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St. kicie 66-12 St. Iucie
Florida
1. CITY. TOMM, OR IOCATKHI t. es PtIICE OF DEATH
IOE UMITSI e. CITY. TOV1N. OR tACATKIN •. IS RED
INSI CITI LIYITSt
Ft. Pierce HK
„a~ YD O
Ft. Pierce ,
YES No ^
•. NAPE OF (1rfYt i /M~1, pbt sAset add-eM) •- LEIIGTH OF I. STREET ADDRESS 1
ON A FARMt ~
a 3207 Tennessee Ave. 1$T'~lori s 320? Tennessee Ave. YES^ NDO
3. MAa1[ tHF tTret xtddk Lot 4. DATE xoa4 Dp Yatr
( Henry Sebastain F~ tEATH Feb. 25- 195b
SEIt L. COIDR OR RJ1cE 7. ~p NErER MARRIEp /. GATE OF RIRTY 9. A6E (la ptert r uKEel 1 YEAR uROER M HLi
felt ) A/w1Ar D.w Bw.. Alfa
,
Male 1lthite „„~O , Jan. 3p 1895
IOt. USUAL OCCUPATKIN Glee lied Kotrl Iewt 1~. KNOOF HIS11fSS OR NIOIISTRY 11. NRTHRACE ($afs A /~eal/R otllatr/) 1 GT03l1 DF atwT DoM11RTt
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Fire "apartment Boston Hass. USA
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1/. FA71EII'S NAME 1 MOTHER'S MAIDEN NAME
Sebastain Frans Elisabeth Pink
IS. wAS oECtwsEO EVER w I1. s ARMED tTIRCEST K. soclAt. SECURITY N0. 17. s sttMll-Tws Or 8 a rans
Ir..+.~..la...l u 1
W ~1 ~~ NOne
~ wares.
arcs
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11. CA11/[ K MATH [BWr aRl/ the ONet per 1ifRt M ~e), (A). iad (c)J
- IIITERYAL /ET1rFEN
ONSET AND OEATH
PART 1. pEATM YJAS CAUSED R1/s
YI~pA,E uYnE W rdial lnfraction
QwdititRt, iJaal. DuE in (1)
eR~ia/ ~o ~. DUE TO (d
-ART IL OII@ SlpiKaANt OOIIDItgNi OoNIRitlRalt 1D oGT1I RIR NDt RELATED TO tHE TfR11aMl DOYIISF CDNg110N GIYE11 ^ PAtt 1(a) . VJAS AIJiOPSY
PERFOIIY
ED
I
F -
I
~
YESD Nao
Z~D•. ~. OESCRRNE NoM IIIJURY OCCURRED- (TilltO attars yfyarp iR Par! I M Past tI •/itas //.)
ACCIDENT SUN~DE MDMM~DE
D O
tot. TIME of tfiw x..r-, n./. Yar
WURY a. te.
p. o.
md_ IKJIIRY OCCURRED ml. PLACE OF NLNJRY (s. /•. b or tEtal laws. mJ- CITY. TOYIM. OII LAGTKIN COUNTY STATE
TeHRt AT O IqT TTNR.E D Jfarw, /dr/. Was. Mu t#4., ac.)
YIORK AT V10RK
21. latbredadtMdoooaatdlroal D•~•A• , to - - andlaata.Ir wi~ee ali.eon -
DeatA ooourred at ~ ~ P_ -_ _ e+ en tM dab abted abore; and to ttl. Gott o/ ny AnorNdp, born ttl. causes atatai.
tt.. stow-Tws (awe... firs.) >~. ADDRESS 22c. DATE SKNED
M.F. Watkins M.D. Ft. Pierce Fla. 2-2 - 6
Zit. w1MnL. CREIMTIOIL Z71. DATE Zlr. NAME OF CEMETERY OR CREMATORY Z1/. i,OCATION (GTt/. leers. M ttaeq) ($ats)
""°r~` ` ' 6 Mt Ba di t Bo to Count
Z4_ Y sl/NA ADDRESS a. DATE RECO..Y L,ocAE REC. REwsTRAR's slcNn
J W Y Ft e e - -6
IN RE: Lot 1 and westerly 15 feet of Lot 2, Block
1, FAIRLAWN HOMES SUBDIVISION, plat book 9,
page 10, St. Lucie County public records.
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