HomeMy WebLinkAbout0492 Z j~
192521 =
sate so~a ot 8~tb C:ERTIFIGATE OF DEATH st.~ ~ue No.
Bureau oi Vitat statistia F L O 8I D A R~°1'~ N"
l. PLA~CE Olr DEATS: USQAL ~ O~ DDGiAB~
o u~ c~v Indian River ui.a~oc rr ~ Florida ~bf c~z et. Luoie
~ IDl ~~n fWrlten~me.notnumbeel ~ No ce~ cev ae ~ 1~ . Pierne L rurnt l
~ cc, owa VeI`O Beaoh ~z~ po aW~atVae~ra~~~nwuu~wa.r
~ at s~wc xa. 9aint j,ueia
(d) Name o! haspltal ot tostl (s) Cttlsee at ~b[d~o oamtqt
~7 (It not in hosptt~l ae t~tiWtioo. ~rl~ a~m~bee ae !ow ) NA
(e) L.eattA at sW: In Ewspltal ar ~M Oe Ifo
~ At place o! dea ~ 7M. ~ '4
(Spect~9 tLae 7e~t~. mOnl~ o: d~s)
~ ~
z~
~ s. ~n.i. Hw~ss or n
z ~ (a) It ve~eran. • • ~ (b) Soclal ~aatb TaTCaT10M
er
~ o. name I~o !0. Da~ ot D th;~ontl~ f1 Y~14~ t
Y K~ H.~' tns ~tt •
o~, w e~LYA 1e s. v~o~ ae u. i mst t m. a.e...~a
s. slnsle. m.rdea. wlao..en or mv {
~(a) I! marrled. wfdow~d ae dlMOCeed. httbaod d(ae) mat h~. a1IN m0
~~~o fh~! a~m o~atrd oa tbs d~l~ aoQ bota ~a1b ~bo'~. D~t~i~
w~~ 6(b) A~a o~ hu~b~od a! ~lE~. !t ~ltt pt1N ot 8•
t~ ~ 0 1_ B1rth d~te o! (mmt~ (d7) (7~~
R. Aee: Years ~[ontes Dq~ I! le~ tbm qo+ ~
~ ~ 50 10 10 wa ; ~
B~rcea.ct
~ cc~a. s~.~ o~noo~~a~ c _ cme~nevr.s,,.oo~.?,mms~ia.ae
10. v,wl occuy. ` t - :
D~ 1L Industr~ or e' - p
? ,To~ ve _ _
~ N~oe _
A ~ ,a, ~ tieh st - ~
~ ~ ~.~~z ~F`'~ ~T/
l< llalden ''S" ~
3 - i _ =
B~ ` .8 da~ w aa~ to .~sEeee.t ens.~ en fn m.:oUo.ms:
~O d ~
. L L~ s.
1a. InlOrIDanY~ StBa~ tPtob~L17) A~l6eaL ~1C30~ (~tfl
1R (a) A . _ (b) Dat~ od
(o) W~e d14 t~a! ooe13'f-~
v s.tM ca n~e wurs ooarr m or n~oms.
m~sn~a.~~meudriat~pta~o~, -
17 Date~~ ~7 t7 tb) ~
is. 1~lmeral DleectorU 1o DuD11e piaos t'DS a p1~)
; _ _ ;
` ---a y~o~
lt (a) _ _ - -
I - Whfls a~ ~ OLiYl0~1
~ 21. * . . 1i t
~ ~ ~ yern Rea~h? r1A_ n.~. •K ~
I
I
I
~
!
i
~
FI~ED AND RECORDED
ST. LttCl~ C~UMTY. FL;,.
~ . . • ti,-;:,_.~
. J
192521 ~
'7Q t',?P 22 Pl~ i: 43
~
- ~`i.~~ ?i,cJ
CL~R%~ C~~,tltT COURT ~
~
~
~
~
~
;
~
`3
3
3
~
~
a
..`y
s
rS',
c~
s~
~k
~ 8~~~8~ .49z
~ -