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Home My WebLink About0793 , . IQCFQFIIY 1Q~bl0 _ . Iw~ibi~i#,y at ~ritin~, t~rpin~ ~r priA~I~ aawtisisotor~?. io t6is doomii~st for nioroiilains . - _ CERTIFICATE OF DEATM ,~,6~9;; ' ~ - srwrs ru.s Ho FLOHIDA ~ ¢ Bl TH NO. RE iSTRAR•f NO. 0•~+ 1. PLACE OF D TH ' CooE NO. Z. USUAL REjS DENCB (wfr~ re.nd sna u tw ~ oet.n a. COUNTY ' / / ' ~ SfAiE ~ b. COUNiY b b b. COIR ! wvlb a.ro~+ 1~. ada 1IIa~LJ a lHi6TH OF c G17Y t~" ~tN «4.ew iWU. ..w aLSaLI ~a tal~ War) OR ~ TOMIN ~it , • . ~~.i0 TOWN ~ ~ d. FULL NAME OF tu rt 1~ ~.ou.t ~r frtlaaMti ~ra'it tossW d STREET ttt a1w 1~eus~.1 NONSTITUTION ~C ~1~-C. ~ ~ NAME OF ) 0.(Yiddl~) a. (Lst) L OATfi (Yoat~) D~s) tYear) ~ DECEASED ~TM ` [1L 'S ( w P.+wt J •~.~C i, SEX L. GR RAC~ 7. W1RRlEO NEYER 11AWE0~ R DATE OF NITH 1. ACE ~i~ v uN~ ~ rw n ruc~ aa w ~ WIOOWEb, DIYORC~ (~,ddl s~nWt) stwr nan' msn . xia i~t-e.,!.t. W .s_ .~.dc. C-~.c.~c , z 3-/ 88 S o i IOa. USYAL OOCU?AiIOM~oiw tW t wet ~Ob. K~N~ OF WSINKS OR IN- 11. ~ItTHlIACfc (snp t lKW~ ew~t41 IZ. GTIZEN OP WHAT Cor vrLS ~~t ~e1~l~t ltt~ «rJ~ rd4~a) ~ ~ ~ DUSTRT ~ -COtlNT 7 ~ }2~ C7~/4c.c--'o-'t~ 1~. PATHER'S NAMi 11. MOTHEI'S ?WDEN N/Wi 16, WAS pEUeA5E0 , IN U. S.AWW FOtCESt 1~. SOCIAL SECYt17Y 17. INFOWANT'S SIGNATY~fc ,*_.tQ~ ~atawd lu sa s~w sv ~ euw d w+leN NO. ADD~ESS _ ~ / 1~. CAUSE OF oEAiH M@DICAL c6RTl~S~?TION~ „ nnrwvw~ .mrmt Sat~r oeb os~ 1. DtSEASE OR CONDITION ' C~~'8'r~~--~~L ~~~'/UZ.t9 oMSSr wNa oswn~ y~ l`). OIRi~CT~Y LfADIN6 TO DE/liH'(~ as1 /1lfTECEDElIT C/1USES . ~ tk~ woi~ ~j Jri+W. Y~rbid eaaiiti~wu. il ~ st~*IDUE TO i sadl n Iu+.e 1~tw. b N1. s~o.~ o.w (U .ut ; sdia~ia, sta lt ~ fp~'~ ~w pUE TO c f eoa~y5oseiewp~ e• II. OTHER S16NIFIGANT CONDIiIONi ry L•t~,r,~t ~ usr~ol I~sti. ~y~ey q W~k ht wot ~ r r~ srlaui t~ tA~ li~n~ e? enwditiow cauiw PJt. 4l7,..[~-L'p_~G ~ ~y~, p/~TE pF O n~ Hb. MAJOR FINDtl16S OF OTFRATtON 7R. AYTOKIft t ra ? Ko ? ~ LRws?b) (~h) Zt0. tLACE QF INJURY fas.. fa ~c sees llc (CITY Ol?OWN (OOUNTY) (STATEI 21a. wa~owr r... wa ~.wa. w«t M~a ttas.. ~c1 u Ra1. Kw aoa,u.1 ~u~c~o~ 'g 21d TI?IE (Nr~?! (DV) 21~. IHJURY OCCUtRFD 21 . H D D 1 V~ . Of n~~u~t ~OT*Yl~t ~ IWi1tY ~ ~ou ? ~Troa~c ? _ 7L I lureby ~er~ilv~ I qR~nded tlu deceased /rmx~=i .tJ ~ J ly ~ 19 ~lhat I iast mro tlu deceased ~ ~ aIive on~: 1'J Sf•7 owd that dea~A occurred at' ths cawa and ow the dc[c stoted abovc. # ~ Y1a. SIGN/jTURE j o: titlc) ~b. • ?Ic. DAif S16NE0 ~ ~ ~'J ~ _ ~,j -i~=~~ ` . . :~~~a-c.~~ ` ~'/1/s~ i I1a. ~ U l 1 A l. GtEMA- 3~. W1Tfi E OF GEMEfEIY QR GREIAATOIY 2W. LOCATION ~t~. 1/+~a, ot aoe*Vl ~St~ate) ~ no : ~rovw<«o.ar„ r ~-[.C-4.~-~ =~-r" i i . ~ ~9 " - ;~-t~ e~~ ; DAiE ibC'0 ~Y LOCAI~~sr~ 'S SICNwSURi 1S. FYIt~~AI DIREG7 R'f SIGNA ADDREif ''~~-4 2~ ~ yG 1L- %-h.~~',_ L ,!9 ~ ~ ~ ~-trC.t~tx1 r=,, " FILEO ANO RECOROE01 ~ " ST. WCIE COUNTY. FL,A: ~ ~ls ~~6.bi .i tiw and correct oopy of ths Loul ~ . R~Str_ ~l~Cord on•~ilir _i~` tl+a S~. Luw Cour+ty H~+Ith D~psn- ~ c ~ 0 P f' V~? FI F 0 : n`~ P~.~.:•~. ~ ; . 16589~ ~~yy.rnirq= Not'~ya,~ unbst r.is~d ssa, of ,h. Sr. 1~,c1.; ,se . ~ , ~ r Fl~l, ' p~partrr„nt h aff'uc~d.) . . ~:.s . ~ _ S ~ ~ Q • y 5 r . ' ' ~.i•. ~ i• j ~ ~ - ~jf ~ , • i!% ^t!1. 0. MlItER. AA. C. 'q ' ! f:UJE.~ r ~ . ~~'~?N a ~ ~h+~ CLERK CIRCUIT COURT _ ~ . ~ • ~ , " - ~=•s `~fl~ ~ . se~,~ ~ ~ . ' Op~ D~pu~y, L°'cal Rpi~'a~ ~ . ` • ~ ~ ~ ~171 ~ 792 ~ ~ _ ~ . _ ~ =z.~-~~-~.~- : .