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HomeMy WebLinkAbout0442 ft~EO ANO REGOROEO ,T. LUC1~ COUN'fY, F~A. ~ ~ t~F ~fl(ir1 ~rt': !F?F~? - i~f~`712 , 'TO Jll~ 3 t PM ~ 2 : 06 ~ ~ : : . . ~ ~ :;p ~ ~7p;TR :S ~ CLERK CIRCUtT COURT t. . . C~~RTIFIED GOPY ~ WE NEREBY GERTIFY THE CUi~Y REPRODUCED E~_ J:ti TO BE A TRUE ANO CORRECT c:OPY OF 1H£ ~?~a~. RECOftD ON FII.E IN THE c..REA„ ciF V~TAI STAiIb~IGS OF THE STATE OF ~PAR1'1N6t~T OF NEALTN A!~~ RE?+:.BiL:TATIVE SERYIG:ES. DIVISION OF NEALT ~~4V~.`FLORIDA. . ti.., . . ~ iNOT VA OI..X~E~~TATE OF F~pR~C+~ ~ Cs~ ~ ~'~Eh' ~+CAL7i1 AhU RENABILITATIVE ~ stpvlC ~A~1 ? ~ ~ M ~ "~=i~ h W ~~v'"" ~ ~ . j I? ~ ~ [.r ~ . •L~~ Oi Vllwl STAl1iTtC• VS8 ~ l~~ M~ r~~~{ Iv ~,~'~'K •~~Tt •~G~fTA~A O~IIE«OR. OIVIfIt~N ~F ~ . ? ntl~1M L~(YAIl~M[HT OF M[ALTN AND ~ ~ r1 1- ^ ~~T1V[ LCIIV/C[9 S . ~ X ~ _y~-~~... _ . . . ~ .T„t~~`' ~ CERTtFICATE 4F DEATH 6~ O 1~ 9~ ± P fTATE FIL[ HO, - - - . - ~'n Hp~~ , yr '~~'•~f FLORIDA R~GISTRARB 'v0 1/IACI 0/ O[ATN ' GOd[ NO. ~ 1r1W1 A[{IO[MC[ •a..r~K~uNi.••d 1'w~.~.t.•• Rrw~+al~~a~.h~.~~..~' C ' « Columbi•. ,d ' ` F'_ ric~ ~ n . .___.z - . o C.tr '~)Mh ~sR ~tX~1~N~ r :9~~ft O+ LiATk ~ . `.:'A~ ~'~.'~'~JN ? ~S NlS~CC~:f N tM`.-M T~ S~ViT;r ' IMS~W Cltv l~V~i~~ L.~ke City~ Florid,~ . ,~S`~ ; ;~ll:~h~ssee, Flor`3d~ ~r rE~_ t---------,. . 4 n~1rA ~A -~/IMf 1~~NyN~1.tN/11~cttNfrtq: M S '_'~EL' •;'~fSi . ; _ . MGS~I i ~ l 011 ,M,T,.,.~, Veter-u~s Acbniniatra~ion Hospital 2118 Joe Lou1s Street _ _ _ ~ ^ _ Y ~ - V _ _ _ -=-~>s- 7 M~M~ 0/ ' i11r~ u ~I~QIIt Ltr: 4 D~TE A[wtA O~~ Yta~ e~c~.~so f}eorge ~.~:LSO!". o~TN Harch 8~ 19u9 ~ l~pt M {~e~nh S'(t 6(.`~c~A nA A1C1 ~ M/~A{~G LJ N[VIA V~RNI[C L~~1'f Ct ~'~'r 9 AG['~Y *t1q U'~D!R :~W iAG(JI~ MS i/V Ant~eN .Vw~4 D~p Hw.