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HomeMy WebLinkAbout0247 - r~ - - ~ 194418 ~ ~ ~ FORM VS.90 ' ~A~ ~ . . OOPY OF A REQORD OF DEATH ' o iTATE Of MAN~E OHARTM@1T Of l~AITH AND WElFI1RE - • f/,~. Q/,OiA111 2. tlfYAl wli001CE w~...+.i.n.w r../. M:....w~.n:...i~aK. Mf«..iirx:.w 1'i~YC~ck sr~~ MaiYe k couMr lY=~c~c k _ _ - O ~~~J . . OR WCATION c LB~I~iTM Of tTAY IN ib o CITY. TO'WN. OR IOCATION ~ . , a . ~~lYl $tlEi t~l s il~:;; of ~.a,w. .+r..a _ d s~t ~o~=-~ a e~oercE on w r~~ °~lue 1i121 Mem. Kssp. r~ ~ ,,p o Naw ~ 'a ' ~f OECEAi~-firq Naw~~ ~b. Middb lian~ ~ k laq Nt~ . 1. DATE Ma+1b ~op Ywr ;..-~.r ~~W~I'~ I J• 1 j+ 1 DEI?TH.~@ #i~ 1 1. 6 ~ S. iEX OOIOR OR RACE 7. ~w..cw a w.« M..~:d r, ~ATE Of ~IR?H J1GE (In wr.. t ti.e. K r„s.. t~ . ~ ~ male white - ~ N~v. 4 1900 ~ °ij~ - IOa USt1Al OCCU~AT~OWIG:w uw a lOb. Klt~ OF WSIWfSS OR 11. Nt~FIKACE (Sw» a fe~~ cw^npj 12. CITIZEN Of WHAT t O.o ret,.~~r~'.,""a wousntr N w Y USA cour~~ra , ,r," ~ S fw~ers r~ ia. w?on~rs ~ wu~ ~s. w?,~ oF s?ousE c~ ~e..:.d? ~ B~w~r~l LuYi ~'.~r Crawii~rl 3~s~liYd Schaefer p! M u. wws au~sto tna~ M u.s. NMCO ?o~st 17.SOC.SECURm?tro tt. INEOItMANT ~ ndd~MS Me. ~ 0 M. M. w w~.) lM yw ~iv~ ..rr w~w~ d s~n~a) \ « y ~ ~ ~ ~v. c~ of ouTM c~».. ••~•r~ : ~ o.. k~. co~. roi. ~~+a c~~a M ?ART 1. DEATM WAS CAUS~ ~Y: owsEt ~uo oE~tw a IMMEOIATE C/WSE (a) ~ ~ ~ ~ ONE TO (b) ~ . ~ ~ ~ ~ W ' ~ M~o.w 1~~`«. ONE TO (c) . ~ 3 rARr a. onfEt s~c+i1?~Gwr ca+onw~a w e..M ew ..la..s a M..~:~d s....,. ~ona:aen ~0 y~w.. ~n ?an Re? • A Y ; ~ ; chro~.ia u1m~YSr fibr~s~s ~R~~~, ; .i-~ =la /1CCIOENT fllK~E tWMK10E 41b. OESCROE lIOW IHJURY OCGtIRREO. t~r...ew...r .,y,,.r M ro.+ i w?«. n er i~.~ ~ ~ ~ 3 ~la TIAAE Of N.w ~arR o.r. r... f ~ p WURY ~ i ~ OCCNRRED 21~. M~IJ ~w « ~Yw~ ~w.w. ~lf. CIiY, TOWN, OR IOCATION tOINiTY STATE ~ ` W . i o W~ipR~K AT . Vyp~ 1""t 1'c'°ry• w.w, eic. w~.. .~s.) ~ ~ ~ Yla M~ICAt EXANIrlt ~ i ~ ~ «..y nb~~9M'~ q~ 5 ?5 69 ` ~ ~ a....~. ~.r... ww .r.... ~ a~.~ i r.w « cM»+:~.~~ c«..r.~ a ~ . ~ ~ ed~++. ~.~a~ 7 ~ aw dr ~~i~ M Mr Ma~wi « n9ri!~ rl d w~ ~w rM AoN ~ad a8eve. i C s~. siow?tuis m.,~. « K+.~ 2w. • ~k ow~ s~c.~u ~ z ~ ~ ~ ~ 0 2ie. 2 DATE 2k NMAE OF CEIMETERY OR CRE/NATOR1f ~Id. IOCATION (Ghr• tow^• x csunhl (SeoN) + ~ti~ ~~y o ~ Bra F~ er~l K~m~ lsw~ h~~~~~ ~ ei~ut~~e~'~e . ~Zage . ~ ~ ' ~ ~ ? 'S l~pt This iastro~eat i• ssa~rd~d ie erd~r to ~or~e thero~hl~ FIlEO A ia.atir, t,b.t o.~, n~.t~, c.~itia.a reeorded in ST. LUCIE COUNTY. FLA. p~tioi~l ll~oard H~~Ic 184 pu r~:;.:.. pa~e 27ifi et tbe blie r~a~rda 1~~418 at. I„oi. c.~mt7. lloria.. .rbia6 .s. m..tiat.at.r~? i~s srpr~dYCtim ~i Nr s+~o~rd~s. 10 ~I. 9: ~6 :~o;~`Wco R~s !:~ERK C'RCUIT COURT. ~ 185 ~ _ _ ~ _