HomeMy WebLinkAbout1392 _ . _ _ .
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IN R~s Lots lI and 12 of M. A. TYLER'S ADDZTION TO FpRT
PIERC~, as per plat thereof recorded in Plat Book
1. Page 5, of the public recorde of St. Lucie
County, Florida.
z~ S D._ iTATi sa?nn o~ wy?~.TM CERTIFlCA7E OF DEATH
coaes • ' ~URGU OI VITAL tlATIfT1q STATIC RIL~ NO
le~al r~e- FLORIDA '
ord ~hsn S~ rM N R N ~
pro.~rl~
:.euc~~ i. PL%•CE OF DEATH Co~[ tto: USUAL RESiD6NCa ~q«.a.rw~..a uwq~rr~:re.t~.r~w.+
sn 11 CO~tN1Y w YU11i OOYllir W~ISn..).
j a. yi.~~e St• L12C~6 • - 02' a s
( w~
~p r••- L~, cin w..ow..n.~w ww~ .,r. ~vu.~.? e. LENCn~ oF e, cm w«uw. «.ww ~.,w ~os.L
1 e~n~at OR ' Y 1~1f4~Lr) O! '
' t~~.. towu Ft. Pie ca ~C Ft Pierae
d FYU NA4E Of ntrtal~wN.rfruatw.. W.w.n.M~w~.eraer.l STREtT _ Q[ ~ir.L tlw wrWwt
HOStI?Al OR ADDR~t
lNSTITUTION $
DECEASED ~ ~riest) • 1. (~tWL) • (t+~ ~ ~tE (14at1) (Das) (Y~s)
• Lucil e H e McCa •~?n+ J 1
f. SEX COLOR OR RACi . 7. ~ l1F0, N~R MARRi~ 011TE OF NKiN t A~ I Iiwr ~ TDVwi Hs~
i~ ia
t• Female Whita ~a
rie~`~" Au 8 ~
' 1~ tM. YfUAI OOCU?ATIOMIwn tw d~sf Nr. IqNO OF WlJNKf Ot !!i- 11. tltTlillACE tww ~r ~w~. ...~r) IL ClT12Fr1 OF W11AT
•i.n p~~- NlIY?
••n•p~ `~~'~~OUSew '~`e Home ~ Pocahantas Va. U~'
b 1 a c Y f at 1~. FATHEk'S NA1/E IL YOIHERY MAIDli1 NAYt
~~p•~«~•~ Ed~rard Linaoln Holmes D ~
If. WAS 06CEAi~ iN Y. S.AlMM FORCfSf N. SOCIAL S[CYR11Y If. INWWANf't ffOiiAiY~! • • 8t'i6$ ~
QM. ~ {4 ~tr~i (tl ~ s!w sv r ~uw ~t ~1e~) N Kp~, , .
1'~ ~
Fun~r~l ti. C+~Ilii Of DN1TH MEDICAL CEItTIFICATION . u~taw~t, sttsaw
direetor Zater ~sb w 1. ~ISiASi O~OONWilOlt
.~.c r~~. s~- toe t,~. w>, a~ttY taouio to oE?n~ L 8'. -
ene e.r_ .sa te) - . ~
` t i[ i e aN ANiEC~BlT C~AYSES
. f c A tl• ~37w d~es w~t +wR DUfi TO
1 o e a 1 tA~ w~is ~R ~ a ~
ei ~ j
~s6lst~a• wcd u M~rt /dnn. ~y ~!I es~N /Wt. '
"'w"u. ~ 1~ DUE TO ~
•ithfa Ts 1j~Nl~, ifjs~ N ~
hours at- a~~Geatiss rAt~? 11. d1NER SICNIfICANT OONDITIONS
c~r d~at? asyoi iertA. Cw~itiw~ aweriLwia~ b t~ irsfA Mt ~t !
or D~fer• b t~e K aw2iti~ y
- ~ak1a~ ~r~ Na. DATE OF ~ 1!b MAIOt NNCMIGS OF 0?ERATION 70. AYiOKY1 ~
1
~ dlsposl-
t• ef rp ? +w? !
~
p 1V~MUb1 1~~4? !10. KACE OF IWURY ca~„ 1~ ~e ~ws ttt (CIiY O! TOWN (STATq
ita, wceiowr ~r. 4a~. AcMS~. r+.s. ~swc. ~tai Jt mR MaM1IILL~
su~ua~ ~
lld. TIME I~t+~U Nvt /tMr1 t8.~r~ 21~. ItIJUIY OOCURRED • -
~ IWUt7 ~ ~?r~uar w~~iou ~
*eut ? ~r ro~t ? ;
n. 1 l~acby artilY that I ottesdsd tlrs deccatsd fros?.].2=~~.19~, to ?~l ~ . 1D.5,~j.. t~nt l bst soa tAs dceoosed ~
a i i s s•ss alive o~ 19 a~d tJlat dtalh oce~cmtd c! • a? ~ks arwa axd ow lJls da[s rlulcd abo:+r. ~
ar~ -s• 1~ SIGNAT RE lDeRrM ~t tIYtI 2~?. J1DClFSS IJc. QAiESICt1~
~
co~pl~t• E
•CCYT<C~. '
i~a. ~ U R 1 A L c~t- ia. o~rE 24. NA1~IE OF C~IETERr O! C~FMATORY aa. aoca?no tc-~,. ...o..a~ t a
n ~or~t cs~,~n ~
Du?ifi lECD R L~ RK. 'S StGNAitItE . ii. FU DI~iCiORY i1CW?TY ADDtKi ~
v.s.~soo F .
, Sr~ ZE
~ E GO ECORDEO
~~'~~~~j11 ~ ` r~'
i h~~~ t~h~ ir~o ~t
~s trus and correct copy of ths Loui ? Of?n y~
R
FY• F~~,
Rgq~stc~'s~~r~q~ ~t1q fri thi St. luci~ County Health Ospart- ~/~Q~p~ EQ ~
rrye~re~~at ~~lr~`ReFc6.~F ` - _ ~S •~rv ;
Q~Ifun Not v~lu~'bt?~s ralsed seal of the St. 8 SEP ~ PM
Cd7ntY :~1a~?~? : Depanment is affixed.) 3 Q ~
~ ~ V+S ~~s `N R _i' - ~ ;
. ~ . c `t`-.} ~W
. ~ ' , ~ a ~ ~ ~~TM~u~, o. Roc~~~• ~
; i~ ~.•'~ry' Hsalth Officer d. local Rsgimar ~~`~RK CIRCWr R~ URT
_ • ` CO
3 . I a:'~ ~^..~r~ ~ J ' ~ ,
0~ D~puty L~ocat Rs~istrar ~ . , ~
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BITTAH d pRiRFIN eooK273 facE~.383
a ~ox so.
!'Oil7' IMtRCL RI.ORtDA
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