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HomeMy WebLinkAbout0864 i Recei~ed for recard thia 30th da~r o! JanuaryA.D. 19?0 at 9:30 o~clock A.X. ~ ~.90588 • „ , ccc+c.~ R ater o Deeda Da~pn t.,. e.. ~TATt .o~o or Nu~.++ CER7IFICATE OF DEATH ce~es- • ~Y11UY OI YITAL fTATIrTId RATt FIL[ NO. FLORIDA ~ L~ • BIRTM NO. REGIRI~Aq•8 HO. •~~~'ir17 COD6 NO. L VtYAI 11[NO[NC[I~M~/rrNAr/ ~N~rwti.w: R~J~.rM1~.M~w:~+) 1. ~lAtt KATN •a~t~tN ~ ~~~y l. ST~T CqMT ....~~1 St. Lucie -0~^ ~'lorida ~t. Lucie , C~T~_ TO~M.M IOC~TIpII t. K K~C[ Of DL~TM l. CITt. iO1fN.011 IOC~TiON f. K ~[S~GErC( •~~~~t u~5~0[ TY Uy~Til ~wS~ ~T~ Lw~tst Ft. Pierce .~,~'j „op Ft. Pierce „ES ; I. ~urt Oi (//~M M~~qi. ~irr rbM Wrtw/ I. STII[CT ~DD~ESf 10068 S. 17th St. Ft. Pierce Mem. Hos . ~ NAM[ ~I 1~d Al~LQt l~af 1. OAT[ MMf~ Oq Yt~r i ~cca~u~ ~n,.«a+r~ KAItL THERON HAZELBERG o~.N January 15, 1968 i S scx s caa~ w iutc ~ r~u~ao ~~crc~ r~a~KO s wrc os ~~¦1~ f.cc r~r~ r vu. ~,u. wxa .ws. ~ ^7 1 A / NOrU/q) N~W~ O~w Mwn M~. _ r/ t• ra a..du . ~It00w[O u pVO~C(0 u uly i~~ 7 ~ O ~ 1~ 1~ la. IISY~I OCC1i~~TlOA (QMf 1~~ ~M~ <Nf IIMO~ ~4SM~SSOA 1110YSTAY Il. NIIiN~UQ (9dt M M~MA tMM1) C~Iib~ O R14T Ca1MiA~/ •/t~ /~riy~NfMwNIMlMr.nt~l/rdYMl S i ~ 1 !~r2~ na C~. I Grani t Falls, M~ nn. ~ USA •Iitk l~t 1). IA7M[II S NY[ It. MOTNCA'S Y~.p[N ~ur[ Tobias T. Hazelber Helen Jarqo 1a a~~..~ia.. g ~ ~s SOLy~ y(~y111Tt p ~ a~ww • M~1IATYAt~, '~~'r•• 12 N. ~T[1dY'1/ZZ1S Drive 336-07-524 i~~;/~ti- n~ ~'v c-~ I ia Lake Esta~es Fla. 1. i 1~ C~Yf[ N K~iM IdYa w~It w s~nr Itr /..~i.. c.~. a,..~. «>.i I~Tf 11W1 i[TMC(11 ?~w ~ r~ 1 p~StT U~p p[~TN r A~I~~ta~ ~~~iLO[~1MRI~SC~YS[O~' - w.~wa c,~ w_$g,q,'2irzt_Q,r,y involve ._ent secondary te ,;i ?si. ,_„r t~. c.r- - ~ ~ tfffeat• C.d:N..a.y~.I. p~ TO (N Yilli!10 -^Z`~7 B'3~`~P:na R_ ~ .~t\ a\• tait\ we ri~( N r 1• e• 1 ~!w< <~wt (~1. i r•a~•a••• w""'~'~""k'' pKTO~d Secondary con,-estive C~".an~es /IiV aiar /ut. C ' ~/t~lw 7~ T .M~SAUiOKY ! ~ O /APT Il W~[~ SK~/Wf CA~li10116 C01TIM11f1~1L 10 OUTM ~{R IW RI~IiTO 10 TM( l~~r/IY Otft/~t[ C0~0~1~ GKU IYt 1(U S q •f- F ?