Loading...
HomeMy WebLinkAbout0318 _ + ~ ~ l9 238 in~• D.- ~TAT[ ww~ a? Mtwt.t~ CERTIFICATE OF DEATH co¦as • ~YRGY OI YITAL fTAT1~TICS STATi fIL! Nd - '°a•l'•°_ FLORIDA o~d ~6~a 61RT N. A[GIiTRAR•! NO. 1 yrop~el~ e:~eut~~ 1. KAt[ O/ KATM COD[ N0. 2. YfYA< RWOCNC[l~~~rrMli~r. U:+w:~+.a t~il..rMh~~ir:~) •nd •111 COY~7Y STATf 001lNTY be pl~e~~ •Sti Lucie 'd C 1 n y~ pT11. TOMM. Oq LOCATqM t. K/L~CE OF OEATx C~Tr. T01~M.OR L+OCATION t. t5 RES~DEMC[ ¦an~at WS10E CITY UYITSI IIISIOE CITY LIYIT51 ~1t.. Ft Pierce res~ ~o? t?ier e ,res Mo ~ l. ?u~E OF . UI Mf 6 My$~1. ltre ~Oreat sf~rar) STIIEET A001lESS M06MTAL 011 "~~"1T01 Ft Fierce .'~em Ho s. wwMC oi str.e I~ti~lte t«c owTC 1?twn Dn Yea ~ AHTHUR STAidLEY rRYAi~ o°~`~tN ' . ~~u~ Aovernber 21 196b s. scx i. •oo~o~ o~ ~ucc wuuuco ~ NcvcR wuie~co arc as wTw ~ec n«. s u~oo~ ~ rw uror. H~ws. t.~e a.u~a) r..w o... k.... x:.. i c• I~i W vnoorco O wwecco A 2 il i 7 i$84 82 p l a 1 e 1~ 10~_ U5UAL OOCWAT10w (Q~/e tt~(1~rMt fMt 1~. KINDOf W57lESS OR WOYSTIIY )t. NA7MqACE (Sidt p~i?sV~ qaAb/) 1. qTtFil OI InMi COUMAYt . i er ~•r- t~+LI ~wt N~?WI Ak. ae~ y.etvsq , ••^.nc Salesr~an ReLired Kansas USA ~ Dlaelt 1~t ~j.lAT1iER'S IMME 1{. ItOTNER'S MAIpd1 IY1Mt ' o,p..~ia.r John D. B ar? Sarah A. Everett ' ~ 1 1GS OEtEASEO fY[II W Y. i. AQMEO iO11CtS1 K. socu~ sECU~~Tr No. n. u~n s wau?rvwc ~cn J. Brvan ~ ~ tr.....~..l~.~!_ _Ltarwltsi~...~r..~...w_ i , - ~6b=I.I.-20i3 --wrt.~ $0? S. tith. t: : ~t'ce, a. - F u n~*~ 1 1~. i4Yfi 0/ KATN (b1Ne? MJ/ Nt ~NM p lfa~ r? pI (t).) . IHTUYAL ~E~MEEII ' . d 1 r~ e teT ~~T l OEAM tiAS GYSEO ~1fn proncho ~~TM r,,. w•~co~~ cwsc ca pn~umonia 4 da s , c~• esr- ~ titie~t• ~ ~y.i/n/. " . ~ i t B N• ~ 01L TO (1) 1 o e• 1 ~ENt t~pue~~~ r~ a i s t r~ ~ K~ti~I qs rwler- 04t TO (d •Sthaa 7i 2 J~iy qur 1W. ~ • T o u r• ~ 1MT IL df1E1 SK1s1CJMf OOUDR1016 GOMtA1rtMG 10 Df~TM MR MOi REUTEO 70 M 1Elu1YML pSGSE C.Oi011D~ G~01 ~1?Mf 1(~1 . M AS AUTOrSY , f' ?EJIFQ~MtDi ~ a..a? 3 Uremia- Yephro-sclerosis - puLnonary embolism ~„op or b~Cor• r, ~ mp.pE~yE~~YOCCUR1lEQ (bl~fa~[Yrrs ~ k 1 es a~~ ~ ACCIDENT SYICIOE NOMICI~ NW~r i~ Pvt I~. Art l~ y4a~ u~ • ve~~- ~ ? O ~ el ~ Tu~E oF Hwr X~. M/, Yar Dod~. V IMJYRr : S w. i _~l/. IwlY~11 OCCUIIREO 20f. rIACE OF INJUIIY (t. i~ M 1W~f b~t. mJ. QTY. TOKM.OR IACATqM 001/IIiY STATE j WX1l,E AT ~ wr wMat ~ lK..h~s. wea../ks e?y.. ete.i f ~RK AT rIO1lK - ~ 21. )~tNn~frdtlwd~owNd/~om ~ l~ . to ~U=~~ndl~stwr A~"~a~ ~li~~on ~ ~-~-bEi ~ DwtA ooournd ~t • a~ on rA~ d~t~ ~t~nd ~eor~: ~ad to tM 6Nt d ap kno~IM/~. /roai tA~ uuw~ ~t~t~d. A 1 1 LN~• ~~~~T~ j s. (uep« r wts) ue. aooRCSS tts. eie~ sw~co ! °°'p'•~• • J.H. tiatsche I~.D. b Delaware Ave. 11-2 -cb " . c c ~ r iT . wiuK. eaer~?noti 236_ a?TE 14ME Oi CEMET[RY OR GREMATOR~ t3t. wuTaw (GYi. tw.. a~w~rA (&rre) ~ ntrov~ (8 ~ 1 , Buri 11-2 -ofi Hillcrest 2-.er~ Cdns. FL. Pierce Florida ~ ~ Y. 9.~!1 a 2~. ~ FWEltal OME 'S SICIIA CY11 ~OR~}l . Jt.. ! ~S. OATE 11EC0. ~Y IACAL REG. ~E615TIUR'S SIGII~TLLRE . a"'1°6b 2-~.ilton til. Baird Ft.Pierce Fla. 11-28-6o Anna Lee Denison d.r. t ; : . • s ' FILEO AND RECOROED : { j . i heroby aertify thb 1a be a true and correcf oopy of the loui ~,=T l'.;CiE C~JUNTY ~L?'?~~; ReQistrars record on fils in the H~alth ' r; _ r ti~. ` ' St. Lucia County pepan. . t = . ; ~ ' • ~ ~ ~ ~ > s~, msnt at fort Pierce. Flotida. 19Q~ , y , ~ ~ ~ . : ~ ~ t~~~,` . (WuoinQ: Not valid unFess raised ~al of ths St. t = County tteahfi D~p,rtrrknt ~ ,~~s.~ '70 FEB 2 4 PM ~ f : - ~ . . a~~ ~ r$'` j t M~.y ' £..~C ~ ; , , , ~l~,~ rf ~ ~ , N. D. 1WltER, M. D ~ 4 ` ~ . 'y ~ ~ County lieatth Officar 3 locel Istrsr ~ •4!Y ~ `r'~~•3'` ~'~vk ~ % Re9 ' ~ R r CL=RK CtRCUtT l3R~~' ~~I'%~~:~'~i,`s~,,~ ~ :.fl~~ :~'~i'.,i±~~.~~..~,_. ~ De~wty bca! Repistru ~ ~ /C~ . ~~/il~~ t . ' _ :a.:` . . . . . _ . ~ 3~$ _ : - : . - , 7 ~ : . ~,.a : , k x ~ _ ~ ~ T~ _ . _ " e,,, ~ ~