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HomeMy WebLinkAbout2728 ~ \ ~ i~~4 ~ r . . . ~ ~ ~ ~ ~ . - - - pU$~~i AL1H.~. C. - - . r VITAL STATt:' ~~^S SFC jt~~ D28Y'ltICT C~ COLUI~[BIA DEPAATMEII'1' O~ PVIlLIC I~AZ.Y'tt i~cate CEA'1'I!'ZCA?S OF DFJ1?H t%'s8 ~3 5 P~i 2~4 6 8 . l 0 4~ :fully ~ ~as rtw Bura Nw ~ 1 l. 1fJ17R OT D~ lint ~/i1r1e lw~t fa. DA'1'~ ~f~tA D~1i Y~. ~~A. lte~x Desl? S r,,~~r w. ~~~~r D~;~ e 3~ / r = a~' em ot iri- ~ g~C ap~,pR OR 1tAC6 ~Twer Mnnial •trieJ ~ DATE OF BIR'iit f. A~lt (/w ' n s2~ould b~ ~ t, E IT`@ w'a°'roa~ . .y au eer .~j r, ~w~.. w cuPP~ed. a PI.ACIi OF DEAT![ 1N Washtngton. D. C. vs0~u. a tu~.~res t~~ ~K•••~ ~l e•J«s ~ YAatB OF HORPITAL, NURNI~T(f HOAlS O.^. OTlfElt 1N8'fITVTIOii BTATS b. ~.'~,i1U rtwiwiiw) 4 99 l// ~of i+u u~lUrtww. /~te Nnet dlcty) s:~~Uld b~ W ~j_ ~ e. C~ `~'f ~ • e. INF! C!1'Y Ll~lITR -`~.a ,wM.v t~1+ ~ /~7 (SPBCI! Y YE8 OR NO) r~,1r i! 2 t 7i d. S'TRBhT ADDR8B8 (1J rnd. ~iee t ww) e~ in p~s• 03~ ~Q ~C!'`~,t - iype blaek ~p,, t'SDAL OCCUPATiO~I (Cie~s liut ~J ra! J.w~ 1~b. HIND OF BU8iNS3B OR 11. BlR'I'HPI.ACg 1t. Cl?iZEN OF WHAT G~OUNtRY! , ' ~ ~ Iwi ~ e1 ~N s*ew iJ retinsl} ~ 1ND BTRY ~ ({~,~tA~r foni/w eow!?y) ~ , ~ y JGG . lia. FATHBR'8 NAAlE l~b. EA8 AlD ~I ~iJ1)!B H. NA]tS OF 8UR~'lVIJ10~8POUR$ r i ^'t i o~t,a,t,C, A t KvL ~s u.~.: ~ ~ ~~t E ST~ f'/t ti.. ct,.s rlitit~te b!- ~S. htier iu V.9. lt 90CI.1LSSCURI?YNO. 1T~. INFOAi[ANT RaLArlO.YdR/PTODBCBA38D Ifb. ADDR~B Sirc~et Ciqr b parmnaent a F~,t 3.1f? -~6 SE'o1' h~?•,. ~'h«~..~e. ~!?uYv~.~/, l,n~~ 03 Q,~ ~?...~e ls.t~,~i.~. rcord whet! 18. CAIISt Or bEATH: (BwfA Orelr Mlt tfYN ~O li~t IO? (6), twd (e)• ~ laternl Bel~ Oiset ~ eXecuied. 1'ART I. vSATH WAS CAUSSD BY: ~ ~ aaJ Drstb: IMMSDIATS CAU$S I Cwditinw. i/ ay. ~ ~ rhitk pae siw te DUS'1~0 (0) (iRhi ~~tit7'~1'. ~ " 1 aAosc ~ows ~lat. 2o aubmii a iw~ fAe wda7yiu~ nr~s • ~ • 3t~ of Death z , bepatimeat O DUS'PO (e ~lic He~llh E' 1'ART ll. 01't1SA $IaNIFICA_~T CaND11'I0~18: eontritwtio~ to de~/6 bnt wot 1M. A1.'TOP3Y7 1lb. If1~s,~Yere~iadinpConwle~twl U !lliltd l0 l~f Ll7fn1O~I dLSlrfQ lOI~Il10A <1Yl0 A p~~L I(~) Yk~S OR \O in 1Merni~iut C~use o[ lk~lhT 48 hours e.f• ~ . !h is a vi0- w 1R OpSRAT10~1 N.