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HomeMy WebLinkAbout1472 - ~ ~sss~~ rs~: s~- ~ rr~T~ YOARD o~ Nrw~t~ CERTIFICATE OF DEATH eu~es oUpcAU OF YITAL ~'fATIfT1C~ fTAT[ FILi ItO. '°a•""- FLOBIDA orA ¦Aes BIRTN NO. . R[6ItTRAq•S Nd. yroD~rl~ L uw~~ ~cs~w~ec e: ~ e ~ a e A OI OtATN CODi NO. ( ~?4~ Iw~d iwt. fJ wNw~.w~ R...rwr M..~ y~,N;~.) .pe .lil oou"Tr 66-025 a. ST~TE couNrr e..~.~.d orlda Saint Lucie ! a A. CITY. TOMM.OR IACATION t. 15 ?I~CE 0~ OEATN t. dTY. TOMM.O~ LOGATION s. 15 RE5IDEMCE ~~A~~~ iN51pf Ci7Y LIYIT5/ ? IN510E CITY LIYITSI f 11 YE MO ? r y i erc e ~S L tu~YE OF (IJnM in ~MNtd.Ir~Wtd WrtM) STIfEfT ADOACSS NOS?1TAL OU y, i 1MSTITYT1pN OY~4if th SLreet ~ 3 MAY[ 0/ f'bat ~1/i//rt LYf pATE ~LAI~ D~y YtV ' occus[o ~ n~ P~ra l~~ii 1 e s ~*wTanuary I I, I970 i S. SUI ~ CO1011 O~ RACE 7. MARRIEO ~ MEY[w MM1140 OATE Oi WTN ~ /A~GE KM~ li 1J~0[I11 TW II~O[A t~ MS- ; If r t t• F e e MlppyrEO~ dYOACED ril I5 f I7~o `+7~•r' p~ y 1~1 ~ 1 r ~a. usu~ occw.ra~ ~a~.r tr¦~ y~«~ w.. 100. Ku~D Oi WSUKS50R wOUSTIIt 11. t41TUKACC (Sldt ~r .1 t A o~ r- ~rri~/ ~wf N wrtia~ b/t. nn iJ rdirM f~~M ow~(rtl 1. crt~ o~ ~i CouNmr? None Geor ia U.S.A. Ol~tk lwk fATNfl1'S ~uYE 1~. MpT11ER'S MAWEN IIAME Of s~p~~r~t~r Rachel ~ UYi~CI~O~iTl~ ~ 1~. SOtu~l SECUR~Tr MD. 17. NIO t f10~11TY11[ • f4ta _ ~ ~/1 _ ~T4-0 ; rs~ ~ i Pun~ t~ 1 1~. tAYK OI O[AT ' H w1~ Mf C~wt ytr liwr /r (a1. (Sl. ~a1 (tl-j IM YK KTIMLfM air.~c.r ~~~T~ OEAT M u~o.•: xeart Attack ANODfATM , a r ~ cou?TC c~usc t.)D . O. tA• t~r- ~itA`•t?e C~a/ifiMi.?lAi. ~ ) ~ • ~ v?ic! ~v~t ru. ~ W[ TO • 1 • e • 1 ~Dp~ r~s~r (i). reRlst~~r~ +~~I t~t t~ftr. ~ 70 t) hiM t~rat fsaf. ( AOU?s • f? ~ fMT 11. pTMq 51GIfICy~i (qqT~p/~S CO~IANVIyK TO OGTM ~ItI 11DT 11[.U~AO 10 7M( 7EAMIML p6(AY MUOliqll Glr[M M/MT f(~) . 1~A5 AUTpSY H c~~ d~ate 3 /E11iONME01 or Defer• ~ TES? Np •~klas •w] ~ IP+~iNYI IOO. DESCIIIKNOMWUNYOCCN~RED. (EtUOwdVt - ~cciocMT wK~oc NorKioe N~V•?r a Prt I r Piw !f yr~.a ~I.) af.pe.t- u Q ? D tlOq O~ ~ ?oa~. i Ior T~rE oc rr... x.~rr. ar. Y~r u ~w/u~r a. o r. W ~ 20/. YUU11Y OCCURIIEO ~r. rutt os ouu~r ~e. I-. ~r dwrt b~r.. m/. Crtr. 7rnrN:0~ ~OCwtqN COUpTI~ STATE WN4E AT ~ NpT WMKE ~ ~w. ~N). +~rtH. o~tt DI//.. d1.) ~ MORK AT OOi1K ~ ~ t 2L /~t~~nd~d fA~ d~ea~a~d pom e~er .,o ever ~nd l~~t w~? n,~ ~li?~ on ever j D~~~h oeeuti~d ~f A~1f _ nn en on tA~ d~t~ ~bt~d ~Ow~: ~nd to tM 6~st o/ m~ lm~rbd~~. llOfn fA1 GYM~ ~f~t~d. ~ A11 ltf~i •re to De T ~--~~M~° M rWki 22b ~DWlE55 17t. OATE S~GMEO co~pl~t• ~ •ce~r~ t~, ~ e I~ ca ^ P ~p?_ C° .S''fi . Luci e oOllllti Ci~urt HS • ~ 23a. 4. CREr~t ~ Zb WTE 2Jc. tuME OF CEYE7[RY 04 C~CMATORY - . j3/. ~~TIp11 (Cf1. lwA. M tM 1 ( dt/ • N[r01f~1 ! tip~ti 1 :,~1 anua I8 I9 O Pir_e Grove ` Fort Pierce, orida Y. S. /6I2 f{iNENAI O1NE Oli SK,h TY/~E ~DOnESS n 25. WT[ ~CCO. IOCAL 11E6. ~ 26. EGKTiUII'S SK%ATY11E Re?. 1063 • `~r ~ ' „~,~~J,-iP U /y, A I ' January 19, 7 ; / y•^~~ ~ • COUNTY, FLA: , ~ ..n~,, y~ R~~~FD ~ I hereby oertify this fo be ~ true and oorted copy of tha Loul -iC7~:~~ Registrer'a record on file in the St. tucie County H~alth Depart• ~TO - ment at Fort Pierce, Florida. Jf;~ 2 7 ~y j'~-:~ ,~3' Kt7~_, r (Waminq: Not vafid unFess roised teal of ths St. Lucie - = ? • . ~ ' - ' County Fisslth Department is affixed.) .`r • ~ _ : ~ ; f ~.OtTR.:$ • ' ' , N. D. MIIIER, M. D. . C~~R~ CiRCtJtT COURT~ - . : . Couniy Ith Officer •b loul~ Regisitar ~ . ~ . . .y 'r~ 1 ' - Da Deputy L+ocat Qcgistrar • . .,`•i' .:i-1'~ .j;.~.1 S . , . eooK 1$2 PACE 14 ~Q - - - _ - . _