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HomeMy WebLinkAbout2059 ~ _ 1$9252 C.:: cTlFICATE OF DEATH Dtp~~twa~l of i ka1~L and (2c6abili~atire Scrvicei iTATE FIL[ NO. INVIW?N (K HF ~LTII : L O R I D A ~ ~ iY/E. O¢ ?t~NT IN ~~~^~~~~1°° ~ ?::,ti:..rtENT INK REGI6TRAR'S NO. Slj SEE Ii+N~J{00[ f0! -CEASED-NAMf ~usr ..rou ~~st ~x pATE Oi DEAM ~ ro~tr, e~~, rw ~ ~ IKI~U(11~K ~ 7 l 9 n Rn~E ~wn. «ecw. uunc~.. ~.w~.+, wGE-us~ ~^a• ~•e.~ ~~..oe~ ~ o.~ DwTE Of ~MM ~.~awr. o•~. CqXiTt Of OEATN iu. ~ vaw. ~ u~na.. ~~u~s~ ws. ~ wn ~.ows I.w. nu a • A A ( 'S~ i 1~ ~ 7 CIiY. TOWN, OR lOCwiION pf afATii r.~+a un .~..~n nOShTAI O!l OiilEt t+STITUTION-N ~N .ot w ~mn~, a~ve Sne~~ ~.o ..w.~t~ ~ E a?uw~ .~s u .a n ~ FT. PTFRCF ~ SiATE Of 4RM ~ r ro~ w ~.t ~•re CITIIEN Of WMAi COl1NiRY i~CiFD, NEYER M~RR~EO, SlJtr~vNG ypUSE ~ r~ne, one rwoEw wre ~ cOwm ~ } W _ ...,>res usuu~esa[..ce • ~t~ \ ~ ~tl. rMH OFCt~3lD ~ ~ ~~.eo u u.r~ soGiu SENntr w~uE11 uw~t oCCUrwT~Or+ ~ w.e .~.a a.~o.a oo~.t ow~+c wu a tr+o O~ ~uSr~ESS O~ u+ousner O:cuutD w wiOUr+G bN, fvlM w~~r~~~D ~ „ 261-09-7779 OF FT _ P~R .F u.o.. woa~siw«. R(S1pfNCE-SiA?f ~pUNiY U1Y, IOMIN, OR IOCATION wa~w unr ~ras STlfE~ AHO HU+a{ER I31lCVt t~1 W MDI IM N~ . ilk NI p~ / ~ fAiMER-NwME r~tyt .~op~ ust /wOTHE~-MAqfN NM~f rrfr .uepe uu ~ is ~ • iu • . . ~~IOqhuNt-H~rwF ,Mwnv+G wDG~tESS ~snee~ a a.~.e. w., cm w ~o.~.., s..n, i~~ ~r. Ti jin 1 EO ~ ~ ~ rT,(1 1 ?ART 1. pEAiN WAS GUSfD \t: 'EN7Ft Ow:~ Wrt UUSE I(~ lNE f0! e i ••r~oaw~t u.re~+.. ~ fe?. ~u+D (al~ un+u.. o.s~r .w w.~. 1/ rreo~ n uust ~ ~ ~1.~ ~ A,~ ~/~~t_ ~ ~ W ~ -1 - - . co«uwi..ci w. :~~e...o~,. ~ ~ ~ ~ V J - ~cw o.~~ .~s~ ~c j ~e, ~ ..w~.re uuse ~m, ( ~e ro, w •s . co..Haue..c~ w. ~ f~.uho i~e u.oe~- . , ~~~ro c.uie ~.u r ~ l~1 ~ IART Y OTMf! 11GNYKwHT CONDITIONS= twaua.a ca.*~.wr...o .o u.n. wr ..or ~turtu ro cwse cm.. u. ~u~ ~~o~ AVT~Y ti YES .e~~ ~~..ci..cf co..- ~ 1111 b wD Lpl~IJ ~u Olit~r~MU~G 4Vll p ol~~¦ If~ VO tM I i~.