Loading...
HomeMy WebLinkAbout1492 . ~.~~3~;~ - C~.~TIFICE;7~ OF DEATH nrP..~.,~.,~ .r ~~.n~ ~nd R~~..~..~:~.~..~ 1ff~NH F L O R I D A iTATt r~~: No. ~ IN\~t~NA\ lN 2+. \i lll ir7E. Ot ?R~NT IN ~°w~°°•~O 4ZJ A[61iT1~A1~'/ NO. ?itMARtNT INK ~CEASEO-NAMF ~~~N rwa~~ ~~t~ SEII DAfE Oi OEAM ~ row~w. ~~t, q~~ ~ Y[ wiJ~00t i{~ r~Twc~a.s , ROIIERT L. POULSO~I ,Male ,Se tember 15 19~0 t4CI ~r.wn. .eto~o. ~r~~~c~M n.wr, wGE-..f~ uwt~ ~ o~. DATE W NRIH ~~Wew, ti~. GOIMTY OF OEAi11 _4{~ -T----+- ~6~i .c ~Y~t'~~Ylllt~ j~.~~~py.~~~~f~ ..Ot w~1 .~7~.ai ~ rr+ hu~ , 79 ~t, ; ~~Aug 30, I891,~ St. Lucie . ~ CItY, 1OMM. OR IOCAiION Of pfATN ~~.s.u~ .•n .,..~n ~ np:h7Al OR OTMER WSTiI'JIION-N ~r wa ~r~ ~nw~~, pM s~r~~ uq rw~y~~ ~ 1~~CU~ ~Il J~ ~+O n Fort Pierce 1,, Yes Ft. Pierce Memorial Hos ital STATE d~ttM ~w .ror w. ~ s..«..u CItILEN OI ww?t GO~nt~Y--±w~aRttO, riEVEt W~RiiEO S11~VIVlIG Sp(~S( ,~o~ve wpr wr ~ cow.a. ~ ~ , w tDO~A'FA. ~ wto.. Y~YY1~?WMC~ .Ja::zaca, New Yor- U S A 1?iarr~%`c~ „ Mar L~-(Black) Poulson ~~~.uo - - - .~.w y a~w~ USU~t JCCUt~i10N ~o..~ .~«o ur ~a ow+t ov~~ ~ SOCIM StC4M~TV NUAVE~ ~+O rOf~ Ot ~WD Or WSWfS3 Ol Y/OUSTlT ! OCCWUO w ~Wa ~ qn~e ~»~*,•~-~...o,~ ~r068-16-I218 „ ~anking ~xecutive Bank ~~YOf~+C~ MMM ~:.u~e cw`. ~..m STeEfT ~?a0 Ntw~E! i `0~'»'~" tEStOfNC[-St~tf COUNTY Cii~, tOy+n. OR ~OC~1~ON ~v~un .es o~ .a~ t"~ „~'lorida St. Lucie Ft. Pierce I,.~ Yes 2410 Kelly Court fwIHE~-N1wE .,n~ ..oa~ •.f, i M01KER-MAW[N N4ME .rs~ .r~o.t us~ James Hoc.•ard Poulson ~ Ella Eaton ti '7~ INfORMANI-NAME ~.u+luvv wOGYf15 ~fu~n w ~ r o. .a. cm o~ ro.w, s..n. ~r~ '~~~:f1'~-:~~ ~+--r.i- ~,1 . , , •~-,'/C'-i _3+~' ~If'.r~~ • IARi 1 - p(AiM WAS UUSfD ~Y: '.EN~E; Or+.r OHF C~usf ?ER ic+rE FO~ to1, f6;~ ANO (~1^ •~ro.~r. ..+r~~v.~ 1 ~~r.~e.. o..f~~ ...s a.+~ wro..n u~u ~ . .Y (~1 ~/'!"~/,'l. `(~"(y~ / / , Gll~~ j wr~. : ~s ~.,t,-,.:. co«o,~~o.~. .r.. l ~ / .~.c~ o.r~ ns~ ro Isl /y /Z ~ ~ • ~y~D~~\I C~Yf~ ~0~, ~ _ / 4 C ~ ~~~C.i ~ L~~L~ ~ ~ f~~t~NO tlM01~- ~ TO. p~) ~ COtiHOMwCI W •~~w0 C4Y~f ~~1~ id ~ ?w~l w O1hfR SK'i~+NK~wt COwWT~O~+S. caw+r„r.s ca.ri..,,r.,,o ro ee.~» ~o. u..r~o ~o uus~ o~.+~ ~...ui ~ a~ ; M?fO?S? 1F ~ES .