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HomeMy WebLinkAbout0256 i ; S i Y ~ i .151% ~vu ? ~ i i De- BTATE BOARD oF H~?~~x CERTlFICA7E OF DEATH ~ ~o.rs . Bunuu ' ~i,~~~ FLQRIDtTi ord ¦~rn• P1RTN NO. REGISTRAR•5 KO. 57p i prope~ly ~~Ut[ O~ O[ATN GGOE NO. 2. YSUAL A[t10[NC[(~P~..~Iw.N:...~ /!w~...a...~ XrJm?.~~•.l....,..•~ eletYtad t.STATE D.COLwTY CpUMTY •nd r1I1 ~ n~-~.~~ Flori(j3 St. `~C~ 2 e~ p~.«a ~ lq p~~_ A. UTY_ TOMN.OR IOCATqN a b Pl4CE O~ LiATM ~ UTY, TONfA,OR LGC~Tqb t5 H£StC[KCE tMS~U[ C~TY C:ytTS~ j ~ ;hS~~E C~TY L~M::Si ••~•s~ res:~ wwu ~ Rt. Pier @ ~ rss~ ~uu' ; n~~. Ft. Pierce J. NAME O~ ~/IC~MAw ~+pt~i. /irt dr[N ~Q~~tul ~ d. STAEET ADOAESS ~ HOS/IT11L 011D ~ V ~ l1 • IMSTITUTION Ft. Pierce ~fenorial _Hosp~l 123 Aldea_ Stre2t ; 3 Mwac[ OF---- F'v~! Vi:dlt La~t 1 G~iE bloalA :ic~ -1•~s~-- ~ OtC[I~SEO ~ (T~prrp:wt) q1~T~iONY JACK F;LCO~IE GCATMp~cer.i~er 24 1969 S SEX 6 CO:OR OR IUCE ~ yARR1EO ~ A£YFN YARN~CD L j DAiE Oi BIRTM ' 9 ~GC ~4 ~ta~~ K ~ ti :;~.El:~ w'+5. ~ r ~ t c. ~ w~ocwco ~ atioi+cc~ ~ S@ 21 190 1 62 ~~U, w„ . ir..,, y x.. ~1ale i White ` p l~~ p ~ r t0~ u5uu ottuv~T~u~ iGis~ ti,~~ o/rar Qe~r ~ KI\OOi ii.5•AESSOR :N[n/STNY 11. B:ATMi~~CE ( Vofr ~r Jor[yw toyafril 12 GTII[n p w.4T f,CAi.~Twt~ - .1 t~ yer- Q~cnn~ w~af e( ra~tullik. ~srw iJrtfirdl ~ ¦~nent cxec. En ineer Electric Penns lvania USA ~ Dl~ek Iqk ~A7NEA 5 M4YF : MOTNEN'S M~~DtN /CAME or ~,v•~~z~•~ Phili Falcone ~ary A. Dovella 16 SOCUI SFCURITY wD 17 ~NFORYw ~ fIGNATY~E A[l~ua 057-09-404 Cath D. ~alcone 123 Aldea Street Ft. Pierce, Florida r~ner~l 1• CAYKOI OUTM~~wltro~l~~wrt~wa)~rrGwtp~(~i. .1.•~ed~ci.) N'[:tw~BiT'XE[~i ~I dl~ftt0~ /~AT 1. D(~TN VASC~JSED~r' L~r . - - . / ~ I Gh)SET Ahy~G[ATM ~ust file IMrEDUTE CAUSE U)~_• ' ~~'7: • ~ ~ f ~ y, ~'~i.L3~---- -j-' ? ~ ~ r?= ~vr-~% ~ - tAe e~?- ~ f tiffe~l• Co~l~law~.~/~~I. DUE TO (6i _ - - ~ i ~1t7~ tAe r?~•~ - - ' Q~re r.s~ l o t• 1 sDa~ :awu Iil. i re istr~r ilet~nY t~e r~Qr- - - - - _ . . - _ - - - . ~ ll~~/ naae luf. DbE TO (ti . ~ _ %iA5 ~i.:Gi'~7 +l ln1 e 72 O ?Al1T 11 OTM[A SIGNLK~Mi (pMpil~I~s COA~RITIYG TJ 0.