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HomeMy WebLinkAbout1062 ~ _ ~ tfATt ~o o~ N~TM CERTIFICATE OF DEATH -1-~~~68'O Z 5 8 Z,7 _ w~ .~RU~ o. w.~. R,? ~ P~~~~~ '81RTH No. n~~DED. ~~...N..WA{~~~~ lLOHIDA , ~ STATE BOARD OF HEALTH • NO. SZ ' ~ OURGU OF VITA~. BTATIS' ~t Yucc o~ OtwTN COD! NO. 2. YfYAI Wio[NCt(Aa..~..r.r6.r. tt:.~rw...: sr;Mt.MI.+.~.w:.,) _ I ~~uN~ 66~OZ5 STATE A. t01?NTY NAME OF DECEASEO 2 CITY. TOYI/.OR IOCAT1pN - ITrK OR MIINT) t_ 15 iLACE Oi OEAT/I t. CITY, 70NN,OR WGA t. 5 E Henr FO P• INS~ CITY l OlO ~ 1~SOE tITY lIM1TS/ - DATE MON?H OAY t. ~uME oF cry.n ~..~w. r+. re.at w~?a~~ sT~r ~oo~css J ~ N0 ~ ~F.°w~n+ A ril 17 r+os.~r~~ o~ Lake+YOOd Park G~• ~ n n15TITUT M ITEM OMI7TE0 OR IN 3 MAM[ O~ i4q! /1/id(t LW! DATE a/Mf~ Dq Yt~? D[CEA{[O pF . - ( 7yrPr or pri~f) OEATH s sEx , c cao~ os ~ MAll11E0 ? NEYER YARR~EO i~*E 9. n6E Ua 7. MeritaZ Statu ~~~2 lyt OtrtNq) ~?w~u~ wM xw.. ~ri._ 1~i~ • wIDONED qMORCEO ~ IOn u5U ATIOM (Gi1r ti~1 ~/sN! I~~t 1~. KIMOOF N~SINESSOR INDUSTIIY 11. ~INTNPI,ACE (yY~fe ~rhrti/t po~ 12. GT~iEN OF InMT OOIW1Rrt au.i¦o s«t yw.ti.~ l~/rr. e.r,. y.ai.rn 13. FATNEN 5 NAYE . ~ 1., YO Bernard Waish Catherine Flaher ` ~s socui secwm No. n. s siawrws ,ubu, 14 PJ ~/S' ~O 18 , z' N<It[ M ptCLAR; ?NAT T R A Ft.Pierce Fla. u cwws w~TM IBir~..4..r a~w ss? p. c.L c~ ~ c~ . w~~ uRCSV~ ~ - ?iuir i oE~iM ~ws t~us[o R~: ~ OrsET A1D oEATN su~scw~sso wwo ~wo~a~ ro qOlE01~TE CAWE W G-G~G q ~ . Fu ~ewt DiRCCro~•s S~ r~ Ca~liftNl. i/ol. OIR TO ~s ~~i~ ~ f~~ aiE T~ (t~ ~ 1~[D N T s o ?ue~ a ana 9~s~ ooiar~t cmn~rtwo ~o ouni ~ur ~or ~unn no nE mrw~ asr~s[ ooiomo~ saio~ w rMr ~(y .~ns ~ ' ~b ~ ~E11~IIE0~f " YES ? MO ~ ~ ~ 260 ?«~o~.r wmoc ocsain[ ~aw wuwrr oauiacu. (~te. wrws y~rr~ 4 Awe I~r Aut ~I ykes 1fJ ~ ? ? ? 2Sk. TIME OF NN? J/Mf~. DQ, YqI NAM! AMD KIND OF OOCUIt ~ uuuRr a ~ ~ s. f ~ 20t. ~1tJU11Y OOCU~IIEO ~t. RACE OF tl!lU~11 (t. f~ M~DNf Mflt. mJ. Clr. 70~11. OR LOGTIOM OOYMTY STATE ! W?~tLE AT ~ NDT f1/1lE ~ ~*•I~Ml. ~O?sd. ~tt OfI/•. elC.) NroNK AT ~K , a zi ! ~tand~d tM d~a~a ~l~om ~ , to ~ ~nd ipt s~w ~Iin on ~ ~ INFORMATION De~th ooeurnd~t ~3~_ aR tM d~b ~e~t~d ~bo~r, ~nd to tM b~st of a~~ keowNd/~, ltom eM uua~s ~l~eM. ~ ?2a SiONATYw[ (DrpK ~r H/~,~!~ ?2b AODIIESS ?2t. OATE 51G1E0 2 ~%!~L 1 z- ~ G~ ~ ~j a ~ Z3~ a~at. QEwt101L 2'~ OATE 23t. NAME OF CEMETEIIY OR CREYAT011~ b/_ TpM (~Sf/, p1rs, M eoafll~) (B~If) AODITIONAL INFORMATIOI~ R[rOSA? 3 " 1 ~ -1 -68 Hillcrest 1~4en. Gdus Ft. Pierce Florida ~ ~ t~ ~ ~ f~~~KCe c •s s~~nu~ ~ooRCSS zs. a?r[ Rcco. sr uoc~ Rcs. ~[ea~~~s siGUn~ r. documenr: reterrcd ro obwe. ~ .yJj~s?~ Yates Funeral ~ne q_22_68 ' . . , CERTIFlEQ ~OPY ~ ~ ~ . ; . / Z • c; ~ • 1 HEREBY CERTIFY THE ABOVE TO ~~`~,;,.~Rt7~ ~AMQ.~CO~i~ECT COP1I ~ RECORD ON FIL.~ IN TFIE BUREAU Ci'f~~ ~ ~1::~7 ~g ' ~SF 'l'ME :FLORif MEALTH AT JACKSONVIL~.E. FLdRI~: i-' ~ f r,J C~ „i ~~r ' ' [c: C ' !3)':~;~~ ~ ~f' p ==s.' - fN0'i VALI~ UNLE'Sf TNE SG4:~M~! it~91O~.l~+K.T~ ~ORR~:d! NGLTf ~ • ._..,c . s ' ~ ~ '`•'J - ~ • '~~~'.~:~~i~~~. ~ ~ ~ ~ooK1?4 ~A~~059 - • _ _ o~e*a~. ~uRfwu o? vn/?L sT~TMf1CS I ~ V~ , J~8 0~ ow. • ' i _ " ~~r~- . ..~~~--~.T •