[RSO+~r[or 4 l~~ ~~~t• V 11[S? MOQ ~ •r ~•r• ~ ~ ~oe ocsc~~~c ~r wu~? occu~~co tE.ta ~~vr NnJw~ t. P..~ 1 r a.t !I y~~s ~~a •~kl~s ~w~ ~ ~CC~O[MT SY~pOt MOrK~OC ~ •~f~~~~• hl ? ? ? ~ •t i IOe TIYE Oi IIN/ Xw~N. IH~. Ye~r _ v ~W~~ o /.iw. ~ ~ Y 20/. NUWf OCCUR11t0 20t. fL4Ct O~ IMJU11~ ft. i~ w ~Mtr Mns. 20/ C1Tp. TOMII. 0~ IOC~iqw COYpTY Si~T[ ~Mil[ AT ~ wDr w~il[ Q lr~. NHw1. w~~d. Gt/.. dr.) MOOK AT MiO11R ~ 21 /~~NnI~I fM 8 , ro Z~15~ •ndbatw~ A~'a~ di~~on ~l ~ ~"'8 ~ ~ . ~ 1H~fb oce~rr~d ~f _ m on tM d~b s~~eed ~Ao~~: ~nd ro tM M~t o/ m~ ~m~Nd/~. /ro~n f~~ uu~~s u~~~d__~ ' •Il ~1~~• jj~ NOMTW[ II2[. WT[ SKMIO --7 (DVMtt Wkl 72D • ca[ ~ Y ' % - - ~I~2 Oran~,e Avt•. ~ t s~ ~ •c~~r~a~. 27~ a.catr~nw tb WtE 2]r wwrcWt.rt:ea~a~t~tr~i ^ • ~ ~ ~ t Wt~/~~ ~ i~M Y?: fk~. M fw~Ip (57d~~ R o~'a~ 11- 7-68 Fla. :~emoriaZ Ce~:ater Melbourne °lc==Z3 ~ •.s.ISta s R. ~o~es rwc . 25 o.rc•cco.~rwa~uc- t~.~cwsT~•ss~raurw~[ ~ r ~ ~ ~~%~~~nl:~ :~4~'~ Iv . 7t}1 St I - - •f~.l~« i ` ~ ~ ~ _ _ " '~r' - _ `~~41 / ~ .Pie~ce,rla~ v~.i~.o, . ~ . . - . FILED ~ND RECORO~~°. - ,z ST. Lll~tE COU'~TY.~ _ _ ~ s, ~ ~i F~,~ ~ ~ _ . - = ; , I heroby ccstify this to be ~ Mie and correct copy c~ tt~~e Locai 190588 z'~~; s~ ~ Qogistrat's record on file in the St. lucie County Naa~th Depart- : -t + ment at Fort Pierca. Florid~. t*~~R 3 P~ g ` ~ - . ~ j ' - ; e ` ~ - -----(yyarrtinq:-Nat-veli~-vrtksrraisec3~3ea1 of--the St.-Lucis--? ` . : : . . Counry Health_ Dspartment is affixad.) au~ i~ ~ ~1 - a _ . ..l~ ~ ~ . ~ - ~ ~ _ _ L~ , • ''i - k%. : •I . lJ?~~~^4 _ . _ ~ s.. f~` ~ ' N. D. MIIIER, M. D. " CL~ R,~iR~.,JIT ~~U 1 ~ ,F _ ; - ~ Cot?nfy Heaith Offic~r'b Local Registrar ~ ~ . ; ' 3,~ ' ~ - ~1 ;7 j : . j ~~~1 ~ ; , ~t s Dtt~ Deputy Lacal Registrar - ' 'x~-i'-l~-' ` j _ ~ _ _ ~ , ~ r~'y ' ~ , , ~ , p~~ PA~E 535 d~OK183 P~CE $U4°- ~ _ .E~ . ~ ~r re~ _ ' . . _ . . a , .C . _