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HomeMy WebLinkAbout0014 :n~: De- BTATE BOARO o~ HEwlr+ CERTIFlCATE OF DEATH 1'7'744i ~ o~+s • BUREAU OF VITAL rTAT1YTIC~ itTATE FILC NO. FLORIDA ord ~A.~n p~pTN NO. REGISTRAR'S NO. properlr ~~UC[ Oi Y[ATN GODE NO. Z• UfUAL R[f10[MC[(w?w~~sr~NGr1 !!~w~At•~+r RrJwrM~.~Wr.v.) etttuttd ~ ~FTM STATE CO~hTI' .~a Aiartin ~~j- U 2l Florida Saint Lucie D• yl~ee~ a 4 a[SiGEn[E ln pf~- D. C1TY. TOWM.ON LOCATION IS PIACE Of OEATN f. CtTY. TOWM.OR LOCATqN INS~DE CiTY ltr~f5~ •~p~ol IMS30E CITY LIMIT$7 _ r,l.. Stuart •ESQ ~+op Fort Pierce Walto rf5? ~ K?rE Of (lf wH iw ~wyifd. fi~e ~bsd stlra~) l. STIIEET ADDRE55 "?sy*~Ta°,j.fartin Aiemorial Hos ital 12051 South Ir.dian River Drive : 3. tu?w[ Oi Flnf Vidllt L~at 4. a~7E MaU? Ua1 }ia? octuscn oF rnr~ N w~¦~~ LELANp pBRYAVT CO~ANT °E"T" A ri 1 1 1969 S SEl( S COIOR OR RACE ~ 1lARRIEOtJ NEYER MAARIEDQ ~~TE OF NRTM S AGE *tt?! ~ ~ L~DE.7 2~ M~K 9~14/1899 `"`~+~"''N o... N.... .+r.,. r c. yt~ 10 Whit 6 rnoowco ~ avoacee p 1 a 1 n 1~ ti~ ~S~u ~~V~ATION (Cltt k1~1! O~iNt I~11[ IOD. KiNOOi ~1i51MES50R tNDUSTRY 11. ~iaT~cE (Srat~ e. ~irayw coti~t•r% 12 4T~IG O~ wW1T CAUt~in~r ~ ¦StA p.r- .a.~.~.~o.+yr~.t~.ot~/e.«t~i/rehrd) ¦~n~nt ' Salesman Co, ission ~9ercha ts Ne~~: York USA ~ . Dl~et ink ~j_ FATNEII-5 1tAME . I~. ?~OTMFR"S MAIDEN NAwE . I ~~p.=«~.~ Chestez W. Conant Ada M. Wares • 16 SOCUt SECURITY NO. 17. IN/ORMA • t16/U1TYR[ A!/?eu 5 ~.QUt 1 n ian iver rive I 35-03-3888 ~Irs. Leland B. Conant Fort Pierce Florida Fun~r~l 10. f.AYK 0/ O[ATN ~S~ft~ OO/~ 1M CtrK~ Ju~ (al, iG). a~d (r3.j Q J~ 1!.TERtAI BETW[fN _ ?ART 1. DEATN WAS CAtiSEO ~Y: i C..C` LGlr _~-~~?~~~Oc~v''~~~~~"'"'~-L~+ I~h~ N dtttctor ~411EDUTE CAYSE ¦uac tlle tAe e~r- tlfleate ~ ~ ~ r 1 t~ t:~t r~aA~O~rs iu~~~4 1 DtJE TO (0) ' 1 o e • 1 ~Dc+t [arw (i1. } ~ _ _ ~ ~ •!~C ~C 4~ '~7 ~ 6 Ha[iw/ f4 rRfn. D4f TO _ l~/~(. - ' re ist~~r Z lt~w/ taru laal. ~T ~ - - - " s i t ~1 n 72 O ~ART tl OiMUI SKtif~Wi COw~TqNS C~f,M~MlturG TO C(U~~M REt~iC070 Te~E ii Ml COwD~i~q+ WKM W ~MT I(a3 WAS AUTGiSY ~ houfs •f- /J C{,~~ PERFORMEO~ F ~I ~ t~~ de~tA V i ~ESG or De fore a~Mie ~ ZpD. DESCR~iE NOM ~MIUNY OCCCRNED. (E~I[r wdrrt ~Jnj~~~ iq Put I M PU! 71 ~J(ISw !f.) ¦~kins •n~ ~ ACC~DEMT wK~a MOYK~OF dl~post- u ~ ? ? tlon of ~ 4od7. T~wE OF /brr MaU~, lHi. Yeo V IIUUIIY a~. _ p p. ~ ZIS! INJUI1r OCCURREO mt. fl11CE OF u+JU1111 lt. P.. is er J~eW ~e~ct. IOJ. C~TY. TOWN. OII lOGT10N COUMTI STATE ; wti~U AT O NOT 1MMILE ~ /~r~. /ulaf. afnrl. ~~fu DIt9.. d:.) ~ MONK AT WONK tl. / ~tt~nd~d th~ d~eua~d /iom !n ~ ~ . to ~ ~nd /ot a~r Aim ~lir~ oe~ ~ _ ~ - O~~tA occ ~~~d • _ m on fh~ d~b at~teJ ~bor~; • to th~ 6~at o/ mr 1cno~.l~dp, from ~A~ uw~a at~t~d : All 1N~• jj~ sICMAT Ilt pr . ' n 22G ~GDRES IIt. WT[S:Gt`ED •r• to D• . ~..p~.~. . ~ / ,/,~'1-~i~ .l.~~~/' -c1~1~ y - 3 - L5 23~ . UE~~Tqw_ j3D pATE ' 23r \AME O~ CEfMET[RY ON CREN~TGRY 23d LOCAT tr (Ci!/. [am~'w. M COnwl~) (Slaftl •t t~J11 Buria'f` 4/3/19b9 Hillcre-~s{t- Mem. Garden Saint Lucie, Florida V.S.tdl9 j~ fU~ERALO~NECT011551GNATURE at~qE~3tlj]Qra n(~ ~ 6ATE`~ CD B?IOCALREG. ~REGISitR,AR'SS~GNATURE ~ x~..ioba y ie~I - f?~`~tc.Ft. Pierce Fla. ~...,1 3 1~1b~1 `J4.t~s- ~ L.. ~,(~•~LC~~Gri~?'~^" ' . ~ c~ `~-s~ - % ( hettby ce~tify this to ~e a s:ve ar.d corract cepy of fih~ l~ai ~ c= ~ ~ 4" • J~ ~enitir~r't reccr~ an tiie in ~he Martin Cou.~ty Health L`,a~F` ~ T cm . . _ ~ mant at ~t~srt, fb::~a. 7c`~ ~~C)~ ~ (11,/arnir:~: :t va;i~? un'ess raised se31 0.` t^~ Msrti;t n~; s `~m 2 ~ Co~nty He:.':~ De~artmer.t :s affixe~.) ~ n~ ~ ~ ~J' V. ' • -1 -1 ~ Z' C~ ~ 1 ; • y. rn;.t~~, r.;. ~ ~ ~o ~ - County Heaith Off:C'_'f Pit <G:B~ QEy1S~g~T' 4~ ~ . " o~o . dy ~ ` ~ D o - ; " ` Date Ceputy taca! :?L~~~:cr p g B~K 1 ~r ~~t - =4-~'-~'~ - . - - - - - - - - - x ~ - ~ _ -