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HomeMy WebLinkAbout1478 - ORANGE COUNTY HEALTH DEPARTMENT ~ i72 W N • fTOiFICE WX ~itl • Tft.: 211ri11 • ORIAlipO~ RORIDA i1~0! ~ J ~ • 1 . ~ ~ R ~o; 2C~1423 ~ o 2~1423 ~ ---~~j~}- _-Y-~; ~_r-sTATE'Td~~7 oF CERTIFICATE OF DEATH • ~ : ¦u~rwu OF Y17AL ~'fAT16YSCY F L O R I D A +Tw~c F~~c Ko. BiRTH NO. REGISTRAR•! NO. ~ 1. ILAC( OF O[ATN COOE NO. Z. YIYA~ Rtf10CNCE(MV.t1~e.r~f/:wJ. /firA7~fun-Rr~f~W~~Mww+) cou~ir ORANGE S~g~ STATE~T n~TnA a_ cou«Tr ~i1lNGE 1~VlL14/~~ C~1r. iOMN.p11OU17~OM t. K K~CE OF OE4M . t. ClTY. TO~NN.OIt IOGTqN t. K RES10[NCE qIS10E CITr 11Y1T51 . MIS10[ C1?r 11Y1TS1 QRIANIDQ •ES Q ~o ? ~S . _ ~.8~ f. tUM[ OF (//w~f ~ ~iht. i~ ~hal ~(drtu) 1. STUtET A00!nESS Mos.~T.i oR ORANGE I~:ORIAL HOSPITAL lllg OVEftBR D MKTITY?ION M~M[ Oi f`~Md ~~/iNlt La~t M~[ XW~ D~/ Y~M ~ °iy,~« s?~.n HUASON J. I:CRE"YNOIDS °EA"*~SEPTFI1~BIIt 1 6 S. SE7[~ OOIOR OII MCE MARIl1E0 ~ NEYEA MM~I[O OATE Of ~U1TN AGE 1/A Nr~ K{/~0[R i ~W 1/r0[A l~ Mi ~ 1Mt wN/.r) x.rr n.w w... x:.. KAI~ WHITE Mnoowco O oryoRao JUNE $ 1 IOa- Isn % nwt Nw~ti ~ h~e,~~i t/?d M~ IOA. KurOOF NiS~MESS011 wOUST~r 11. ~IIITNlL~CE (.9~ft MM~M~ CNAb~) 1. Of~ 0~ ww1T 00NAi1 Tl.'RUS D CITRUS I~Ni'iJCKY U.S.A. ~ 13. iATNER'S MAME 11. Y07MEJ1'S MA10CM NAM[ THOMAS JAri~'S ricRE7mOLDS MARY OHI~f ti socu?~ sccu~m wo. n. wuo s NCNATYIK wtau. 263-5~52 Mrs. Geraldine B. Lon 2 Mulfo Av 1~. CAYft 1~ OtATN [Ealt~ ~afl pt pwt yn h~r Nl. s~~ (t ) IMTLRYK ~ETw[[N ?ART L OEATN ~/~S CAYStO ~Y: ~ ~r~,~ , ~ ~T ~ ~TM IMMEOYI?E CA4Sf (U G~ ~ Glr+~litiwa. i/~w1. DYE TO ~ , ^'~r~ ! •~it~ /MS ?u'~ b ~ .e.sr c...s • j at~tiy qt ~~fer- D1,i TO (e) ~ ~`yG ~ 4i.~ a.,r t..r. O /MT N. OiMOI SK10qGNT CONpi~0~6 OOMIIIIMRM~G 1'O OE~TN RR~NOT 10 T+IE rMLL D~ffASE C01r01110A M/MT 1(~l -*~S ~Y?OKY /'[~011MEOt 3 _ m0 w0 . tp.. inw. ~Da. usu,~ ,aw uuuar occuRUO. c~r.. ~.rws iy.q f~ Pwr 1« P«i Il yY.. uJ • ~ ~ccac¦r wK~a NorK~oE - u ? ~ ? i mt TMtf Oi H~a~' Xwti1. Dq. Y~M ' V IMJ1111r A_ 0 A. ' . ~ ~ 2Q1 WlUllll OCCW11E0 20r. ?IACE Oi ~MW~11 (t. I.. iw M~Maf M~r. 24/. CITf T01NN. IOCATION OOY11Tr. lA1E MtMK[ AT ~ 1qT 11M~1E ~ lY~. I~d~?I strtet. s~K AfI/.. dt.) • . 111011K AT MORK ~ ~ J• d~d fM I~c s~d / o . fo ~ed l~af sr~ w~~ ~/is~ en •tt~ ur~«d 2~ ~ A•~w~ on fA~ d~t~ ~t~t~d ~60~~: ~nd to tA~ b~st o/ mr tno~Ndl~• ~~OI!! fM C~YNf t~t ~ 1 C Or/,I~~t~Ylt1_~ ?IA ~0011[SS ~ll W ~ ~~r-~ r~~% ~ ~ C'~ ~~~P C~ 23~ . C~[w~ip~. 2b O~TE b[ I{AYE Of CEY[TERr OA CR[MATORr 23i. IOCAT~011 ( f. fNCA. ~r tM~f/) . ~bti~ftl 8e~`. ~`ia`~~ e t 0 196 . Oaklawn Cemete Plant Z~ Al [ 011 S N V A SS 2S. W?TE wfCO. ~r WG?l 11EG- ~ K~T11 11'S TYRE F~ F ~ om F SEP 2 91°S7 ~/~Q - _ - . - - - - _ . ~ - - " . ~~~.~-.~y~C~.-z..~-~•-«.,..~- CERTIFIED COPY ~~~~e:. , . • ,``,~'0~~~ , ~~'',~ri. _ . . . . ~ ` - ' I hereby certify the above to be a true and correct copy of:~~;`' .~~ar'~ record on f' e t Orange County Health Department, Orl~~' 1•~ ' . . ~ ' _ , > .~.a~ . <3~ 4~/f~ ~?r".. ~ • ~ ' ' o! _ County Heslth Offi x { ~ - - cer and Local Registrar ~ r. . . , = ~l,.~v,.....~~ a~ ~••A-;` OCT 3 0 ~TO - " ~ o R i~8 ~.i~75 o ~=~o-.r Date ssue BOOi( _ ' ~ ''r~~•,...»:..•~ ~ - ' . _.y!", j'.'S::'Y~~;l-?!"'= WARNING: Not valid unless raised seal of the Oraiig~~:~ ~ County Health Department is affixed. , - .,:M~.-~~ ~r ` W . .~-a~ s ~