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HomeMy WebLinkAbout1971 ~ - ~ `?;~5`~'3 . . . . - . ~ ` tei. r.• . nwTS ~o o~ Hw.TM CERTIFICATE OF DEATH ~o••• • . ~u~~u?u or v~~ .~rwn~rric~ fTATt RIL[ NQ • ~•s•~ ~•e_ • FLOSIDA ' . ord •A~~ sl N. 11 1 A• ~ y?ep~el~ 1. KAC~ N MATI COD[ N0. a STAT[~I~fN~i(1?MnlwrrtMu~!/~ R~WwMAnN~wW ~ . . •:~~~t~1 L ~r - •al' ~111 >>.e.~- le ~ tm.1'OMM.O~ WCATqN t. /S ?LAtE OF OEATM t. tm. ~ow~. o~ wuTa~ ~s ~cs~ocMCt ¦~w~~t MSWE CITY LIMITSt MIS~OE CIlY l1M~T~f • t11~. YES No ~[f MO . R iunc ar (U~ ~ M~l~. r~+•s«r.ur...) 1. sT~ccr ~oo~css • 11pSMT~I o~ MS11T11i~011 ~ . 1 wu~t N Flnt XiNM IwM W?rE JlfiNpl AI Yer anc Iws 3ni1~ ~TM ril 25 1966 - s uroa ~.w a~oE. H Ms. SEII OOldl O~ IIACE 7- MAIM~Op IEK~ itARQI[O M?[ Of ~MITN ~~~K~~~1 N~~ D~w Mwn Mf~. ' l • 1 t• ~ w100~1E0 pYORUO A .Z~ ~ y 1~ 1~l ~ la. YSY~I OOCINATIOM (Obt !f~ I~~M~ /M1t rwo oF ws~csso~ wousrnr ~t. wiTwuu ~a.u w/~n+r. as.ar) 1 i71YO1 a/ rIMT ~Y111R?f ~ .is~ t~?hlawtNrrWldR..w~VnltpA Geor a U.S. llast f~t 1 /ATN[II'3 NI1N[ 1. MOTK~ i MAtO~N R4~ti , •r - ~~*••«a•~ Jamea e Hartha De2k • K. ~ocu~ sccv~uTr Ma 17. a s~aw?Twc ~ Nrs. R.H. S eon 1 Okeechobee Rd. Ft.Piarce Fla. ~ rrs•r.i ?a ow~ M wrn (a~e. wt~..e aw ~w. w. /r c•). t~). q/ (t).~ . NfTU1YAl KTwLEM rruT ~ ourn ~i?s c~usco w. a~scT an ouTN u~.~e.• wrcou?TC cwic W PileUmoYlj.a . •Y~t t11• t~~ s~r- c~rie.e. ~;et~.,,t/..,, ouc ro p) Old A e .~s~ a~• ry~ 1 • s • 1 ~ e~irar ~ r~sias?~r w~I t~e rs/n• DUE TO (e) •it\i~ 7• M~ a~ ~ ?A~T N. Ollfll SKIiKYrt OOIICIt101i OOMIMMlIMt 10 OGTM ~1R IIOT IIE~?1W i0 iNt lE/II~MI 06Glt 001101110M CIIaI M Mff 1(1) . XAS AtlTO/ST . Ys~I• •f- - KIMORMEDI t~* t~~t1 s ~ES? M~0 ~ t . r r. r• r. ocsurc ~ar w,wr occu~eco_ csr~...rw~ y~ a Arr ~+.r » y rs. ~u ••ts•s ~a~oc~r w~aoc ~~uoc ~ ~..i- ~ , ~ • •t mc. TwE G? l/ws ~[i~ti. DrI. Yar 1•a~. ~ wNMr ; w. tor. w~r oow~uco 2oe. ~u?ec os ow~r ~~s. "a~«.e.,u ?.wr. xo% sm?. rorr~. o~ wa?Ta« oou~rrr sr~rc " MMKE AT Q MOT 1rNRE ~ Mf1. ~I. ~bM. y~a OIN. qt.) MOIIK AT ~IORK , =1. !~tNnd~d tly d~eMMllrom ~ . , to r •M Wt M~ A j~ ~Ii?~ ow pr DNt~ oee~rnl ~t ~ 1= p-~- m on tM d~f~ ~f~hd aAw~; ~nd to tM bMt o/ aq knesNdN. /~om tM uuws aMal. •I7 ! t~~l ~ Na~~ ~aNa M wk) AD01lESS 22C. OATE SKMEO •f• t~ 1~ : • Francia J. Carbons+ra M.D. 503 N. 7th. Street 5 3-~ ~ •~QaNt~. l~. ~IIIIMI. dnYilOR 2~. OA?E bt. NAME Of CEM[TE~Y 011 CIICMATWIY Z7/. IOCATION (Cif/. b~1. M tM1fp Ibtdt) ,~0~ii~~"+~' 4-28-66 Ft. Pierca C~ets Ft.Pisres Fla v. s. ~ si s u. ~s s~uun~c ts. wn ~cca .r wc~u ~cusTw~~s sK«nnMc a...~oas ack~ ~J,=l`f~ora, Ft.Piarco,Fla. • 5-3-~ Anna Iao Denison d.r , t~,, t'`, tMt~tp~b~_i true and ootrat aopy of th~ Locat . I th'~~~ ~fY ` `~~~"t~oord.q?'fii~~,the St. Lud~ Cour+ty H~alth Dspsrt ~ . , Fd~t Pieroer ; a~ .v1. ' • ~ ~ , ."~afflifl~t HOI~Vd~il~•~NNI~lii ~lji~ iN~ Of ltl~ Sf. ~IJC~ ~ "'~~.i Q G ~ • Cp1~f11y`~f~L ~fff~NM 1i ~XK'~.) _ ~ TC~ ` - t': , ; 7~ 0 ~ ~ n ~ `y: ~ • C) f~1 ~ ~Ab t=~ : t'. N. D. MIttER, M. 0. ~ m z ~ County HwMh Offiar ~ Lrocsl Rplstwr ~ ~ d n v. ~ . ~ co ~ ~ <o~ : ~ ~ . . 'i 1~ 7D Zn : c N. x c N S~ C' m.-~~ o. . - ~ ~ ~rp D ,y aooK~~74 ~~cE~~67 . ~