HomeMy WebLinkAbout2482 T n 1 s De- fTAT[ lOMD O? MfALTM CERTIFICATE OF DEATH
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co~es • ~U11t/?U OR VITAL RATIfi'id 1TATt RILt N
leanl FLa$IDA
ord •Aen BI T NO. REGItTRAR•f NO. +~W
p ro p e ~ 1~ 1. KAC[ N KATN COD[ IiO. L YfYAL w[NKMC[ ( ~?~m /a...t ti..t l~N.w:hru.• Ro;I..~.W... d.w:..)
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'^d 001"~t. Iuc3e 66- Florida St.Luci~
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1 n pe~- D. CIT/. TOwN.OR IOCATION t. 15 KACE Oi OEATN qTY. TOMN,011 LOtAT1pN t. IS Rf510LIN_'E '
¦anent INSIDE CIT1/ LIMITSt ~1~yi~E pTY l~M~i5/
t, ~ Ft. Pierce „ES p„p O Ft. Pierce ,~S u~_~
NAME OF (/ItMt i~ Ntylld. Iws 1l?td ~ff/tM) I. STNEET AOONESS ~
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436 N. ?th St.
3. 11A~IR ~F Fbst Nii/~s L~+t oA~E 71/aUl L~~ Y~a.
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.r~ Harry Root ~?*N Ju]~ S 191?9
S. SfX 6 COIOR OR pACE 7. y~pR1E0 NEVER MARNIEO e. ~TE ~ uRTH 9 A6E ( lw ~etla ~~aA ~ t~ thOEd H w15 ~
Jvt AvtY~t) x..u. Mr. w..n x:..
w ~ i s. l~ile White rnoorrcn p ava?cco NO~?. ~i ~ 1~0 gg
p 1~ 1 n 1~ ~a «~pAT1011 (Qilt ti~ ~/rat Mte 10D_ KIND OF ~USIME55011 INOUSTRr 11. MRTMP~ACE ($~tt M/0~t1/w CNUM?/) ~2. ~ OF w~NT OO~M.T~r•
• 1 C h pt~- ~ y~ttR/ l~/q eer~ iJ retirNl
..~.p~ ~ar~er Farm Busti~ Ner? York U.S.A.
Dlaek lat ~3, FATIIER'S MAYE 1~. MOTMER'S YAIDEN IUIME
or
t~p~~rlter ~ ROOt Nancy Draper
~ 16. socu~ sECUertr No. D. s aaaTY~c Ai/.us
; - Kre. Harrl Root Ft. Pierce, Fla.
F un e ~ al le. CAW[ OI ~tATN (E~[t? MI~ Mt t~1tC pR fiiE j~/ (~1. (DI. ~11[ (t).] IItTERYAL ~E'1/f[N
p115ET Ahp OEATM
E d 1 r e e tOf ~AI1T 1. OEA7M wA5 CAUSED ~Y: U~_2 _
IMMEDI~TE CAUSE (t1 i'WYi~
f ¦uet t11•
iE tht p t 7~
~ tifieat• Cqfiftw.~/t~1/. DUE TO (6) D~iltis ~t DiJ~i ~ -
.icn ce• ~,u~ y
i o e• 1 ~e enae ~
t re6lstrar f~ py-E TO (c) ~
fiiM t~rae l~at. ~IAS AUTOKY
~ A o u r sp f ~ MRT 11. Oi~~ER 516NF7CYR Cp~DIT10Nf OONiItl/11tuK TO OEATI !U~ NOT R[lATED TO iME 1FRYUMI DISFASE LONOi110N GIKM W ~IYIi I(~) ~ ;
rEIKOitMEO. ;
~ e~~ a.ses S resU NoD _ '
o r bt Co~• ~ ZQp. pEKRIlE MOW WURY OCCUNRED. (E~1fa fdwt ~Jiwjur~ Iw P~?t /0? PPt 11 ~f $tw la.) ~
¦akla6 ~n~ ~ ACCIpEMT ~ SUKiDE MpMIt10E
disposi- ~ ~ ~ ~
t i on e! TIME Oi Hwr MowfA. Dq. Ytp - ~
~ Dod~. INJURY
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~ 20/. INJIiR~ OCCURIIEO mt. rI.ACE OF INJUR~ (t. u~r ~Nf ~se~e. mJ pTT.10NM. Oit lOtAiION OOUNTr STATE
~ NNILE AT ~ NOT NfMKE ~ J~~.I~MI. ~btd. ~a AfM•. dt.)
MORK AT MIOIIK
a sn, ~
g 21. /~tNnd~d tJu d~cwsM /rom J~n. 5. 1947 .~o Ju~,y 5, 1949 .,,a r..~ hi~ ~li~~ on f
~ Dwth oecu~r~d ~t • • m on th~ d~b at~tM ~bw~; ~nd to th~ b~at o! m~ RnowNdh. /rom tM eaua~a ~ta~~d.
~ ~11 it~~s ~ ~a~~~ '
~ a r e to D• (D'H~rt or !U1~1 22b ADORE55 IIt. MTE S~GNED
3 ~o.ri.t. ~ L, L. Whiddon, l~I. D. Ft. Fierce, Fls. 7-5-49
~ e e e u~ atf . ~u. pEwATOw. Z3D Dy~TF j3t NAME OF CEMETENY OII CREMATORY 231. LOCATION (GYI. fNFf~. M t~ffl (St~ltr
- w (Spec 1
~i~ova~ ?-6-~l?9 I~aice~riC?r Cemete Jameetoiai Nex York
. S. j 412 j~. iU1E~Al. 3 51G11ATYIIE 11DORE55 25. W1TE IIECD. ~ LACAL REG. REGISTIIAl1'S SIGMATYtE
' i~er.lp6S Joa~ph W. Ystes Ft. Pierce Ju~j S, 1949 Yar~ K. Frere, D.k. °
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