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HomeMy WebLinkAbout2526 ~I 'r ~ " _ , . 6001~ ,VIIV. P116F it7t7 : -M`:, ~ ~i:! z.,,•:-~,'~? OUNT~ ~ALT~ . ~ ~ + ~ - 1 ~ ; ~ tNlt4~~~ ~ ~ ~1 1 j C~~ ~ j~ ~ ~ '~A DAVI~ L. CRANE, M.D., M.P.H. A P. O. 8ox 2868 . Dirtcto~ 1938 lw?N Stn~t ~T l S~rs~oa. F lorida 33678 _ . TN~PAonr. 9558101 TAts sTwTS sowRO o~ Ns~?LTM CERTfFICATE OF DEATH eo~es • ~U11~/1{I Or VITAL ~TATifTiq fTATt fILR N0. i•s•~ ~ FL"OAIDA ord ¦A~w SI T N. 1~lQISTIIAl1~~ NO. prep~rl~ 1. KAC[ K KI?t11 COOt NO. Vi11Al Q[NO[MCtI/L.~~.rr.Iw..t 1li..aw..rr R~..I..wW..~.w~J ea•eYe~! ~ ~NTM ~~d .11~ .Sarasota . ~ s"~" ~oM~ OD1MT1 ~arlotte e. ~l~e.~ 1 a ~~r- a. Cllr. T0111M.01! IAC~?qN t. K KACE Oi OEA t. C1T1I. TOIMN.OR IOCATION K RESIOEMCE ¦~a~~t Qenice MISIOE Clr IIMITSI ~y,~,~1~~~.t INS~Ot CI?r 11Y1TS1 f l 1~. ~s ~ ua,b,i V~a KS p~ t, iu?rc os tq,w a~..~d. ~+.a«e.w.a.) t sT~~ ~oo~css _ wNOSn'Tnmw D.O. A. Venice MemoMal Hospital Rt f l, Box 4?1 ~u~ ~F Ftr~t AtiNts LaM 1. a?tE A/~wM Ori Yw ' ~n,""'„M; r.,, G~OR(3E i. scxnE~ a,?~January 5 i969 i . SEY ~ OO1011 OII 11ACE 7. W~RIIIEO NEVE11 MARII~EC OATE OF M11TN t~~~u ~ Mww D~w ~j 11I~ ; 1 s.. ~''.ale T~hite RBCe rnoowcaD avo~cco NoR?ember 17.19~'l p t a iwl ~ NI~. US1lAL OCCINATION (Qi/t ti~f ~/wrt ~Mt 1~. KIND OF WSUIfSSO111N0UST11~ 11. MIlTNRwCE (Sf~M M~tMA pr~f?I) crntt~ ar.rwt •~oiarm.? •1tM y~~- y~..~~..r,~..~.~~•.+ ~rr? ~utomobile Cleveland~ Ohio USA I ..~..e Ana~ist ~ Slsek. l~t 13. iATMCR'S NAYE 1~. YOTME~'S MAIOEII MAME i o~ ~,,.,~1e.~ Ch~rles Schaefer I~"3.nnia Boll f 1. SOCI~L SECYRITr Iq. 17. IM • sISNATYw[ Alb~N ~ 2?3~01-2168 ~fi=`3.a~n R. Schaefer. Rt #1, Box 421, En~leFrood. Florida Pun ~ r~ l 1~. CAYK N O[;!M (6kfa wf/ pt erwt p N~t ~r pI. (S). ~~I (tl.] ~ INTf11M111 ~MEEN d 1 r! e t0? ~A11T L OEA?M INAS CAUS[D ~,r~~~~ ~ w _ - ~ ~ ~ ~ET ~ ~TN IMYE04TE CAUSE (4 ~~~Q~•:sw ~ ¦u~t !il! t th~ . - . 