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HomeMy WebLinkAbout1527 ! 1- . - ~ y ~r- ' ~ ~ - N 18443'7 nwTS ~owiw o~ Mu~r+ CERTlFICATE OF DEATH - - - . - ~ ; • i roa~c • SYRGY OR YITAL fTA41ST1p lTATt FI~! NA FLOBIDA F sN •~ew rIRTM NO RCGIif11AN•f NO. 45~ Z} p r~ P~ r l~ i KACt Oi KATN COD[ l10. Z YfYA~ A[f1~lMt~ l~~ r•rrM ~..t 1! wn~.ou. R.n4.~ ~I~ ~I....d~.) e[~tYL~~ ~ ~TM STAT[ GDYwT1l : Sa~nt Lucie - F ~ se ~t•e•~ K RES~ocMtc t~ /t/~ ~c dTr. 70wU_ OR IOC~TIOM t. 6 KACE O~ O[~TM t. Clir. TO*11.0~ IOC~TIOM .•.•.c uwoc ~r~rn u.s~oc uTV «wirn + f ttl~. t @ rts~ ~+o? ~ rc i+o t. ~urt os cp rt o~M)iNf. lirr aorat ~t4w) L STIIEET wOOAtss ~~~Fort Pierce ~iemor3.al Hosp~ 806 Ave. D. ~ ~uwc ~r Ir.~t ~liti~ Lrt wTt X«r? D+~ Yra ~ccnsc~ t ~n,•••s•:•n ~s, L ans ~T"October 3, lgti9 ; ~ S SEk i COGO~ OR ~/ICE ~~~ED 0 KvER ~u~11~ED 01TE Of MIITN KE (h K~?~ ii 1/~OE~ 1 1W Y~0[a 2r ~rl'L 1 i ~e~. / w..w n«. r... r.~ s. .~oo~e~ xw.ccn h ril 12 1$$j lSb ~ ` * 1~ 1~ 1~ {Oa uS~~l OCCW~TiOw / C~r~r iial y s~rt Mt ~00 KuW Oi M+SwEif 011 rOUST~Y l l. WTW'I~CE tS1ds M~nnp ow~Erl1 1. tmur~ Cf nw?T OOU~~/ . • 1 t\ • r- !w/ trk. arw r~tret) N~n@ : ; ~ C-°~~ South Carolina II.S.A. ; , ll.et t.t Il s~TN[rs warc 1~. iroTMC~I'S w~oEw ~u?rt ` •r t~}~~rla~r ~r $aV~~ I iOCyLL 3tC4~Rt wp. 17 t TYa[ A/dta ~ $22 Ave. D. Fort pierce~ Fla. ~ 2~1-2~-Z ~ ' ~ i '~'r~.. r. ~ u cwsc ~s w.n~ «h..• sw« rn n.~ Ir ca~. ~??...s i~~.~ IwTE~YAI ~ETIr[CM ± rur . Ot~TM Vn5 CAYSEO w- 01KET A1p O(wTN ~a~..ca.r wnca.TC c~usc C-V-A- ~ ...a tu. . ; R~~ e~t- i , ~tffle~t• C.,~y,~,.i/q/. 11 pyE TO (N ' . 'v''it~ t1t r~+c~ ~r ~u~ q ~ ! ,~f • c • l ~r esaat ~~1• ~ j '~-re~tstr~r t~r.a/ tOr r~/n- ax To (cl ' l~y c~sar t~t. j .~tt~1~ 7= _ . rASA11TO~SY ' f .Jwf t- O ?MT N onu swx~ ca~anows ounrwnwc ~c Oun~ ~rt wi uus[o io trt tt~rw~ psus[ Caataw G~ w rrir Ku i 1 F r(I{FO~M[Dl ; s~r a~~cr < rE5? Mo[~ ~ ~ , r le f~r• ~~~~d ~ wwr occuRao (F.~ta ~rrr~ y~.i.~t ia P~rt t r Iqrt Il yi?rs u~ ~ ~ •k~~s ~w~ Y AOC+LEwT 51qd0[ ~~OOE r„~af ~~~st- u ? ~ ? ' ! r'~~~1~. ~r u m[ T~YC Os !!~a? ~le~N. UrI. Ys~r ' ~ ~ raw~r s. I [ ° ' ~ IO/ ruw~ OCCU~U[O me ?UCE Os wu11r ia r dysr y~r. ml pTr. T6MM. 0~ LOGTIOM COUNr STATE i ~IMR.E AT ~ WT 1mLE C ~~t1M/. ~tsed. ~~[t Sf~/-. d~.) ~ NO~X 1T ~Owi[ t ~ tl J~trend~d rA~ ewoMwl lrom _ . ro ~ ~~M lwt w~ A~'n~ ~J'?~ j Osath occu~i~d ~n on ~M d~t~ ~~~t~d ~8w~: ~nd to tM bwt oI eq tno~?/~dN. I/00~ fA~ CIYNf ~f~f~d. •13 fte~s ?2t f~CMnTW[ (!~r/rar 1[~ 22L ~D011[SS 72e. DATESiGMEO 1 ar• a• 1• ~ a t~,,,,,,~, 706 North 7 St. 10-14-69 ~ •ctr~~t~. Z~ Mu:.UEraip. j]S D~T 2][ w~rEO~CErET[~~WIC~E~tATO~~ 23f IOCAT~dI(GV~.lwra.MtN~h) ~81~ft~ ~`"`~u`i~~ ctpber 12 ~ 1 9 Plne Grove Fort Plerce Florida ~ r. s. ee~s su~c~ a.cao~ s s+wTU O~TE R[CO. h LOG1LlEC. M IIEWSTW"S S1GM11T11~ - } a...~oes k ~ ?28 ~v~`3S. ~'t. Pier ~be~c+ 15~ 1969 ~ ; FiLEO aNO .RECOROEO~ ST. LUCIE COUNTY. FL~. _ ~ i?ECOr.^ ~;Ea~~~rp .,;a:"~;~,J,; . ~ heraby oat;fy thfs to b~ i ttue and aorrect copy of tM Loui .l,QA 43~ t~~~• Registrds r~cord on fik in ths St. luci~ County H~alth Depart O~ .=3, i` d-=_ ~ ~ P~. ~a.. '6S OCT I 7 P 4 :::30~~~ ~ = _ M~~~9~ ~ vatid unless nised seal of th~ St. ltuls ' ~ ~'~.r''^: 1.,~~ County H~ahh DsputtrwM it affintd.) ~ .f , ft - ~-f= -+'-Ky`i~,-" -:`J :i~ ^L,~~M~~ - . ~ . N. 0. MILLElt. M. D. CLERK C~RCUlT COUp~ ~ 4 ~"t~`~~` Gounty H~altlt Officer Loul Rplmar . . ~ ~ ~ r~ ~ ~ t~ . -y i~=. :.1 ~x - ,rk.:';,.. • rf',~,r-,:~~ _ . • ~ f = j 7 ~;t' ~ ~•7 ~ ~Y1~~ ~~..~JII/t:/ ~i~~. 600K1~ ~~5z4 - - ~ ~ t '=~r.- , at~ ~~'x - y.... _ _ _ _ _ =r<, _3. ~