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HomeMy WebLinkAbout2155 - . _ _ _ _YICROFII.11 ltFYO Lesi bi 1 i t~? oi wri tins, typina ~ ~ or printin~ unaatis~actory in ~ this doow~ent !or sicrolil~aing 1668~~ ; . ~ ~ ~ . ~ ~ T:Ss a.- BTA7t eowna or Nrr?~TM ~ CERTlFCCA7E OF DEATH : coa+a • BYwEAY OF. VITAL fTAT14T1C~ SYATE FILi Ii0 ~ 1iaa1 FLORIDH p orE rAtq BiRTH NO. ' A~GI:TRAR•S NO. 1 7 yroP~r17 1. ?lwC[ 0I OL1TN GOOE NO. 2. YiLLRL 71Li1G~7tCil~aw~l.erdW l!:..+:tiw R...I...W...I+...:..) . a`:iii °0""TM St. Lucie ` S'"".'lorida °0""T" St. Lucie ne p~.e.a 6~3-025 : 3o y~t~ 0. GTY.70~.0~1 ~OC~T4N t. +S KwtE C~ DE4TM t. GTY. TOMM.OA IOCATOr . t. K RES+Ct~CE : ~~e~w~ IxS:LE C~T~ UrITS7 UtSWC C~TY Uw:TSt i f~l.. Ft. Pferce ,£SC~ „op Fc. Pierce Florida ,~s '.o I, MYC Oi (I/ M[ bl W)it~t. /Nt ~!/fd dJ/fl1) L STRCET AGOIiCSS YtSTITJTqN 102 Osceola Ave. ~ Ft. Pierce Memoria? Hos . N~~lt os t"rat lfiGQs Ltd l. Wit llwt! Dq Y~i? r ALBEAT JACOB 3~~t;~3'3i+I ~TN ~s ril 24 ? 68 S. SER ~ OOtWI G~I ~K[ 7- 'a+1Tt Oi ~UTN ~GE (l~ No1 ~ N.yE~ ~ e4c LKt,i i~ NIi. NML~IEO ~ t~[YUMNIRKO? tsi0vliG/) Jf..d. Gsp Mw.. Y:... ~ • r~ a s• i~'I C&U. • wacrcu~ OtVOAtf7 Na3! 2 s 1898 ~ p 1~ 1 A 1 r IOl. {iSUAI OCCIM~TIOM (CIIf ti~ yUNl /M~ IOD.1[U~OOi ~YSIKSSOR WD'JSTRY 11. MATNRI~CE (S}~ft r?/Mty~ oaatt~) it' CR~tE~I OF ~MZ Oa:ItiMtt •1cA ~~r- Icr:,~f~watdw?tialbk.t~t~i(rftvM . ••*•p• Sa~ er Box Factor Chio U S A Dl~tk tAt j]. fATwIR"S IJUI[ . It MJTxU'S YMOEA JtAMf . O! ~w y~y~ ~M t7D~fTit~~ ~P.iTma141 ~l[L~~ Tra~ eser u. soau ua~,n rq. ~Mrow a~c u~ec .tu.a, • 74-O1-6~4 ~7 .Q//,~/ ~Tiyl/ 102 Osceo? a Ave. Ft, Pierce . I~lorida F~r.:.~ t~. CAYi[ 0/ OLATN [~l~r plf ~~~r• c.~. u~.... c~~a . , s.t~Ay.~,~~t~. r~ur ~ ourK r.s wnco , ~ • O~SfT Al~D OFAT asr~acor wrtW?T[ 4?Yf[ W ~L~~ ~~f^~ ~~'`~l~r~~, ~ ~ ' su~t tll• . t • tlffe~t• Cwl+li~w.+/~+? OKTOh~ ~1`~.`/~%~ i,~~~-L~'--~/~~~'~~..~.!~c.:C~~-J%~~'1s ~itp tA• r~id ~W ~u'~ p ~ ' 3 o e ~ 1 ~Ex~ rsue `i). ' ~ / ` ~ ~ ~ ~~~(r ~ > ~ r r~aiacr~r h~~j~clrK OK TO ItI ?