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HomeMy WebLinkAbout0643 ' ~ ' CERTlFlCATE OF DEATH Dep~rliweNl o) (k~llti ~~d R~~ii~itatir~ 1rr~irts fTA7[ IrILR NO. ~_~~1 QO i~vn~w~w ~rw~.,n i~~, LORIDJI - y w~a~. v rnu mN?as RtGISTRAR f NO DECfwSEp--r+µ~t ~uf~ r~oo~~ SEX DwTE 01 OEAiN ~ ror~w, e.r, ~ . I:I.~i,.~~ji:~r~~ 7• C.:1:)~T~~v t ~~ClilillC ~ i~~li'll 15 1~70 4CE ~rwtl. wf4M~. ~WIK~M ~..o:..., wGf-~•~~ ::.o~e ~ q~a oao1~ ~ o~• DA~E Of ~~RTFt irO~.rw, O~r. ~COUNTY Or OEA111 !IC ~ f1fC~I1 ~ \~~fMOat . tl~~lt rpti . y ~1~~ 1 i T ww~ , ~ ~hite ~,g I ~ov. 33.1 J(11 ('iilellzs C(1r. fOMM, Ot IOCAiION Oi p[ATN ws,s~ cn+ ~~.~n dps?~iw! Ot OiNER NSI1TUIqN- ~u rqr ~r uw~. ~w~ ~~r~~ ~.o ~uwa ~ t~ICI~• •IS 0~ MO n St i i•_pt,~r.shu r~ ° H ~~G4 64th ttue SQ. SiAiE Of WM ~ u..o~ ~w u~~., w~r~ CITIZFN Oi WMAi COUNT~11 MAtRlEO. NEVER MARMEO. • SUtVIVt1G SlpllSE r.~-+~N. ~ne ~uqM wu~i ~ eow»~ ~ W1OOwED. 01vORCED e veen ~ • 1~E~r Jcr~e~~__ • L~.S.1. _ ;ti,~d~~ ~ SOCW SECVMY rNIWE USU~I OCCU?~tqH .an ar.e a+w~ oo~+e wwua ros~ a KwG W M1SINESS OR ~HONSTtY ~O~awG urf. Hre.. M tlnelO ~ ~t 152-12-3:~ ~L ~s U lESWENCE-SUff COUNT~ dTr, TOMM. Of IOCATION ~fw cm ir~n STtEET ANO NV ! ~N Florida ~N Pine2las St. c , ~'etersburg ""`"'Ye~"°' fATMf~-NM~E .~a+ +i0a~ usr JMOtMEf-/MAIDEN NAMf ~yu rex~ usi ~ Thoma$ L. Smith Emma J. Swith 1 ~~~~-k~ w?SM~G wOG~ESS ~s~an o~ a.~ o. Mo , cm a~o.n, s~.n. tr~ ~ 1, W 1 ~ 8 - ~l 1~ : ~ /I1tT 1. pE/~M WAS CAIISED Lr: ~EHiE! O?~lr OI~ UUSf IEf IINE FOt (ol (e~ A1~O Icp Krne~w owsn wr a~ . u wWOMR C~Yf~ ~ Occlusive coron artery disease Years i ~o«~,~o». ~ M1w~Cw O~tl f~U q 1 IwrtW~li C~YH /M. NIf t0. OI ~ LOMSf011lM[/ O~: ! st~i~NO tw~ YNON~ 1~~r6 c~YR ~xsr ~ ~A~t ~TI~R ~K.Y'11 (a'~ITlQNS: CO~pDOrl CO~MMY~w~O 10 OY1M W1 wOt tlu/W M C~YlI GMM ~M ~I~M ~ b/ AU1aSr M Y[s ~~N I~MY~wOf CO~? 17~) O~ MO~ YN~~O ~M N1~WMM6 C~IA o~ e~ar ~w ~w ~ 11DM_. O! U10~lEfYMlp ~~rr. O~a, ?eV ~ MpW IN1URr OCCUtRED ~ e.et~ wnw p~wun ~r ru? ~ o~ ~.M .n. ~17 7M ~ M t~l ININ~~ AT w0lK MAGE O~ silUR~ wore. ~.u. ~rrn. r.cwn. tOCw~10n ~ sotn oe ~ ~.e. wo , cm w ww., sru~ ~ . ~ waw ns w.a ~ oww ~o.. ne. ~ vecw ~ 71~- !M ~l CElTM1CAT10l1- . rPAt~ o~~ AY ~Wrw~ o?~ ~tV ur ut~ Lr ~wr/rtt uM Ow ~ MO/oe +~O? rMr M OlAIM OCCYYlO 1M ?utf. o. w~ ~MItKUM: TO ~~M - O~~ 1!Y WO~ UR! M~1M ~MOW ~ Y~i~. ~M. q 4! ~O ~~*RMto ~Mt p r~ aMO~ntOG. eM 1M OlU~HO ~W~ _LTI? ~It ZII ~M M t0 M Gwf~it. f4~tp C~KAt~ON-MEDiG?t Ezw~tNEf O~ CORONE~ or rwe ~.ati o~ ne .~ow a a.n. .re auaMi w.f www.~cro w,o ea,uw.ro.. o. we wo..,ro~w me Mreaiw.~w... w.+.o». +a.~y s~ . ~py~ ~+a~ ou~ea o. ~e w~'+~e a+.+p~?~et,aus~ s~ s~.no u111LIlOlii!! ApI'll. Zrj ~ 1~0 nu 1V ~i ' CE~T~HE!- " , - f SK,N ~ ~9$~i a~~d•~n~. DwiE S i~ ~n:, c....w ~ t7~ t•- . s t~ 77~ ~ ~ ~ui~ - . n ~ r n.a a a~+•. ~ n 33'7'~1 " Ol b~~i ~t . So. St . ~e'~ersbur Fla. ~ . sN! aEMATO~f-NAME IOCATION C~n q q.r sr•q N. ~ .~~h -r_ r ~~ctors Sereice, Inc ~ St. PetersLurg Flurida D~R_~~~ - ~:~i~ rs" fiOME-lu~?~F wr+D ~ODRE ~~nur ~ ~ ~ e. wo . crt~ w ro~r. ~~.q. ~ ,w . ~ ~ q?~s 1'uneral ~lome ~`~5-9th SL. fio. r~L. i'et.ersburr, Fla. f~-- i ~ ~EC'+1ST -S~~Ty/~ _7 Ow Ct~rtO ~r pip(~y ~~it~wt _ ~ r !Y CG ~ ~ ?N 'K - ~ 7 lJ a :`n' '':i ~ ~ 1; ~#hat thia is a true and correct copy of a certificate =t~~q ~ffice of t6e Local Re gistrar of Vital Statistics of the ~ ~s ~ ~pit~~~ Q~~_`~.' ~ 8ealth Departseat, St. P ersburg, Florida. ~ ~~lti ,.3 . , Aor.~ 20, ~1970 /t?~,,%Y-y ,Deputy Local Registrar ; r ;..EG " '7 rZECORL~ED ~ ~ J U.~-rv FL;.. - L~~~;tF ~ , _ : t, . ~ ~ " „ . ~ yy263~ ~ . 2y ! r - -~~s`~-`_ - . ~ . . r. : ~~_~RK CtRCUij COURT ~OOII P1l6E ~ r