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t~~s Oe- ~TATt ao~o o~ Nr~?~„+ CERTIFICATE OF DEATH
eo~es • ' BURGU OR VITAL fTATIfT1C~ fTAT[ FIL[ NO.
,~s.~ FLORIDA 1
ord ¦Aen BIRTH NO. RFGI6TRAR'S NO. 5~1
prop~rl~ 1. ?U1C[ O~ CyTN GODi NO. 2. YtYAI RtNO[MC[l~?wt~.wdwd if:w.hr...: RrdwuW~..~.ww.)
a`:iii OO1NT' 66-085 sT~TEFlorida s~ ~+NTrSt. LuCle
e. j1iei~ St. LuCie
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•~eewt INSIDE CNITY UMIT5/ IMSIDE CITY l1y,TS1
Ft. Pierce rE5li3 ~00 Ft. Pierce N04J
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I. MAME Oi (I/ M! ua MI~IfN. fMt Wtd ~II/tl~) STIIEET AODRESS
NO~T~LO1 Pierce Mem. Hosp. 3211 Rid ehaven Rd.
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s'.r.ii LUC ILLE L.~• BARD oi7M November 12 , 19 6 9
S SEX S COIOAOA ~ACE 7. M1~MIEA~ M(VENYA~RtfO / OATEOf ~IwTN ~6E(i~/t~r~ ~1M~0[~1~W UNO[aNNK.
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r c• F CaII rnoorrco~ avoncco FE.'b. 4~ 1898 1
p l.~¦ 1~ 12 atuu os wwi oowm. r
i0r. ~SU~I OCCU~~Tqw (Cirt tiw~ ywr! b~t lOS I(iADOi ~uS~+KS50R wDUST~Y 11. ~UITNKAt[ (Sl~ft N J~?ti/~ tNi~hl)
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••••p~ Account nt Re ired Ohio USA
11~tk lek ~ATN[11'S IuYE 14. MOTNEII'S YAWEN IU1ME
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~ William Shar Unobt.
U ti socu~ sEtu~~Tr ro 17 u~row a s~t~u?TU~t .,7 w ~a// ~ ~
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21 1~tt~nd~d tA~ d~c~~Nd /r I¢ _ d . fo ndl~st s~ ~ m~li.~ on ~
W~tA occurr~d ~t m on tA~ d~t~ st~twt ~bw~; • fo th~ ~st o/ m~ kno~/~dj~. Iiom tA~ uuwa ~t~t~e. '
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23~ Pum4t r~ 23A WTE 23r N~YEOfCErETENYO1lC~EwAiOqY 23/. IOCATqN(C1t/,lwew.MCwafp (Staf~~
Buri`~ 11-14-69 Ft. Pierce Cemetery Ft. Pierce Florida
r. 9. ~ t 12 • F'~ 4~~ MR C-TOII S N E ~'~5'l~ • 7~ J t. I z5 LwTE FiLD. ~t iACAI IIEG. 25. FE6:iTAAi1'S S:G1~AT::.^.C
a~•.'96s G;~~~2c<~~ Ft.Pierce,Fla. vember 14 1969 ~ ~
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fILEO AND RECOROEO_ ~
~ ST. LUCIE COUNTY; FLA. •
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I heroby cectify thls t~ be s true and correct oopy of th~ t.ocai ~ r. C C~ V= R i F! E 0 ~
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{ R
e gistrars record on file in the St. Lucis County Hwlth Depart- ,186u6`l i,
ment ~t Fort Pierce. Florid~. '69 DEC 2~ . Z,~ i j~~~
(Wami~g: Not valid unless raised Kal of the St, luck 1
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o un q H s a k h D t p
e n m s n t i s a ff i x
e d.)
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~~O~r_rc ~ OITRAS _
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y~ , N. D. MIIIER, M. D. CLERK CiRCUIT CDU~~
County Heahh Officer'~ local Registrar ~
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~ix/..~i.~~/, /q69 ~ t d 1 ~ .
.Da1r Lotal Registror 'r ~ ~ . . '
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