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23r. fAAalt. CwtwATlOw, Z1t DATE 21t- wAYE 0/ t:EMET[wY Ow RENATORY 21/. LOCATK•1 (LTfp, Mira. K etwwtij (ltAftj
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Crematio 7/9/1969 t. Pierce Crematorium Fort Pierce Florida
: "' E °A Y s""AT""~tateSD01f~(neral Ham ~- °ATE RECa !r Loco REC. xc~RAl13 sK;+u _
8
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JA
; 1969 .,
Ft. Pierce Fla.
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I hereby Oarfify fhb 10 be a true and OOrreCt' copy Of the Loci ._~,~`.~;,~-,
Registrar'a rsoord on fits 1n the St. Lucie County Health Depart- FIlEO COU. ~- r~ ""'~?.•%:
rrlsrlt at Fort Pieroe, Florida. gT, L_UCI Pt, VE#~~~i~=~#'~' ~'-`~#~~.
(Warnings Not valid unless raised seal Of the $t. Lads t2- C ~.,-.:, +R..~.. ~ e ; : _ ~ ~ _
County Hsahh Department a affixed) ~a~lyC~'~ .' ~ `° j i ~~ =
lati a `~, ~ - ~ ,~ t ` r
'69 SEP 9 ~.,F~~_~._ ..~r
N. D MILLER, M. D ` - .:..~t.;,_ :,::: ;
County Health Officer b Local Raglstrar `2,Lt/ . ~~w', ~~'~ ~~,c.~ -`' ``:~ ~ ,-
~ 6 Roc _,`,~~.,. . _ .._ - ;
~~- CLERK CIRCUIT C f •...
~b I Registrar . - _ . .
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