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T.t. .TwTS .auo o. Krrua+t CER7'lFICATE OF DEATH :L`'7~.~
eo~~• • iURtAU Or Y1TAL S'TAT1rTfOf RATt !lL[ ~
l~s~l r~e- FLOSIDA
ere .i.. s~ No. Rco~stR~•s No. ,
p~•~•rir 1. KAC~ N~[ATM coo Ha. t uw~~ ww~~tra.~.w..rr.~. n,.r~r..~ ~..~w+...r~..,l '
e:.e~t.~ ~ a STATE o01Nrtr
•nd Indian Rive ~ i S. u ie ~
p~ ~l~e~~
i• ~~r- dTr. TOMM.OR WCATqM e. K OF OEATN e. dTt. ipwN.O~ tACATqM e. K RES~OEMCE v~
iii: t ~irts~ NoD Ft. Pierce r~u ~m~w~!~
t~µ oR t7•~ ~.a«e dsa.) a. m~ccr sooass
'NST1f1T10M Indian River Mem. os 1 5 4 •
1 1u?Yt oI FMrt A/Wte tyt o~tE afisa Drs Yw '
~n~.•+~n JOHN VINCENT BROTHERS ~?*~6eptember 23, 1968
- SEII i. COtOR OR 11ACE 7• MARRED ~J 1~[YERlIMRIED DATE Oi NRTN AGE lh ~fMf If UMOfIt t vEYI IM~0612~ Mli
1Ml ~iNjq) XwIM O~~ Nwn /ti~.
i s. M C8u rwowEO avo~crn Jan. 4 1935 33
* i u.1 ~ ~0.. uw~ oaa~?rqM cQt~r t+~Iy.«~ Me roe. Ka~o ov ~a~u oa wousr~r u. wnw~?a csrrs.? Jwey. aw.r) a~n as.w~r aaw+~r?
.~e~ ~•r- t.?W b+wttalbk.ar.r~+ewM
~~p~~~ l~ana er~ Rinker Materia s Missouri t1SA .
Dlaek i~k ~ ~A?NE!'S M~ME t~. MOTNEI!'S MArOEN NAN[
•s
tn••~~~•~ William W. Brothers E12en Do le -
K. ~ SECURITtt N0. 17_ • SWM11 A~6a~
~ 89-36-3125 ~ • ~ I ~ . ~
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.~tt~~ m'~' ~onaMr witroc eow~uot ocst~nt eow Muvar oatint~to. (A~ter wuv~ ytyrrr 4 Artl~r Art 11 ylr~ M~
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• a.
201. wnp~r OewaKO 70~r. KACC o~ auu~r (s. 4 v M~.t ~.ue. 2D/• tmr. rowM. at toultqN aouNn? STATt ?
~r~ ~T ~ Mor ~a.c ~ M•. Aaay. nnr. Ma etp.. .u.) ~ _ ' :
MORK AT • ~
21. ! ~fNwdrd /aerw ~ ' ~ , fo ~nd fwt ~ ~ ~11?~ on ~ 11~ ~s
' D..eA ' ne r a. on rl~. J.a ~ar.d.8o..: .n1 ro rA. b,re ~t.ylne.lN/•, lrom d,. e~r..r ~aad. ~
~11 it~~• . •
ar• t~ 1~ _ ~ ~rfYf~) 72?. AOOIIESS ?tt. OATES~C71[4 S
~..,i.:. . ~ 11o c - N Si: i~, ~i• ~.3 4
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. a e ~?~t 2A. w~w. na~ 23~ a t7r. w?rc os etwEtc~r oa e~cr~~r l7~. ~ou?T~a+ el~rr. arw.~n e~w~r~) t~we) ~
va~`~"' 9-2 -6 Aillc st
r.t.Isis t 9"~E~1. 7th St. a. a?rcaaarrwe~'"°~ ~~ess+uuTU~
d'".'••s Ft.Pierce Fla: -2 3- 6a ~ ~
"I hezeby certify the above to be a true and corzect copy of a~
the Local Registrar's record on file in,the Ind~.an River ~ ~
Cou~ty Health Department at Vero Beach, F'lorida.'~ ~ ~
~ r" m
This is not valid unless the raised seal of the Indian Rivez ~m ~~D
County Health Department is affixed. ?b~z
' ° A ~ '~AO
`r ' -.•t'•,' . ~ ~*~`lO~
~ - ~ . . ~n ~-Z+o
" • County Health Dir. Local Re istra? e~ ~ rn'~~ ~
T` ' , ' 9 r~ ~ W O~~ ~
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~ .
~ - . /Q/l~~ ~
' ~ Deputy R istrar
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; gooK 174 PAGE 810
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