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HomeMy WebLinkAbout0069 _ . - ~ ~~33~ . , " ~ 194289 ~ v y Tols e~- ~ ~TATE .owao o~ N~?L„~ CERTIFtCATE OF DEATH co~es a •URGY OI VITAL fTAT1YTiCS fTAT! FIL[ N~ ! i:a:i t~c- ~LV1L1~~ t ord •~en BIRTH NO. RE61 RAII•f HO. ::.c.i.i w?ec o? w?rw cooc Na. z. uww~ wcs~Kwut•.~..r...rw u:...,.r~::.w..rw~...w..w~ i ~wl sill ~ ~A~ ~r *l~e~~ ~ ~ . i. ~•r- R Cmt.TOrN.01t WC111q11 a?tACE Oc oEATN c. dtt.7ow11.o11 wCAT~011 e. a RES~oEMCE - •~~f~t MWOE CIT1I LIMIT51 MK~OE GT1I UYITSI til~. ~s[]( w res? No~ I. NAME Oi (I/M! i~ Ml~ifrl. fMt I6pf MJ/p~) IEKTN Oi STR[ET ADDi1fSS 011 A fMMI • NOShTAL OII STA~ YI H "'sT'T"T'°" Ft Pie e:. mo 'al D "ts~ "~O 7. NAY[ 01 Fb~f ~ A!i/Ift bYf ~ OATE X~wN Dq YtM K~ M~ G lad i~a rIe HcGauran ~`TM 2 2 60 s. wc c. oo?o~ o~ iucc „~,~o jD ¦cru ~w~co p~. a?TC os ~ TNl ~ ~~„r~i w..+. ~ a*..~ M~ wr~.. ' a s. Female White ~noorco p wvoRac l~.ar. . 11 ~1 ~1 ~ 10~. uSUA~ OCCIMAT~Ow (Qirt ti~1 ywrt Aet 100. KwD oF wSIMESSO~t u~ouSTRY 11_ N1lTIMLACE (8~fc M/~reip ew~b/I . 1 on7EN os wwT ORMlt~trt ~ ~1tA l~?L~I~t~/wrtialbJr.nt~i/rphrN) Corres ndent i~eWS er Grand I;a iu~ :i~tt. L'. ~ 11~e! i~t Il /A?M[11'S wME 11. MOTMER^S rAlOEM 1u1rE ' •f - ~n••~~~•~ Geo e Conklin Bertha Knur.bien ~ ` ~ IS- MAS DECEASEO EYER M Y. S AIIMED MRCESI K. SOCYL SEq~111?1I N0. 17. W f M~MATYAt i ~r~....~.......~ u......:.......~:.,?.....~ J.W.Yates ~ ~Io e Fl a TuN f~l 1~. CAYf[ N KATM (Batd wtI Mr swa >er tiae /r (s). pI (d.] IMTE11YAl ~ETMIEEw ~ir.es•r rMT~ awn~r.sc~uscosr: . ~~AODO~TM ¦Y~s t~l• WMEONTE CAUSE W ~ ~ t\• t~f- ~ . • ~ tltlt~t• ~.[r~..~. ~~q~. a~c ro (H / ~is~ tl• r~K~ ~ru~ ~ 1 • e ~ 1 ~e nrae , i f~s?stt~r l~ h~t Oui TO (t) . ~ital~ 7~ . MIASAIROrSY i O MUIT /L O~IiA AC1~/~hwT COOO~i~ar6 CGNIWIJtrG 70 DuiM ~11? M0~ REUIE~ W tft 1~u~M~l OtfGf[ OO~OIiIOw ilYiw w/MT ~(~1 ./E11i+011~tE0i ~ 10YT• •f- . e~r a~~s~ 3 • . ~r ?~t~r• ~ rES? ro -•rs¦s ~~s ioaocNr w~uot ~ Nor~uoc 20e. ocsuuc ~aw ruu+~r occwuca (~ra wvs yiy..~ h a.t !~r P~.~ 1! y~a. iN •~~~i- ? i.e~. T?~TS r~... xwr+. o.r. r... S r- W = i0r. ~wnx~r oocuiuco m[. KACE OF INJYRY (t. I.. if M~1+1rt w~t. lOf- MY. IO~R Ow LACATION ~IINTY . STATE ' 11fM~l.E AT ~ NOT MNR,E ~ /~?~t./~[q?I. d/td. ~~[t Ol<I•. de.) . MIORK AT IrO1tK • 21. l~ft~ed~dfMd~oNNd/rom 9~ ~ 9 , to 2~23 ~na/ytN~ A~'a~ di?~°~ ~ ~ : Da~th oeournd ~f a~ on tM d~t~ ~t~t~d ~io~~; ~ml te fM bwt N e~ 1no~Mdp. Iroe~ tM uu~ ~t~f~d. ~11 lt~~• ~L. NOMATWt (Dpr[sMfYk) ?b. AOOIIE~ 7?t. OAT[SKKO . •r• t• e~~~l~s• i !yt '1 2~ •0~11f~t~. 23~. ~Yw~l. b~EWT~1. Z~. OATE . 27C. ~M11YE OF CEMETE~Y OR C1IEYATOQY 23/. LOCATI011 (Cif/. fMn. M tM~f~I ~8dt) . rov+~t (S 1 . G~`remat~on 2-2 -60 Broward Crer.~ato Pom o Beach Fl r. s. tsis u. w~c~ o~ -s s~c~unxic ~oo~css a_ a?rc ~cco. ~r ~oc.~ ua tc. ~carwi~s s~uurn~c a...~9ss Jose W. Yates rt.Pierce F2a. -1-60 Anna Lee Deniso ' F1LE0~AND RECORt_~~~D~ ~ ! M~Y ~fY thu t+~ b~ a trus-and come~:t oopy of the iml gT. LUCIE COUNT~. iFi~:~~, . Replshars record on file in th~ St. Luct~ County He~hh Dep~rf- ~ . m~m at Port Pisrce. Florida. - RECORD VEFt1~t~'~3L~.:~-_:>,:: . , QAf~minfl: t~lot valid unless raised sesl of tfie St Lucls 1„942Q~ Counry Health Dspsrtment is affixed.) • ' . '10 JUN ~ ~ ~~F - . ~ . = ~ ~ ; N. D. MIl1ER, M. D. ~ . - - ' Heaith Officer d~ Loa! Rpianr R 0 C R~~ , R'f~ ` ~ - ~~aK ~tcu o~ - ~ . ^ ~ - • ~ ~ ; Dd~ • Dspu~y baI Re~IStrar = 1 W A` 0 ~ • . - . ~ 8~185 ~ ~ - ~ ~ ? _ _ _ _ _ _ - x~ r