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HomeMy WebLinkAbout2128 Y , t?,~, t~_ sr~TC eowno o~ Hu~rt CERTtFICATE OF DEATH -L~6816 ~ ~o•~: • euaEwu OF YIT/LL rrwriar~ca srwn ~~c Ho. ~ l~a.l FbORIDR . ord rAen gIRTH NO. R[G16TRAR•9 NO. p e ope r 11 2_ YfYAI R[11O[NCt l~Mn Mr.d Mwr I!wti4w~ t~Nwr M~n ~iw:. Ya) eaeeuted ~u« ~TM CODE IiO. ~ ~ STATE A. OOUMTII .,,e CO°""' Saint Lucie (pb--ba~a Florida ~aint Lucie be pl~cad !n y~r- e_ cm. TOXM.OR IOCATqM ~ t. K ~IACE Oi DEAflI s. pTY. TO11f140R LOCATIOM e. 15 NES~DEtfCE ~KS~sc~ u~a ~:ort Pierc@ ~~ocarr~r~rs? f~i.p` rart Pierce f. 1uYE Oi (l/rwl iw lwyifd, /irt ~btN ~f4ur) I. STREET A0011ESS ~ T Ta :.aster NSanor ~:ursing Hone 1217 ~asi~r Ave., ~ s. ~..c o. ~.r xua~ Lart WTE u..u ar Y~.• ~ °~y~.`,`;~i,~~ ::mraa 3lizabeth : osdick ~°i„~ 2 2S 19:i3 f s. scx t co:o. o~ ~cc f~. wrc or wn+ A6E (I~ ~tYa s v.oc¦ ~.w u~.oc.:. ~ws. ' MM111E0 W.MEYEAMARNKO? f1l~tT MwY• Ww Awn ~fi+. • r i e• :~-':12.1G L%t12t@ ~~wcoi] avaeeco 11/2/189~ ~ pltiwl~ IO~. YSUAIOCCWATpM(CiKli~1~/rMlIN~ IOA.KINDOFWSINESSORIMWST~Y 11. WITWLACE(Sldt~?IMtM~OMt~p71 12. C~i~idOF~nMi00~IM~t1 ¦ f t A p~ r- trria~ ~at valia/ d~r. ne~ ~J retuM ....p~ ;-'ouse:aife Znd~.a:~a United Sta ~es Dlaek iqk ~ATN[Il'S 14ME 1~• MOTMER'S MAIDEII iMME ~ or ; rancis Y.ill i~ettie Ross ~s. socu~ sccuRm No. ~Mro a s~c~u?tuwc wtau. . . . :~oae 3dcvin .~osdick 1217 Easter• Ave.,Ft. Pierce, : la. F~p...l 1~. CAYK 0/ O~ATM I6~fp ~I ~~t p ~i p. c.~, c~~. o~ tc?. . on weo~ ~ air.eear ?•aT~ a•rnr~suvuo~r: e ~ ~ ~ r ! GL 1.~~ - ; au~t t11• WMEDIATt C~YSC (~l ~ ~ / ~ t4• C~f- ~.i~~/~. L 1 ~ ~,!n .~c ri~ w t i ti e~t • Cwtitiowa. i/ AI. py~ TO (01 '~l Z.L a O W:~-Va~ •1tA tN 1t~lid ~Mt r+a~ q ~ . 1 e e• 1 ~t caur (~1• ~ •[diw/ tlt rR4r- + sitAlor72 t~~M c~~K f~. ~ TO (t1 ~ O 1~RT 11. OTItR WMTIYRIf WG TO TN ~{R T UR O T1K iERYWI 06fAS[ ~Ipi10M GMDI rl ~YT 1(y . MAS AUTO~ST Aoars •f- KRF0IIM[Ot / ; ter d~atY s ~j d ~,r ~ or 4~for• ~S~ ~ § = m. ~ w•~ ~ tDe. asc~~u ~ uuu~r xcu~uc. ~tauo ¦rve yi4..r pac t r Pwt y~r~. ua x ~~tia~ r ACpOENT WKiDE ~qMlClOC ~i~pe~l- w ~ ~ t tioa of ~ ~ Dod~. V~. T~rE Oi ll~ar ~/Mtl. W/. Yse 3 WYR~ s_ ~ y_ n. . . W ~ 2Qf. WYRY OCCYRREO IOr. ?utc oi w~u~r iw v ~Mat Maw, ~A/~ dn. TOwM. OQ IOCATIOM COUNTY STATE WMIIE AT MOT WMIL[ Iv N[tM/. Ib[d. i~tt DI~I.. t(L) • WOIIK . ~ AT MOltK ~ ~ / 'r ~ ZI. I~tt~~d~! db d~eNHd /ioai . to ' ''2 •nd b~t w,~ h~~ ~~tir~ on i D~~t occurr~d ~t ~ m on tA~ d~t~ st~t~d ~Dor~: d fo th~ ANf ol a~ tnorl~dN. ltom tA~ uus~a at~t~d. •r• so`l~` ~ 1G ~TY11t ~ - Y4) t26 OO~E ' I2c. D~TC SiGMEO L;~` r.L~~L~.__C~~. f~--~~E~_ C.~ 3-~r~~ ; •tta~~t~. ~.~~T~. z3A DATE 23t lUMEOi rETERYORCR[MATOp1/ 23~.lOGT (GV/.Nrw.Mt~Inlf/) (SY~t~ R[rOllai (.'ptn/~l '.:emova 3/3/b8 Crotvn i-:i.ll Ce:aetery Indiana~olis inGia~~. Y. S. r614 j~ FUMERAj OU1E O~ S SWM~TY ~S ZS. pATE I~EtO. ~r tACAL 11EG- ~GISTMR'S 741tE a .f R~..,oas -~t~f(.~•~~'-h`'s~ttePierczrall~om 3- 1 y- 6~ Y. = i 9 S ''~~~~////e~~`' ~ . ,~i~' ~ tJ e . - .1~ 1 - i h~F ~t`teriNY M19 .fo b~t ~;true ana correct copy of the l.oca! R~tj j~~rs~(~d~'f~~'µ~ the St. Lucie C~unty Health Depart- FILEO QND RECORDED rqent at Wft ~efc ,rF id~• . „ : . ~ ~ - ~ . ST, IUCiE COU~JTY. F~A. _ jVya~rtingr Not va)~. ~n7~ts. rolsed seal of ihe St. lucie n:^ n=•^`~'' F' r~:~ County Health~ 8epartment is affixed.) jsf'j~~~j ,t~i: ~ r ' ~ v . ; - ~ J;Y N, D. MILIER, M. D. 68 M;{ s ~ 9• 29 F _ ~ ~ • ~ ~ , . ~~County Heattfi Officer 8 tocal Registrar ~ . ~ . . ~ . ;3 "f ^ . '~i>; y s? e f~~ s ~ V Y ~,-=7+~{=-b0 \'~-tLi~ L c C~~~ ` ~_~__~s~u-. ::e ~~_a :~o~t;~: ; : pns pepury l.ocal Registrsr a, _ r` CLERK CIRCUIT COURT ~ 800K ~ 11, PACE~1~ _ ; ; - - ~.~'J;~'' . _ - - ~ . , ~,a.,r ~.-.=~>3 z ~ . ; ~ - ~ -