HomeMy WebLinkAbout1473 r
~ ~
~ ~
~L ' 3 '
i
4'Hif INtTRUM[I~T ?R[PAR[O ~Y ~ ~
CHESTER B. GRtFFIN
1~1/ILLEg. BITTAN Q aRIFFIN 1932()~ ~
? R O. OOX 30Y . i
S~RT'~~~~. FLORIDA 3]480
RE; Lot 2, Block 3, RIVER PARK SUBDIVISION, Unit #1,
according to the plat thereof on file in the public
records of St. Lucie County, Florida.
WA~NING: - M 1~ IM~I b MYcsN N~ sMf h? ~MNq~ M ~Mhpa~.
~rs-iw it wr » ~ .
t2s c.n. ?..?1 COMMONWTi/?LTH OF PtNNSYLYANIA •
~ DEPARTMCNT OF HtALTH J
s~.~, ~R~~. .T~,~~ N° ~ 18 7 d 8 i
LOCAL R8GI8'TRAI~'S CEBTIFICATION OF DSATH ~
liRatscerea I~lo. ....~fQ~._._
Fuq Name ~ j ~ ~ ~ !
of Decea~ed ~....~Y.,~. j
~.e Mwri: ~
Address~i.4..!j._ - ~
dM « C.wrr ~
Place of
Death Prasaylvaai~
--G~r.
M~w~? ~r A.w+r
Qatt Of Dtat~f _ ~......SOtli~l SltutitY No. ,....r ~
i
w ~
MarFta! Stahu. - .:'a°'r's°rr-'~q?~.~,w._.._Date of Bittl~~
. ~
OccaPati«, . _ ~C~ ...c r~ '
n .
~
If Veteran. which War ...._____..~...Vebera~'s Sais1 No.
MEDICAL CERTIFICJITE ~ I~eerval Betwcea
Part I. Death was cawed bY~ On~tt aod Drat6
~ iate Cause (a)E~.._K'ye.T . _]?~-s~tl ~
;
Due To (b).__._._, ~f
±'~j
Due To (c).... _
Part II. O~I'HER SIGI~IPICANT t~ONDI'I'IONS: oontdbutiaQ to death but oot n1~M oo the tsa~ediate caare yivw in
i Part I (al ' -
; ~ OY~JL~ ,
~ ------_______._.Y.__...___ _._.__._.._.~....r_ -
; AccWent. Sutdde or Hamiade Ha.v did in~rry occnr w
I
~ Name aad Ttde of Peraon Q ~
f I Who Certified Cause of Death (M^D., DA.. Coroner) --.~..~.~„1~1277.• :
€ +
f ( Address..__...._.___~__._....~ ~
~sw"~ ~ ~r
° 'll~is ~s to certif~r that the informstion herr giv~ is caxcdY caPkd froae an
c~ertlEicate oi dcath
~ as Local Resistrar. Tbe ort~iaa) cfrtifica0c wi11 be fonvarded M State Vifad Statistin.~Harri=but4 PtoasYlvaa~for peraiaamt
filinq.
Y
. ~ ~
~
~ ' W~..t nw s~xa orrw M.. ~
~ f ' `
51wM Ar/IM~ W?r MwwM. T • c~_
~ ~ ~ , r _ ~9 ..s?_ ,
o.~...~...
~ r~~~
~ ,~L. _~~a. :
~ ~ - ~ ~ ~
~ i
s
~
Su
~ FILEO ~PlO RECOROED
a S~. LUCIE COUNTY. FLA.
a:' r' C:~~;; Vcr?~F~ED
~ 19320E;
~
~ '70 P'~Y I I ~I IC~ : 06
` '~r~,c~~?a~S
~ ~
r: t:r?;~;a nS
~ 6001(~~~ PACf~.4~ CLErtK CitZCUIT COURT ~
~
~
~ ~ u?w oFnccs
WILLEB, BITfAN d~ GRIFFIN
w _
; P. O. ~OX s00
~ FORT PIERCE. RLORIDA a~460
,~s`~
- -a
. - 1