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T~1, s~- ~TAT< ~OARp O~ NfALTf1 CERTIFtCATE OF DEATH
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wa~K 0 ATlOQK Q Street Ft. Pierce St. Lucie Floridp ~
)~fNneNdtMd~ewNd/rom , to ~A •ndl~~tN~ h,~ ~li?~on never '
Dwfb ooev~r~d ~f in on fM d~t~ ~f~t~d ~bo?~: ~nd to tM bwf oI sq ~wo~NdN. from th~ e~u~ ~t~t~d.
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• t e Y~ ~ t~. 23f. FJle~t. CR/Uf10M. 2~. TE Z1[- ME 0~ CEMETEIIY OR CREMATOIlY . IOC~TIOM (GY~. f~f. M lM~) ~bTit)
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v. s.~ e i a t~. s s~c~u 7S. OATE IIEC0. ~11 tOGll IIEG. RECKT11A11'3 SIGMATI/RE
tes '~14~ra1 Home In .
a"''~°• Jack J. t~Soore P erce FIa. t1-2-66 Anna Lee Denison, d,r.
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I hereby oertify this fo be • true and correcf copy of the local ~
Registrar's reco~d on file in the St. lucie County Heatth Depsrt ~ ~ ,
rnerlt at~ ,6~rj~.Piecyqs Floride: ~
.;~;(V~a~ciing: No1~iHd unles!.{a~ised seal of the St. lude FILED pND RECOROEO ;
'-J Counht.ljeaUh. Depa~?~ent is affixed.) ST. lUC1E COUNTY. FLA. ,
~;G~~~•• t/cntF~Fn -
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D. MIIIER. M. o. _LC8~3`~
Coonty Health Officer ~ local iteflistrar - 5 pM 3• y~
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~ - ~ _ _ '68 JUI. •
~ry ~«.i a~ n~ ~ c
? ~ 7~ ,
• ,;~~,L t'V~ 1 Rn7 f
CLFRK CiRCU17 COURT : ~
aooK ~72 ~~E18Z6
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