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HomeMy WebLinkAbout0708 _ ~-`~8g~ ~ ti..~RTIFlCATE OF DEATH ~rput~w/ a( Ika11ti ~n~l I:~a{.alil~tlre Se+vice~ fTATt F~l[ NO. IM\'lV(AV ut FLORIDA ~ iYlf. OR ?f~NT IN ~~w~'rn•~° RE61iTRAR'S No. 389 ?(RMANINT IMK SEf Ml#DIOOI f0! ~CEwSfO-?+M~E ~~~si .wa~ ~•a~ ~X OwTf W OEAM 1 ~OMiM, ~~t~ ~ ~siwcu°'s , WILLIAti1 S?IITH Gi20AT i~tale ~ Au ust 24 ~ 1 O 66~2 ~CE 'rwry. N~G~O. ~r1~K~~+ u~p~M. AGE-~~ft ~`~D1~ ~ r[~~ V~.61~ ~ D~~ OAIF Of ~tfM ~~W+IM. Yf. COIJMr Of OEATN ~~t. 1 YlCM~ ~ \~~tMO ~ ~ tl~~f 1 ~Of i 4~1 I MOV~s rM. n~ 1 ~ White w~2 t ~ .Jan 5,2908 St. Lucie C11r, iOr+n. OR IOUtIpH OF DEwTM w.s.o~ cm .~.ns :~pShTM O4 Oi?~Ei KSTItUiION-N ~r ~.o~ en.a~, ae~n arrn uo .rrru ~ v~cu. ~~s o~ ro Fort Pierce Yes „ 604 Gardenia Ave STwTE O/ WtM ~ w ro~ M+ ~ f~, w.+~ CIT12fN Of WrWi COUNTRY w,RttEO, ?rEVER w~ReKD, SU~VIVNG SWUSE ~ r vrra, pm ~~of.. w.,r~ ~ uwu nfw..c~ ' c~~~ w~ppwFD. OrvORCEO ~ ancnr ~ ~~ew York • U. S. A. Tfarried „ Helen Ewers ~MM OKf~lfO u.e~ o a.w SOGwI SfCUbiY NIM+~E! USU~I OCCV?wTiOn ~ar~ a..~ u.rw~ oa+~ owwa ros~ a [1ND Of MJSMiESS O~ 1nO1JSTtY OCCYMlO M rO~WG ~~tf. lYIM \l~~~FO 1 ...o., u. I n s e c t o r ~:553-10-8219 p ,M Aircraft 'M'?w" tESWE~+CF-St~~f COUNTY Cti11, 70wN. Ot IOCwT~ON wsw twf ~rm STREET AND NUWE! ~ veurr r~~ p s.o Florida St. Luci Fort Pierce Yes 604 Gardenia Ave FATMf!-fiAME r~p~ .ww~ ~ u1~ IMOTl1Ef-MAIDfN N~MF ~rs~ rOWt Wr ~s William S. Groat Ida Leason 1 W01WA?~T-NM~f (~w4wG wDOtfSS ~ae~er oa t~.a wo., cm w ro~.., a~.ra, tr~ ,~irs. Helen Groat ~~n 604 Gardenia Ave. , Ft. Pierce Fla 3~+50 IAR7 OFwiN wwS Cwu5E0 ~r. ~EHrER ON:r Or+f UuSf iER lwF fOe fe~, p~, wND kp ••r t..., ~ ~~~'NM Qwy(t ~q p~TM q ~..ew cwa ~ " I ~ 4' " G-~ 1 e 7` s «aa.+~.ce COw~~t~Ow3, i~ .wic~ G•.t ut~ w l~l rrto~•n c~w~ ~a, ~~o. p.s . co..uoue..ce a. )~~~~MO ~M! YM~~~- \i1l~0 C~~Y l~~l t (t~ ?wRT Y OTr~E~ S~GnY~GwT CONWt~paS~ ca.ana.s caww~n~.c co a.a. wi »o~ uu~~s ro cwu a~n. w ru~ ~~o~ ~~r . ~f vES .~.e r~wo~wcs tow- ~ - ~.~ti w wnuo ~r oan~.u..