~ V.. M~1@ } Nioowcc~ a~cau~ E-2-1a90 l-~ ~ ~ ; • . L_ . ` lO~. ~.S~.41 tKC~.f~TM?y : r,K• ~~a~u)rat 4s~~ t'J?, RI~O~ ~US~NCSSON iN0U5~11r I1 ~~'rr:~~f ~Y~ e~ (~rr~0~ ra:s~rY~ ~qt~n~ p ~w1i GO„rr~t• ~ f .?u/ wtM rariia~ JU~ rn~ ~/qfuN~ ~.aboarer unlaioWn Flarids DSA , - 13 f~tN(1! S IUYt - 1• Y~!N(~ S YA,pLA ~11Y( . ~ _ ~ Milton R3asaa , - Bl~ck Palmer _ ~ 16 ecxy~ 3tR~~tr ~o Il 111/0NIA11T t N~MnTY~t 266 Ol 6022 h. J. I~'~ Chief Meriic~l admit~i.stration Division V~Ei L31ce Cit Florida ~ ~ ti 6AYN M«ATN A~It~ MI1 ~M NYIf /fI bY ~N 1~1. (A~, ~RI lf 1~ ~ 11fT(11VA1 ~qN~[CM : l4R1 1 0[~1M M~S CIIYS[D `i 1rCi~A ~t ~~8ti3tie ~ ~~'ii'8 M IBYt01~TL CAYS[ (~1 . , _ _ . . . . ~ . - ~ - c•..t~v.w. ~f.~r. ow ro - - . _ _ _ - _ . . _ . •Aw~ Nre r~ re - ~Ia~ rw~r ~i~. . hyM~~~r l~art O~t t0 ttr . . - - _ _ - - - - t ~ ?a~T n OtMt# S~c~w/K~ G~Od~0~4 CO~rM~uttiK t0 OUrM M M01 11tUrflO TO'M 'i~~Mt ~S4ft fC~tqM GirG~ tM ?Mt ~l~l Au O?S~ ~ ~ IIrIO~ ~ Pulzaon~ry lntsrction O ~c . - - - _ - - _ - h jp~'i14.Tif~~--_._ . _ - " !On txxsiM ~w ,NJUII/ ~CC.;R4[0 E:•~• ,ors•~ v~sri~t Po?t 1 a /Wt f! y Uew ~ « KC~UlMt Su~: ~W ~VK~Oi ~ f' ~ _ _ . _ . . ' ' . ~ . . _ . . - ~ 19r ~w1 c~ //~r~ , AlvR~~. P~~. 1'~w ~MJYwY ! M . . . art - i M/ niUa~~ Oew~M 20r ~~~et r.i ~p~~~~ rr w~•err ~e¦v 2^ ~pw• 0~ dx?'~ur+ fM.MIr sTitl r~~u ~t Uy w~~~~ .Nj ` h..s H?.r. «~in. ~Ai~t ~.7~~ 1T rr4~~ ~ ~ /~e • d~d ~A~ dn ~~u2d /r.~n j'D CL .~7G7 ` . e~~ r ' - •nd /l1~7//~ilt/'P~/"!' ~-}~S~i~~ ~ ~ Dw~~ ~ u~i~N d J=20 • 1~~ 1- --A+ nA fh~ d~~~ ~N~eO ~Aor4~ ~~nd te fH~ 61~f re~~ Fnowhd~~. /rom tAt ~~uws~ ~ lL~ MMI~tW1t rtr y r d2' .r~~t~s i!s na?~ s.G~an t' t , + . • ~ • ' Il :f, t ~ 9AH I~~KE CI'i'Y FLO - - ? ~•ea ~+n.arrN 2V+ ;,~~1 J4 MYI MlIM11l~~ O* cRt~~~.+• I~f .Of~TKM~ itV~. tprw. sr ro~~t~~ i>td~: ~.t~'~V'-~`~"'" { 3-8-69 ~4reernrood t:emstery ;T•~11_~t?assee~ Florid~ _ l~ ~ .~1~1N~?e~(tf, . .s~~~ q ~ • •t,ri , . _ ~2! D~~t ' ?OC4 RlG 'tWSTAAII S SKd1~TUf1[ ~ ~ G ~ t ~ 1 4 f< «G~7~ ~ ~ tt~r~ .t/. ~ea ~ ~ ~ , MICROIIt~I l~MO I.l~tbitttr ot wtltfn~. tpping ~ R~~ ~ er prlntln~ ~~atiafa¢torp in ~ ~ ~ ch docuia~nt tor wiccofil~in~. - _