/~'r~ - -i / • L-;,,~~~~~ ~ , • 1 C L i A 79 O ?A~T 0. OirfA SK.MiYiMT QpW~flOicf COwiRy~R:wt 70 047M iVl IfO711L4IiD 70 Tw[ T[RrtMl 06UY C0~01T1W CM~1 1t ?Yt 1(p i' tiA5 AUTCK~ hOUrt •f- F . rEpfOxMC~7) t~r d~a~• ~ ~-iV.i`" ~ ~ . ,~f oe b~ lor• ~ ~ '"~"C/~ ~r YES? r.0'..a.? j~. lhM~ l ZOO. OiSCA1K MOVY W WY OCCJA4[O. (E1¢tt/ ~afY1[ ~~I1~j117 y P~K I N PiY~ II ~Ilta I/-) ~ ..tlas ~ acc+oc~rt w+c+ac iaru,a ~ e~.yes?- ~ O O L200 v ~ aac Twc or x.., x..a. w.. ra. ~ bodj. v .uunt . O ~ a. ~ W ~ YJt. uUU~r OCCU~JtCO 20t. ftACE OF uwr~ ls. i~ a aDOn[ 4ws. 20% GTT. TOnM. O~I IOGT~Oti COYKTY ST~TE wKnt ~t ~ wT rrwnt Q /w~. f«uri. a.~u. sptcc etN.. ur.) . M~OIIK ATMORR ~ - ' ~'r-_ ~ 21. ! ~t~~od~d t!w d~sd Irom • - 'i ! ~ , ro ~ t ~l t Nr A~~ ~Jir~ on ` - " i J • ~ Aitn ! D~~tA oetutnd ~t r' b~ en rh~ d~4 auud ~Da•r, ~nO ta fM but o!•mr tnorl~lp. lrom tk~ eaus~a aut~d- ?11 1t~~• jj~. fl TYA[' ~ ci 'k) ?1L. `II2AES5 ~ C~TES~Gw;,D f _ -~J./ ~ eoayl~f~•• .~~l~ 1 ~ / t/ / i'~~G ` ^ ti r •CCY?~t~. ~~~-.~WTq~ 2~D p?TC 23[. MYtfOFt[MCTLIIYORC~EMwTOAY 2~/- IqCATi6NIGlfl.trvA.MqCtf~) (SYsf) 'D"`~'' Gar~e Ft. Pierce St. i~:cie ~ ~..u-,cia~. 4-2?-68 Hillcrest I~e~. , .~'1~. V. S. /617 ~~sR~LL W+K Tu •DQr~(S 25. J~TE ~[C0. iY LOGL IIEC, 26. REGKTWU'S S~G~uT~aE r~O~ ~ A t~er.3~bS ~ ~ ~ S• ~Y~~2~5'~i~~,~tr~= l1~:!~ ~i~~pg • .4~i~':i?it:Sv^/ ~C/ ~1~~ , L~ I.~ _ t hera~y cert~{y is'to ~;a .m~e and correct copy of the Local ~ Regi3irar,i;.r~cor~brt•#ife. irr the St. lucie County Healsh Oepa~i- ~ cine~~t ,at Fort ~ie:ce;. Flocidq,' ~-i ._~(VNarning: n6t valid unless roised seal of the St. tucie • CouC~y healtK Oepartment is affixed.) _ ' ` FILED AND RECORDEO` ~ ' 1 • ~ / . h . > ~N, D. MIItER M. D. ST. LUCIE COUNTY. FLA. 4 Counry' Health Officer ~ Local Registrar t~~~~~! E U ~ ,f,•` _',t~~'~ . . ~ ~ • '68 MA 6 I : 43 ts Deputy Locai Registrar ~~~Gt'J . ; ~:0•;~:n c~OiTP~S ~ CLERK CIRCWT COURT ~ r ; ~~7~ :j r ~ - - - ~K~~.. ~ ~ ~ - ~s