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it?'J~ ~ CHARLOTTE COUNTY HEALTH DEPARTMENT ro M~„R~'',,
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S`' -~~O P. O. Box 698 4~~:.,"1? ~
a ~ ~ PUNTA GOROA. F~ORIDA • 33950 ~ ~ '
~ - ~ PHnNE NE. 9-1181 `.4,..arw. ,,t~'.
De- ~TATt sowao o~ Nu~TM CERTiFtCATB OF DEATH
°`BS • BUNEAV OF VITAL RATIi'ftC~ STAT[ F11.[ NO.
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a e e u t~ A ~~MTI/ STATf ('p~?pTp
Charlotte / - ~!X Florida Charlotte. ~
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1 n y~t- A. ~ITI/. TOWN, OR IOCATqN 4 15 KACE Oi OEATN CII~. TO~tl.011 LOGATIpN t. i5 11ES~OCNCE
Port Charlotte `;~p port Charlotte - ~NS. CITr LIYtTS1
nUMC OF ~ ~ ?
~WShTA~ 011 iw 1Nyifd, /irs ~t?tN ~lrtp) 1• STR(ET A0011E55
INSTITUTqt1 3t. Joseph~s 195 N• Waterws~y Dr.
/ NAMC O~ iUrl A(ilflt LYt DATE J~lo~/? Mi }~P
otcu?sco ~C• 11 1969
.j ~~~3 Mar ret L. Cum.min S OEATN
S. SEJ( ~ CO[OII OA AACE 7. MARRKO MEYFA YAMIE~Q 1. DATE Of NIITN A6E U~ Ka~ i lMrOI~ 1~W 1lMOEA i~ N1f.
Fems?le White ~ Feb.19,190? `r`6~u.''
r r l t• IM1pOMED Q qY011C[D
p: a i n 1~ ia. usu.~ occur~TaN ~c~.. tr.~ y,.«t e..e 106. K~NOOf' NJSYIESS OR IMOUSTIIY 1 f. NIITMrl11Ct (S1Nt M/~Mi~ tMtqt~I1 1 qrup 0~ wwi ~punnirt
• 1 t If p~~_ fari woN • rerti~I d ertR //rNiref)
'~ous~e wl~e House aife Virgin a U.3.A.
D 1~ C k 1 wk iA?NEII'S tU1ME 11. MOTNER'S MA1pEN NAME
~,p::~,..~ Underaood Flera2ngdom
Ic socut sccue~Tr No u. ~Nro s aaaTU~s ,~~r~,~
226-36-411 George B. Cumminga, 19j N. Water~y Dr., Port Charlotte, Fla.
F u n e r a 1 1• CAYft O/ Oi4TM [~UN ~wf/ ~ errat ~p fi~t /~r (Sl. ~a1 IMT[RVAL IE7YR[N
d L r~ t t o? ~~~T t. OE~tM WAS CAYSEO ~Y: Ib OEATN
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• C t u t a L! . ~~~1. CR •T j]b D 23[ NAME OF CEMfTCR1 OR CREM~TpqY 23/. LOGITqN (GY/. JNVS. M toltdp (57Nn
C~~6~ 1 ~/1969 Fort Myers Crematory Ft. Myers, Lee Co.,Fla.
3.~ 61 Y 2~ iUhEN~I O ECTOR :~.T~ ~ t.$ Gorda ~~TE RECO. ~r IOCAL IIEG. 2~. R 61STMI1'S SIfiN~TYRE
nev.1~66 "I l~ ~
Edwar . Pon er F- neral Home iydy /,~L.C
I hereby certify the above to be a true and correct copy of the Local
Registrar~s record on file in the C'harlotte County Health Department at
Punta Gorda, Florida.
~,~:lSr! ri . .
(Warninq: Not valid un~'~rai seal of the Charlotte County Health
Departmer~ ~r~+b~Pf~E~ed
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. S~°'~, n~; ~ County Health Officer d Loc_1 Registrar
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Date ~ ~ ~ • ~ puty Local Reqistrar
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