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VO_LUS1A COUNTY HEALTH DEPARTMENT 8l~-SS_
440 SO. BEACH STREET • TELEPHONE 253-0471 '
~ P. O. BOX 2329
OAYTONA BEACH, FLORIDA 3201 S
T ~, s -•- RAT[ ~owRD or MIEALT~I CERTIFICATE. bF DEATH -
eoaea • ~uR1iAU OR VITAL eRATItet1C! Q *TATt R11.! NO.
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CERT I F i ED COPY `~ ~~ ~ ` ~ `'
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i hereby certify this to be a true and exact copy .g-~;'.• 'Fiefs. ' ~~tB~ i stray's
record of death on f I I e i n this off 1 ce. '-'' ~ r% ~~<"~~}~"
(Not va I i d un I ess the sea I of the Vo i us i a County, He~;l~ Dis~~tl~,efnt
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BOOK 17~ • PAGE
1. KACti OF O[ATN
~ COD! NO IMi AL wEiMKMi[ (trti. wr.t MN'
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~ Volusia D -
Florida St. Lucie
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Da tons Beach ,-ES No^ 11es1oE clTr lwlrn
Ft. Pierce
f. NAME OP (/Jwtf b Mgt1a1, /Itt ebpt affrw) ru ,,,,
f. STfaEET AOOAESS
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KC[At[O t.le 1: DATE xws px Ytar
('~" ~'rtwl) h ~ t o °~ TM Jul 1 19 6 9
. SEX i. 001011 ON MACE 7. t0]~i NEYEII MAllttl[O . OATS OT MIITN !. ACE (h ti Mi0O1 I rtAw latJEA M Ntf.
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