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HomeMy WebLinkAbout2861 TAis D~- ~AT[ sow~w or Hsw~TM CERTIF[CA7E OF DEATH / ; • ¦uncwu o~ v~w~ srwnrr~cs - ) srwrs ~u Ho ~ l•a•''•`- FLO$IDA ord *S~p prop~rl~ BIRTH NO. RCOIbTRAR•s NO. ~ •:~eue~d f. PLACE OF DEA7H ooc Na t USUAL RESIDENCE lw~na~eewsuswi uwwww:~r.u~~wtn •od ¦111 COUNTY • ~A~ k Cpy~ ~ 5. yi.e.a ' -1 ~'Zorida :I2rtiri ~4 r•~- b. cin w.~.w e....a e~ ..w :oa.t.? e. LEN6YH OF ~ cin cu ..~r~....r.w u.w. ..w .u..a, ¦~n~~s . Ot ,~r~ YtvtWlwH OR . ' nl.. TowNStua^t d ir_ h~s~it~, 3 a s... Town Stuart Rur~7. ~ ~ d. f Ull NAME OF Q~ M M~1tN ~r fawuatM~. p» ~tew~ ditw~ t MtYNU d STREET !If +~a1 i1s IeaiM~U ~ HOSfiTAI OR /1ppRESS ~ INSi(TUTION ;•i ''i v~ ~ o? ~ T. n^•~ o ~DECEA ED ~ ~ UtiiiN) e. (L~t) L ~Tfi pt~t1) (Dy) (?~ae) ' r ~ T S ss ~?n+ Oct,ober ' , L SEX COLOR OR RACE 7. 4AtRl ED. HEYER MARRlEO. DATi OF qITH ACE (L r u ~ rau M N~p ~t W + WIDOWED, DIYOtCiO ~y~e1ry) Wt llewto) t~r~a~ ~ awa 111~ P,:~.~~ ~ Fe,:. e t rr~ ed Ju.~e 8'T$ 77 18 ~ •lsb ,~r- 1~ USUAIOOGU?ATIONIp~n tlr d w! I~b. KINO OF ~USINESf Op t'~tRT It. pRTHItACfr ~~y~ ~~p ~1 ' pp~y~T' ..n.¦c a..+.ers,r.~.rw.arsYfw.w.r.ar.A MiRYt ~ D1.Qt s~ti -:~ouseyi fe At I~A~e C~:;ca~o Ilt~nois ~~.p. _ 1~. FATFifct'3 11ANE 1~ MOiHEI'S WUOBi NA11i c~p~~HNr GeO~`T ZI S3.~S ?,tt r . - is, wws oEC~seo ~N u. s.~wEU FoRC~r ik soeu~ sccuRmr n. ~NFOw~urrs s~r.w?ruRe Philip 31iss (tM. ~ ~~trw) 11~ sa sN+ w~r ~w ~t wsk~) NO. T ADDREfS n 1 ~ ~un•ral I~. CAUSE OF ~fI1TH MEDiCAL CERTIFICATION ~x~~r~,~, dtr~es~• ~nter oay ea~ eaa~e DISEASE Ot CONDITION sq OIt6CTLY LE~lDIN6 TO DEATN' ; i• ~~TM ¦u~t ifl• DKmnelo~ (~1.11). Q 3 ea• e•~- "a (•1 ~~t~~.~. ~c~?us~s F1LE0 pN ~~UNtY. F~' ; • i c? t~• 7~t~ ~osa w~e www DNE Tp e 1 e e• 1 tl~~ wats ~ris0. ~siw b si~ p w'~(s ~ ~ O x r• ~~tr~r ~rai ~s Aea+t Jselw. . ~t~._~i s ~d~ewi~,. sta /t t~ssa~ ~ ~M eaw Iu6 ~ } sef¦ ss ~;.~.,R DUE TO c ~ ~o~r• af- uw~liostiN rii~i OTHER SICNIHCANT CONOlilOlft u ' c.r d..t. eq~d Ie.f~. C..~ti.~. erwtn'Mt~, b t1~ i.sfL i~t,.t 3 Pf'~ • ~ or D~fer• rdstei b W ii~ca~t er eewlitiow cnudw ; ¦:tf~s aa~ 1l~. DATE OF O~ElA- HM. MAJO~ NNWNGi OF 01ElA710N AYTOKYt = 8f spe~!- t~~ ~'1n1C • sie~ ~t •~.D ~~1 ; Dod~. lYne~W) IM~11 21b, tLACE OF INJURY (~?L.L~r~Mt 21a • (gA~ , ~ ~I~. ACC/DlNT M~l. fY~. AeY~J. ~Y~ N!L• ML) f~Ui~ v~ ~ f V IC~D[ :ie. to~ cY..w wa~ ~r...~ c~..~ u., e?uuer oc~ut~m a . ~ ~NJ~RY ~ ..~?~.tQ rot.wyD ~ r~sc ~r ~oat ~ ' ~t. r lKnb~r «.k y t1~oe t oeesnasa rJ~s a~uoua ~?os~~.Q~~l s~2Z, to I~f r1 , 1~~., r~ot r re~e ~o,. rds asaoxd ~ •1 i ie•¦s eiivt or t0 2~7 1~ aed !Ae[ dialla oce~rrui at 10 A m mn tl~ oausu aAd on t~s dats slated aboi.ti. •r• te SlGNA7URE tp~rw ~r tiW) ri\, /~ppREiS p,A~~~Ep ~ eo~~l~t• t .ee.r.s.. j~hn Gunsolus :i. D. ~ Stu~r~ ^1.orida Zl 1 S4. t U R 1 A L, CREW?. ]q, p/?TE ]k, qqyE OF CCi{ETftY Ot CREMATOtY 21d. IO~SATION ((Ytt. W~,, ~r ~way) (gyy) a , C . ~FMOYAI ~ i ~ a :i1 . ~ DATi RECO ~Y tOCAL ~[CISTRAt S(GNATUtfi FiINERAL OIiECiO~'i SIClIATY~i ADDlKt ~ r.s.fsao October 27~ 55 Ethel C~Isncock- R. C. Johns : StttLrt~ ~ls. T _ . . ~a . t~ill~lilta?~~i~~~, ! Mrob~? caMify !Ah t~ b~ ~ f~t~t Nti0 CO~IaGt Cop~? Of tfi! Lou1 ± - ~ 3 rf Ys~~~ . Repistra~t r+soK~i en fiN k? th~ AiiMlr~ Cocu~ty lNshh D~psA- , , , ; ~ ~w~t at Stwtt, Hori~ta. " ~ : . ~ . .i1I' ' 't~:~~~;/ i ` : ~y"~~. r, . • t ~ _ ~ ~ ~WifAifist N~f WIId Y/1~lff rijf~ fOil O~ 1~M JIAi/1Tfl • ' ' , _.~~,~.~'i" tA`'Y` ~ ~ ' Cr~Yf11~/ ~~~t~1 ~O~filtfYfOrf1 (i iff1X~.) ~ _ : : p' .;1 ~ • . , : .:-,~'l~,;,-cy ' '.~;r:~ = ~ : ~ N. D. MItIER. All D. , ~ s s-~~%~:--.,~~ t , ' Coumy th Offiou d. Lo~l Rpfskar ~ I ~ '~t~i~'f 1 ! T ' !~j t: ` h t` ' _ c~ ,~'••.a~,~-~,,; 7d ~*jF:v'~,~ f-~ A _ ~~il;,,,,,»tl~t' bp . , i!t O ~ aOMY , _ . , . - _ . . _ . . ~