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HomeMy WebLinkAbout0440 t e~•~._ ~wr~ ~o~o o~ N~?~.~+t CERTIFICATE OF DEATH ~ ~o••~ • ~u~uu or vn~ ~nc~ liATt ~ILt N0. ,.t.1..~- lLOI~IDA •rd •~~e R!O A11•i NO. . pr~~illf COOt NO. . YWAL ~f1K11Ctl~~...lwrNwd. 1/inw...: t:il...~.1...+.fr:..) ' ~ ~ 1945 ;1. n~n ~ .~a e• ~1~••a l• ~~f CITY. TONN.OI~ ~qCAT10N t. 1S K~C[ 0~ D[AM t. C1Tr. TOwM.OR LOCATIOM ' t. K IIES~DEUCE •..~r` • 111SIpE CITr IIMITSt ~ IIK~OE C1T1? LIYIr31 r~ i.. $ res w m n _ ~u?rc a ~ry..r a ~..r+ai. Nw.n«r.u..u~ 1. ST~lET AOO~ESS , IIOSIITAL O~ INSTITYTION NAM[ M Flqt NI/Yt I.~M 1. a?TE ~/wH W? Yea ~ ' ~ l1lf1R7V~[Liii] M~ BRA~~ OUTN ~ 1 17W ~ ` SEX ~ COLOII 011 ~ACE ~ MAR~IEO ~ MEYEII YAl1~1E0 ~ OATE OF NIITM ! AiE (I~ !~1 i IP~0011 vW IIMO[A ~I Mi y,r 6t?rwa) x..w w.. r«.. x.+. r t. Fe1Y1~ T~h1~ Mnoowco avo~cEn 3e t. 26 1~ bl p 1~ 1111 ~ 10~. uSU~I OOC1M~?TIO+~ lOia ti~/ yva! N~t IOS K~NOOF NISUlESSO~ N~OUSTRII I1. WtT WLACE (~~ft R JMrM~ ar~tr/1 1. CR~ta os twlt Oouirlwrt •ft~ ~~r- Irrt,~ ~NtN~t4Nhk.~1/retMd) • ..e~~a tious~lrif~ Olat AOnN Aevane Crib~ ~ Olt~~ L~k ~_/ATME~'S MAYE 1~. YOTNEAY MAIOEN IIAME ~ Lsura Jo~r Erxin Aar socu~ sccuR~rr Mo. 17. s s~~u?w~[ wu?~a . , 218-18-861It Jnlian L. H~emcian Britt Rd. RFD #~1 Baa~ 175 - Stmrt ~lorida I 1~ eNMt M~TII [E1~/er Nf1 Me cws /a Rse r c~l. (sl. K).) IItiERrAI KTMEEM , fun~f~l - - y~ D~EA~~T~M~ E ~i•~et~r °E•TM'""~`"'~`o"'• C~rebral Yascular Accid~nt ~7 i •~~t Nl• IMMEOUI[ CAYSE p) t\• f~f.- ~<ie'•~~~ ~ o„E To cs~ rt~nai~s Cardio Vaacnlar D~is~ase _ ?sars , . . . ~ .e... ~'7.~. ~.Si.t~.r M~tfsl tk rder- ot/E to (N _ •ftAfs 7f M~? ~ra tYt. ~ ~ruT u onq s~srr¢urt ooswnoMS coKr~wrtwe ro outw wr Nort ecuico ro nrt ~r~w wsu?sc oo~~ C~ w?Nr Ka) rr s ~ orsr Aour~ •t- ~ rE~FO~MEDf t~t A~at~ Np~ . o r~~t~r• t - ~ OE3t~~~ ~ww uuu~er oCCUR~EO. IERta w~trrs e/i~jrr~ iw P~r(1 a P~M 1/ yMes 1/a ..tfe~ •w~ ~a~aMr wK~oc No~rKia at.~~~t- O O c t~~ ~t ~ T~wE OF Hw. Alwt~. M/. Ys~r - - ~~d~• ~ ~MJUl1r s. mI INJ11~Y OtCUMEO me. KACE 0/ INJUI111 lt. I•. ~ M~l wnt. mJ CI?'I. TO~N. OR 10GT101t ODUIITr STATE NMII[ AT ~ Ip? MMKE ~ ~w• w?td. ~tt EfM~. dt.) . MO~K AT wO1lK / ~fand~d tM d~wwd /?oa+ _ _ . fo •ndlNf M~ ~~fi?~ on DNtA ooeusnd ~t m on tM dat~ ~t~f~d ~60?~: ~nd to tA~ 6wt o/ af~ Rno~bdp. Irom tM uuw ~t~f~d. • i~ f t•.. s~w?Tw~e ~nM.r. r wr.? itb ~oo~ess !?e. w~ s+eNCO _ •r• 1• • John M, d~meolns N. D. -3tnart, 1Rorida 5/2/66 •tttlf~l~. ~~T~ j~ ~4YE O~ CEMETE111f 011 CIIE~AT01111 LOGTION (G~f~, twn1, M tMUI/) (8d~1 Rewo ~~Y'"y'' /4/66 Dslra~ Crs~tor~ ~i1rsT Beaob _ ~lc~id~ , v.!. f A i s 2~ suN[~ [ s SKN?n~E ~oo~css 2S w,s Rrro ~r wu~ Rc~ tf. Rc6KriuR•s sw~u? . s s Ron~la & Job~s stw rt, llorid~ 19b6 ~.andr 1~ti~t; j~~;7 FILEO AND this to be e tn~ and oornct oopy of the locd;; ST. ~LUCIE C an file in the Ma~tin County Health De~~tF ~ " s P. E C 0 uatt, Flo~ida. ~ = . : ~ M`'' (Wamin~: Not valid unless raised seal of the Martin ; . ? JUfi ~ 2 ~.9 dg°unty Health Department ic affixed.) ~0 : , ' = 1~~551 ~'jf. - . : - N. D. MILLER, M. ROG~' R POITRAS County Health Officer b local Re~istrr , CL~RK CIRGUiT COURT? • ~ r"`~ G` '~G irn~ eooK 185 PA~ 440 o~. ~n? ~ ~ _ . - - ~ ; ~ F ~ Y ~ ~s'"~;~c~:'~^' ~"-~~.~~r ~r - - . „ is~ . -