~S PSRFORM6D ff.. DATlt OF OPERATlON lOb. CaVD1T10Y FOIt hH1CH OPEItATIOY o# She laws E+ CO:NPLkTh I97i]t~ !1a •al f04 . NAti PhRE'OHI~fED Disfrici of u,_~~ ~fr it ~+ride~?~, aeicide, Iioimi- ilb. HOUR AND DATS OF IJI]CRY: ]tow~A. Dar. Yeu tfe. Ds~CRlBF. HO~Y 1~JCRY OCCURRED ~i]. a w ur~ y~~~ieed M (Bwta w~~r~mr oJ lv~ u~ l4rt I or Pwt !l) V lld. 1\]URY AT WORK: tle. PLACR OF I~TJURY: (At Nowt, Fnw, P~fw~, tlf. I:OCA1'ION CIT1 COL'Y'i'1 $TATB w+ ~syKyr Yu o. No) ar.s+c~ o? Ol~ce 8~1~.i, 8u.) FIER W ; OUT 22. 1 s+~tlt! Oiat pl ttp ~d tM d~t~m~d!~ - l~ s~ ~at fA HM laut ."fiHIS saw tD• d~ews~d ally oa Si~ir 1! JQ aad t5af d~ oarornd lraw ~ ears~s aad oa AN dat~ aad Aerr stebd abo~~. SPITAL" - na. sccxw z~,. n:~rp: siarsn n AT'I1L\A1~1(3 litEDICAL ATAFF c PHYa. ~ 1)111E(.`TOR PHYS. 3~ ~ ~ 7 6 y ~n of ihes0 ~ PHYRICIANB ~,r~~~--?. ~ W x~?a~ E t'hv~~ /}'L-FR E D /jA E/Q /h. ~ l va, s punishabI~ ~*i imgriSOA- Ri:R1AL 1tL. DATLT 23r. ~I:1]16 OF CEa1}:TEItY Olt CItE~tATORY l7J. , LOCaT~O~~••~-(Cil~r, I'orw, or to~~f~r) (Stotc) ,r ho:h. iisuovai°~ ~ 2-5-19b8 Cedar Hill Ce netery Suif~~ a~d',+ ru~~naLa~o~+sJoseph G~wler'~j °ons, I cx '~uEttT~11~k ~~iC • us~,~ i~.; La•DF.RT.~KER•s ~ ~~1SC • ~V@ • ?`l ~ n • W S~'1 • ~ ~y • ~ % i,, r ~ - iliiCl.~C1'RAT1U~i ~n~>aF:.~.s 513~ a _ ~ ,f , ~ l ~ , . _ .a~Hr•u lte.~tatcss: , / :r~~ . _t - 7-?HVS : ~ ; . `t . 1SM i~ - - - ' • ~ - . - - ~~~N~L~~.~.::: _ - - - - . . I .t~ed ~ ~ f-- ~ N - - - ~ ; A-.":'~=""`~~: - . _ :c:~ ~ :r t~~ . i~, i~ ,8 0?!~ VALID WI'i'~Oi1~ ~RAISED SEAL _ ~ . - - . ' ~ T}TI: IS 'i'0 CLRT'= I~Y _ t-hat the a`~e~~e. is a. true and correct reproduction I t^e ~rigi,l~.i. ccrtitic~~i:e~ f:s_]~-~! wzth the~ Vital Records Uni.t of r1-_e s trict of Colun?.~ia Uepartn:c~nt 4••f Public ~ieaith ~ ~ ~ , ~ ~ ~ ;,y.t , ~rr . r~.. _ f Jo n H. Cran a , C ie =,~v; t-~1 Rccords Unit - i FILEO AND RECORDED ST. LUCIE COUN7Y. FLA. ~F.CORn V~R!Ft~C 1'73054 '68 DEC dal 8:43 R ~R ?"•OITRMS CLE CIRCUIT COURT So~~i74 ~?~2"1~ -