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ord ¦Aeq BIQTH NO. RC616T11AN•f No. 44
properl~ L YiWI R[f1O[NC[(~M.~sr~/A.i It.+w.w+w.-~ R..J.wW~../.ww)
e:eeuted. 1. ?U?Ct O~ OtATN GOO[ NO.
•nd ¦fll ~~N~ STATE Florida b~~~ Saint Lucie
e. ,~.~.a Saint Lucie 66-025
t a P~~- A_ GTr. TOMM.OII IOCAT1pN IS ?IACE Oi DEATN t. QTY. TOKII.OA IOCAT1p11 e. K IIESIDEhCE
¦~o~wt iNSlOE CITY LIMITS/ ~NS~DE C~TY urif5~
r,,.. Fort Pierce .cs~ ~op Fort Pierce
I. ~ur[ OF (!f iwl is Mqil~l. fvr abtN ~16ta~1 STREET AOORESS
NOS/ITRI 011
UISTITUTqN ~ster Manor Nursin Home 300 South 17th Street ~
] w?rc as i'~•r NWte L.,t a_ wTC al..e~ Dq Y.u
~'y~M~'u~ JOSEPH HEI+iPHILL BALLETT OE/TM Januar 25 1970
S. SEX 6 C0:01~ 011 11ACE 7. Q~. DAT[ Of N11?N AGE (l~ ~[M~ r{I~0[~ 1 YW 1M~DEA t~ WK
MAl1AlED~ MEV[RMAA~I[O ~~w~w„~ ~/~y a' M~~ IfN.
r ~ i c. Mdl@ Whlt@ rnoowco? aroncco Md 17 1891 78 ~
pl~lal~ 10a. USU4lOCCU7~T10N(Cittli~l~/IiMl~O~t I~.KIKOOFWS~MESSORIMDUSTlY It. N~iWIwCE(Si~tew/Wry~nr~tr~) 1. pT17Di0it~YTO01JNit1~
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Realtor Real Estate Delaware USA
elaek !wk 1~. fATN(R'S rutrE 1~. M0T1sE11'S YA?pEN MAY[
e ~
~~.•••1~•~ James Dallett Mina Betts
~6 SOCIAI SECUR~TY h0. D ~M/Ow : u~?T~.~ ~u?.,. ut t treet
221-OS-358 A Elizabeth Y. Dallett Fort Pierce Florida 33450
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~ ateYr~t~. U[r~iqw. ~ pATE 2k w~aEOfCEMETERYOIiCR[MATOIIt 23J.LOCATIpN(Llf~,[New,M~wt~!/) (Stift! '
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C mation an.27 1970 Ft. Pierce Crematori Fort Pierce, Florida
~ Y• S•~ E12 j ~'U ~ R qRECT011 SS~IGMATURE ate~~Rur.era H~ ~TE NE[O_ ~Y LOC~L RE6. 26. 6KTM11'S SIWIATUIIE ~
i Ret.lo65 ~KlL r 79~~I t1~1~1• 27~1970 ~ 1
~ ~ Ft. Pierce, Flori a ~Ie~
~ FILE~~~i1D RE ~ ~
~ ~T. L'J'~`~ COUtd7Y. FtA.. i
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_ I hereby artify this to be a mie and oorrect wpy af tha Locsl 18~?1( , ~
~ Ragistrars record on f+le in the St. lucie County ii~alth Depart- ~
ment at Fort Pierce. Fbrida. u~ r~ I 6~~~1 35`~~ . ~
~ (Warning: Not valid unless roised seal of the St. tucie ~
Counry Heafth D~partment is affixed.) . • , ~ . .
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, N. D. MILLER, M. D. - , „ ; . ~•r.• , • 4-•a
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' ; County Heahh Officer'd~ lxa) Reyf:trar 2 ~ } *~.~s ~ 3 ' ;
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