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HomeMy WebLinkAbout2470 - ~S-S~7 . ~l.i" ~?'034 ; ; ~ tnls s~- ~ •rwT~ ~o~_ oR N~u.TM CERTIFICATE OF DEATH ca~ss a ~41![Iltl OR YIT/tL iTATif~'ICt ~ea•: r•a- FLO$2DA s~rwn Na ord •A~A ~ prop~rl~ •1 NO. R dl AR•f NO. iT •:•cut~t 1. PLACE OF DEATH tOOS N0. USUAL RESIDENCB (~tin~cerNl~wi tttrua~w;~e~~e~r~wdn and •111~ a. ~VMn D• ol~e~~ ~ fTATi k OOYNtY ~+1- : In p~t~ CITY IR ~wli~ ~e~M M~Nt` ~~W ~UltV.l o lENG1M OF v Cfir IY w~W~ w4wN Ir1tr. ~eW lUR4Li ; ¦~n~~t O~ SU1Yt4~wN~w O~ lil~. TpWN ~yK i FULI WIYE Of tlt ~re M 1~d rr iwM~tM~ ay+www M~r ~e ST~EET /1t ~Y. stw Mauw~ • NOSMTAI OR ppp~ iHS~m,non ~ y ~ • ~ , DECEASED ~ (~t) w p11i~1.) lL.t) ~ ~tE t~) lDV) (Y~ae) od?m R ii7l OOlO~ OR RACR f. WM~IOOWEO DI~YORC~W ~ OA?i OF tlliM t. ACfi~L r N ~ tw M MN~ 1~ Ilp " r•1 t• 1~Mb/ lrt MMM~p lIr1Y Oq~ ~wn lq~ ; •1~1~ ~ " • t tA *~r- iM. YfUAI OOCUtATIClkOew W d wt Nr. KlND OF WSINEff O~~ 11. ~ItiH~LACE l~w ~r MM~ w~tvl IL ~CITtZ~TtOF WlIAT ~ ¦ss~at M~i~hswt~twdNtlM~wrfteMUW bl~ek !rt d ~ u. ti?rN~Y ruwa K MOiHixf MAIOEN NAYE , , t~p~t~ft~! it was u~ u. s.ww~ ro~i u. socu?~ s~wurr 11 INFOtMANI'f f1GNATUp i. (T~,.4~.+..., w~.a...w.Nnd.r.YN Ma, J.W.Yete$ j: ItNREff sun~ral 1~. GIISE OF OEATH 61BDICAL G'L'RTiRiCATION a t r~ e e~ ~ E~t~r e~b ~ etre 1. OISEASE Ot CONDRION u~+~~k ~a~rs~N ¦usc tsl• w~~ t.). U). ~~~r t~AD~IMG io DEJ111i'~ °uTM t~s a~e- a~i (s) c i [te~t• ANit~OENt G?YSK .1 s! t~• ~lAt~ ~ea w~t w~ew DYE TO 1 o a • i N~iwl. Y~r~ii s~wifNw~ ap~, /iws/ ase~ w~eart I~wn. siM N fb sMw ww (~J ~t~ reaist~ar ltsNw~ ~I q~ eJa~y ~w tae, DYE TO •1t61¦ 7~ ~ /~~aK ~r~, M . hoar• •C- e+alie+tirw f I~ p~~{ ~IFICJIM CpNpmpNf ' s.r a•.t~ c..iww. pwlriMl~ a w ~.a?~ire.d ar ~.n.• a eJ?. ~Li.e... w awlifi~w •~tiw~ y~ H~. CA1E OF OTE~ 11~. MAIOR HNDINGi OF WiiAT10N 76 AYTO/SYT dl~p~~l_ .~o ~o . ?•e~ •f ' tP.++~b) tM~~b1 21r. /LACE OF IWUlY (v» Y~e~r¦t La (Cfir OR i01YN ln~?~p i l1~. ~cwoar M~~ 4nR ha~q. Knr. ~~W.. wal 8 ~N. Mw iIIi~Ll {YICIO[ IU. ~ !~1) [~v) 1t~A 11~1 !IA illJURY OOCUt~EO . ! ~w~u~T ~or~~u • INJYRY ~ ~su ? ~t Nat ? 1 aa ~ tt t l~ereby csreiJy thae I auewdsd eJis deaaud Jrow 1!~ ldi~l~ 7? ~ ly~ ~t 11a! ao+r tlys daxoesd , 11 i~... ative ow .T 1 ~~d deaeA ooewred o~- a~ t~s oorus awd os l11e daes sealed abou~e. s~ SiGNATURE co~pl~t• ~ I~P+~ R tltM) t~?ADDRESf ne. OiAiEfiCN~ •«.~•s.. John D. BroKaix~ , H.D. Ft. Pierce Fla. ?-14-74 21~. ~ U R 1 A l, CREYA- 2~. W11fi l~ NAME OF Cd/fiTERY Ot C~[MATOIT 1N. LACiAT10N (d4. M~~ ~r ~b) (ihq) ~ TION, REY011AL lAndO') ~ B shore Cremato Miami Florida ~ owr~ ~o ~r iocu ~snwY s~a+wlueE ~s. w~u?t auarors s~au?ru~ ~ _._J r.e.tsoo - . . . . ~ ~ ~ ~i I h~n6y cKtify thk /o b~ • true and oornct ~ b' ` copy af th~ loui ,n ~ m ~ Repiqr~a noord on fik in M~s St. lude County Hwtth D~part- X~ ~ ~ v ; n»nt at For? PiN'~a. Ao~d~. n,`-.i ~ ~ T ~ym [ lMhtninp+ Nof valid uni~ss nis~d sNi of tM St tuci~ j; . .,s~~-~ c~ ~ v ' HMhh i~ d o ~ ~Y ~ : , ~ ~ ~ ~Q' ~ i c m . • ~.,'s`t,, ~ ~Zn ~ N. D. MIItER, M. 0. • . ~ CowNr 1~alli~ OffioM' i Loc~l R~qbttu. `J = ~ c - '`r - c @S' rn ~ ~ ~ . , ~ ~~ron ~9~ ~ ~ ~ ~ . t D° D~M t~aal ' ~f,: r ~ ; ; '~r~ ~ { ~ ~ c ~ ~ ~ j • , . • I ~ I ; - - . ~24b~? _ ~ ~ f ' .:A~. _ _ - - - ~,'-,~+r-~-~'<`:'~` d~+; i r --:i-,a- ~ -y Yj _ ~4 ^.`y'~'~-~3R