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HomeMy WebLinkAbout1279 . ~ , `f ~ 18G516 iels .T~T~ YOARD Or MtAL71t CERTiFICATE OF DEATH tO~~• • YURGU OF ViTAL tTAYIYTtCt ~'TATt FIL[ NO. ~•a~l ~•a- FL08IDA •rd •S~a BIRT NO. REGI6TRAR's NO. pr~P~~l~ 1 KAC~ OI ~tATN CODC NO. 2. YWAI ~tHO[NCtl~a..I.rd1~..t l/:.w:w~w..: ~r:brN...iw:.+) •:~eat~d ' OOU~Tr a STA7t OOUNTY ..a .'ll ST. LUCI£ 6-02 D U IE 1• ~lae•a lw ~~t- dTY. TOrM.O11lAC~TqN t. ~5 KACE Os OEATN t. GTT. TOwM.011 lOGT10N t. K RES~OEMCE •~~~~t IN510E CITY UMITS/ IMSIOE CITY LIMITSI n i.. FT . PIFR CE vcs Q w O FT PIER ,res ? No g1 NAYE OF NI iq ~M~ihi. /is Wai ~ILtM) LEUGTM OF ~ STIIEET ADOIIESS OM A FA11M1 NpS?ITAI OA STAY IN 1/ '"STiT1T10M FT.PIgtCE I~'ri. HOSP. Da. 80 FffQ~+AY RD "ES~ ' s. ~u?..c or n.~ xw~. LYt OATE u..n A.s r.« ~~?v~•~« s?r•n HII.DA ~TELSGN ~TN Jb:1. 2? 1964 S. 3E% OOLOA OA AAC[ MARRIEO {p pEYEw WR111[D OATE OF MIITM Y~M a~ Ywr~ Il'r. . i s. F W w~oo+~co0 DIVORCED i:EC. 13s 1908 55 ~l~f~l~ 10~. YSU~LOCCWATOM (a~4wN•«~e..~ i0/•KWOOiWSIMESSO1lIN0YST~T 11. N1ITNKACE(BdtPhrel/Aa~tY?/) 1 47i7D~Cf~MTC017~R~Tf ¦ t t Y y~ r- ~,-,.~h:~. wwt wrtiy bft. an y qtird) ¦~~~wt ~IVU.S~Z ~ii!~~ H~l~.' j'.%LUCEIULl~ F~ • U~A ll~~t 1~k 1 IA1Mt11'i w1Y[ 11. rOT11C11'i MMO[II MAY[ a»~~rta~r SI}~~T T. T3RO:tiT1 SAI.LIE CARPEPITER ~5. wws ocwsco cv[e w v. z ~Rrco Fo~ccsr ~i. socu~ sca~m Na. 17. w s s~ow?iruu r.r V tl.~.r.~.~lrwl U/w.«ww~K~Nrwi ~~•n• ~rCl$OI'1 NO 2b3-3b-8836 .?u?... 80'T ,'~zdwa , erce, a. ' Tu~~e~l 1~. CAYi[ M KATN [E1W? w~ll Mt tNiN yt?1i~t/iv (Ot. ~a1 (d.~ IM'ffJtvAl ~tT~M[EN ~l~~~t~t fAIITLOGTIM~SC11YSfO~Y~ 01KETAMOOEATM j ~r~t fll• ~rME~n Circulator Colla~se I tY~ e~r- f :i~:••~i. ,~.c~a~..•;i..~ ,~,E,oq~ Advanced L~..~ho Sarcor,~atosis • Yrs. ; i . . . i .e... ~`7•L ~ .r.n.. u. ..k.. i r~si~t?~r l~ip nrk Jut. OtK TO (r) ? . i se i w» ~ ~AAT IL OTIf~ SIWILMR OOIbf~1016 CCMiA1MRMC TO OGTI FJ~ NO~ RGA7ED TO M[ iF~M11M1 06Gf[ C01d110M G1rO1 M?MT 1~) _ W AS AUTOKY ~ a~.r• •t- F ( tEllipAMEOf ~ a..c. S Pleural EftLsion - Pneumonia t,nemia ra? Mo~ ~ •r e• hr• ~ t0.. ~ ~De. ocst~uc Mow w~~r occuaao. (Bsra •.rwr y~ar~ A.?t I r art Il yv.+. u.) •~tf~L ~~7 ~ ~~NT Su~GOE wor~ao[ ~t''"'' ~ O O D ~ .r r~t~. u~. TIrE O! Nwcr Xwt~. Dq. Yur ~ uuwr o s. s. ~ i 7~. ouu~r oa.wuco xor. rucc os uuu~v a....eo.r ~.wr. m/. cm. ro,r~. o~ wuta~ oouNn sr~n MMKE AT ~ 11OT MILE ~ l~A. /«'wI. rf?td. ~~tt OfII.. tlt.I MOIIK AT MOIIK 1~~t~nd~d tL~ d~owwd /roa 9 , to an• ~nd l~~t w~ w,~ ~li~~ on °n • Dwfh ooeurnd ~t ~ P. m on th~ d~t~ ~t~t~d ~bw~: ~nd ta tlw bwt d m~ Rno~.Hd~~. /rom tA~ uuwa ~t~t~d. ?11 ls~~• ~ Ha~ri~ •r• to 1• (Dr/~tt N tY(r) I1A. ADD~ESS ?I~. D~TE SKMEO ~ ~..~i.s. a John N. Si~as,~i.D. Ft. ?ierce, Fla. "•-64 •eerr~t~. ~~TqR j~. pATE 23t- MAYE OF CEMETEIIY OR C1IEMATOitY 23/. tpCATf011 (GS(/. lNts. s? tlr~) (ST~tt) ~ ~ ~n~`a~L°"y'' 1-29-64 Z:'HITE CITY C~'....~'FTERY F; . PIE~CE, FIARI D:. ~ ..s./eia n,?~~uuo+R o~~ssw~,?ni~ ?S. DATf RFCO_ ~Y IACAI REG. RE6KTMR'S S~CNATURE ~ a... ~asa j~j~~c,p W. Baird, FT. ?IERCE, FLA. 1-2g-bta ~ Ar.na Lee Denison, d. r. ~ ~ z~. A5 1 hereby oertify thls to b~ ~ true snd oorrect aopy of ths Loui FIIED A - Registrars record on file in the St. lucie County H~alth Depa~t- N~ RECORp msnt ~t Fort Pierce. Florida. ST. LUC1E~ COUNTY E~ . F[,A~ ~ - F~tFl~p - ~a (Warning: Not valid unles~ raised seal of the St. luck p ~w County Health D~parmtient is affixed.) -1.0~~,~~'' • . ~ s:= , N. D. MILLER, M. 0. '69 oEC „-y ~ 1.:~ ~ S - County Officer ~b Local Registrar ' . ~ u~ • CLE.RK3~~~~''~ITR~S ~ ~ ~ ~ ! • CIR~~1T COURT pst~ Deputy Lotal Regirnar . ~ - - . eooK181 P~~E1279 - . . . . - ~ . ~ _ - - - - - - - ~ .w~_