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HomeMy WebLinkAbout1076 ~ 1;~~~~~;1 FIlEO AND RECOROEO?,_ sT.~~~~Ra°F~TF E~LA~ - : l.`)~Ufil < 'TO SEP 29 PN 12:57 ~ ~ --,s~ , ~ e~- •iAii do~~~ ~r ~'ERTlFlCAT~ 4F Q~A7!-! :~~~i :~S_ w~cwu w v~Tw~. ~rrwnmc. ~ FLORIDA ~b~~•TRAS ` ord •Mn B~RTH NO L~j~~~ri~~T C yr~p~rl ] 1?U1G[ O/ ~4?TN ~GODG IiO. 2. YWwI Q[t10[MC[IAM+~+r./Ar1 fJwhw.rr ~~~MwWn~ww) e~~ t Y t~• r~q~MT~ STAT[ COY~T? Saint ~Lucie 66-025 Florida Saint Lucie ii.~.~ ~A 1. dTV.TOrw,O~IOCwTqN f. K K~C( O~ DCAiN l. C~Tr.10rN,OA IOC~T1pM t. K ~t[S~O[wC[ •~11~\~ MSID( CITY 11Y1T51 U~S~OC C~TtI l~~iTSt Fort Pierce .~Sp ,-0~ Fort Pierce ~o ru.. I. p~Y( OI (I~N/ q M/MhI~ I~11 If?tN ~LItNI I. ST~[ET ~DWI[SS wpShi?l 6~ ~wST~TYTqAD.O.A. Ft. Pierce *:er. ::os 108 South 35th Street ) M~Mt 01 ~Yd pfilCi( LMf WT( XMf~ D~/ YIV rn«r~~, JACK i~ILLIA.': :ti'IND.S08 ~:*N November 11, 1969 ~ S SIX L Cp1011 011 ~AC[ 7. M~RAf[0 ~y wfKA r~~p.iDC • OwTE Oi ~~11TN y AG[ (I~ ~fY1 1 tW 1i~MA 1~ W1S. S 1Mf ~YW~f) Mw~rb Mw Nwr~ Y~+. ~ r ~ t a• ~ C.8L1• w~SOwro ~ av:.pcto i`:~rch 5~ 192~ 4. ~ yl~lwlr 10~ usu~~oCCW~Tq~lOwll~tyerkre~~ )Op-RU00iii.S.AESSO~M.~.STRY I{.~c~Twucc(Sr~r~whrry~cw~tr~l I.Gf1tO1WRM~tQpNwT~~t t •lt\ frriy N~~+anM.a~r~~/~dvd? Carpen~er Building Green Co. Georgia U.S.A. : •1~s¦ N4 1~. /~Tw[~'S 1?~r[ tt{ MOTNUT MAIO(M IyM( ~ ~s.•~•?~•• J~es Windsor ,;~iora N:oon ~ I~ SOCN1l StCWITT NO Il INIORYAM • NGMATYIIC Ail~nl ~ 62-20-1850 Mrs. Betty :Iir.dsor 108 So•~th 35th St. Ft. Pierce, Florida ?uMf~l 1~ C~YKNY[~TN~Swtr?~~i/~w[nwpaf..[r(~I.iO).~s~lci.j MT[IIYAI~Rr![U ?~AT L O(~iN M~S CA{~[D ~r~ //JY OrISCT AMl O[~TM s e~ s e f~ I• W M(OMT[ G?YSt (N ___-~G7-- L/ura-'~ :._S~_ti'a~~ ?~if/~~ tG• Nf- / D/A ~ aiftc~t• C~~I~fi~u.~ ~wt. ! ~ ouc ro (u _ _ ~%v.Gt 1~~~ ~`-~r rZ~~ f //lL6L~ L~.~l~ . ~ s1a• t\• r?w~ ~ f~ ~ 1• c~ 1 ~D~rr nwr •1. / ` / ~J f r.R,.ar.r e.sr Iw- a,c ro (c/ L%GLS_CL<~'!!