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HomeMy WebLinkAbout1170 rn~~ e.- srwt~ ~owwc or Nrwt.TM CERTIFICATE OF DEATH ¦UII[AY OR YITAL fTAr1~TIC~ RAT[ FIL[ NO. ~•s•~ ~•a- . FLOSIDA ord •Y~w Dt T HO R 1 A' 'r o p~ r l~ 1 KAC[ KATN COO[ NO. 2. YNIT T w[NKNC< l~W M~r M.; l/ iww~rw: Rwd.r W~r. W:r:wl l~tY~~~ .~d ~ . 53-027 F~ Lu - T orida ~e ~~r- cm. ro~r.o~wuT~ . ~s n.~ct o~ a~n~ s. aTr. rowK.o~ wuTa~ ~s ~ts~otMtc w3?oc cm ur~rn NK10( CITr LIYITSI Stu~rt .c:Q9 Nop Jansen °.Qsch Rura]. .~sD Nol3 11AY( O~ (//Mt 1A ~M/td. IM KiN/ M6q1) ~ l(NGTN Of I.~SiMtT AOifllElS 011 A IAIIMt ~~~u*~o: Mart3.n Memorial 3osoita T~cta s St~r Ra~ite "`s~ MO~ 7 wnM[ Firr A/1//It J.yt o~r[ AIw~~ Dn Yea Os ~i. «~+.n FLLA ROSE A,t]'~?L^S ~"T" JulY 26 19b3 . it~ ~IOR OA 7. YAwllt@ ~ KKA MAIUI[O DAT[ OF MATM ! AiE (h /ap i WO[111 TW Y~EII M Mf. `~r ~q1 Mr1Y O~w /~rw MI~. r. i t. remale 'atlite moowc~ avwcw Se t. 28 169~ 611 y 1. f.1 ~ 10~. uwAl accuti?noA (OMr Wt yw.~ Mu 10~. Rwa oI wsMESS o11 wa/srnr I t. w~TMKAU c3~ft )Mty~ a~M.~r1 , a wM~ aOYrtt+? . . ~ c e r- ~~?MI ~t ~IR. wr~ y rNtreA - •~n~wt TI . ° 11~~Y ~N . - - - - 1 .~MOTMCR MA - . • - - . t /ATIO[~'f MA11~ .~1'~.""~""~ •t _ c,,...~a.. A j~• Y• R~' t~ns aansco cvE~ w u. s. ~rEO ~s• socu~ xcwutr Mo. i. u~ s s~a~u A. L. c?uarles 1?r. r. ~ Wrw~ 1/! ~w. ~ir M~ rM~ ~w~1 - .I e~u..« _ o P ~ ; ?u n~ r~ 1 1~. i111M[ M KATq ~61~1a w11 Mr enM In Ihe /r (A). p/ (r).j IIRE1ivAl ~ET111EEM r~Rr~ oun~rnsc~uaco~w FILED ANQ RECORDEO~ ~T~~"TM G t r• e t~ r wr[oMtE ewulE (d ~ , r,~. RFrn~t V~Rt~~E~ th• t~t- ~ i r~ ~.a. , ~.onths cti.~w.... r/.s~. ouE ro N1 1 ~ r~l['~ ~/t ~ • . ~ ~.a„«.; a„~ <<~ Chronic olone hritis . 1 ear ~ • 1 t A i• 7~ M. a~ p~TM ~~~A~ ~ M 1fAr H~ . MAS AU 6our• •t- ~ . /EW011KEm ~ t.~ e..'. ~ Para le ia - nrob~bl due to subacute combined s sten dises s~s0 ~o~l or s~f~r• ~ ~ ~pp. pE5C1~yEMO~IYYy~rotCU~R[o. (A1law~tvtyf~y~, J~ y~t t f~~ ~q ~ KCWCIIT Su~C~o( MOM~C~OE y T~ U~ t ft F Ja JI.) f ~1~~~~1- a~ ? ? . ~ t f~• J~ TwE OF Hw? ~LMI. Dq. Ytr ?sd~• 3 ~wJ1MtI w. a w = tw wnr~r occu~uo m.. nxc a~wu~r p. i..?.nw~ br. tDl. cmr. w wuTU~ oou~rr sT~n Mtnl.[ AT ~ ~or w~st ~ J~?w. l.a..r..~,ar. Nkv etM•. .rc.l lORR 11T ~IOAR ' ;1. I~tt~nd~I tM MoNwdlros~ a1112 . to ~~li~.f 2 y~~.9 3~nd JMt w~ ~~/ir~ • ? DNtA ooc~~n1 ~t • rn on tM d~t~ ~t~Nd ~nd fe tM 6Nt o/ a11 Rno~Ndp. /rom tA~ uu~ ~t~t~d. ~ 1 1 lt~~• !2~ fi~IYTYK (DMra ~r tYk) ~D ADOIIESS ' ~t. OATE SKMfQ •r• t• N " • ~rvl u. "arst~ller r. Jensen Reach .'~lorida Ju'.~• 0 • c e~r~t~. Z7~ wa~. ptrnnoR t~ O+~Tt 13c ~urE Os etrETE11Y 011 tREr~70~r 23/ WGtTq~ lGYI. Nw. r e~~t/) d~iir~a~~ 7 2~3 63 All Saints Cemete Jensen ~Pach :lorida ~ Y . ! . ~ ~ 1 ~ =1. ~ i ~~T AOOR[SS 35. WiE RFCO. ~Y LQGII 11[i. . REGKTIUII'S }IGMATU11f ~ "••.1f°• R. C. Johns Stuart ?~'lorida JuZy 30 19b3 Blanche M3rtin ~oat ~ - ~ • : . , ~ nsr.b~? a~fif~? fia b~ • tn,..na oorna «~p~r of n+. ~«.a ~ R i~tnrt rroK~ fib In f~ MMM County HNith D~psA. ~ ~~l1l1.,,~~4`!A~/~;, ~ , il~ir., s~ , /1 i~ t• erwnf N 3tuarl, ~ ~IA'"•.~ ~ ~~A -s ja' `"l~~' ~ lM~~n+inls tN~t v.iir unlas ab~d s~ai o~f th~ Mahin ' . . 7 ~R Ft~alth GM+rtm~nt Is affi~c~tl.~ ~ : ~ C~+^ty •J':ti ~•'a~ ,••1 ~ = • $ ~ U A i ~ : . _ . . - N. D. MIIIER, M. D. , ~ - •R:r;~~,•..~: i~,,.~ . ~ 2 z''•~ ;c,~F t O!i /'~(j*.'• Y ' Ceunt~l FNalth Offioer i l+ovl Rplslrv _ ; ;t._ ~.~~'A ~ : . . _<f , ,~-'~j;~~t~-\~~-~- ~t 7~ " ~ ~ ~ ' ~ ~:1. L . ' R~pWt~t i ~ : . ..J 0~1~ R~ L p` ^ - . ' ' . •i//t~~"'~ . ~ ~ ~ _ 8o4K 187 i17p . - , r„~,.~ ' _ i.i 14 ..2 '32`~ ;