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HomeMy WebLinkAbout1032 1'739Q6 • - ~ ~ 5 nwzi sowaD o~ Hsw~tw CERTIFIC~AT~ OF DEATH ~ - -~~co.es • ~YR[AU OF VITAL S'TAT1fT1C! lTAT[ FtL[ NO. ~ '°s•' FLOSIDA ~ ~ . ord •A~a SI T N. R GIrTRAR•! NO. ~ ~ prop~rl~ . eieeut~~ 1. PL,/?CE OF dE/17H COi?[ NO. i USUAL RESlDENC1C fwlw~aaerMYni 1tir~uK~r:mW~r~Mtw •nd •111 COUNTY iTA/f COYNTY D+ pl~s~~ ~ 1n p~t• b. CITY qt AtW ae~nM Or4. ~Ir lULL/ 6 Of R G1Y l~ wRdM ~eMr~M M~M~. Mq R . ¦an~at Ol fTAY(h1W/YW OR t ~ 1 TpWN 1~dWN d FUII NAME OF 1u ~r r~ 1w+~a a~ qw ~awt v IrrYN fTtEfi llt we~ sM Mat~i HOS?~7AL Ot A~i ' INS?ITYiION • . ~DECEASED ~ l~) ? ~ I~~) tY~ar) fTss• Prs. ~ f. SEX k OOLO! Ol ~l?Ci 1. MAll1ED NEYE! W1~~1~, t OJ11E OF lTM AiE ~I~ v~na~ ~ rw r ~~K~ ~u ' tAl10iD'1A/E~. OIYOlCiO ~ 1rt MnMV/ ~Mrr Dq~ Hwer Iu? ' ' e • Mal @ ,•in1 ~ IM. USUAL OCCYIATIOtI~ww aW rt w? 1N. KINO Of WSINESf O~ 111~ II. N~THMACi t~aw r ~+e~a w+bl ~t cn+z~ of wi+~r „cb y.~_ w.a~. .~.~.r.wms~r....r.rrw~ w~tt~tr cou?lrart ¦~n~ot S~es~ elaer t~k q, FAiHER'S NAMt K M01/1~Y MAlpill E o~ ' i ' c~p~.ras~r ar T ~s, wws oEC~?sEO u~ u. s.~uw~ Fo~s~ sod~ sECUtm n. tNrownNrs:~ tu } . ur„~.,.........r.,r..~,.., Milton W. Baird r . ~ Pun~~~l 1~. CAYSi OF DEATH ME~IGAL '!.t'RTIF14'ATION um~wvw~. ~rwcw i a i r. e c•~ li.Mr e~b ~ a••e OISEAfE O~ CONOITION or~sr wNO o~?tM ~ ¦ u a t f il• M* W~ !~e l~)~ l?). MlK.1LY IEAWN4 TO OEA1M~~ che e~r- ~ i c i t i e a c• ANT~Ddf~ GOfK f . i c n t~• •l1W Ma srt wM~ «iii ~/i11w~ U eM. ~IDYE i0 ~ 1 o e. l w~'•~• •t .;.e a eM s~ M.w f~~ ~a1- r~slat?\~ ~ft~ Y Lss.! l~i7o~. W~I p~ bMa' ' ~ ¦icnis ~a ~TO 1 1i1M/R ill~ N . O ~ • Lv~/Iwat~ew n~ f/ A OiMEI SICM~i1CA/IT OOMWf10Nf ~ c~r d~~tY ~~W' ~ pRdiWiw~ b W JMtA i~t M! ~ or E~t~r• f~i t~ w Mw~iti~w • •~tte~ ~w~ Itw OAiE OF OIjE~ 11~ MINOt NNDINCS OF OlEL1TION ]R AYiOKTT + - } d•apo~t- . .tl ? ~ ? ~ j •t lr~+MWI tb~d41 21~. K/1CEOi INJYIY (~t»b~e~M1 !It 1GiYO~10M111 (nATE) l 2I~. ACGO[MT Y~, IM~, Alw~. ri1Ml. i~ N~F. MI MN~ iOYLj _ w~uo[ l1~. TIMi (Wiw~) Wol II~r1 t1~1 !1~„ IIUYlY QOCUt~M ~ IWUtT ~ •nu~t ~n~wu . ~p[ ? ~f tNt ? ' j 1: d NO t ? n. r lkrc6y ef.c~~y ell.~ r.eee~dsa eA. ~eawe~row~ U_.~Cf,ily~ ' t~.e r r.:c aou e~. ase~o.sa i . 1'~•¦• . alive ns ID n~d tA~t dteeA oawncd ~t +w lJ~t eawe~ ssd os tAs dat~ sta~ed ab~~e. ~ e. i~ SIGNA UR cc+n•••~ w?ns~a+EO ~ co.yl.e• ? ' •«•P•~•. L.D.VanTilbo , M.D. 101 Atlantic Ave. Ft. ~ i+.. ~ u a ~ ~ ca~w. x. a?~ wura oF c~rur oa cmutoar ~a. tocnnoN [wa. ..,.a~ twe.~ + TION. tEY01lAL lMeh1 i: 1_ Ft. rierce Cemetery Ft. Pierce, Fla. DATM ~ECD R[idfi~Al'f SIGNANRi s wNwLL aaaro~~t s+sw?nn~ ~oo~s ~i ..s.,:oe n s r M31tor~ W. Bai7c~d~ Ft..- Piei'oe ~ _ _ _ _ , ~ . ; I ( h~nby c~tif~l fhk b b~ a tnu and aanet c+op~r of th~ Local ~ # Rplqrars r~oad on fil~ in th~ St. t~N CourMy llMhh D~pwt- ` i ~ rn~nf at FoA Pi~na. Flortel~. ~ ~ (Wwni~p~ Not w~ raiad ~1 lad~ . ~~,t ' ~~~'E ANO RECORDED ; 3Tt ~E COUNTY. FLA. ~ c«,~n? o.~.r+~ . ~ ~ ~'.~7~?~6 ~ ~ , -f.. ~ ~ N. D. IlAIItER. M. 0. • ' , : - ` , • . 1 • c~? ~+,n o~ a ~ w.aa... , ~ ~ ti ,'69 ~ ~I~ ; ~ 6 2 • 4y ~ _ . ~ ~ C . . , - • f ~ " ' ' ~ ~r ~ . . - 'r- ~ rOG~R : RaS + ~ • ~ ; ~t,ERK CtRCUiT COURT ! ~ 4 ~ - ~ ~ooK~.75 ,~~~f1029 : ~ w ~ ti~ - _ __W - ~....~~.Q~ . . _ Y ~ , . , n ~ °:w..ai:~- 4