~b~Nrl ACGDEM, SUICiDE Ot OA E WIURY ~ rp.r«, y, ~eu nOi)i i MOW IN/UR• OCCUlRED ~ t~*~~ w~v~t or ~r~u~~ ~w r.u ~ q rur n, rt~r ~ - MCMIGOf; OR UWFIEW~NEO ~ ~ ~M ~ f~ H:~ INIVRY AT WORK .?UCE Oi W/U~Y.* ror~. r•~~. srue~, ~K~o~•. ; IOCw~j~t~ ~sneet o~ ~.~.e. ..o.. cm p~ rovw, sr~q ~ 1 f~~4n efS M~OI pN~(! MOG.,~K. ISIK~111 . 7:~ 7M ~OD CfRT1f1UT10N- ro.~rw w~ rw ~ ..wrw a.~ nu {•.o usr s~v wr/w~~ u~ ow ~ ao/aiC'e~ v~i.r +wt OF~TM OCCYUED .r at n..[t. a. n.t ?NiSIC1AN: ~ roi•m w• i~u ~OM uni a.tN. ~~w~r~i ~ o•n, uw. W~.e usT ~ •mr.oen Tw[ 1/ ~ ~ .TO, I YG/ O ~71~ O ~ fl/ w ~r ¦wrn[xe. ouF ~ tl~ DICl~)FO t~Or ~ 1 ~ :1/ jl~, ~ /M ro a.e c.ws~~s~ s+.no. GERTR~CwiqN-~EDKw~ Et~~uryER OR COROr+ER~ o» r,.e ~.s~s a r.e „o„~ a u.n, rw~ wce wr ...s r~o.a~..ne w•a ~ ~a,..w.r.w w n.e we. ...oio~ rw ...~snc..~o.+. OIMWn~. iM w. .e.¦ w~~ Of~M p(CYUtO O~+ M D t! Y10 OYE i0 ~w~ C~US~tfl yf~IlD. ~ ~ IS ~ 1A - rh ~0'1: / S , M m ~'Rt~f E ~NnME a*rno`n •nA i ` wTU E ~q ~~r iOwTE D~+wm, o q•wi t` t` ~C ~ l 7k a~wR w tCEJ7tF~ES s~ne~ or ~.~.o. r.o u t ~ - 7N Y ~ i- ~ u n Q {UR~AI. C~E TIpN. YfMpVAI GFMEtERI! Ot UtEMATOkY-H~Mf IOCAT1pN a~ p ro.rr st~rt ~ srlCMr ~ , ,N BURIAL FT. PIERCE CE~iETERY~ ik FT. PIERCE, FLORIDA DATE ~rdnw. o.~, n.n WNEW MOME-?JwME wHp wDpiEiS ~ tneu o~ ~.r.~. .ro.. tm w~o+w, u•n. ar ~ :u~L~._ ~ . . ? ~ ~+n _ Ft.Pierce S. r612 fu~,E~Q ~fROR- iut ~ rEG~StR SiGN~TU# o~~[ nt[ !O tOU~ ~F6~}ru~ R~r. 1V70 ZH/VL~G~C..~~~LG,) l~ ~h:j~ /?e. f tw ~P.i~Y'lk3T'V 197Q I hereby eeKify this fa be a true and correct ca~y of the loui Roy;istrers record on file in the St. tucie County Fioalth Depart- .~.t~~.'~~ mant at Fort Pierce. Floride. ~ ' ~ * : (Warning: Not valid uniesa raised seal of the St. tucie f~~~. ' Counry iiealth Depanrrwnt is aft;xed.) ~FILED A"~D RECORDE-Q~;' ~ - ; ~ LJCiF COU~JTY; FLA. ~ : . _ . ~~~~~C. ~ .,Y•~: . ~.~~.i . , N. D. MIIIER. M. D. . , . . . . ~Qp~C ~ ~ ~ County Healih Offictr lacal Rcgistrar ov~~ ~ ~ ~!+~.4 : ~ ~ . '7 FE~ y P~d 2 :'2~~ ~..`z.~~ _ :.;lu'.:..-r.~~_+ ~ ~ Date Deputy Loca{ Registrar ~jG~~-!~'-~. - ~ ' - ' ' ti):'t='~S + ~.,¢1 i - CLFRf: CtiiCUlT COURT, Bo~K 1~2 PA~~ ~U~S x - ~ ~