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HomeMy WebLinkAbout0458 ~ _ . . . _ . _ . . . . TAfs 0~- ~tAT[ .ow~o o~ Msw~„~ CERTIFICATE OF DEATH ~ 1 e=~1 ~.a- ~u~uu oR vrr~t ~r~rumes F L O B I D A ~rr~~ ra~',1ld ~ i ~ or~ •S~e BIRTH NO. RtOIiTRAII! NO. I~ ~ prep~rl~ 1. 1LACt OI ~tATN COD[ N0. t YsYA~ ~IKlIC[(In...~r.r.tM.t Ilww...: R.:4.rr?w..~.~«:..) •:~cnttd ~ •"a Saint Lucie ~Db-D,ts Florida `~~Saint Lucie s• *1•e•~ ~~t- Gr. TOMII.OR WCATiOM _ t. 6 KACE Os OU?TN e. C~TY. TOnN.011 IOtATiOM t. K RES~D[NCE - ~ •t~~11t INSIOE CRY UMITSI IMSIOE CITY UMIiST r~~.. Fort Pier e ~s~ ~w? Fort Pierce K~ ,w f, wu~c a u. Mqia1. ~r. w«t.uru+) ~ sr~crr ~uacss "~s?'T"T'°": t. Pierce rSer.?orial Hos it 112 Na le Avenue f - a. wu.c ~r t~.,t wuus tw a?TC xwn a~ r~a ~ ~ id' h 1 ~~'TM ~'•a?rch lo, Z958 ~ s. scx aooo~ a~ ~ucc 7. r.~a~co~$ wcvc~ rniu~co wTC os a~ ..ac U. r..•. ~~•~o~• ~•w ~ j t.rt +~wr) w..w n... x..+. r:.. ~ r ~ i e• Fer,iale [~lhite woo~rco onoRCCO 12/26/1915 52 ~ ~t•~~1~ 10~. YSU~LOCLIMATIONf01rtlfa/~JN?tfMt IO~.KU{OOiWSiMESSO1lIM0YST~Y 11. NIITWIACE(9~GIM~M~tMnItrl) I anraa~rwtoouwmtr .ic~ ~•r- tu1a~...tyw. p~qwAr rNbM - ••eiwe Pra~ct~cal ~Turs Nursing h:arcellus 1~Tew Yor~ United States ~l~sk l~k 1 iAT11ER7 M~WE , 1~_ MOTMEII'S MAIpEN NAYE . . •r ~n•••se•• Een 'amin Weeks Arlie ut~?vailable ' ' ~ M~~TV~ '~u"" 112 ~idple Avenue 076-16-329 Maitland H. Mitchell e Florida ~ ?~~~r~l 1~- iAwt N KwTM (il~fn NtI Mr owN ~e? fi~e /r p). (e). ~n1 ec).) InTE~rµ ~ETwc[N ai.•es•r r~?ouTMrnsuuacow~ ~+woun~ .ws rs~• wrcou?n cwx (a ~ //~'7~ ~ ~ t~. e.e- _ ~ / `f~~ ~ ~ tftiest• ~Ky~u. ilpl. OuE 7i0 _~~C 1~[/' 7 OYV ~f(.1 ZN ~ Il~3sfL ' ~it\ eb ~ ~y~ ~ ~f 1 • s ~ 1 ~r eoas (i~ y ...~,,,Q~/ r~~i~tr~~ ~~~I t4 ~Nn- 01~T0 (r) ~ JV ~ ~r 1 Y ~ ` •ltbf~ 7~ h~ Ao~ • f- ~ ?11~T IL Or~ 9iiilCrR OO~pL0r6 OO~Y~K 10 OG1N MJ1 MOt RM7[e TO Tx[ tEpu~l 06(Afi C~p~mOM Cwd I~ MMi 1(~ . 1~~5 AU7dSY = 3 ~EIIFORMEOI c.r a..c~ res~ No~~ or f~e• D[SU~aE eoM rUUl11r otCVIUtED. (b5~la a~trn yi~/w~ h Pir[ /a PWt !l tlt~ /1-) 1 ~ ¦~k~~s ~w~ AOC~O[MT SYK10E MOM~CIQ y i. ~ <1~~~~!- ~ ? tf~~ •f ,•a~. ~ mt. TwE Os /Jwr p/. Y~ j wwr a, a ~ m/. wJW1r OOGM111Ea ~t_ RACE O~ NJ1:11t Ir. I•. ia ~r ~Nt ~est. ~l~ GTT. TOIIIR 011 IOGTpI~ OOYMTY STATE f Mn~t[ AT ~ n.E l~~.l•~a?f. atreu. y~er e?M•. dt.) MOIIK T DOItK ~ . 21. ! ~tt~ flw /rom . ro ~ed /~at w~~~ o~? , DwfA •f ~ m d~~~ a~qd 60~~: ~nd to bNf o/ e~ ~no~Ndh. /IORI tA~ C~YM! ~f~t~O. . i 1 s c.¦. w~ r wk~ 2m •ooscss ttc. wra secNCo •r• t• 1• ' co~pl~t• a ~ ~,p. • t err~t~. Ll~. M/~Y. C~E~Yrq~l I~ OATE 2k. IUME Oi CEMETEII~ OIl EMAT011~ Zj[. IOCATION IGY~. lwrs. M l+M~fp (Staf~) :~uxia'~' 3/21/68 illcres ':e~. Garden Saint Luc~e, ~:=lorida v. s. fsia ; u s~"" Yat ~~unera .OA . DATE 11[C0. ~II WCAI REG. R[WSTMII'S Tw~c J : ter.laas " • ` • (3 •~r' e Ft.,Pierce ' S~o~i a 3- z.l- ~C~S ~ 1 - . ~ . ; _ t,ty.~~rr!"tit'` j'~~:~, ~ ~ ~~1 ,``t` ~ ; ~:`~r _ • C~ - . ~ bYc~( ~~f -~tAi~!!p'b~~i'.ttw ano correct oopy of the Locsl c~ ' Regi ars" lecord ort; f' 1b ahi~ Sf. Luti~ County Htaith Depari c~ _~„~v m z ~ a r??. a t f o r t- P~ e r c e~<: ~ F I~ . ~ c~ v ~ - ~ ~ ' c~ uni valid:v~Dbss ialsed seal o f the S t. L u c t e e o ~ ~ c~ - ~ ~ - rtmint is affixsd.) ~ Z m _I, • ~ - , : ;3 _ . ~ ~ o _ a ' 'J``~~ ~ { -t O ~ , ~±;''it~t~~e. ' _ 1~:•~. MILLER. M. D. C ~ • • i ~ • ° m ~ J~,1t~`~ ~ Coum~/ H~alth Officer 6 Loul R~pbtru ~ ~v ~ v } - . tJ1 D 3- a.. ~ ~ • ~ ! ~ ~ . . . . ~ ~ ~ i • - p~ D~Ar• bui i~pisttar d . . - aooK i'?"7 ~~f 458 ~ : _ _ . . - - - - - - - _ ~ ~ . ~sm, . , ~