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Home My WebLink About1673 CERTIFIED COPY 1~~~~g_l WE HERE9Y CERTFY TNE COrY REPRO~UCEO BELOW TO 6E A TRUE AND COR1t~CT COP1/ OF TME ORIGIM •'R~pRD ON FILE IN TNE BUREAU OF VITAI, STATISTGS Of THE STATE OF FLORIQ~;;~ I~T , OF MEAITH ANO RENA6IUTATIVE SERVtGES. OfY'SION OF HEALTN qT~ ~ '3.~I.ORIOA. • `.Y"!;t•v. ~ ~NOT VALIO U~ ~ ~j1y~~ ' Tt OF FLORIOA, OEPARTM~NT OF N(AITN AND RENAYIUT~TrvC iERVICp. OIVI~ . . ~ ~4U; i h6 l~ ~ ~:~,;~~i. ~ t~ C 10'^~ 'R`~ • ~ s _.11~ ~~~V' ~.~.,^~TO cH~cr. •~•r~u o'~ si~nsncs ~ ' ~ (i L ~ : ; ~ E ~6~~t £ ~ . r A~~~+ 1 • ~~1 ~ • • •'~i i~ ~-~44~,. ~ rr . sT~n ~cc~srwww a~[ctew. o~v~~~wa b~ ~ " ~ ~ Z , : ` . 1`~/r' +E~.C.~4~~~ •j ~ t~~'l ),1•,`''~ • II~NA~ IITAttrl f[RYIC[[• 0/ N[ALTN AM~ ~ ~ ? / ~ r~;~,ii~~ ~~:~-i ` ' 3bte ~asd ot Health , a'~~~,. CA1'E OF' DEATH State File No__ ZS;~? V : ~4.4 L. . I ~.eaia st vttat stausucs - '?~r.--T'.=: ' F L O B I D A R~giscrars ~Io. _ Pt.ac~ « ~~rti • _ ~ . q y~ Lsuwt. s3~u~.-~cr: ot [•Ea:T:~~k:li: v p~~ D!r-.ct \o~ • ' I (a/ SWt ~6/ Count~ fDl ~leQ • ~ - P~ir.et \ _ - n / ' wao..~. n.• wEe p~~~ b ~J Qtl~ R-~ cr ~ 1.~) C:ty or Tons # =,R,s T. ._\o. _ Ul uc•. t.~v or W.~n' ~ a=- i'AI i Z ~ ~ ST~ • ~ ~jre~t Xo. Z3 • ~Sbl~ .~1 ~L~S ~t 1~+trtal K instltuUcri ~ ~It rnra:, u~ w.~aUunl ~ cot t~ Awy+tai ..r fmtltuUOn. wr?e~ r-eec ~nmwr or iw-~tfun) Citisert ot Forel=p eatntr7r: ~e) L~[.L1 ~tal' 1~ s^•Pl~l o[ (i~netltutt.~t yti ~ op ~~i ~7~ec ~a~l t~ ~ r.f~ wh.~thr. y~.~r~. -~e~:d~ ui darsl If ~~er. nams ta0otT7 4 ; a,=,,,~ y~j ~,t~- - • ~ i 1Tt1. ~~E O!' r•r.rr_..~.u _ - - ~ 3 ~v 1[ a~a+aa. ~1 .~oci~l ~r~ritj ^ ~aCAL t'f - =F1 =\TIO\ ~ - ara~? rar ~ I)a~e ot ll.~tA- Y~atl~~~ Da~ ~ t- - ~ 1'~ar 6oa' YinQ:~~~L. t !ea :r. Cobr ticr • ~ fi t t. ~1 e~~t~p ceru/T t~t I atten `ed t!r deecu~ (rcm & n~le. nrRiM. ~idoved or Airwced YY~_~~- ~ w(~~ ~O 19 T~~ ~ 19~~: ~ ' C 4) 1! o. ~~~ow or Jic.,r~ hust~nd u' ~ r ~ _ ~ ~ ~ tDat I l:,~t .~.c h ~'L, ~t'~. 19~'~_: 1 ~ I - ) • s anA t9at deatF. occvrrvj ^n tAe datP and hour •lat.d aEc~n ~ U~es4~ ~ i i ta? at~ at Dosl~and or de. ff ~If~r _?'ea:-a' . ~f j lmn.ed'~ rac ot a:e _ ;=~J~~~'/~~ , ~ «y~~:i ~ ~:.~..e~~~... ~3 - ~'8'9/ ~ t i ~am~th~ •CaS) 1~ ~ y 1~ 7Nes ~IoetAs D~~~ i[ ~s tban one daT p~ to ~ ~ S~ ~ ~ - ~ - i ~ nr~ ~~m. nue h~ - - • ~ t~' BL~~a ~ Uther cond~ti~ n• ` ~ C~q-. to~D or cuYpq ) {i'hb R ter•KO countr~ ) (Iec1o4 Drcrnan:. ~ n~~n S rtu~oth~ o[ ir~ ~ ~ t Iw r.w .era~.e+.n . - - ~ :11. I~ia~es~ ~r Mns!we~a Ya;or tindinR~: - ~ et o~errder.. ~ C~Beelir ~ ~ ( t!. Saa~e : ~ tYe ~rulr t~ = ~ ~ whicA 1e~t? ~ ~ ~ I /Grredaa •~:.tr.~::.,n) sY~~ld p• ~ e~~K~ sM?- ~ ot autoPa7 ~ ~ tWlea~~. IL iaae au:.e ~ ~ I~ - - - - - ~ f tS~ [or.lp:sR _ • _'L~Q_ _ _ _ _ - - - _ _ ' • ( IL dlatb war C,t t•~ «trrrt? eau<.e, ftll in [G? !oLe4'aS~ ~ I~d~iut • S:~utar~ ~ ~ ~~r - ' 'I! ~~1 ~Yrol~al~t~~l A~~cid~r.:. .u..-'t- f.~m'ciSe V1••~ ~t.l _ 1~~ ~i V•~ ~II (D) i~ac~ of occorresk ~ w Itl Aen did laJary o-~ n~' ~ i•!la,t~ ~ce aiK. or :emwaS' I •a~~l~.,r tunnl ,~Y.oty/ ; cace~ 11 (sj ~ 1: ~*1 Ylae~ / D1d Ir.~ury• oceor :r. or sb Aom~. on t~rm, In ~E~Ir1a1 y'.ace. In I ~ IpuDllc~ ~tace' ~ 1i p~i1 G~ 61~ ? ~i ~~/;,`r ~D{+mt~ t~t+c ~_ere~ ~ St {a ~d r ~ ~ R'Lik ~t rt? J!r t M a.-. I~ ~ / . g4~trr~ ~ ]I. U. . tC+sC ~1? / ~al R«Wrar (L) ~N~~M ~ Datd Si6naJ f _ ~lI ~ i.K rJ _ !r gf rn . ~ . r m ~ ~ ~ '~o -~v n ~ ~ _ ~ D ~ ' t~ ~ ~"fl~ C O ~ - } C :t ~fn -1 --1 ~ ~~~1 n ~ O ~ ~ I~ C~J ~ ~ ~ s~i87 ~~i6?3 ~ ~ ~ x Do : ~J~ ~ ~ r_. % ~ , ~ = . q ~i.