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~ CHARLOTTE COUNTY HEALTH DEPARTMENT ~
~ 514 E. GRACE STREET ~ ~
HUN 1 A(iUHUA, tLUIiIUA - 33950 r
~ ' PHONE NE. 8-1181 4~.~::.~~'
T n 1 s..- ~TAT[ ~OMO OP MtAL1f! CERTIFICATE OF DEATH
e o~ e s • ~{I Il[I1U OI 1IITAL ~TATIfifC~ RATt FILt NO.
leg~l - FLOSIDA n ;
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~~y~ June 13 1891 ' 6`w.'' o... r«,_
r r t t~ ~ZO Aiiite NIOOIICO~ OIYOK[o
' l~ f O1 ~ 10~. YSUA~ OCCIMAT~OO (04t ~t~ yuM! N~e 1a. RMIOOi Mlfll[~SOA MIO{I!i/r 11. ~MTIIKAC~ I~tlt M MtM~ INAKI~ OIIRI~ ~ ~111~1 ~11~f~
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ll~ek 1~4 1 ?A~wy ~yy( 1. YOTN[A'f MAIpcN It1?ME - -
aeorge N~. Leeper ~li~ Decker ;
. soc~+~a sccuam ~o. n. s s~.w~w~s wwn.. `
Mra Adele Lee e~r- 20 n Dr ~ -
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• c•.r ~t~. i]~. w,~nr. acM.r~ t~ wn Zk. • O/ C[MET[Ilr OII CREMATOAr tx. ~ou?T~ (cirr. Mw. r a~r~) (bt~u) ;
Remova~`~ 10 6 ~ rt eroa St L a
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I hereby certify the a~o.v;~,- :a`:~rue and~ correct copy of the Local Registrar's
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record ort file in tt~~ ~ ~n'~ l~ealth Depa?rtment at Punta Gorda~ Florida. ~
~ 1 ' ~'~f~:+iYQ''~:~
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(YYarnin : Not v 1`-id eir~;;~? d~~~ of the Charlotte County Health Department
g is affixe~'~`; ~ "
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::,?"~y County Health Off icer and L 1 Regi st~ar
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~t~ ~ i ~ ; ' • uty Local Regi strar
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