Loading...
HomeMy WebLinkAbout2192 . . ~ - a--- - - _ - ~ . S4~ ~ ~ . - • - _..._.~.~5.. _ _ . _ . . . . ini. ~TATt sonao o~ Niw~tx J CERTIFICATE OF DEATH ~ =a... • ~URGY ~~ri~,w .~~n Na .~o o:~~ =.s., ..a_ FLOBIDA ord ¦A~w SIRTN NO• RtA16YNAR•i NO. prop~rlT 1. KAC[ O~ OLATN COD[ ~to. ' 2..~uww~ wcuo[wutw,..r...~..+~..~ a~..wn...: !~:/rMh.~~:~ ~ ~ e.a oo~~Tr ` S~pRlpp BRIsVAItD - .~a .i~l BRLVARD =/O e. Pi.e.~ s. a us~aNCc 1 n *~t- CIiY. TOw~:. OII WCA?IOM t. K~LACE Oi DEATN t. pTY. T01MM.011 IOCATIOM NKIOE CITY tW1TS1 .iniwe s'~? `~"~TS~ TIT0.SVII,LE rc: Mo r~i.. TIT~SVYLLE vcsX7~ Mo0 t~uwc or tq..t t. ~..~r.r. ~~...aa~.tau.) ~ steccT ~coacss . i~~ ._JESS PARRZSH NH~IORIAL H06P1TAI. 115 BRO~INING AVE y~ pATE ~ Xw~r~ D~r Ysr 1 NAM~ 01 F(nt J1/Ii11t ~ i~;~«~ prpZg NM. HOI.BROOK ~?TM JANUARY 26.19'j0 s. scx ~ s. oo~ai o~ ~ua 7. wu.,cn ~cvc~ wuu~co OAT[ OF WtiM f. .cc tt• rr.n s~ca ~ rw ~oca ~~ws. e• ~LE WHTl'E w~oowco ono~cco JONB l~i.l~i ~r..w a.. r.r.. ~r:.. i~ 10~. usw?t oawaTnw f Oi~e ~~ar Nwt Mw la. KINOOi WSUIESSOR IMO{KT~Y. 11. WTNRACE (St~ft M M~ tN~E?I~ an~ as .~w oawnm .ie~'~~~ 1~~ ~w! sw~~(/~w~pt+N~/+l~kv.mw~i~~wN1 ~fT~ TT L~ - U.S.A. s~o~~t. 17ff~'~Alw(7r 17M1~ 1'l1.7.Sllari ' . )1 ~ ~ k ! ~t Il iATMER'f !M!1[ , N. NOTMtIt'S 1410LN W1ME ~ . ~ c~~~~r~t~? .NIWP flOLBR00K E[.IZABEI'H HONTER SOCI~L SCCY~tTY MO~ q. INIO • NaNATY~ M4sN :?35-10-8258 NIRGINIA ~i0LBR00K~ 115 BROWNING AVE. T ' INTEAVAL /F1M[[M ' ~a c.vK w~s~?Tw latiw...r,...«r..s~?u.~~r. w. c?~.••~ c~~.~ .`.FI 0 RECORDED'` o~a~r n.nouTN ' run•r•1 ~~r~, outNrnsc~usco~w ' ae/~G ' ~~/~lG~ ~ .u•t`t11• _ 1MMi0Y?TE CAYSE W - • E ~a. •.r- • RECORD ~~~Fc1~lE0 tifis~t• ~ J •lt~ tA~ ~Rk~ ~ r~~p/~~• ~ ~ u~ 1 o a • 1 ~w r~=l~tr~• ~ 01~ TO (t) ~ ~ •isni~ ss M'M a.u ~~+t. ~ fAIIT M. Of~i11 S~KwR GO~OfTWMS GOM1MRw~ i0 0[J1TM MR MOt 11[tATtO p M/UrYMI OKG![ COn01i10M GN01 M?YT 1(a) . wAS AUTOKY Aour• ~t- . ' t.. a..a~ . raD ~oEX o r s~ t~?• l 0[SCRI~[ MOM pU1MY OCCYIt~E0. (AMa w~fwt ~I/Ytf11la ~ ..k~.i ••s ~ AOCWENT w~uoc ~~uoc _ CLERK CIRCUIT C URTj r•. O ~ YYA~• •r ~ NNI r~I~ YSr . a - i mr. wuu~r oocu~co m.. n~cc or wxair u. v.?wr i..r. ~DJ cm. Tow~, o~ wuTaN oou~mr sT~n MIM0.t AT ~ ~ar vrM,u ~ 1~~.!«~•~~. r•••r. yk. a4..•rs.) ~ MIORK AT MO11K snd /s~t w ~ r~ ow ~ 21. 1~f~~M~I ~M d~oNrd /ioa+ . Io i~rr~ DwtA oee r~d ~f ' rn on IM d~t~ Nat ~bw~; ~nd to tA~ 3+at o! snlr~C7~o~~NdN. J~om tA~ uuiu at~t~O. al l fa~~• ~2?. AoDIIESS 1~l~7 $T• • !?s: wTt W.IItO t?~ N T, (DrMa r~w~) J / i O ar• t• 1~ j ~ / ~ ~ 1 eo~~l~t• ~ . ~ l~ a • t e ~f~t~. ~~T~ ~ a~ j]~. NAME Oi CEMET[R~ OR CM[MnTOiIY 27/. IOCATION (G~fI. fMr~. M tM~~) «~t) B~~l'L`s'"~"' JAN. 29.19'r0 BBEVARD M~40RIAL PARK BREVARD COUNTY, F'IA. v. ~as t~M? o. ~?Tw~ SMrP'I!°"l~'4~N9tAL HOME ts. a?n ~uco. ~r wcu ta. aT~~s sw~u a... ~.as ~ / - a.? 7' - 7e u,,,~., ~d~.c . I HEREBY..C$RTIFY'1`HE ABOVE TO BE A TRUE AND CORRECT COPY OF THE RECORD ON FILE ~ IN ~TI~E~_.,T~OC~ ;ft'~iSTRAR'S OFFICE IN THE BREVARD COUNTY HEALTH DEPARTMENT.' .~(~ibC vsl~~+d ut~I'~s~~` ~he seal of the Brevard County Health Department is affixed) , ~ 7 . ~ : ~ ~ - . y -~'r i~ . - {.j - ji ;~~n , f ~ ~ ~„'~~-,.r.c-c-c~ 3~ /C • f, . J / T^ ~ Deputy Registrar ti- '''YL'~~` ~ ~~J,~ _ ~c ti,' ' ~Y ti s r,A's ~ ~ ' . ~ ~ ~ ~1~,5 _ ~~9~ : ~ YS•'tl~;,~y ~-Y . ` - _ : _ -