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HomeMy WebLinkAbout0744 FIIED AND RECORDED sr. LUCI~ COUl~TY, Fla. _ ~.~?rn is~si~ 16'7819 '68 Jt!'' 7 PM i: 47 ~ ~ . . . . ; . _ CIERK CIRCUIT COURT . i ,o~~~NE~ yj~ G~a. • . RANGE .COUNTY ~iEAL~_..H DEPa~iTME~TT,, Y~ :o . ~ ' . ~ • ~ ~ Weat Central A~~w . u~ - ~ • . ~~r: ,.~~~'r%:` P. O. Box si8? . ;--„r+ ~ti CX~rc~? 1-~t~l OItLANDO: FLOBZDA ~-'dt~M ~ . ~ y - t _O~?RD OF HEALTM CERTIFICATE OF DEATH . - swu v~F VIT/1L fTATIQTIG~ • lTATt Rllt NO. _ - FLOAIDA ' w ~ R[GIlTMR•f NO. ~ ' 3 , . r D:wTN COD[ NO. ~:ST T[ Lf10[NC[lwbn/wrM1 l~M~wTMw~: Ard~wWi~~/..w~:.-. - Oran e 58-0 4 ohran e _ 1. GTY. TOwN.OU TAC~T~ON t. K KACE 0~ ofATN . t. GTY. T01YN. OII lOG?TION t. K R[S~DEMC( ~1 IMSIOE CITY UMITS/ M1S~0[ CITt llYlrsf ,rc:a w0 Crlando ,?cs~ .os?_ ~~ure a ~~/..r a. ~..yr.t. r...aa~.taa~) L. STIt[[T AODRESS NOSI:T~I OR . .KST~TY7qN prdn e i.!emorial H 101 East Vanderbilt Street ~ w..iet o? F4d Q(iN?~ Lyt 1. aeTE 3~fi~N Dq Y~r ' ~~~«rr.n p1~t06 . pNDREpt ROPER JR °EATM i?tarch 24 1967 ~ ~ SEx i. Oplo11 011 11ACt 7. ~R~p MAJlUKO ~TE OF ~tRTM AGE (l~ ~eM1 / T4t yrp[a!~ Mls. lad ~i?tWil MwW Oa~. Nw.~ N«~ Male tYhite r~noowEOp avo~:EO ~ 61 , I~o.. ~w~ oeeur•ra+r ~a~.. ~i,~ yr.?t a¦e t0e. Kuwos wsu~ESSOR w+ouster 11. uRrwnna (Sr.rs..lw~4+ cw~nr) 1 ama or rw~r ao~smi.r ~ t~ri.~ wwl w?ti~I f~i. ea~ i/ ~ft4efl ~ g,e2~~nx'~~'''`Q~ Refri eration Washin ton ..C. U.S.A. ! 11 ~A1M[R~S ~IA~E 1~. MOTNCR'S MA10EN IIAYE Amos A R Mar ar ~ socu~ sccua~rr ro_ u. ~so s s~o~u?TU~s wu'~., 101 East Vanderbilt StTeet ' I , Ohclando Florida i~. enuu or oewTN (s.ra ..tr ..s e.we oe? ri.s p. e ee~...~ e~1.) ~~rte~v~u acTxeeN ?~~T ou?TN wns u?usco ~r: ~ ~C-L{K'-~siR1~w4F. ~T M~D 0[ATN wwcou~ uusc ca ~ - . c~..i'rf.w.. r/..r. ouc To (el ~ -(I.~,t~tFWs~4--t~-- r~'`G~ S~`n~ - ra1tZ ~Yt f~7 f~ ` . ~Of[ ~~tlt I ~l~tiy l?t Y~Qf. ~ TO (e) _ ll~~/ e~~u fwt.. o ?~T oi~w sww/~r~r ca~ano~s oownrwrt.~ ~o oun~ (wrr ~ Ranno ro rnc ~rw~ oausc caanoN wra w?Kr K.) . w~S ~uTOrsr . . S ~.//h~'M~/ M/r'MF Wr^~~~Irf~N~~ KwFO~M[Ot res ~ ~w O ~ j~. t a ' . o[suut Now uuuer occuRUO. (Ewtn ANrr~ yf~j~r~ Is Avt I~r Paf !I ytttw /1.) ~ ACCIOEI:T SIJICIO[ NOMICIOE V ? ? ? _ i mt. TIME OF NwS M~~. ~+1. Yt~r . ~ NYYRr w. _ ~ . p t~. . ~ ~ 20/. MUUII1/OCCYR11E0 mr. rIACE Oi IMlUl11f (t. iw M~Nrt A~wt. 2% QTr. TpINM.011 lOtAiqN OOYMTr STATE ` 1AfMIlC AT ~ NOT WNKE a IV~.I~MI. ~(~ttf. ~~ft OII/.. fft.I M~OIIK AT MORK .L,+ ~ • t ~thnd~d fM d~cu~~d /ions ~OAR~A~~-{ ~ 9 G ~ . to • ~ •nd l~st a~~r A~ ~li~~ on ~ Z.e_f.. ~ D+~tA oee~re~d ~t ~ rn on tA~ d~r~ ~t~ud ~bar~; ~nd to tA~ b~st o/ rn~ tnor+bdp. /~or+~ tA~ wuNS ~f~t~d. 7L. f1OliATY11C ( N M f k) ?2A AOORESS 72t. OAT[ SK.MEO ' ~ - ~i •ur G,~,~,,~, m~a~ t~~~yt 27~. ~JR~ti. d~Cr~i~O~. 23A OJ1TE 2k. NAME Oi tEMET~11~ 01! C11EMl1TOU11 Z3/• IOCAT~ON (GV/. fw r~. ~r t~~~f~) (8t~f!) Iltrorill lsprn/pl : Remo`ra l 3-26-67 F ort Linco n emete tla sh i n D.C. ~ j~. i{M[RAL ON1t 011 i SKM~TY A 011ESS OATE 11EC0. ~Y 1AGL IIEC. 2i. G~STRAII'S S N jYR • ~ ~ ~ Garc~er, Cha el ~ 25 ~gg~ . ~G~~i~'~ . 9 Orlando F a _ C^ ~TZr I:.D COPY _ - - - . - - - - " . . . :.:areoy certify the above to be a true and correct copy oY the Loeal r:a~istr::r's record on file in the Oran~e Couaty H@alth Depart.ment at ~ G: : ando, : lorida. ~ • ~ :~.:Z::~:: ::ot valid ur.:ass raised seal of Orange County ~ieslth Department ~ is aFfixed. ' . . ~ ~ /~,,c~~~,',~ , . Cc~:r.ty .....:lth OFficer & Loc~: Re6isLrar ' ' ~ • _ ~ `_cL~t- e~~--`s7 ~ Ja:.e Issued Deputy Local ~e~i:.~.rur ~ O'LAtJONUN AND O'LAUONLII~-RTf~7~111RT~~TrS.AV~? /~OAT ~it1~C=. RLOIt10A _ _ _ . .r.s. ~ - . • - - - _.,F"+>=~°,,y~,..: - _