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Home My WebLink About2196 , . . ~ , ~:-.m _ : _ , . _ . . _ ~ ~ ° - • ~ . - . . . , ~ ` , - _ . _ ~ . ~ ~ . . ~ - . ~a , : . . . _ _ . Tb~i.. .:r~?~~ :~.,,~a ;o~• GERTtf1~AT~ 4~,D~A'TH . . ~ E -60~'Ri e. ' ~Y11[AY OI.YITAL. RA~IwlICr.`~ ~ ~ . ' ' . - . RAT[ FILt .NO ~ ~ . FLa.$x~?~ . . : . 1 , 1~~;~.I ny.~~ . _ . ~ Qrd ~A~n ~ p, , R A' 9r•ptirl.~i . . CQO[ l10. Y-.~~?R11[N~MRtw~...wwr:ri...r rr.,.r~~.~:R.++~•~:?.tw..~ww1. ~a~s~'t~Q 1 l~ER OI RR!?~ii. . . ~ • STATE, • A: COUMtY. . , ; .sai " cocn~rr : ~AL•t?1• ~~EA.CN ' ' ~ ~L.~R 1 [?4 , . t~1~i._~1. ~E ACN:. : ' sr,pl.a.e ' ~IR ~ p~f _ . ~ b. . Gt~Y. TO~MN. Q~ tOCJ4TlOff ~ . . . - 't. 1S~~l~Q"Q~ bE~4.TM 't. CIT'C. ?OMfM ~OR LOCATYON-.. : . t-.IS I~ESIDE . E..: ',INStDE: S1TY L1t~IT3~ IdS~OE. QT~1 LIM~ ; ~Rw~at. i A+~r ~~...f~71~l~i. ~E ~.C?i ;si.•. ' ~~S'f t~A#.l~1 ;~E.kCFi. : r~s ?~io resC~ ~oC~' . , . . . • , . A f4RMt ~ ON , ^ ; . ; ~MAME ~CF- ' i1/ wM i#r.ANJIN~I.'!~M ihftf.NllhlMl . - . t..(;EIf16'zq hi; . , : STIICfT ~ADOIIESS ' . , , _ . . : . : . . ~ ~ ' IIOSlttAL dl , . ~ • . . : ~ STA~ IN Ib . . ' ~ . . - ; u~st~YUtaN; c~ E-j - . , . . R ~ • l . c ~ res p . ~o Q . . . 3 ~?~MR N . #YtM . . Nii~e . > ' LMf WTE 'J1fMl~ !M1 . w.Y~N , : ~ E~~E'V~~K~ MH~ : `'T~!ti~-t~k.~ ~,H~~~~u~~i- ,~z :~~~r,~ ~ . S: 5[X ` 6~ COIWI'Olt 11ACE. ` 7 Ml1RIl~D NEYEIf M~R~I[Q DATE QF lJ~YN .9 ~GE I IR 1~aa. ~i tMOCR ~?~AR Yr~6E11 ri 1~K. fi~1 ° rw~~.~~.r? - rr..n: r,... rr..~. ,rA . ~ w r _ • ~ e ~ ~ ~1 A . ~ h1 ~f T~ . . wtoow~o • . qiroKCCO . ~.A Y • . ~ ~ t` ~A . ` . - ~ F€ . ~ : r~~; . pl~~il~l~ - ~p~~ ySq~IOCCL?~T~ONf4K~k~w~.~(.ratl~wr. 106 K+NDOiWSuNESSW11~tOV4t~Y 11- NRrNeI~tE(9~t~wfo~c~~es~~l?~I. G~+tttw~M~00MM1~Yr . . • f t h. p ~ ~ ri~/ wat H ~F`a!k ~ 6/r ~ee~ iJ r~rtrrel l . ~ ~ . • - ~ ` ' a ..~.A~ ~ A ..N ~ k' 8t.tc ?~oc~~ J~'~t~ent. r~~rrr. ~ F~~d. .r . ~ b3~ek 1nk U. fATNEM'S MAME . 14, MOT/iE11,S ~tAIDEM NAwE . ~r . ..t,r . . AM ~ ~i7~~Rl.Ci(SEM~ ,r„~~.~7{„A.H MAC 'vN~11rE'>,:,,. . e~p•.rtt.r. ; ri1t..~.I. • ~ ~ IS.~ ~MAS DECf~SED fVER',IM V S: ~RM[D~};Ollf[Y ~}4. SOC1A1. ~S[CUMiY ilq.~ IT. IMlM~A -f~ flPl!MTYR[ • . . . ~ ~ _ I Yw.~w: r r.k....f - Uf M~. a ~ ~wr. ir iM1a d. ~~r.a ~ . C ' rJ~ _ . . ~ , . . ar iM . :C;.1...~e~.~vpJ'~ .t+tru.. 'ES•T k'k M :AC~ ~.1.'_1F~ 4,,~1! , * . ie. a•u.~ e~ or.~rw ~~e...~~rr o~ H~ c~f ~r,.~ ~ ~Mrc~v!c~ a~cN - . ~u's~~Rl . - ~ : ~ ~ , : . ' _ . . . . ' OMSET /~t10.D~Ti~ _ , . dfr~cCOr . t~RT;i OE~YM--WnSCAt1~ED/Y . '.rY~i :~}1~' : - . , IMM[Q1ATE f~USE ~ ' . . . - . ~ , , : . . . ~ ' ~y~,~~,.,~ ~ ~ ~ ~ rs e ~ c. ~us..f ~I oar ovc` so te~ ` ~ v - .f.eM. tb.. . .er+r1 IArr .ia~ ra ~ . 