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HomeMy WebLinkAbout2097 1'74623 . . . ~ j ~a:'s?~- ~TATt .o~no o.. CERTiFiCATE OF DEATH y•j l. .1 ~.e- ~URGt! OF YITAI. fTAT~ i1C~ F L O H I D A ~I~~ er~ .r.e s~RT o. . A~• ~9~• ~ri31fl~lf o. ~roo•rl~ ~s~cat~~ KAC[ 0/ i[ATf1 COD[ N0. YWAI R[SIO[IICtI~'~Irir~/Itwi Iliw~.n..: .~.r.W....~.;..:.+1 awA •131 ~ ~ ~ STATt CouMTY~ ~t ~l~e~d ~ 1• !~t- 0. pTl. TOMN. Wt tOtA7qN t. IS ~tACE Os OCAT!1 t, pTf.10MIN.OR IACATION f. ~S R[StOtNCE ¦~n~~t NISIOE CI LIM17St NIS10E CITY 1IM11S1 r s i.. nr .e~,~I res ~ No Q U /S res ~a M,?wc oF cry..~ t~ w.~r.t. ~:s weu saaw~ ~ sT~ccT ~ooecss ~osnT~ ou . .~T~~ ~c~ • 6'E~v:c. .o z ~ !T/ 60 ~v E i 3. MAMt ef fYr~t NiM/s Lpt 1. W?1E ~/rnM Dq Yta ~ ~ w; A~r.uc. .?o.~v ,f3 oo,c~s ~ ~x i ~ 1IAQRIEO ~MEVER MARRIEO ~TE OF ~1RTN AGE ( /~V~ ~ 1 « 1MCE~ 2~ MK ~j y /aK 0'v t~I /~«w 0.~+ tf.w X:.. • r 1 t• ~I~ ~i jI~/ MrtoowEO ? dv~ontt~ V / }1a1~1y IOa.11SUALOCCU?ATqN (Qlteti~lyr~?kle~e IOD.KINOOFWSIMESSOR11t0U5TRY 11.~IRTMMACE( ~ftMhn!/wtw~trl) 1.pf~EtlOSw~MTOO~M1fY1 •itA y~r- l ~atywrRialMe.ek~y?ttinll D ..A.ae t0~//.CG //v~ ~~9'S E'lTS . S ~laek lwk ~A111EIt'S NANE 1~. MOTItER'S MA1pEl~ 11AME • •f ~,,..~z~.~ ,C,S' /y iv E li. SOCIAI SECURI?Y N0. IT. IN?O f SIONATYR[ A~b~u I~ /~/U~ OcPO-O15~03 l~~t.o~f'E7?C~ •~/PDD.C S 1iv ~ E~b~ b~•~' /~~4 fre~t~l 1~. tAlik 0? OCATN (E7~ft? qf1 ~xt ttr~e Pp ~~r (~l. (A). u!t (t1.] IIfTE11YAl EM • di~~tte* ~ART1, OEATIIMASCAUSEO~Y: • 0115RA11DOEATN, •Y~t L11f u~M[outE uVSE p) /.1 tA• e~r- t1tle~t• l~J~ti~si.f/p/. Dt1E TO (~1 ~ • • ~itA th• pre ru't , 1 s e a 1 ~~e r`.te.~ i r~sist~a~ M,y nru ~ut. p~,'E TO (t) lo~tT sp ~ t o MRT 11. OTNE~ SIGwFiCANi OOMiDIT101tS OOK1qUTING i0 OG1N ~Y1 RR11E0 TO TN[ 1ERrYYI SE CON01TqM 61Yt11 M 11UtT 1(y . 1NA5 ~UTO/SY rERFpRNEOt t~t d~atA S ~~kfaroaw ~ . DESC ~ uuuRr xtueeco. (~te. R~ttire ~Jt,~h.~ ts ~rt I~r Pwt ~I yire.~ lt.) 1fES~J NO ~ 6 7 ~ AGCIOENT SUfCIDE MpMK10E ~l~~OS!-, Y ? ? ? t1oA •f ~ p~ TwE oi Nerr N~tl, Dr~r, Yea lea~. yuuRr o f. s. ~ 20d. tlUURY OCCURRED me_ KACE OF ItUUR1f (t. I•. i~ A~wt. ZAf. CIT~. TOMtN, OIt IOCA?qN OM~NTr STA?E wN,~e ~t ~ Mor ~r?~KC ~ Ib•.l«~«~. ar,~ee. •/[ee ay.. «e.) ¦IO11K AT MORK ' I att~nded tJN d~uaaW /rom v j~ ~ ~ to ~ •nd l~at s~~ hy~ ~/ir~ on s DNeh oceurnd ~t = m on eA• d•r• sr•r.d •sov: ~nd M tA~ b~st o/ tn~ k wbd~~. lto~n~uiq st~t~d. ~11 lt~~s ~uTY •r~ to e• ~Drf?~i w f4k) 2?A. ADORESS s~~~~~ tZe. oATE S~GNEO ~e.p~.~. . ~v~• b7et~~7' T. S'/ •eeaea~ 23~. ~u. CK~u? ~ t3s. OATE 23e. NnME OF CEMETERY OR CRE~ _ IOCATqN (GSt/. bvR. K ew~) ( dd ~ ~?9SSAs ~ /~~?.9 sftS .?i~• r.a./eis ou+[ ~t{ ~ooREs 7~nD 2S. 7E RE D. ~Y lOG?L REG_ 26_ IST 'S RE 1e7.1~63 ~i~/?/T~ ~ I?~•I~' . s;196p ~ ~ / `~'V . } ~ • - Z O . < q 6 w v ~ ~ CERTIFIID COPY ~ r ~ ; ~ I hereby certify the above to be a true and correct copy of the Local ~ M~ Registrar's record ott file in the Broward County Health Department at Z o 0 ~ ` ~ Fort Lauderdale, Florida. ~ : ~ Y ~ ~ ~ ~ o: ~ _--t~arning: Not valid unless raised seal of the Broward County Aealth ' ` z ~ _ ' ; ~ `4; ~ ~ ~Departu~ent is affixed. ) N : o c:~ Q ~ K :u~ ! 2 0: ` • ' ~ ~ i,;• ~ 5 p! ~ `i~~ ~ ~ Q~. ~ ~ - - • ~ ~v i 11 ~ / ~~,~y' 4, ~ . j b ~r . ~ r.'- • ~ ~ - • , - . b~ ~'t ~ w e°~ w;_• ;Q . ~o`~~~~~ cP County Health Off cer and I,ocal Registrar ~ . ~ ~ _ ~ _1 ~~J ~ ~ - . v: 'E+"..' p`'j' Q, . . . ~ s - =I o~c~~~ G~ ~ ~.e:cz~ ~ `I \ ~~,°3' ~ P~,Q ~ - V ~ 4 - ,r _ Deputy Local Registrar ~ ~ . • _ . _ . . _ . _ » rn n ~ r cn m -n ~ ~ ~ r+~ xo a~ =;rm c~ co - c? ~ z, o E"' z~ r*~ z c ~ c~ v o ~ ~ ~Zm P~b'f~~ ~c°~ '~o ~ ~ ~ ~ . ~ A~ : _ - - - ~ ~_....h ~ ~ ~ .e. _ ~ ~