+~~e r~~o~~ati co~. . '~m a~r, aauo u. a~~~~~wo.a c.~w t ~O ! w ~~arw ~~Y ~ i +~N-+ '?•~bop~ 1 AC.~OENT. K~bF pATF ~ Y . rp,rt«. p~r, ~t.~~~ifOUR ~ n.~rKWE. Ot 1MOftEfYWlD~ i i MOMt INIU~Y OCCURREO wrW~ p.wwn r.~r . p~ ~ur .qr ~ . ~ 'M I • IM f 7R M ~ ?4 iN/UfY A7 wQRR ~IACf Of W!lNY wu..e. r.~... yYa, rr~ in, ~ fMC.h ~~t Oa r`O f ~NK! Mlfi . ~K ~~rk~n 1 IOCATI~N ~ fNtl~ W~ ~ O. w0 . Ci~ M tO~M, ft~h ~ ~ 70r ( ~1 CErtR~G?i~ON- +wn~ w. .w ' ..o.n. o., .i.¦ !.w ..sr .....i.y~ wu.~ a. ~ aor~r r~tr t«e oear» oeeun[q_ n.~ r..ci. o~ m. /M~LK~AN: jO ~ wp•Iw w~ nY ~ov~ .rw~ p•m , Mou~ ~ O~t~. ~w0. ~O M 41r : 1~n~40~0 (M~ ~/y/~ ~ " ~ / / A/~ p~~ lMOVrUpG~. 4W Zi• Otlf~1lD 1~Or 21? ~ 77~ ~j'L~ ~i~ ZI~ /%V p'~• t0 /Mf CaYM~11 11~ilD GERTIEKATiQN-MFO~Cw1 E~wr~ER 04 CORO++Ei o« r.i ~.,.s a r.y „o„~ o. ,r.r. *we wc~w«+ w.a rwwp~,..us a•e • lau~w•~.p.~ D~"~ q0~ .w/ W r+e ~it~G~•y` . prr.~.<y., ~ .ytw . O~~M OC(y~NO M D?N ~wO OM Mf U~J' f~ )T~:~p C~ Mr~~ '~7l~f w0.~1 CE~TIfIkY-n yY Sw,r~wTURE M.J7~ 7~ I) lQ ~~v ?N M r~~ `4GCL ~ ` ~ ~ wwe~ tv ~m~ OwTE SK.~+EO ~,.w.~w. . ~ ~H Me i ~TOiko'fask M D~ ~Y !r~ 9~23~`)0 i.tw4v.G ~ SS-CHT~ifR o. a ~.c nn o~ w,... yr.a t~. 7L ~UlYA1. (.fEMAi1pN. ~[MpVly 'CF/aEIEiY CR G.~f+v.TO:V-NU+f ~OCASION C~i~ q soYV~ srary ~ vK~n ~ 2.. Removal-Burial :rir.i~y C~metPrv ri~'ens Vill~~~ ~~A~., vork , OATE ~ w,, nu~ fUwERAI NO~+E-vwME ~vD wDJtfSi ~ u ~r un i.r, n, i,~ 4 ,~~ept ~6~, 19 Baird r^uneral Home ~~i~• ~t~ ~'t. ~ierce, Fla ~ v• 5. ~612 ~i cFG~ ~t-bGn~rwE w arlO w~OC~? ~lo~Stut iv~o ,,~t' ~ . ,w Seate„t~er 24 197C ~ hereoy aacrity thlt ro be • rrue end «xrcct copy o:~ rt~ t«al ~ Registrar: record on fite in the St, Lucf~ ~O~nty hc~;'tn p,~KEO AND RECORDLD~, ~ t~~ ~ msnt ~t Fort A+ence, Fbri~. ; , ~ lUC1E COUNTY, F~. (W~rninq: Not vatld ur~less raiscd seat of ths St. Lucti a~~ n~^~!~ R 1 F. ~ Q - .`i` ~ ~ County Heelth Oepartment is affixed.} 1~~3 = A. e ~ ~ ~ . ~ ° ~`x t . N. G. MtItER, M. O. ~TO OCT s~ :~~~~~a•'~~;,~'r~ ~ Cot~ry liealth Officer E~ !xt! R~istrar t+~,0~- ~A.~~'~:`~' ~ KOGER~OITRwg~~ `=1;.' , , ~ ~RCU,T cou ~ , ~ . Daputy Local Re~pistrat . •x ~ - . . ~S : , ~ , . . ~ . _.a t~$,,~~;,, a~ax3~7 ~~4~ ~ f,~;r.~~+1 _ , _ , _ «ti_ _