HomeMy WebLinkAbout0528 ~ FfLED ANO R~COROEO
S7. I.UC1E COUNTY. F~A.
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t~is Ot- tTAT[ eowRa of H,~?~,-,: CERTIFICATE OF DEA7N ii~::~ 0lTR:+S
oaes a 9UREAV OF VITAL UTATIBTICe ' (;~R~~~
~~a•~ t«_ FI.ORIDA
~rd ¦hen BIRTH NO. REGISTRAR'S HO. ~
properlr .
exttutld ~ r~At[ Of OLATI! GQD6 NO. Z. YSUA~ Rf1iOtNCC(s~~.~fKw~fAr~1 I!:~.t.t`tw..• Ra~d~.u~.•~.~w.~w~,~a!
and'~111 f• ~uNTY / ~ STATE . a. (pUN1Y
De pl~ted OW3Ya F7+ F~ or~da Broward
~ ~ y~~_ A. CIT~, TO1K~.OR LOUTqt/ IS ?~ACE pF p(ATN t. [~TY, TOiMN, OR LOC~TqN K R[51pfYCE
•anent INS~OE C1TY LIMITSI INSIDE CITY LiY1TS~
r>>-. rt Lauderdale ~rcstA Nop a~~-,~~uderdale _ res~ ~,oQ._
t. iGYE OF (J~~ ~pjt~/~ ~y~ ~ry~N ~,!d~t~~) I. STREET AODNESS
NOS~ITA~ OR `
. WST1tYTan~t.`Vernon ~ianor Nursing Home 0 E 56th Strcet
3. lIAMi OP iSr~t ~/l/id1/e Lut ' OATE' ~1Vort~ D~r Yts?~
O[CEAS[D
~rr~ ~ D~~~'+~ SEPH I. RP.YM0:1 liarch 8, 1969
S- SEX CO:OR OR IUICE 7. MwRR1[O ~ IiEVE11 NARRIEO ~TC OF ~1RTI. AGE (IR rlltf ~ 4'K+E\ 1 TW yvL:a 2~ Wti.
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r. i e• ~ White nnnoweoi~ avoncco Jan. 12~ 1894 7S
p 1~ 1 n 1~ ~p,~• Uw~l OCCUi~1tqN (Citt kie~ e/tat le~t t0e Kinouc sus~Ntssos ixousrar I1. ~1RTMKACE ($f~ft p/~?ty4 CO~tI?11 f2. G~NFw iY w?tAi tq.MiAe1
~i t R yer• lrii~~ iwat e/ra?~ia~ l~Jr, dt+~ ijrs(vd)
aineae Office Mana er Wi~iy9 ~iotors Louisiana U.S.A.
Dl~cY iak 1~, ttpTMfR'S_k~IptN N/Mf
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~,~••r1e~• John Ra .on Marie Boro3 '
~6 soeu~ sceuR~rr wo ~7. ~n~ores~ s
s~e~ru`ai- Aft?eu 'ZQZ Y
299-07-949b Mrs. Mary M. Raymon - Fort Lauderdale, Florida
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Puner~l ~ ~'i- - - IwTERVA' E?
d 1 t e t t oi MRT L DEATN WAS UUSEO ~Y: J. ~ ~ ~1ti AMl LLiTn
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registrar +«ini tie re~tr-
frie~ nrse faat. ~E ?O (ti
To u e sn ~ C ~ /~T Of1~fR ~WUSK~AT (,C,~pI~OMS COt~iTR•p1TwG TO DUtM R!f NOt RtU7E0 iG TNE TCRMPUL Ol$UH COl~Cif+0.V GnFN 1!t ?altt 1(~) w~5 A:ITOPSY
ter de+tA u ~~a~~f~~
or Detor? ~ YES? NO
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~ IOd. 1NlURY OCCURREO Z~t_ tt~CE OF INJUaY (t. i~ w e~enf ~wt, 20J. CITY. TOWN.OR IOUTA~N COIINTY STATE
" MN~I[ AT ~ hOT Y:M~LE ~ h~,w. Ncrar. ilrttl. cJ1Ctt 6fQP., dt.l
t - N'OIIK AT NOpK
21_ J ~tte~ded tA~ dtc~eaedl~om _~~C • ,.E: t.~ . to ~~jT ~nd /~st s~+~ ~/ir~ on ;.i
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De~th oceuried ~t _ ~ m on the date at~ted ~bore; ~nd to the best of m~ kno+~%dje. /rom the ceusei st~ted.
~11 lte~s jj,~ SIGNATYRE '
(At//tl M fUk) 2I~ ADpRESS
~ re to De ?2s, BnTE 51GhED
e o a p ] e
t e ~ ~ ~ ` _.~l- t%r7'Zi Y"L!`-2,,.- {!-'t ? C` ~ ~./~(').r~, r~-G:,~c.-- 6at:. ` ~ ~
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/ ~ ~c /'Jtt1~1• CAEM~TUY- 23~i WTE 13[ NAME OF CFMETERY QR CRf ~+4TORY j3d LnCATq+I (Cif/, lOa'7t. N COSr.Ir) . (StJltl
i ~ REr~I~I (lptttJpl
C ~al 3-1I-19b9 Queen of Heaven Cemetery Pompano Beach, g r~~,~
Y. 812 js. fUHERAI dRfC70A S 5::liATU4E ,?p~RE55 25 ~ E R[CD. ~Y lOC4~ RiG. EGIi:R11R-S S' V AE
R~•.,obs Baird-Case j ~E`lliG ~~?l~ .
• t auderdalc Fla. ~,~1.~~, /96 ~ '
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. : CERTIFTED COPY: . ' •
I hereby certify.the above to be a true and correct copy o£ the Local
~:C~+: : ~c''~C:3'a i ±t~~s R~+~,4I?_r~ (_~»rty APaI th n~~,a~tment 9.t
~ Fort Lauderdale, Florida. o ~
(Narning: N~t valid unless raised seal of the Bro~aard County Health .
. : Departc?ent is ~.ff~xed. ) . -
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: : ~a ~ ; o ; ; ~ . County Health ~fficer znd Local. Registrar
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~ ~ - D~puty Oc21 ~6'o1StY'3l' . ~
RETURN TO: ~
FRED S. SCHMUNK, JR. ~
Attorney at Law
4540 N. Federal Highway ;
Fort Lauderdale, Florida 33308 ~
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