~'N BJ7 !Ki p[~Tip f0'M[ TCqM~M~ ~IYAY CObDfT~Oh GIYEI~ W?MT 1(~) ~ l~ou[s •f- r, PfRiOR~i'.' E tef de+lG ~ YFSt~ h:;._i- ~ ~ or Eefore ~ ~~~ieV~ - - '.0~ 2D6 OESCR~if Nuw ~AJJRY fj[C~RkFU ;F'strr adrrs ~/~~j~r~ iw Pt~[ 1 w P~rl 1! ~f Jfs ~ •~k1nR •nl Y ~CC~~EwT SUIC~OE MOMfC~OE ~ dl~post- C r~ ? cton or v - - ~ 20t 7wF ni //~rr AJewf~, /tif• )'r~r ?0,~• V ~NJUA• A. O D• W ~ 2Q1 ~Nlui1V OCCUANED Xk 7UC[Of i~J~~~ (r an w a'w+.t Acwt. 20/ C~TY. TOW~.OA lOCJ1TqM COuMTY ST+~TE t tNM~tE AT ~ (qT M"MK[ ~ H~~. ~f07~_ Yllti. Gff.[f OiQ~.. f:~.) ; WJN~C AT W011K - ~ i 21 l~ttend~d eMd~e~o~diom__~Y._~~.-1 j-i.-==s. fo ~~~_~~andfut s~r ~,m ~lirson.~~.~;-~-~ -r=-- ~ 1 De~th occui~~d ~t ~ m on the dste ateted ~bore, ~r~d to ths 6~st ol m~ lenowl~dje. lrom ~A~ c~usea at~fed. All lte~s j2~ 116 7UIIE.' { ~ •re to De f~/ (~Ninror(vtr- ~Z2: AppR[55 ) ?2t. J~TES~G~fD - • / . " i ti / i 4 _ - . i eo~y7ll• ~ . ~ ~ i Y^:~~ 1 -1 ~ , L..--._-L ` ---i.• { ~ ' " r ~ •eeur•te. ~ s I!a ww:u_.:Rir~i:.iw 2.f~ D~iE • s~: C' ~°v: TE.7Y OR tFFYi1TGRY ` ~f ~OCATiOA ~CvI. [arw. W cccr~i) :STi:N ~ 3 A[rcr~i I~~Wnlt~ ~ - ? ; __g~~v,a~ 12 24 b9 __~~'~_;~;'~~,-i ~ ~.~-~,,..-Y Banaor rorthara ;.on C~. ru. , \.S.?d12 jG~~E:Ai/ laF~TOd S$:GM4URE A,-^pF55 ~2i DATE RfCA. BY:OC~LREG 26- Gt57AAR'S51W1ATURE. ^ i ~ ~ fl:~l ~ y~~pr Y~~ ~~t~ ~V f~. wes.iPOS /~/tJ • ` ~ Ft P~ c~ ( T`PnPr^%-t,v.?~ ~3C,0~ ~.~v~tl~xJ ?~~se'_ /".s„"aij ~ 1 - - FILEO HND ~ECORD ~ ~ ~T ~~JC~~ C~UKTY~ Q~''• - ~ ~ ~ ~~ri f_ . n• ' ~ ` I i-~ortc?y ceRify thts to 6e a true and :u::,.-F c.:r~ :;,.3 Lc:.a~ ~ Q;;.oisirars record on filo in the St. luc~e i.oJnty F:.._:ih D_r,.r.- ~~`~v ~ ~ m::nt ai Fort Pierce, Fbri~a. ~ ' 3 ' " ~ ~ - ' . , ~ L ~ I U c•`. 6 J ' . - ~ (1Narning: Not valid uniess raised ae:.: o~ rh~ St. iuc::, L• HL ~ ~ Covnry HeaSth Dzp~rtm;:~~' is crfix.-,~.) .~IN ~ ' - ~ l1 ~-j T-.ItS ' ~p~RT ~ . ' 4 ' ~ . N. D. MiltfR, M 0. CLc;.rK i,{FiCUIT ~ ~ ~ County Health Officer & locat R~~is:rar ~ ~ ' ~ ' r 'S~-~ ` ~ ;5' • - ~ f ~ ~ ~ . ii . . t Date Doputy Locai R~g:s;rar ` ` ' ~ ` ~ °s Rr 1$2 rACE 254 yi D~~11 ' ~ ~ ~ ,y' - - ~ _ _ - .r . . _ . . . - .