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HomeMy WebLinkAbout2289 - - . _ - - W . _ - ~ - _ ao~/s iy 3 ! ' ` . CERTIFICATE OF DEATH :i~~~b'~ J>i~ A d,Q o iTAT[ ~1 S N0. ~ - FL08IDA ~ a SIRT r+o. w a~ wrt•s no. 1. PLACE OF DEA7H coo¢ No. USUAL RESIQENCE Iww•ae....au..a u~.uasw:r«u~.o.~«. cou~m Mas`tin 53=XS srw~ Florida a courm ~i~ •+•ww.,- ~ s. citr ~u ....w a.w.w n.~~.. ..w zna.,a c. 6TH OF ~ cmr ~u ..~.w. «...w n.~+.. ..w aua.ra ~ ° ~ ro°w,~ Jensen Beach ~`$ea~'' to°we, Jensen Beaah v d iULL NA1~1E OF Ut w 1~ 1rNu1 ~r trtttKM. sh+~t+~ ~w ~r Leat~ d. STREEf . ~u nraL dn heu4U , - ~ ~ HOSMTAL OR ADDRFSS ~ IHSTITIITION ~ 7. NAME OF ~ a. tpfiss) s plidaLl, a(Lsc1 L owrE (1la.ss) tnas) lYear) W DECEASED ~~h g~edricksen ~n, March x 1953 ' ~ i. SEX COLO! Ol RACE 1AARRIEO, NEYER UARt1ED, DA7E OF tIRTM A6E tL n s~w ~ rw v un~ u~n II o Fer~ale "Vhite ~"~~~eo~oacEC~~,a, 11~ 1873 2~ u•••• Y~• ~'.J+ ~ IW. YSYAL OOCY?ATION~~tn tuI d wrt ~Ob. KIND OF ~UfINKi OR IN- 11. tltTMflACfe r M~~ wMr~t 1!. CRIZEN O~ WMAT i 1W wa S+wtwp DYSTRY lY1 4 `°F~'o"u~e~'e ` OGrae Aom4 CarroltOn, a8. ~.°.1'."A. z~ a q. iwTNiRY NA11E K MOTNER'S MAIDHi NA1~IE _ ~ r'. I• N• ritLBI16 MSl`fil'!S B8I'b82' _ ~ is, wws occEwsc~n ~N u. s.w~ww ?oec~t ik socu~ sccuun n. ~NFOauwNrs sisw?rue~ S. N. F~cedricksen ~ a~ 1T... a., .r ~.sw) m sa sew..r .r a~w ~f ..nf.u NO. ~ y ~~~5 i~. CAUSE OF CEA1H MBDICAL CERTIFICATION ~Nyruvw ~stwco~ ~p L.s.~ o.b 1. o~sFwsE oa coNwnoN OCC uaion '1 ~ °i1?•„ ~.r7 .C~ a~ti ~!~s A). DI~iiCTLr LfAWlW TO OfiATH'~~ ~ ~ ~ /1111~IT GUfK ~T1W lew wt ~wsw Wi TO -''-s ~ W wd~ ~l Mis/. ~ ~ f~~si~ ~a ' aa~k ar inst ltitw'ti . "r' u ~N~swf~ s~ It w~w tA~ ~wI w~M LM- o W~~~y M DUE TO c ~ ~ ~s~~+~i~~~ !1. OTHH SICNINCA1iT CONDIiiOlK C«~Iiww~ rwasl~efs~ a w i~st? t~t +wt ' ~ ~ a „ a~.. Arterioscleros ? woy Na. DwiE OF O~E~A• H?. ~WOR NNDMJGS OF O?ERAYION • i0. wuTOKtf1 ~ w c n~ Y[! O NO ~ ~ l=e~Wl 1~«~41 21?. KACE OF INJURf t.s ra~ tlc (CIiY OtTO'WN (COUNiY) (ST~?TEI ~ ~ r..-w«~oan w.. a~ a.an. rws. r..1ws.. w.i a n..i. w.u svsara .3 su~nos ~ nwE a.w cn.~ R.r? a..? t~.. i?uctstt oocuu~o ~ ~ nnu~~ Nt~iuu 1liJYtY ~ ~~u ? ~tneaa ? p' ~ tt 1 Atre~? ify t11at 1~Ltswde~ t~ deeea~sd /ro~w__~~8~, !0 3/~ , Ia~. tAoe I lo:t ~av che ~Isceassd olivr on ~ awd l~at drol~ ocevrred ot = • ne o¦a tJ~ aaur~a nrd on tll~ dnte itated obove. .3 Zfa. SIGN TURE (D~rM ~r tlWj. 21~. ADDRFSS 77t. DATFSIGNEO ~ v St i ~ ~4. ~ U R 1 AY ,l~ G~fN/b ~IM. QATE i1e. NAME OF CEMETfcRY Ot CtEMATOtY 74/. LOCJ?TION (Qtf. M~. K eo~sV) l8tu~1 # T1O~r`~°ai Mar. 1953 ill 3ainta Stuarti Fld. ~ a?n ~cro a ~oc~?~ ~~sruas ~aw?tuRt s. wa~ a~croas s~r.?u?TU~a noo~u ~ J F1 . . _ ` ~ `'~y. ~ , - ~nY ~RILED ANO RECOR0~0' C C~ 1+1 hasb'!~ ariifY lhis to b~ a trw and oorrect o~f tM ~ ~3S~rart record on fite in the Martin ca,n~y Heairh o~~. ~UCIE COUNTY. ~LA. ~ ' ~ p~~pR~ V~RIF4ED - ~ ~ , ~M N Stus~t, F{orida. _ _ • ~ . - } ' E. i-~(W~rninQ: Nct valid Vr+las raised sesl of the llMrtln , 1~~~ : s • . ~ T L` . ~ , • Count Health Oepnrtmc~t is affixed.) ' ; . ` r~r' y '6~ SEP 30 PM. t2' I 3 . . ; . ; : - tt ~ ; ~ ; N. D. MtL1ER. M. D. . . ~ e ~ ` r • HCd~t~l Q~iCCf dt LOC~) ~~fTfK ' y{~ ROGER i'OITRAS _ • i~~•~i~J4i~.~~'' ? 1~ rIRK1~ . . ` - . RK CIRCUI? COUR7 i ' ; ~ . , s Ddr O~ub t~u~ ~9=~u . ~ - - - ~ ~