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HomeMy WebLinkAbout0710 . ~ _ ~ ~ ~ 186111 t~?~ e~- ~TwYC oowRO ot Hc,?~rH CERTIFICATE OF DEATH i ~o~~s ? ~UAUU OF VITAL tTAT1~TIC~ fTAT[ Fil[ NO. FLORIDA ' ord •ae~ BIRTM NO. REGISTRAR•f NO. . t=!!Ytld~ 1. ?lAC[ Of OtATN GOO[ NO. 2. Y3YAL A[NO[M!t(1?V.eMrdl..d l/whha.~a• R~~wWwY~wir~1 I' •nd •111 ~MTM ST~TE 6. tOU11TY ~ Oe pl~e~d 7: • =.i:(`l~ _ l(1 : f •,i ~ ~ , ~o 0! C~T1I. T011~N.dl LOC~TqN K?IACE pi OE~TM t. CITt, tOMN,O~ IOCAT1011 t- ~S 11ES~OtNtE ; ..~•.s ~~s~uc cm ~~r~tsr ~~s~oc urv ur~rs} fil~. r~iC3"LC' rESO MO? .~r±2. P~_ Yf5 ~+0~_ : I. N~~f Oi ` (IJ wK ia ~Npfd. pe ~t?tt2 M~rtM) STREET ADD~ESS ~ MQSPlT~L OA wST~TUTqN ?l1C t'~' C` n . n^.f~ i ~ r h•~- a=, l n ~ NAM[ OI f FirM Vi~f([ LMl DAiE A(~wt~ UeI Yeu ottuuo os (T~yt~rDii~t) t f~,~:~Z~i i.[1~.ri= ''•"?.:..'~~er OEwTM ..C~~~-C':'0~~ - ~ ~~~:~i S SEX ~ CO1011 OA AACE 7. MAltA1ED Q NEVE11 MARNIED ?~~TE OF ~111TN 9 ~6E K~+ ~1r0fa t~ M1S. fYf Avl?Iq1 N..i4 Mi+ Nwn L... ~ r~ i y'^'~ ~ c.Li. M r 1 t• .."i.1C~ •!~:~'tQ MfIDOWEOU WVORCED r. >_-zl J_~ tc. p~~~°~ t 10~. uSU~I OCtu?ATqw ICier ti~~ y rat M~e 100. K~M06i ~YS~NE55OR urDUST1IY 11. ~MTNK~CE (9~tr a/~rry~ cw W/i ' 12 anm+ Or rw~ t~+nt» •itA p~r- lariywweNrw?i~Ihk.tN~i/rdvd) . . ¦~n~wt O :C' ~ ~.T l.^.13 C.~Sl~ O1~Ck lwk ~ATNEII~S ~uM[ I~. MOTMER'3 MAWEM MAME er c~~~.rit~e i_ar.~~e ~::..i:i-r:~?~ ~CSS~.e ~?llZel li SpC~~I S[tU111T11 NO 17. ~M/Yw ~ NCMATYO[ A~b[q ~ :O:'~R S:_u.T C~" ~'t{l~ .~C~~~~' Fi'JCr:1~C' '~l'j: 1''~C~~C(? ~1o~"=C'•~ Fun~t ~l 1~ C~Ylf O~ O[ATN (F.~Ier ~wl/ ~~t e~wt pe? li~e /.r ~~1 ltl.~ iAT[RY~tI iETME(~ A i ~~t to~ ~~~T 1. OE~TN Ma5 d1/SfD ~Y- • ET AW/ p[ATM ~yrcou~TC c~usc ~•~~~1- r...,..~.~~ : ~ Gy / .~,e r». en. e.~- "rs°•~• C~w~ifi~wi.il~t/. DUE TO (?1 _I~I~~f ~i. ~ ~ . ~ e e i n. - - r~~t~ pn ru~ q r~`---- 1 e e w 1 ~Dert «rar (i). ~ r~6lstr~r w~V f~e r~~n• ~ TO (rl (Iiy nr~e - - - • ~1~ _ • 1 tA1n 7= ~ ~~T 11 Ol1il1 SKI~fICMi CCwO~iqMS CpKTN/1lf, TO D[~tN q(? Npi R(LAiED TO TM[ iUMYYI TqU GIYFI~ Y~ IMT 1(~) .:~~MOrSY hour• •t- F t~r d~xt~ s ~r befer• YES? i 20~ t~~ 1 2~. DESCANE MOI? INJURY OCCUNNED (EnIP ndYl( ~/I~j6f~ ~n pwt f r Pat yire~ ~IJ ' ••t~^a ~ ~CCiOfMT wKenc tiorK~a ai. e,t- W ~ V ? ~ ? _ :iu4 v. lOt iU/E OF IlNr LN/. Ys~r 3 bod~. V IMJU~r r. o v~+. ~ ~ ZOI uuu~r ottu~~to mr K?CE Oi tWU~~ ia r~wt ?ow[. 20J C~TY, TOwM. 011 tOCwTqN courir st~Tt ~ ~ MMKE A7 O wo7 wMK[ ~ la~. hKnl. N.ur, aJ[cr DIl~.. dc.) ~ ~ WOIIK ~T Nrp11K ~ /~tand~d fM d~c~~i~d Irom , to ~ •nd l~st w~ A~ ~li?~ on 3 D~~~A oceuir~d ~t ~ m on tA~ d~b t~tW • r. ~ad ro tA~ 6~st o/ mp tnowl~d~~. I?om tA~ uuNS it~t~d. ! Al1 1t~1• jj~ fIGNATYR[ ~ =2~ (I « Iti IIb AOCRESS llt. OAT SWM ~ to ~o.p~.~. , . ~ Gy ` ?ecr~~te. ~~~l~~r~t~. 23~ p~TE 27t M~?~EOFCEYCTEI1110RCRCw~TOqY 23(.LOC~TIOM(GS(~.tMr~.ertw~l (Si i ~ R[rOr4 (1ptt~/~l . 11 ::t. ?ior. ='e:~etc~~ ::asontoT~~:-r P~es~o. Co. '1. ° S•16ZY 2< i~? AA1 d ERp11 5 51G1111TUA[ ADW~ESS 25 WTE ~[CD. ~Y lOC4l REG. ~E6KTRAl1'S SIGI1~TYilE ~ a...,oes ..~"/le~t~.- i; tte.s~~ .:~u-~ ~a a? i~o ~e vembex 10,1969 ~ , ` ~ ~~~Efl ~,NQ RECOROED ~ ST. LUClE COUNTY. FLA. ? I hereby oertify thls to be i true and correc? copy of tha toul ~ C n p r~I E 4? IF'. F~ • . Registrar's ~acord on file in the St. lucie Counry H~alth Depart_ 186111 msnt ~t Fort Pierce. Ftorida. " . _ _ : 2y PM `~~t~ ' (Waming: Not valid unless raised seal of the SL lucis ~69 N~v : • . ~ • ~ / ~ " = • CouNy Fkalth D~partment is affixed.) ~ 1 • ~ ' _ - : fiocr ~~o~TRas ~ ~ ~ : ~ N. D. MIIIER M. D. ' IRCUIT C?flU~~ ' ~ County Haatth Officer •b local Registrer C RK C , t ~ k ~ ~ . ~ .r l ~ , } • y ~ ~ ' ,Y~ ~ ~v..lr,. i~_ /qt y ~ ~ ' - ' . Dat~ Qtputy Local Registrar ' ' i . ~ ',1 ' ' : ~ . ; BO~11S~ PAGE , 7~Q . - - - . - - - ~ ' _ , , w