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HomeMy WebLinkAbout2867 i 1'75126 t i•~• ~rwTS ~o~ or Mw.m~ CERTIFICATE OF DEATH ~ ce.•• a ~uRUU OR VITAL rTwTlfTlq tTw7't lriLt Nn i~a~~ r~e- FLO$IDA ore rr•. si No. ~ ~roi wa•s Ho. - prop~~l~ ; •t•e~tN 1, PUICE OF DEATH GoDi N0. U'S~~ RESIDENC6 Islw~ee~ Qo ~ trutww; .na .i1i a. toutm ' ! . e. ,i...t - L ln p~f- b. CI1Y Ilf ~b111 aw~ee~M 1~11~ ~eW iOLi.l G 1Q16TH OF 4 C11Y IY M~IM ~wMW NaN~. ~e1M lUl~~LI - aas~wt OR STAYIUYMWM) OR fil~. TOWN O ~N ~ 8 A W ll NAME OF Iu ~a ~ Y~M1aI ~r frutwMti s1w rawt M~w~ v Iw~wU i STtEET pf ~ aM rat4~1 HOS ~TIII ~Oi1 wpptKS ~DECEASED IFf~~s) l? p1WL) a(Lrt) L~Ti ptMt11 (Dn) (Y~ar) ~ « • Fred Moate ~?n+ 1 L. SEX COIOI OR ~AU WIDOWED DI~IORCED DATE Of ~ItiH ~ 1t~ a~rNa ~ rw N M~q t~ W , " ~ • M. W arried an 2 ' ~ 1 'u` + p. ''i~ iw. utu~oocur~nory~.. u.~ .r ~auc oF wstNESS oR tN- u. Wtrnnwc~ ~ww « w~r...w, ~~A ~w?uT •ftA /~t- ~ ~tdwW~tlM~YntInA ~neman Fla rower tCottondale Fla. D1•et iwt !1 FAiHFRf NANi K Y07H~'S MAIObII NAME - o~ `s'••"~•~ Christo her rioates : iiw~ o~o ~ u~ u. ~~w~r~~o~r a wu~ s~cuRmr a. s~wulws l~ii lton W. Bai rd . run.~a~ 1~. CAUSi OF DfATH MEDiCAL CERTIF1CATfON wna~v~t. ~;nrso~ " et r.et.~ E~hr w es~re 1. DISEASE OQ CONOITION oM~sT AMn oswlrn .~,s r~i. ~ t.~. u~. D1~r ~"g m~?~'l. ~•lec tric Shock cn• e~~- ~ c i[t eac• ANiE~Ii G?11~ c e tl• ~lI1O lia w~t w«s DItE TO 1 o e• 1 ti~ rwJ~ lriw~. Mwii~ e~Aw~? t/ daR. /twN r~ s i~ t r ar wrd ~r Aerrt J~ rtM N tb sirN anw fU Nst- .~ssi~ 7s `M~"i"~.ta te.e... ~I W+sl.ridw~ er... lut. DUE TO IL ~iMaN. injnfK M heur• e~a~iiesti~a •~t~i t1.OTNEtSICNIFICANTCOND1ilONi c~r d~ata en~e! JratJ1. CMit(w~ pwtn-Mt~~ e~ J~stk y~t rt o~ e~[~f• siel~lel b f4 li~n~s w erw~liMw lrtt~, ~.s ~r.. a?~ o~ on~ ,n. Wuoe HnaNSS oF o~ennor~ . x wurwsrr at•~..i- ru0 No~ c •t e~ , lTr~WW) tM~s) 216. KACE OF IWUtY fa bR~Mt 21a (Gi70tTOWN (OOUNfY) 21a wtcio~xr M~ bewi. ~s~ ra/ lt Accident `~ree'~"`' ur~1~t~:~`erce, St. ucie Fla. 21+. TIME c~c..~r~ m.n ~t...~ :i., uuu~nr oocue~ w u ~~u ~r 10- 17-~54 l~ ~:~T$l~:'::~ ? Hit Live ^~ire while repairing it. t J~crebY certily t1Yot t otte~ded ~s decswsd /row ~ n-l ~.19-~}-, 0-1?- t:~. tl~at 1 lost eav eAe dccc~ed ~i i ss•¦. aiive ew 10~17 /9 a~d tlknt deolA ooe~aTed ae~Q~.~A elle oavsa m~d ow [1Ee dac~ seated a6ot~e. e c• 1~ gtGNATURE (D~n~ ~e tlW) 17k App?~SS co~pl~t• ~ lk.O~ATESIGNED ` Watkins M D Ft. rierce Fla. 0-20- a~ 1~4. ~ U R 1 A l, CIEMM IN. DAT[ 21c. NIWE OF CEiIETEtY OR C~EYATORY Ild. LOC~I?iION (qh. trv~ w~ ~wy) l8tat~) y ~"ur`~e~" `~'"'4'' Oct. 19-19 Ft. Pie:~ce Ft. Yierce, Fla. ~ ~ , ' a?n acc~o ~Y ~oc~ u~istu~Y s~cw?TUeE ~f. WNE~AL DI~tCTOR'S iICt1ATYRi ~wo+~ss ; ....~soo 0-20- Anna Lee Lenison s. r Ro er L. B rd ( Baird l~,ineral 8ome ) I h~rby artify thit fo b~ • ttw and oorrecf oopy of th~ Locai Rpbt~r~'a ncnrd on fib in tht S~ Luci~ C~ounty H~aItA c~ - cn mwM ~t ?wt Pi~a. Fbr~d~. ~ nri z ~ - , n, r" : . ~ . • 1MIwnM~r Nd valfd un{~SS ni~d a~al o~f 1M St tuci~ , x ^ c i. CouMy 11whh D~pwtmKM b aHixd.) . ^ _ . . . . , - ~ ~ ~ rC,-,.,. ,y : v` ~ N N. D. NUt1ER, M. 0. - . J , ` ' . • ~ ~ v v1 c, ~ ~ ; . . c C : ~ Cou~My H~alth OffioK i t+ocal Rpistru _ _ ~ _ ~ - _„p : z % ~ ; p, _ .M ~ f` ' • C; ~ ~ ~ y?~i ~ ~~y --z~ aN ~Nfy a~ON~ ~f „ j . ~ • - . 41 ~ i ~,z ~ . i u t! ' ~ ' ~ , ~ R ' ~ do~175 ~,E~ ~ , • ~ t ip 1 ; : . . . _ . . . ~ "'YS~. . . . . . _ . ~ . - ~ ~£a ' o _ ~ _ .'3ai3a