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HomeMy WebLinkAbout1454 fZ~~: , . _ _ . - ~~G3~/. PAOU aAd PAOII A~O~S AT LAW . ~ . ~ lp, M~OiilYlMpOp. Rp~p,A . 4~6~5 ~w- _.:r • ~rAT[ ~o~~o oR N~?t.TM CERTIFICATE OF DEATH REC PJ4GE• • \Y11[AY OR 111TAi. RAr1aTIC~ RATt ~ILt NO. , FL08tDA e~d •A~w 111 r NO ~ 11 iT11A NO. p r~ p~ e l> wYAI~ M~[NCt l~M+lrrrd M~+; l/~N~~hr~~ ~ R~W.r M.N Nnwr+) •t~tul~~ 1. MAlt KAfM GOOt NO. c01M?~ I3roward Florida Droward . e. ~I.e•~ 1 e Clft. TOrIN.O~ IOC~?ION f. N AC[ Oi OEA dTt. ?OMN.O~ IOtATION I. 19 R[S~O~MC[ •~~~wl MK10E C1Tt UYIT11 ~MS~Ot C~tt1 Ur~rit I~~llandale ~o Hallandale nsQ9_ ~a~ ~ ~u?Mt or (!J ~wl h M~rlfd. ~Mt ~herf Mbt~) 1. 3T~[[T A00~[3i IIOSf1iAl OA (~olden Ielee Hoe ital 820 N.7~. 2nd Ct. a i~t~f- ' - ' .S_La~_ = T_~.'S. NwrK I1rM 11/IfY~ L~N a?i[ Al~wl~ tn~r Yw ~::«M~•~? Albert Tapp «?*N 24r~rch 11,1968 Sttf ~ CO1011 O~ IIACE 7. Ml1~~l[0 ~ N[V[RMA11A1[O OAT[ Of N~iN ~G[ t~~; X~ XMIi w ~ t~• riflle W211tA w~oo~rco o~v~oRCCO @0.25 ~1942 p~•~~ t~ io.. uwu occw~raM toi.. ~i~ ywr~ a.e ~oe. Kwo o~ wswcss o~ wousnr 1~. ~al~aua trr.rs w/~...y. ~..rrp ~ unun a wwr oo~wr.,r • 1 t ~rrl ~wt r~r~i~ hp. e~e~ yrdirM ¦~w~nt riO~Cl ~W]1@I' 1?~Of'i@~.~ TOWB U~S~A• ?l~et le! ~ ?ATNEIIS MuME . MOTMER'S MAIO[N MAY( ~~.•~~s~•~ Albert Ta Jennie Unobt. 1. sOtul SeeulnTr No. 17. N1 • f1o1MT1M[ ~ A~rea IIn . ~ ~1, 820 N.E. 2nd Ct Hallandale,Fla. r~~.~.i c.us~ K.rN ~~..cr a.« N t.~. cs?..,~ IIR~A~ O~ATM 6lr~et~f ?~~T~. OE~TNwASW ¦ u ~ t t11 • IMYE0111TE . (u ,C U ee• e+r- titie~t• C~~/illau,i/n~, p~ Tp ~ _ ' ~tth tA• r4d ~Me titt f~ 1 • e • 1 ~t t~a~t r e R i~ t~~~ K~fiy Mt r~~rr- DtiE TO (e) . t e n~ w ~a ~na a¦~e tat. - O fA~T 11. Oi11E11 SKAi1CYR 001101T101~! COMIM~IRMC TO OF~TN RR IqR REIAI[p 70 i11E 1ER1111ML OKGSE OO~IiION 6Mt11 M/1~f 1(~I . MAS AUTOKr Aeuts F ~E11i011ME01 ter d~~tl~ s ~ES? Np~ o r p~ hr~ tAS. ocSCRUC ~ww uuuer oCCURREO. (E~lo wMws y t~/~ry b Pwt 1~? Art l1 yY~s 1/-) ~ •~tlw~ ~ ?CCIOEMT SU1CiDE 1qYK10E eisv•st- ~ p O D t:es •t - ~ le~ TIrE OF flwr MMt~. U~1. Yta 1• ~ nuu~r w. C ~ 1- w. ~ 2fM 1M1U1111 OCCU~~EO 7Ar. ru?CC os uuuRr f~- I•. h M?yrl M~[, mJ. MY. TOMM. OA lOGT10N COUM~ STATE ~ MM4E AT MOT wNKE ~ M~. /~[lN~. ~t?td. Ma ay.. dl.I wO11K . A7 M1011K / ~tt~nd~d tM d~e~~a~d / . fo ~~nd b~t w~ ~li~~ on ~ - D~~tA oce • rn on fM d~f~ ~t~t~d ~Aw~: and fo ~ Mit o/ rr~ Rno~f~dN. /ro~n tA~ e~u~~i ~t~r~d. a t~ i t•s• s~ow?ru~ • r ~ a o~. ( ~••~r ~ 2ta ADDRESS t2i. o~? i sw o ~o.P~.~. , ~1~//~h~'/IL GdY<<3 ti 9n~~~r~. 3 ~~L-~ ~ • t c ur ~~4. CJ[M~ 23~ OATE • 2k. NAME OF CEYETEII~ 011 CREYATOII~ 23/. IOCATqM (Ci~. pr~. w tNi~~~l ( t7~tn M ~K ( \ ~n1 ; ood I~iem.Mausole Ho11 ood,$1 r da ` j~_ iUN[~ 1N TO~ 5 TU E ADDIIE55 TE RECO. ~r L'C~ ~ G. Z6. II[GISTIIAII'3 SK.N~tY~~ / ~ ! ~ 8e~.lYab ~ . • ~ CERTIFIED COPY ~ ~ ¢ ~ ~ ~ . 7~ ~te~y.~xt~fy ~the- above to be a true and correct copy of the Loca~ ~ R~gietrar's redord,oa file in the Broward County Health Department aN ~ • ; ~~ort, ~~rdal~ 'F,lorida. ~ - ; ; J• „ f r,T R\~ I l ~ ; L: ~(i~it~~ag:-. Not ;vllid unlesa raiaed seal of the Bro~ard Countq Health ~ A. 4' : ti.~~:D~~artosat is affixed.) ~ ~ ~t~• ~t~~' ~ ' ~ ~ ~ ~ Tn•t ' ~ ~ ' County Haalth Offic aad Local Regist ~ ~ ~ .~GO~ N ~ Dsputr al Registrar G * ~ ~ _ t ~ ~~„a i.~"'• ~ ~i~~ w . ~ l_• ~ ' " . r ~~u ~ 1 ~ s. r ~i1F 'f~ ~ ~ . _ L . Z , ,~,L _ - ~