1 tffieat• C~fifiw.i/p/. pyE TO ~ v~l , •ith tY• ~ rist h j 1 o e~ 1 ~9Mt s~we ~7 reRirt~ar M~tisl tle swfrr• ~ ! 1/iy nrre i~t. 01~ TO (d - ~ • i t A 1 w T~ ~ ~ARt N. OTIEIt SK~i1L~N~ OONO~i1pN'S OOKIIb~Ii~K TO DG11N 11f~ 1~0~ IKUqED 10/NE 1E211M~1 DtffAfE CON01110M GNUI M M~T 1(V ` AS AUTWSY • ~ Aours •t- - " RipRME~-. ~ ter d~~t~ s - ~p i or O~fo~• w~- ~ ZOA. DESC~uE MOw nuunr OtCURrtEO. <b'Rtsr w~trre yi*/~v~ 1~ Pot Irr Prrt ~N~ ¦ f k 1 na ~w7 « RC~tpENT SUICIpE Mp111CIQ ? ~ i di~?osl- r~ ? ? ? ~y ~ tion sf ine_ TWE Oi NMV A(W~. a1. Yt~r i eoa~. ~ ww~r a. n. ~s v Q; ~t S w. ~ 'a W ~ ~ 701. wu~r ottuiaco tOr. rutc or rw~r ~e. i. r.h..t A~wr. t~! em?. Tows. at ~ou?TaN "oou~ft Q~ wN~LE AT Nor wM~c l~•.1~•~«r. ,nar. Ma aM•. de.) m ~ p INORK O AT MOIIK ~ ~ 2i t~fand~d tlu d~ewa~d lroa~ . fo ~~d !Mt ww h~~~ ~ti?~ on DwtA oceurnd ~t ~ rn on th~ d~t~ at~f~d ~bo.r, ~nd fo fM bNt o/ m~ iew~NdN. /~oan IM eaus~i ~t~t~0. ~ 11 ! t~~s jj+ MOMATYw[ 27b AOORESS ?1t. DA?E SK.N[0 ~e.,i.e.~a Wade H. *lilliams, I~~ ~leaood. 1~lorida j. ` . ~i ~ • i C4t~t~. ~~~T~ j]~ NAME OF CEMETEN~ 011 CREYATORY ZI!- LOC~TIOM (GY/. b1lf. M pttfifrl ISfYt1 11[rGM ~3pKiJi1 Crema~~on Jan. 8,1969 Szr?sota Crematory Sarasota County, Florida V.!./ 01 S j1. FUNEI1Al D~IECTOII S SIGIIATURE A SS ~ 2S. OJ1TE RECO. ~Y IACAL RE6. ~ RE6KTIIAII'S SIW/ATYRE ~ I~a~les Funeral Eome A~ 'y~/,~~ - f Rea.~ose , o ~ d N' //Lll~l ~ ~ ~ - ~ . _ > A CEEtTIFIED COp7t MUST CARI~7[ THI~ El~OSSED SF~AL OF THE RBGISTRAR OF QITAL •STATISTICS. . , Y. ~ ~'~d~~ia a certiP~.ed copy of a Death $~Cord on file in tha Off`ice of the Local ~ t ~ } ' . ` _ : ~ =--3t~giatrar~' Sar~~sota, Florida. ~ ? s `_a . ~ . , • ~ ~w1 ~ - ' ~ . : ~ 3 ~ c _ '~_.e . - . . • - ~ r r;; - . r _t:~..~:=~`~*:- . Q. ,i _ F ~L~ ~ . ~7•' - a~ + . ' . ~ ~ . _ y:.~_~. - • 2 . ~ ~ ~ r n r ~ ~T ~ `~A~ O ~ ~ ~ ~1.. ~ a~ , ~i v n 7~ o ~p ~ n ~ ~ G I*1 ~ G 0 ~3 (~i : c~ p ~'°o , c'u'~ ' w v~ i ~ = i Bo~K1i5 ~AG~252~. ' , _ - _ . _ _ - - . ~.1~~ . _ _~~__.y~ ~ w. _ -