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Home My WebLink About2533 ~ File S-1592 I.F13 ~ Oe- iTATt BOARD o~ Hcw~,n+ CERTIFICATE OF DEATH y cuaes • BUNUU OF VIT/U. fTAT1YTiG~ tTATt FIL[ NO._~ ~ l~aa1 FLORIDA ord ¦nrn BIRTH NO. REGIBTRAR~S NO. . properly rUt[ OF O[ATN COOC li0. 2. YLY4l R[f10CNt[(~?~w.Irr.~t:..t !!wew.w• Rr.r....W.nd..ww) . eaetuted ppUNTY STATE A. COUNTY .na .,1~ ~~irt Lucie (D(D-p - ~lorid~ Sair.t 1,~cie ee ylae.a 1 a p~t- A. C~TY, TOMN, OR LOCATIOM K~l~?CE O~ DEATN ~ t. CiTY. TOIIM, OR IOCATION t. K RES1D[~i[[ •~O~AI . ~NS:~f C/TY 11Y1TS/ iN~lp( CITY 11Y1fS/ r„~. :~or ~ P_e~ce YESL-'~ c~ort Pierce „ESp I. M~yf Os (ff tN! iw ~1yih1. /iK ahtN ~IlrtM) I. STIlEE7 ADDIIE55 • . ~"~T~Ta~ Pierce :ie^o~i~1 .~os~~~~a' r-525. South Indian ~iver Drive - 3. Iu?Yt oF f1irN 11/i:Ilr LW 1. WTE Ale~t~ Da/ Yr~r ~iyruwy.~.?? •.~IC.'TO? UUvL.'~"~ ?,A-^.S~~j cnrN Janua~•y 11 19::3 S. SEx i COIO~ o~ ~uCE 7. ' DATE Oi WTM 9 A6E (l~ ttpl ~ v.a~ t~wt wu[a s~ wes. ~ MARptLD~~N[VERMARRI[0? 1f1~dRlMq) XwW Mw Xwn Mi.. ~ r r i c• ':=,1C *•r;ite wiocwco~ avopcco Juit3 3~ 1572 75 p 1~ 1 n 1~ ~p~. USU~I OCCW~T~ON (Qisr ki~/ y rM! b~~ iOA. K~NOOi ~UStNESSOA 1KDUSTIIY 11. NATWLACE (9dt w/NSi/~ cw~Yftl) ~2. CJT~iEw Os rwT OOtM~n~ti~ •ftA P~r- ~rria~~wty~ratialh/qaewlJr[tisN1 - ¦~a~nt ~,.s~ect~r U. S. ^ TZZ1jlO1S U121f;C'u States .;overn.-~e- t ~ Dl~ek lnlt ~ATtiIR'S nAME 11. MOTNCR'S MA~DEN NAYE ~ or t~~~~r~t~r ~ JOh:2 i_zrso:: ~~na~aiia~le if socu~ sccu~~rr wo. D. ~MSO¦ s s~ow?TU~c 45 5 SOttt. IP_C;l~. ::1tii~r Drive ~?^--3;~-°~ Pearl ?_a.~~c:, Pierce "~_orida 33%~a~ lun~tal CAY~t Of O[ATN (F,~fa ~w uwr fi~e~.r (0) (cl.j ~ , IMERVAI /ET [N ~ dlr~etef ?AlIS1,OC~TNM~SC~~3tD.~Yr OcN.S~ETA ATM ¦u~t fll• IMNEWATC C~uSE L~- ! ce• e•r- - ~ 1 i ~.(/{/"o «rt~.o. cow.u~...i/~~/. OU[ TO A1 `~.i~ ~ ~ ¦lt\ tA• rAit~ /~t ru~ p 1 = l l o e w 1 aGat r~~u } reaistrar +«~a~ t~le rwf[r- f p~ TO ! ry~Ra c.rn t.,r. 1 - - •1~010 72 Z ~ O /MT 1 T SIf.NIfKMT 1qIS COIriR1~1/[ Tp TN T R iE0 TO 1[RY SE iqll filY01 N?MT 1(~) . MAS AUT ~ Aours •t- r _ ter de~tA v ~ K11f0~ ~ o~ O~for• ~ ~ V j~ lP?~W? l 2pp. pEKp~ Mpx yuURY pCCUARED. (Eafo • ve yf~jw~ iR P~rt !a Pot Jl ytftw 1J.) dlsp0•!•p' ~ ACC~OE~T SUKIp( NpY1C10C ~ tios ef v ? ? ? , ~ J TIYE ~ IINI? ~(~IU~. /HI. YfM . Dod~. ~ uuU~r e y. ~ 20Q 1MJU~Y OCCY1111E0 mt. rIACE Of INIURY (t. I.. in m/. nN. Y~K ~ IOCAS~0i1 fONNTY ~ S1ATE - ~ lYN0.E AT ~ tOT WM4E ~ ~A. htla/, H~ttt, ~jftt Gr//., dt.) _ MONK AT IMp11K ~ Z~- l~tan t d~cua~d om 9 1 64 . ~0 1 •ndl~st a~~ hX~ ~f:r~ on D•~ tl~xe m on fA~ d~t~ s~~r~d ~bw~; ~nd to tA~ 6~st o%m~ Ano+/~d/~. /rom fh~ uuNS ~f~t~d. ~ •j u. sinw?TU t~, tzs .ooacss 802 N. 7th Street °"TE swNCo •rs to Dt / , Fort Pierce, Fla. /12 68 •eeur~t~. ~4.~r~iA~. j,3p pATE 2 M yEOfCEMETEN~ORCIlEM11Tpq~ j3/.IOCATqN(Cif~.tNw.~?~or~t/) (S~M~~ R(rOti~t (\jNn/~1 ~ - t: /13/~2 Fierce C~e:.~to~=~ I'o~t Pierce, ~J.orid~ Y.S.~012 j~ NAEM~IOiNECTOR557611ATU11[z~ ,t~oDpE ' ~ T~~. WTERECD.~11lOCAl11E6. 26-RE6KT4A11'SSw1tATYR[ ~ - fL S ~'.:::`ic1.1 ~'.V.. d•P"'~ ~ Ae7.1968 ZajCj ~C~~'E(/ . ~ ~ ~ b~ $ . - r . r-~ . r _ ~(~'flf~Jf":= ~ . . ~ ~ ,`~,~"ti ~ a - . ~ , hg~~ Y ~;t to.~;~ ~~rect copy of the local FI~ED ANO RECOROEO Regist't~~` ,f!"}on file~in~•the St. Lucie Caunty Health Depar~- c7. Lt;C1E COUNT~ ~CiLN. - ~ ~ te Flori - _ - - ; .n ~ me~t at.~~ott. 1~~J~~ ~ r. -(VYarQing:;NoAvah~}..iu~lea raised seal of the St. Lucie ~ Counry Neah~i°~bepartment is affixed.) ~ F 27 ~2 • oy ~ ~t~ ~ • ~ • - • , ~ . ~ . ~ ~ `~~r~~i . N. D. MILIER, M. D. ~ _ _ _ Counry Health Officer ~ local Regl:trar ,,,.4 : ~~lS~.:.~/ ~ CL~FtK C'?C~I; COURT ' ~ ( -(7-- b~ _ ~ ` - p~~ Deputy Local Registrar d- r, , ~ ; t ~ BooK~$4 ~~~530 ~ ~ . _ . .