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HomeMy WebLinkAbout2060 - i ~?v~rv Ta~• ~TAT[ ~OARD Or HiALTli CERTIFICATE OF DEATH }t°~' ° o••• • ~u~uu o? vrrn~. ~wt~rr~w F L O 8 Z D A s~rwn ~?i~s No ~ ~.s.i ord •A~~ 01 T N. ~ ' R~GItT11Aq•f NO. proy~~l~ .:•e~t•a t. ~ar?es e? ~snrn cou t~o. i. uw~t Rs's~osNec(w~...w...~w.r, ti:w~w~..,: R.;r...wwd.;~«..) ~ .~a .ii~ aou~Tr ~ ~D fT~Tt oou¦1v r e. .tao.. d ~•r. 1. uTY. Tow~.O~ Wu?TaN e. ~s ?utc a ou?rN e. arn. row~r.oR toC~TqN s. is asia~+tc I sa~~~t u1S10t Cmf UMITSt u1S10E CRY l1rlTft rii.. HOll OOd res Mo0 HOll IOOd ra~ ~wp f. NAMf 0~ (I/Mi k~ ~M/If~f.11N Ibpf Nl/tN~ f. IENGTM Oi f. iTI1tET A0011[Sf OM A/MNT MOSMTAL 011 . Y tN tA 1• YES ? Iq 1MSTITUTIOM ~'a ~t 3. ~u?MS er FbN AlWt. L~e a?TE x«ua ~q Y~a t~ir~uM s~+~ o°FUn~ scx t. oo~os o~ rucc 7. w~~co wuuko a?~ a a~n~ f. +?cE tl• ~c..• u~oa~ tu. u~mc. H w~s. trt+irWq) x..w o.w Mnw ~ri.. " ~ ~ : • ema Mnoowco orv~cco p 1~ i wl r ~a. uw~ oawsTaN oi.e ~w y.«~ ro~. Kua os wswcss o~ wousTMr 1 aa ~~w.r M~y. a•.M) crtua a.+wr oawnm •1i1~ f~.t+ywwtMw. ~ t?A. urw y rth?~ House i e Own H me • Ohio II tt~~lc !wk 1 ?ATN[M'i Niu1E MOTHEII'S YAtOEN NAwE ~r•~~~~~•~ Addison Do kink Mar Dietz i wu accnsEC ~vc~ u~ u. s ruKEO .~as? socu~ sccu~~T,r ~a. n. a~ s aow~~ . ~:......r..l...d w.«.«.....«..b.,r...:w No 262-80-.464 A+a«•1~+ ~ Ho 0o v o ,roo r~~.r.i 1~. CAYK N KA1N (61Mt~ MJ/ wt ti../r. te~. c~~.l ~ ~YN~.b'~0 1~ ~ ~ eir.ecee ?~~t~ oc~TMw~su?usEC~r: • rll. ~N~+co~?rc c~?usc t.~ ~•dt~VC- G ~ sA• e~~- tltle~t• ~ ~ ..,(7 sitl t1• ~titiMU.i/p/. OYE TO ~ w~v v~k~1 /Mr ~+'~t ~ 1• e w 1 ~ aras l~). a .-n ~ r.ai.e..r ri~~ :~ae r~: OuE TO ct) ( V C.~~.. e~~~ leH~~ •!s IA~T H. OTM41 S~C1~K~Nl '9MOIT1014 TO D[11iM ~1rt NOT IIMt[01'OTNE 1ERMw1t D~fGft i~ON GNiN M? T((d . MAS A OKY 1 t~t ~~wt\ K ~ . ~,4aJ~a~ ~~1~t~ /EJtF011MEW ~ et ti.f.~. Y ~ ttts~ NO? ~ ~ INJIMr OCCYR~EO. (Ellfq NfINt ~Jiq~IK~ It1 PMt /M AI! /J Ntf1 IN .•k~.~ •w~ ~ ~oc~ocNt w~c,a ~~croc • ~~.o••~- s~~~ •t ~ y~. T~w[ or N«u ~/w?. Dq. Yar ~N~• uuL11Y s. n1. a s.,. ~ tor. uuusr occuiuco me, rucE or u~w~r h~ w.nwi ~.we. m/ tm. Tow~. o~ wuraN oou~n sreirc wN,ic ~T ~ ror trniu ~ M~. ficbrt. Knd. Nf« ety...re.) WORK AT wq11K ~ 21. I~tt tM I~ew~ /na+.~, r11 g' l~. to ~ad I~~t w~ ~+Jir~ on V g R ~tA A 1tf~ - +11 9A fA O t~? ~~~t}d ~~l: aw~! ~p~ !?~at 4/ a_A1 kaWlrl~d /~om rM uuw aaad. ~il !Nl~. . N ~ T11~1E - - - - - - - - ~t~ 1• MI • R66U!!b : 9RT€5~4. 9 a...~.~.. ~ ~~~o ~a~~ ~d~d ~w y ~ •~~~~~t~. 23~. MJp~L. TION. L10. DATE Zlt. NAME METEIIYORCNEMATOIIY . 1ACATION(GY/.IMm.MOwft/) dYW) I1t (S~ttifrl - l0 Y.~.~A19 2~- ML E t...iass ' ~j , r~,,~~~ j , ~iollywooa ~ ~d 9G. ~-e- ~e~..sw- - - _.:.x.. _ _ . - - - - - - - - CERTIFIED COPY I hereby oertify the above to be a true and correct copy of the Local ~egistrar'a reaord o~i file in the Broward County iiaalth ~epartment at ~ort :Laud~rda]Je, Florida. • : - . _ ;:.Z,~,. ~ . . . , (War~?wR~.~•l,it~at '~a~id unless raised seal of the Broward County Health - : - .,...,3~pbrtnd+ent is affixed. ) . ~ysa? ~ • . Y ~ ~ ~ _ . s. : a t • • ~ . . ` I ~ ) K ' ~ ~ . . _ ~ ~ . o . . . . . ' ~ ~ - ~ . ~ . . . • ' ~ ~ . . ' :H = ~ . Count llealth 0 , t, _ y fficer and Local Hegistrar • ' . ' • . ~ - . _ . . : _•...••';st~ / _ ; i., i y : _ , . . ,~r a,„, ~Cp.t~. - - . . ` a . ~ - ~ Deputy Loaal Registrar~ ~ . ~ ~ ~ ' ~ . ~ ~ . • ~ ~ • ' . " , . . .s~.. . . . . w ~ ..t: ~~.~•~S'.:=#x~- . ,'`a r_ r, . 'is~ . ~ .\-.a..\.' ..-'.~.::"r~.s`,ar,••-.. _ 'a F~~EO ANO~ RECOao~oi . ST.R~c RD vERIFt~pLa.~ i~zs2o '66 OEC 4 AMI 10' ya a00K~ I~ PAGE~O~~ ~LERK C RCU11' COURT: i li