1_ .~,.0: w Z ~ . ~~t..~ NMN` (~,~5 . : . ~ - . ~ ~ . . . J~N~i1/ fAt I,rt~(? ' ~ - . - . - " ~ . essistr~t,' ` /1!iM nru f~it 'P~E YO l~>" . _ _ - ~ . . : i'~ R E ~ a Tl - ~ . . . . . . . , . . . . , ~ wR5 AUTO?SY ~ . ~AAT .11. ~DiMI SIGANIC~M CONMT~9NS fONtIM~UYIMG TO ~[J1TM hR .MOL.RFUnO i0 TN[ 1i1111~NR1 dSGSE CpO~T10N ~GRIUI IN i111lT t(t) . ?E1lFOl1~tE0? . ~onp; wr , . , . ' : . ' t~~ A~itA ~ . ' l , , . . . . ` _ , Y~S MO? . ee Rtfer'e v~: 1 ~ . 20? FKSCkHE N9~r_ IMlURY 4lCCURRECf (ElJtr wNUrt oj~n/~rT ie Pivt ! as Piit Il a{ 1Mwr f1) ~ . ~,'~aliiw~ ~~a7. ~ Afi~i0E11T -SttiCioE ,.t~OMK10[. . . . . ~ - . . . - ai~pesr . ~ . . . . cio~ e! T+ME OF. llwr s MbwM. hiyr Ye~r Y~~~ . 1ed~ 11UWlV,- • rl: a ~ ~:_..a.•.~ . . .2Al:.1NJUil~4~CURSEP , 20t'/CA~EOF.itiJUR~(d %.~f1oY-~OM/A01!K. ~;OJ CITY.TOWN.ORlOC~710N' ~tbIJNT~ . STATE , . . ~ . . . - , . . , MN11.E~AT ~ ~~NOT~.IMNtt# , ~Nt.s Tittc+/:i~ef~'O~vGi~.,.NF:I ~ _ ~ . . , . . ~ - . . . : . ~ . ~ , . _ . . . . . _ i : . . ~ . . ~QIIK . O ~ .~T:1~0!!K: a ~ ~ ~ ~ ~ - _ _ . ~ . ~ ~ " . ' ~ ~ . . , ~ . . . . . ~ - ; ~ ~ ~ . . . . - % . ~ , ' ~ , - . . tl.. lafarid~d eh~ d~c~~a~d w . . ~ €8 • , ~ . •ndl~st a~w h e~ ~/iroant ` ~ ' . ~ O~~tA accuri~d ~ .r~,,,,T ~ ~{+~A ad'fM ~~'~M H~t~d ~~bor~: and to th~ b~if oY_rsq.l~eo~ihd/f hO~n'lhvuuws ~t~tird: . - ~~~~11 l~~~s NYIMTYR[' : -.(U~tt~Nf[ye)-~~..~. - _ 2?A ADDrE55 i ' ~C: OATES.WMED . ~ . t. 6~ ~ ~ ~ . L t v f ~ ,V E . / , ~ . -e..ai~e. a ' c, t~!? M~ ACN F£'?st1 A~~~-:1r : ?ecurat~.~.... ~ ~.•~µ.dRiuTIDM~: Z3~ TE 23[ M6IREAFCEN[TEIEYOIfCREMAT01lY 23/ LOC11TqN(GY/,-twn.N-erswl~) {SMft) . . ' . _ . , 3~'~"~`;~~~h~, Z!2f`~~G~ A~lt..."SAtNTS~~EhtETERY v~NSE?V BEAC.H ~ ~ ~'r. 8. /A11 ~ " '2~: . S a-~D011ES3' ~ TE CO. ~Y IOCAL REG. KTRAR'9 SICNATUIIE ~ " ~e~.1Y66 ~ir~~..~ 'E~~~~w~ - t ~ , . . _ . . _ ' - : d . ' . ~ . ' : ~ . ~ f ~ . . I f~SRE~B~ CSRT,~ Tf~ , AAt~1~8 'i~Q~ ~~`R~ ~~T COPY OF THE RDGISTRAR ~ S~ ON . FIIE ~N- THI$. +f~''p'~CE : . :~(I~ot v~at~d un7~is~ t~_ s~rcl~ s~~ the PaLn Beach Courrty Hsalth ~ . - Dep~tr#~r~n.t; ~.d aiEt'~ - ~ ° ~ , "~~'~F~, ` ~ CERTIFIEtS ~COP'=:_ : . - , . ~ . ~ _ . T~ ~ z , . : " - s ;~r - ~ . . ~ . . . _ : , . . . . r• . . - . . . . . . - T . ~ ` ' ~ ~ Y - Febru~a~rr ~3, ,~,1965 - : ~ , ~~~a~ : ~e.. . - . . . : +j ~ i _ 1~.. s. tf . . . . . _ X K ~4 ~ A . ~ . ~ . . . ~ • . . ~ ~ 3 ~ tS . . ~ , _ ' ....._e.,-.,-.-.-._ . _ - ~t ~ .i; - ~ . . . . . . . . . . - ~ ~ . _ ' . . . - ~ ~ . _ ..,5> ` . . , . . . . ' . x 1 ~ 4 ~ • Y': eX f 's . ~ . ` . . . _ - . . ' " ' f~'..