or. tlAt[ Of YUUIIr (r. I-. h w?ot! M~e. 7D/. CITII. TOM1L OII LOCAiIOM OOYMTr STATE WMNf AT ~ MOT MIIRF ~ NbMI. lf/td• ~~[t OIM•. lfl.I 1MOIIK A? IWIIK • y ~ ~ ~ 2~~ /~tt~nd tMd~ewaM/ro , to dluf wr A~~ ~li~~on f OtitA oc ufFid ~t on fA~ d~t~ ~t~t~d ~bor~: • to tM bat o! no~bJN. Irom th~ uuHi sar~d. •11 it~~s ~yk~ ~pppEU 1It. pATESWUE •r• se b• _ ~o.p~.e. • c..Q~ G-- ~ L'7 ~ , •Ct~~~t1. ~ ~ jk. ~YE METEIIYdlC11[MA OpY j3~. LpL!?!9NICifl.tw~.NeW~~t/) (SY~tti 11[YO~AL ytti/tl ia`~ 3-23-68 Ft.Pierce Cemetery Ft.Pierce Florida s s.#eis • su ouic ~ . ~ ~Q~s N. 7th St 2S. DATE REfO. ~YIOCAl11[G_. 2~. RE6KTIIAU'S ~TU~c d• r ; "••.~o6e ~ ~./_~n ~ c '~t.~ierce,Fla 3 ' ~ . { " i~~ - ~ ~ ~i - - ' ~~i x ; her~d~r' c~rt~t~Jto be-a true snc~ carect copy of the local FIIED AND RECORDED" ~ Reai~~r~a,t 8'oi?.'#i~e!1 fhs 5t: luue County Health Oepart- ST. LUCIE COUNTY. FL m~?~ ~f P~~e~ .Ebric~.~,. _ r~U.5'1'~$' F i, ~ f~ c (11Na~ning: Not va~id~ ';~talsed seal of the St. lucie . ~ , ~ ~ i~; . to~n ~~He~l ~ ~ , =rtrr~ent is affixed.) ~ - : , ; ~ ~ ~68 APR ~ a~ ~ ~ : s ~ ~ ' ~ ~ f. ~ ~ ' ! r ~ ~ ~MIItER, M. D. ~ ' " ~ ~ fi a, ~ ~'jl Health Officer 3 local Registror ~ • ::~)G~<< i~Ot~Rt.S , ~ ~ r ~ ~ • LERK CIRCUIT COURT ; 3' ~-G ~ ~ Oa» - DsPuW ~ocal tteqi:rra~ ~ . BOOK~ I~ PAGE ~g7 _ - - . _ _ - - - , . - _ _ _ ; . _ _ , _ : ~ ~w _