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CERTIFICATE OF DEATH
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S. SEx i. COIOw OR RACE 7. YARRIEO ^ IIEVER YARR1EO OATS Oi NRTM !. ~ O
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I1. FATNER S NANO 14 MOTwtill"S NAtDEII NJ1ME
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FART M. SltrilCAMf CD1AetK1Ri ODRIRwIttrR TO OGTM DIN IIOt RMIp /0 iM[ TE.MrOL ORf-7[ CppTgM tilYEw ^ -ArT I(d . wAS
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tOI. WORT OCCYRRCD mt. -LACE Oi WVRT (t. •.. is M estrt Aesw, mJ CfTT, 70ttM.OR LpGTKM GDYNITI/ STATE
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DeCCIIIbCI• ~ 4~ to 32'l~iEi •nd rett ees.
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Deeth aoorreed •t ~ Q • (~ ~ to qt tM drN ttetsd •bre; and to tM bwt d ay Anotrbdp, Itotw tAe e•tttee etsted.
tli. pOMATYR[ (Dttrtt M tYk) 7m_ AtIDR[S6 77r. GATE SICIKO
N.e1~1an A. Schalk 2`:.~. ti`t Pierce Florida -bb
27e. ttterAi. (]Irunat 215. DATE 23e. NAPE o/' CErETERT OII CREMAT011T Zlf. lOG1T1pN (LTrr. (ww. tr eeestt) (81dt)
Cr~ta~ion) 3-29-bb Ft.Pierce Creaatorium Ft.Pierce,Florida
jE. rutlERAt s slcwA C S ~ceaar oIDC 73. DATE IIECO..,r rota t1Eti. >!i. REGISTRAtI'S swwATYRE
Jack J. .~oore Ft.r''i.erce,Florida 3-29-bb Anna Lee Denison, d.r.
~` ~ ;
FLED AND RECORDED - ,,_
1 hsr+e6y asrtify this to be • trl-e and correct Dopy of the L(~. IUCIE COUNT Y~DLA- ;.:;,=~~ ;~;, ~ --~ .
ReRisttst's record on file In the St. Lucia County Health DepaA- %~ ~ ~ ~ ~ , c {r4~ _ . ` <. ~l.,H .
Q5 ,__ - -,
.~ ~~, '.,
rnent at fort Pierce, (bride. 182W ~,•,~r•.•:`" ,. , '~~~_
(Warrlinp: Not valid unless raised sal of the St. ludoe P 5 Q~ ~ 3 ' `~~t'. ~ `' ' _ ~ ' ~ 1.~~
.r ,y h5
County Health Department is affixed.) ~9 ~K ::.;; - = _ ,; ~-~~`~ I'• _ : <=
N. D. MILLER, M. D. ~ f:F DIjR"S ' `''~~ ~~ "- =' +
Counq hh Offker•3 Local trarOLERK CIRCUIT COUR~j-.,i/:~~`.' •~L;~`~~~'~~
.7- ~ t
~Y Lecal Rasistrar ='~'~ ~ :~~••~f1 I'~+..
'.'.~iJ~I/N, jll ~.
-.. _ oK179~~z219
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