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HomeMy WebLinkAbout1553 • - - • - - ~ t~~a 0~- ~TATt YOARO o. Mc~?~TM L._r7TIFICATE OF DEATH e~~es • •URGU OF Y1TAL tTATifT1C~ fTATt RIL.[ NO. FL08IDA ~ ord •h~e ~ el TN NO. preperlT R GI A•i HO. +:~ert~d 1 KAC[ KATN COOi NO. 2- YWAt KNi[MCtI~M~Mwr~ili~ l/wwq.tw.: Ru.r~M/~+~ww.w) •n~ c~]1 ~Nlr R STATE OpY1fT~ ~1~e~t ^ - 7 t• A. CITY. SOMM.04lACAiION t. K K.ACE Of DEATN t. C1T1/. TOMtM.O11 IOCATION f. 4 RfS10EMC( .•¦.¦s ~NS~oc urr ur~TS~ INSIOE CI1Y LIYITSI r u.. • r~s w O res ~ no Q t. IutY[ Oi (fJMf M~Mjif~1. /irt Ibqf ~/O[MI • 1E/~6TM Oi f. STI![fT AOOR(SS ON A/A~Nt ~~~T~~ ~ STAII IN IA u~STITUTION IIES O MO wwc or ~f.r xiut. L.w ~ wn x.,N D.~ rea eceus~~ a "ti'""M'" J+CK h'ULL S?~STH °'"T" e t 0 S. S(X ~ GOldl OIl 11l1CE 7. MARIlKO ~ NEY(w M/R111EC~ ~ 0.~T( Qi /111TM ~ AGF Ilw ~eY1 'f Wu 1 fGe {IIO(11l~ Irlf. t.d ww.~) x..w ww r... xw. .l~81e rv~'11te vnoowco~ ava~cco DeC 1 ~ 1 a 1~ 1~ Ip~. uSU~ p~c7N~Tqw IOirt ti~f Nr~rt A~t 1~. Ku~00f WSUrEiSOiI ~MOU5t11Y 11. N~TNKACE (Sl~tr M J~MfA cM~Mr/1 1- pT~p E~ ~MT ~uMf~Yt ¦!tb ~~r- fariy ~f ywrti~I4Jr.eM (/?dirM Dra ine O erator ConsLruction Fort P..erce Fla IT S A ?l~ek lwk fATNt11~S IMYE 1~. NOTNt~l3 M~~O[I~ 1~?rE •r John 9aith Ethe 1~`OOte ~S. w~s acasto cv[~ w u. s. ~~rco so~v W socw~ sccu~m ia. 17. ~wro ~ Nau?~wu Ethel Ro~ers 1~.~. ~ aw~rwl IU rw w~ I~r ~I rw~t :!0 262-18- 6 1 wu'~ D Pie •~A~r~1 I~. iAVK N~tATlt [6Lfi~ M~I w era per t+vfr ~+~I (t).) INi[RV~I ~E7r[[M • f?ss t~t ~~T ~ Ot/~TM \1nf C~tK~D t1/: OkfET AMD O[ATN ¦~.t [tt• w~~n ~ t~• e~r- tlfle~t• ~~~~.i ~1t~ ~a, M~ ~~~t ~ ax To A) Asthmatic bro~ct~tiR _ 1. e. 1 .e.r. in.r l•{. r~sf~tr~T M~tiiy W •~In- ~ 1 t a 1~ 9~ Z rily nur /tM. OtiE TO (r) ~err• • f- ~ ?AIeT N. Opfl~ 9s~sttM? CoMatw~o Corl~WrwG m DutN ~u? Ndr ~wt[u ro iwE nwrrull Oeu7t Cp4noM in~w w M~f . Mr~s ~uTOKr ~ /ERfORM(Di t~~ d~~t\ ~ ef ?~f~r• r[S ? MO ? r~~ ~ ~90 OESCII~E ~r Wu~r OCCU~4[O i65Na ~Wrr ~atlws ~~J ~ µY~NT SWdoE NpMiCUC N~~~ h~ I M irrt ll ykt~ 11.) ~.P..'- ~ o o a .r ..s~. ~ tOr T~rc os Ir... x..n. a~. r.. u ~wni~r a s. W = 2Q1 ~wiwr occu~~[o t0~r. ruct W~NJU~v I, e~ a~Mrt ~~r. 20/. C~Tr. TOMM. 0~ tACAip~ oou~tr STATE ~YNKZ AT ~ NOT 11MK,( ~ /b~. hdu~. ~trtd. ~~ts N~I•. eft.) ~ w~K AT MOAK 21 ! ~tt~+~d~/ tM A~w~aM /rom g-2~63 .~0 9~~,~~ •nd /ut w~ Mr ~lir~ on q~~~~i~ Aim . DwtA ocev~rW ~t m on tA~ d~~~ ~t~t~d ~sorr, ~nd te tA~ 6Nt d ap tm~Nd/~. /ros~ th~ uuw~ ~bt~d. i ~lI it~~• ~ NYMAY,111K ts 1• (UM~* a r4G) l2A AOORESS j?t. p11TE SIW((O • David L Roke M D. , SO I?elai:are Ave ~ ellf ~N. uf /uMY. frGM~iIOM. j~ W7F 23t NAMC Of tCM[TEII~ OII CIIEMATOAr Z7/ IOC~TION (CY~. qi1. M tN1~) ($df) ~ 11CrOU~I (3DK~/I~ i 2 1 6 '.•.hite Cit Ce.:_ete FL 'ie e FIo ' d r, s. ~sia suhca~? oM OII S SKMATURtYatbs~q~~ieral 1?o~?e ~~TE IUCD. ~t ?OGLL 11E4. 11LGISTMII 5 SKMATYRE ~••.»es Jose h lr'. Yates FL. ?ierce :1a 10-1-b Anna Lee Denison d ` _ 1~'~f~ ~ffY thk to b~ • trw ~nd oore+su eopy af the laaal ~ Rpisnr~s ncord on fil~ in 1f~ St. Lucf~ Gouny He~hh Dep~rt• } nr+~t at F~wt ~fu~n, Florida. , - , ~ r; ; M~Wninp: Not v~lid unlits raissd sesl of ths St. Lucl~ ~:`.'T.s''~f r- Counb Hwlth Gpartment is affixed.) f;`~'`~ . `~`T' ~ ' - f-'` it• F ~~`•~y~~. ~•~j~~,LtJ x - ; N. C. MIUER, M. D. . , . •E:,•. ; ' . . ~ ~ H~alth Offic~t d~ lacs! R~pistru :,-.`~~.kyp.`~~. • ~ ~ , . ' ;r:s~,:~ ~_r~> ~-C?c?_ 7L~ „ '..t~ ''~y?f~~( a~(jf` w~ ! ~ ~ • ` ~ ~ ~T"' }~?t~~~~i. ~a7.'~•• 3 D~p+~y t~aa! i~p~ tnr .~'`'':''~'c`~t~ • . , 9 , . : } . C ' ~ ~ , . .,Ji~.. . . ~ _ eoox187 ~1553 ~ ~ ~