~»a u~u ~ a ee~~w O ~w tn~0eDb1 KUDEM. SNK~OE O~ A ~~onn~, W~, .e~~~ NOIM MOW IN/U~Y (lCCUt~fO ~~~n~~ wMt p ~MNn ~w r~n ~ p r~n e!~ i ~qr~K~OE: O! ~MOEIEWWEO ~ ~ +M M ! r~r ~NIU~~ Ai WOtK ?IACE Of Wl11fr .r wo.~. f~re~. r.n~.., ~ IOCATION ~~w~n o~ ~.~.e. .q.. utr w b.w, sr.h ~ ` ~~?e4n ~fti W MO ~ ow~U 40G.. [K ~ sMCN~ ~ ?w M! 70{ CElTii1UT~ON- .o..n~ wr ~w ~ ..ouiw wr r~u u+o ufr f~~r wr/we~ u~+e ow ~ po/w+~s~ vMr wr D(AiN OCCUMtO •t m1 ~uG. o.. n.e IM1fK1~lI; iO j ~p~M Mt riY MM ~~1~~ Ol~1M IwOV~~ O~A. ~wC. p M N3T mMfD M~ 71~ OIGi~llO I~O~ . O. '71\ 17l~ '3~ p r~ 1r0~?tlO6f. K~ ~ 71~ ~Q ~ Ib K~O M 4uM~f~ lt~r~o CEtTIfKAT1pM-r~EDKA? EllAMiNER OR CO~ONER. o» ~..e t.~~s o~ t~.t ,.ou~ « a.t„ fwf OKlO(M ~YV 1~pr~pyw[~y p~~ ~auw~t~p.~ d M WO~ ~N/W ~wf Mrlft~WtUw. ~r ,~y.~0~+. ~ ~OwfM N~ ~t~ wOY~ OlaM OCCWMC OM M! Mw nMOIM b NM 4Vfl~f~ 5~~~~D . M rn " µ • CftT~f Ef_ ~m~ •~~r. ~ Ss ~ eeey~ p~ one ATE O~ TM, wq ~W~ ' ».~'1 ~ Lc~A n S Y?~t ~ ~ ~ ' , ~ ! a ~u+IHG ~ SS CEttK[ . ~ srne. w ~.r • ..o ~ cm n o.r . - t,t ' !7~ ! ~ ~C C~ S a - ?UR~A?. CRfwM110N. ~EMOVA? Cfw~ETfRY Oi CRf~wa7pttr-_N,tMf tIXwT10N un p~ p~r.. st.n ~ Metr~ ~ , Burial HiiZcrest ~fem Garden ort ierce lo ' a ~ . OwTE ~.a.nM. wr, w~u~ WNEI1w1 NOiME-NwMf AND ADDltfif c tu~a M~.~.o. ro., cm w Wrw, tr~n. iw~ ru Au ust 26,~97 x.Fort Pierce lOb So. 4~ St. Ft. Pierce F2a ~ O ' v. 5. t81? fuw~lye) D+RKTOt-SrG~yL,uRF ~ rtfC.i1* SsGwwrutE ~r ? ~to ~tw ' a.v. ivto ,~iCSlGtG~ t,~.-~.~T L~ : ;.c y Se tember 4 1970 ~ hereby c~ert(fy th~s te b~ a trve ~nd oorr~ct copy of tha toco) - Reflistr~rs record on file in ths St. ~~unry Hoat;h po}-~art~ 'F~~p ANO R - m.m .r wn P~ence, Flor~da. ST. IUCIE CO - (Wuninq: Not valtd unleu raised seel of th3 St. Lucfs RECURI? V.~~~".;,:"'j_ f'? . County Heelth D~partment is affixed) ~.~~84r ~ J.'.~`%i . _ ,'!~a~ ~ ~ ; ;s t.,~ t ; N. D. MIItER, M. D. ~ 1 O SEP 4, t: G z~;; , ~ , r`? fi''~~4 ~ 2 t: ` ; ~ Cow~ty Heal~h Oft+ter d~ Loa! Rogistru ` ~::,h` S` ` ~ f ~ . .1_.. ~t:s'~ ~ ~20G~k" ~ ~ • _ ~ CLERK C1f~~t~T'„ . ` . . ~ ~ Dspury Loal Roglstrar ~ , ` Y..~-'•.{~..~~~~~' sooK 187' ~~~t 'r~~ ` - - _ ~ _ ~ _ _