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CERTlF1CATE OF DEATH
YLORIDA
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181844 ~
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•• O01"TT Saint i ucie 66-025 Saint Lucie
F lorida
aTr. Tony. 011 tpCATK1N
e t. K PLACE of DEATH t. aTr. Tory. oa tOtATKMI e. a RES10EwCE
.
Ft. Pierce IYSIOE CITY LIMITS/
TESKJ Yop Ft .
Pierce MKIOE aTr LIYIISI
TES .la
1. MAME Or l!/Mf iw iMpltd. trim Mroef.fItrY) I. STII[ET ADOIIESS
NDSMTAL °" 301 South 7th St .
"'ST'T"T10NF Pi ;~"
~. NAYti Of Fry! /Iriilrt Lott t. DATE XewN DAl Yrd
(,"`y,"~w) Lindsey Ford Emerson DEIITY July 29, 1969
S. SEK i. tblOa Oa MCE 7. MwIl111ED YITEa MAfUlEO e. GATE Os agTY !. A6E (h ptYt rr ulta 1 rEAa UIIOEt Y Yti
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June 20, 1892
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10e. u511A1 DCCWATKM (cite tiwl y wwl /twt 101. K1N0OF ON5111[SS Otl YIpuSTwT 11. 0111TNRACE (Shit w /Meilw teawap 1 tlflml Or t11NT Counan
/w1y.tl.IyYwswAk.tl^wl/.ttven Construction
Illinois
USA
En sneer
1 rATM[a"i PAYE It. MOTYEw3 YAKIEN tU1YE
T. G. Emerson Frances Ford
Ii. SOCtAI SECYa17Y MD. 17. Yt • a1GIMTYa[ AIMea
266-14-69 Addie I-I. Emerson, 301 So. 7th St., Ft. Pierce, Florida
li. eAVt[ N DEATY (6wter ewf/ owe epos per fist /w e), (1). ed (r) • IYTEavAL rEtTrE[Y
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= 201. MU11RT OCg11UE0 20t. fIIICE 0/ rUl1~T (r. /.. q w eAO1rf most. 2D/. CITT. 1G111Y. Oa tAGTKIr COYMTI STATE
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2L- NOIMT
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' DATE 23c wAYf OF CEYETEwII OR C1IEYATOi1Y 231. LOCH Lti toots. er ) (8To1i-
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Yate°S `Ess'uneral Ho ~-oATE YECO..T wcAL AEa 2c oaTAASY SKKATURE
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I hereby certify this to be a true and correct copy of tMFlic~b AND RECORDED
Registrars record on file in the St. Lucie County Health 9ip+LrbC! ~ , " -
rrwM at Fort Pierce, Florida. ~~~~- FL-A: _ t C" `` • •. .
C~D VERIFIED ; :jl~ ~.:~,s r-~
(Wamirlg: Not valid unless raised seal of the St. lode fi,•.' . ' : ; , . _ ..,~, •~
County i!ieahh D.partmsnt is affixed) ~9 181844 ,.~\`` .,~, ~°-: ~ !'
AUG I4 PM 3
N. D. MIItER, Ali. D. ~ ` ~~~' - ;. ~. ~-~.`• -!!`~
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County Ith Officer •dt Local Registrar ~ ~._:. •" ; ~ -_..- - .
RtiS
I CUIT COURT- ~ '~~`• ~.7~, ~- -.~1-:;.~ ; .~-;` .
pat• Deputy focal Registrar = ~^ .,'~~ ~_'', `_'•.; . •' „~j?.
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