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Home My WebLink About0853 TAti e~- ?TATt ~o~~o or N~?~rn CERTIFICATE OF DEATH y • •UR[AU OR VITAL /TAeI*1'IW S'TAT[ FI~.[ NO. ` :•R•l ~b~_ FLOSIDA ..r4 •A~n BIRTH NO. G ~TIIAR'~ NO. c-fop~'1~ 1. ~LAC[ 0/ O~ATN G~p t NO. 2. YWAI w[SIKMC[(w4nlw.r.rli.l //:w~1w...~ RoN.rM/...1~.:ri..) ~t~eut~d OOItNTV L• ~iV STAT[ OOIIMTr •^d •~1~ Broward L~-~~ Florida Hrowurd D. D~.~.a t n O~~- C~TY. TONM.011 LOCAiION t. ~S KAC~ O~ DEATN t. tl?1/. TOM11.011 LOGTION t. K RES~DENCE NISIOE CITt liMiTSi 1MSIOE CITr IIMITSI Fort Leuderdale resg~j w Prvr~ L~uc~er~~Ie vcsi~i wu ~ I. MAME OF (/JM/ 1w M1yYd. /w ~bNf ~It~M) IEMOTN Of STR[ET ADOIIESS OM A iARMt ~MST~TUT WM 3TAr MI 1? YES ? NO ~ Hol Croea Hos ital 2 re. 8810 N.E. 20th Wa 3. NAM~ 01 FbM AIM~t LMt DATE X~ D~/ Yt~r l~j~Mpi~t) Frederia 8~. July . ou?Tw Jan 12,1963 . SEIf OD1011 OII IIACE 7. MAAR~O ~ IEY[A MAA~IEO ~ OATE 0/ MATN AGE (h /fr~ 1~ 11MOi111 ~W UMOER M MS. 6bHlq1 X~~W D~w Nw.n Yf~_ . uale ~Yhite ~p a„~p Dec. 16~1904 b~ p[~ 1 a 1~ 10~. USYAI OCYWATION (Ql~t t1~I ~/vM! Iwt 1~. KMIOOi ~YSNIE3S011 M1011ST~11 11. MQTNKAQ (~dt M/Mtl~ pr~f?I) 1. q~1~110~ M~M~ OOIM1t~f . i t ~ D~ r- /~r1y y w?tly t~p~ wrw 1/ r~tird? ..~.~s Dentnl~echnzcian Odonto Lub New York U.S..1. i 1~ e k !~k 1 j. i~TME11'3 IMM[ . MOTMt~'S Y410E11 IMYE ~,p..~se.r Fred Jnl ~ ---Lilrtsn Ha,rter .~.y. - IS. MAS 0[CEASED EYEII MI Y. A ARMEO fO~GESI . lOCIAL ![CVIIITr NQ IL • M~MATYw[ ~ I~. r. ~r ..~r+w1 lU w. ~ w~ iw~ H~w~iw1 ~ - No - 3T6-O1-9830 ~«6610 N.~. 20t a b. a derd e ~ ~ ~ er?w~ ~aa...+, o...~ r+. eM. c.?. a~..~ c~~.~ , i AN D~ " ~ a~ u r ~1111T L OEATM NAS dYlE~ ~e ~MYIEOMIL CAY![ (y ~ ` ~ - •u~t fl~• tAs e~t- . - •~!_-.r~!:1 ^ F Y. R~~~ , , .?c~~~e~. ~~ktw.qyn~r. out To N). - ~ ` _ ~ ~ (i~ _ ~ ~e~.~ 0 p r~Rlstf~i OIIE TO (d ~i ~ - ( ~ • •tcaiw 7~ ~i~ l~. • O /MT 11. OT~1 SK~IICM1~ 001lII101~ 10 OGfM ~IR 11M1E1 i0111[ liAlliMl 1(~) . MA A Aour~ •f- F . - ~[RF011MED1 c~r A~~tl ~ ~(('C - •~O ~ o. ~.r.r. 4R~lrlF~ ^ ~os. ~ 20s. ocsa~c Mon ruu~r ottv~~co. (awe. ww.. y •,~i•s ~ ~caocMT wKioc ~Kiac IT COURT ~ a?.r.•~- ~ 0 CLFRK CIRCUIT CO . ~ ; ; t•" ~t. TIYE OI Hwr NMN, Dq. YMr uuu~r w. X A. I ( 20/. uUUl1Y OCCUI111CD mr. /IACE 0/ NUUQ~ (t. I. b v~! M~t. GTr. 10aM. 011 LOGiqM tvuwii S7wie ~ rMr.c ~T ~ Nor wM~t ~ lMw. J~rt. ~t?ed. Nter MrI•. ~k.) t MOIIK AT MOUK ~ 21 • ! ~tt~nd~A tlw d~w~»I Rom ~ ~ . to ~ ~ •ndl~~t w~ A~'a~ ~/i~~ on JL / ~ ~e~ 1 ~ DwtA oeournd ~f ~~~Pe~ en tM r~4~ ~f~t~d ~iw~: ~nd N fM !Mf ol ev lnowhdN. /som tA~ uu~w ~t~t~. ~ll 1t~~• jj~ {~OMAri~[ ~ a r• t• 1• ~ ee M fYb1 m' AODIIESS lls. MTE S1GME0 ~ ~o.~i.c. a / ' ~is. 1~` 'C _s/ C!!_~ : /f'G' 7~ ~ . .i~• y ~ ~ e e ~t ~ t~. 27~. ~~1. ' nal. Z~. OAR MAME 0~ CEMET[II~ 0~ CI1[YATOInI t~f. IOCATION (Clf/. twr~. M ewnfp (~W) ~ ~ 11[rOtl4l Sptt~/rl : Crema~ion Jen lb 1963 Bo al Pala Cremator Broward Count Florida v. ~.~ei~ t~. ru ~ Ys~uu?rwc ~?ooan ts. arc ~cca w Rca_ a4~sriu?e~s Rc ~,•.iass a-2. Fort Lauderdele ~ ~/%f~7 .I.`. ~ ~t~ , 'X, , a•7''~, ~ . ~ ' ~ 'C,r., t~~. ~ ' ' ' _ ,4' • . • ? ' • I ' _ v ~i _ s' ? r ' e ~ CERTIFIED COPY I hereby certify the above to be a true and aorreat aopy of the Local ~ t~e iatrar's record on file in the Brovard County Heal~th Departnent at 8 rort Lauderdale, Florida. _ ¢ . ~ ~ (warning: Not valid unlesa raised aeal of the Broward County Health Department fe affized.) ~ . ~ ' , ~ ~ ~ , . - , . ~ ~ ' 4! . ~ ' , / ~ W 1 ~ i V ~ - _ ~ ~ . T' ' V . ~ ; ~i y°; ~ County Health Offi r and Local Registrar b ;e ` ~ ; r.. . , ' [j Q ~ _j~• - , y. V~ . s ~ ~a . ~ t~~ n ~ _ , ~l ? ~ . f Vt ~ a' • ~ ° • ~ . ~ De ty Lo~al f etrar - B~~K 187 ~a~E 853 .