~'/C~-C ~ J W~ Qy'k'a ~ y tUiw 'f! _ . w~S AuTWSY i d ~orf f O ~MT N. O~M(~ SK41f Wt C.OwO,tORS CGwi~~{/fMG TO OUTw Nf MOi R[4flD 10 Tw( 7f~rMti p~y(AS[ (qqiqll GNU~ UI fYl 1(u ~ f[ 11lOIIM[ D/ ~ s ns ~ ~.r.~. ? w~,' _ ~ ~ p~ IM1.~.?JI jQO. ptK~l~K ~yy ,W4AY OCCrAR[O ;Ealff t~lYrt ~/~R/V?i~ PMf /M PMI 1I ~JMt~ /1.) ~ •~ttw~ •w7 p ~CC~O[wt SYK~O( MOw~K1~OE •?~~~~t- ~ O ? U , •r J 20C TIYC Oi I/N/ XMt~. DI/. Yfr 'l• ~ ~wiYe• n. ~ ~ o ~ ~ _?Q/ wlu~~ OCCU~~[O mr. II~tC Of uu~~Y ~t. p.. w s'w?t ~~ov, ?D/ C~T~, TOw~. 011 1OU1/0N CMrMT~ STATE _ ~ ~ MwK[ AT ~ IqT YYNN[ ~ ~A. lK1NI. Yrelf. if~1[t UC).. t![.) _ WO~K 11T Fp11R ~ 2L ! ~t~~M«I fM ~e~~NI /reen - . to •nd /uf w~ A T dir~ on ~~y,~.,.- ~ 1- `i.i - - - - ~ D~~tA oeev~r~d ~t m on ~M d~f~ ~t~t~d ~Oo~r ~nd fo tM M~f o/ Mewrl~I/~, /rom th~ uu~~i ~bud. ~ •:1 lt~~• ~ N TY ' 1• (lXrtr M fYl() ~ IlL ADORESS llt. W?TE SKNEO ~ , . _ o~l ra, ath st. ce.~l~c. ~ T..'.-. ~ n,-:. i oi-~+n F1 n~^i '0 1 1 ~1 4 ~C .ce~r~t~. ~ 2 R .C1tr~~p~ jb p~T( 27r A~MCO~CEMi:[~~ONCRC~~:01Y 23/ lOGT10w/Cfl.fw~.Mhr~el/) y l \~rnJ~l ~ ~ 1- - ~ Pierce Cemeter Ft. Pierce Florida /O1'J uhEMl pA[C70A S SKM~TYR[ ~DW(SS 2S OwTL MECO. IOCK 11[G. G~STI4w'S SKMATIM[ ~ R...,ess ~i~~%i~~!~~' ~«//L/!tG'Lli~~. lOb S. 4th ~;~;ove:r~er 17 1R69 C 7 ~ ~ hsroby asrtify this to bs *true and corrnc~ copy o# th~ Lxal • Repistr~rs record on fils in ths St. Luct~ Counry K~.aIth Deasrt? ~ m~nt ~t Fort Piercs, florida. ~ (Warnin~: Not valid unleu roised seol of tha St. luclc~ , t'~:~;, ~ County H~slth D~pqrtment is affixed.) .y'*'- t ~ I ~ ~y~ d A ~ N. D. MILLER, M. D. ~`~ti.`~~'~';''~' ~t ~ ' County Haalth Officor ~ Lou! Rc~istrar , Y~~ ~ . ~ ~~t''~~2.'F,• r - €a ~ ? . , ,'li ~ . ~ ~ ~ ' ~ ~ ~ J 7~ - DiN~ . Depuly L,AaI Rogistror ~ S ~ ~ ~ . 4,, . - . ' L~~`,~`~~' . 1 . -;,~i:,, eo~K 187 PA~F 1076 - - _