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HomeMy WebLinkAbout1609 1~431~ ; ~ T h 1 s D~- ~TATt wnwo or Ncn~TM CERTIFICATE OF DEATH ' eo~e• • ~URGY O? YITAL lTATIfi1G fTAT[ fIL[ NQ . ' '•a•' FL08IDA ord ~A~a BIRT NO. Rt61tTRAR•~ NO. S7 p r o p~ r l~ 1. ~LAC[ N wTN COD! NO. 2. YfYAt AtfIKNCt (~Yn IwU 4wL J/iriiur.w twiN~ ~N~ Wuww) ~ . tzee~t~~ ~ .^a .,il St. Lucie 66-XX?( `~~~'lorida `~°01"~t. Lucie - • e. ~i.e.~ 1„ p.~- tm.TO+n~.o~ wuT~ POl't c. a ruu os oc~n~ c. cm. TOYM.OR WGATqM Port '~oc~ic r i '"s'°` "TM ' Ft. Pieres - rii~. , Ft. P3ez~Ce- St L resp No~ St Lucie res w t. ~urc as ~ry.w i. ~..~rr.t. w...ear.u.w) a. srRCCT ~oo~css 3089 . Pruitt Road 3089 Pruitt Road ~ : 3. wMt OI f7?M ~liNle L~t 1. OAT[ X~a/~ D~I Ye~r ~i~«`~r.n Lyman John Haviland ~~anuary 25, 1969 ~ S. SEx i OOlo11 011 RACE 7. rARlpEO ~ MEV[I1 MIUt~KO MTE Oi ~p11M 9. KE gt~I~ /t.+~a • u~0[11 ~ Tw uroE~ U~S. t~ale F.'hite ' Y~- r ~ 1 s• r~oarcop o~vaeccu Jt12'1e 8~ 1906 bid p 1~ 1 w 31 lO~- USYAI OCCYIATqM (ai~t H~I ~JNr! ~Mt 1~. KIMDOF WS~OESS O~ WOYST~Y 1 t. ~Mi WLAC[ ($afs M~?ti/a t~M~frll 1. CR13n Oi ~I~Mi COYMJttit . t c A y~ Is?LM ~wt N wrah/ hk. esr~ l! rdaM ••~••c ?dechanical ~n ineer Or an Co~nan I1linois II.S.A. llaek l~t 1~;, FA7N[II'S NM/E II. MOTMER3 NAIpEN NAYE ~ er . ~~P•¦«~•~ Charles Haviland Anne Thor:~ son . j tt. socu. sccwwn no. n_ s aswTws wu.~.. Fl&• . 336-07-961 Mrs. Da V. Aaviland 3089 Pruitt - Road Port St. Lucie1 . P un ~ ~~1 1~. CAYK N~tATN (E1kr Mf/ Ms twM li~t ~r (A). ~a1, (tl.~ IMTEIIYAL ~ETM[[N dlr~et0~ IAlITL0EAT11VASGY6ED~Y: 0~1~~ ¦u~t lll• w~~~ ~ (y t~ tA• e~~- / tltlt~t• ~j~j~y.i/p/. ~ TO ~ ,'7i .scn aM t~~ru'~ _ l o e a 1 dNr cqut (i). ~ , r~~ 1 a t ~ ~l~fiy f~t •Nt?- p1iE TO (tl •itAlw 7~ Z M~I t~~ar fW. 7~ o u r s • t- O MwT ~L Oi~[A SKISKYR CO~D~tlp6 COMI~YfI~C i0 DUfw ~Yf MO~ A[1A1[D W M 1E~~IiMI OIf4iE O04Otp1 CIIIOI M/Mt 1(y . MAS AUTOrSY /ERFO1tMt01 t~~ d~atY or 4efof• ~ ~ ? p ¦~k las F~ ~CCIDEM~ SYICIOE ~10YKIOE ocsceyc ~ow wu~r occwao. (~un a.rr.~ yt~pv~ a.t t~. Pr.t 1/ y~.. u.) ~ 81~ps~1- ~ ~ ~ t Ion •t J~~ryyE Of Ilwr Xwt~, p/. Y[~r ?oa~• ~ wu~r S ~ 2w. w~wr oauiuco ~Dr. rutE as wur~r u_ o r.M.r b.w. m/. CIT?. IORR 011 LOCATI011 oowm? sr~T[ NN4E AT ~ wr rrMw[ ~ 1ds.l~s. w~w. Nkr ay.. ere.) *OIIK AT MO~K ~ 1 • ! ~tun tM ~Nd /rom ~ . to •na lut w~ ti ~ ~lin on O~~t urnd ~t 12: a3~ ~ a on fh~ d~N ~f~t~d ~Aw~; ..~a co re. e«r a a~~ k.w.ad/., /rom tM uuw~ at~ad. ~ A3~ 1ta~s ~ p TYA[ ~ • r• t0 1• ~ ~ ~lAfpK M HN[) ?li. ?~t. OAT[ SIG11E0 • co~yl~t? y ~~vl~~rti'L ~~~C ~/i~ „ 27 ~ •tlY~~Lf. M~Y_ GfYTiOiI 2'!~ OATE ZIt. MAME Oi CErET[11Y 011 C Y~TOIIY Zil. IOCATKM (CW. qos. M twultll (SlYri C~~`m~i~`f$'n 1 27~69 t. Pierce Crematori Ft. Pierce, Florida ? P. 9.~ Ol ~ 21. fYIERAI [ SIGNA I100~[SS 2S. OATE ?ECO. ~11 tAC~I REC. TR11R'S SICIM R[ ~ ~ ~ ~p ~ R~•.~o6e , , tuart, Florida ,1~, 27~ 1969 , ~.~~i~aGGCt.~ ~~C• ; _ ~ ~ ~ hereby csrfify th(s ~o b. a tn,e .nd oorr«x coQy of tFa t,oc.l , ~ Regimsr'a rsoord on file in ths St. t.uc~ County Haaltfi D~put- ~ W~~ ~ mst~t ~t Forf Piera. Flotid~. F~, , f r~ t- . ~ : lYYan?in9: No~t valid unkss ni:ed seal of the St. Luci~ x o~\ Fy c m: uc ~ ~ o, CouMy Hsslth D~partm~nt is af~ixed) • . . ~ • c'"~ l'! ' . - ~a o -vmZ} N. D. MIItER, M. 0. , c ~ : ~ ~ , c ~ < ~o Cq~nry H~ahh Officer 3 L+ocai Rplstrar ' i: ~ 3 m c m; i . - _ ~ 2 I , n 3~b A ~ ~ ~ ' : • • p ~ tq -1 ~ O; ~ ! - n N :C~! , , C ~'1 ~ ~i1~ Q~YIy ~.OC~i~ ~f " ~ , ~ . . ..t, ~ ~ ~ r f~1' . ~ ~t DDi ,rr' . 1 . . 800K ~ ~ PACf i60V . . ~T-~, - ~ _ .~s_: