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HomeMy WebLinkAbout2347 . ~ iZO1.9~.3 i~``E{~~ go~~~i"~, s`~'' •c . RpCEIt F01tUAf CL~RK CIdCytt OOIMT ~ . ~[CORD YtR~fl[0....~...... ~ DFC 9 2 PM'78 ; 201913 , ; 1 ~ f - f 4 - CERTlF1CATE OF DEATH ~F.y' Depatl~eYl ~ lkrltb aad I~'ca+?.:lttrtire J'aYViees ~TAt[ FIL[ NQ ~La$ina ~+~2 ~ iYTE. O~ ?i+NT IH ~ pEGIBTRAR•f NO. ?FCMAI:tNT INK ?~s~ ,.y;,,i us~ pATE pf pEATN ~ aowtw, Nr, nu ~ ° scE r:wsooc Fa °~"~O''''"""E ~srwRa¦s CiiARL^S STATES :~iale , November 9, 1970 RACE rwne. ~uoW. wnC~w ~www. AGE-uf* ~••:e. c vt.r ~ u.~ti r n.t OAl'E Of ~ttiM ~+OwM. ~?t. CONNTV Of OfAM. .K. , ~ w.,.~.. ; w.. ~ Lucie ~ W:~ite ,.73 u ~ Ik ~ Aug.6,1897 st. 00172 GTY. TO~. O~ LOCwT OE/?TN u.w~ car .~..:.s hOS?~inl Ot Oi11Et NST~ - ~r pp w t~wa. om snu~ w.wre~ ~ f~tC~f f{i Ot eq n. Ft. Pierce Yes F+.. Pierce Memorial Hos ital SiwTE Of WM ~ r wo~ w v.s.~.. M...~ G~~12EN Of WMT COUNTRY MwRpfD. NEVFR MAtt~EO. SPONSE rw• an r~+H! ww+ eowwer ~ wt00wF0, i wtr~ ~ ~ D1ew York USA Marr~ie~ Theodora Schmidt v~.eu ~au.seo SOCu? SECURrtY M1+~iEt uSU~I OCCW~T~Or~t .e•n ey+a a wu oow w~wo .oa a KMD Of N/SWESS O! wWKTRV ~1Yf0. Y OU~ ~ - W OSO-Q3-i+281 M~ ~ .~r,.~~ ~ ,N:*„~,~.. Ynspector S er G rosco e Co . lliWfMCf Y/OY ' .o.rsfw~+. !fS%CENCE-ST~iE COUNTY i:JT11. TOwH. Ot IOCwT1~N ' waN cr+r ~wts ITtfET ~M1M~Et ~ ~ , ~ MKw i~i M NO ,wFlorida ,u St.Lucie Ft. Pierce ~w. No ,M180 Ban an Drive fAT?1ER-N1wE rwr ..wo.t uu ~OT~Et-~fN N~Mf ~'ar ~.s~ „ Charles H.E. States tVilhelmina Petry I WO~MANT-NAME wuY+rXi ADfilESS ~we~~ e~ wo.. on w w.... w+R. tr~ ~ Theodora States 1,;.180 sanyan Dr. Ft. Pierce, Fla. 33450 /ARi L OfA1M WAS GWSEO ~Y: ~ ;FN7fR ONiY ONE CAIiSE !E! Llif i0[ {el AL w~ k1I ~t~w~~ O.~x~ ~w ot.n. wrtw4 ^ u. . / ~ t•1 tG;~c.GCCC~/~CC..~C~~~--GL~1 J . u . ~eow ~t o.: ~ COMa~f~O++f, ~Mf, i ~ ` ~ ~'~.~JV'./'~ l ~ ~ ` . .w~c¦ e.ri nse ~o J l01 ~:ir _ ~...ta.ie e~uaa ~a. ~ ~ q, p y w eOwsaWtKe O~: iT•n..G iwi yMp1F ~nwo t.vst ust . (tI ?AtT M. OTMEt SIG?iKICAHT CONOiilONS: COwa~uay towu~~t..w to ua.a~ wi wo~ uuteo q 4~qa wrew r~n AUi015Y Y YES rlae r~MS~wos CO.~- ~ . I~tf ( Y :t- Oli~4uM~M0 4YL iw ~w ~ ~iDwaOE;~~Y~OEi~ WiUill ~.a.iw. wt, r~u NOiR MOW IWYl1f OCCY~tED ~ ewe~ ...~we uwn u. ruf r~s~ M, aw ~ ~ ja. Yh. M. IY. INJU~r AT WORK ?IACE Of Wl:itlf .t wo..e. u+ati, ~.nJn. tOCATiON ~ swen w u.~. wo.. em o~ w~. aw ~ It?!4h 7ll M NOI pNIQ MO0..tK. 1YKY71 ' CEti~f1UT~Ot+- ..o.ww o.1 nu ~ .o..n~ wr •f.a (.,.o ...sr a.r w../w u~va w~ oriao ..o~ .r~+ wr oewnr oeeunEO ~we ?~.a. a. w ?NtS1UAN: 1 .o»rw w• .w ww . ~.ow~ o+n...o. w ~+a ~eu n. oea.uoeeor 7~ 22 64TO;~ I1 9 70 ~'f" :2p w' o;«°u:,;` CERT~isCATqN-w~EG7Cwt EX~+wwEi Oat C6tOt~tE!_ a+ r..E s.s~s a r.r ~.o~. w.n. aee°~¦~ °u na'a"~H ~us ~a.rr...w~+ a:we ww ..w/o~ TMt r.v~snwrw~.+. w++~. ra+iw ~+r nu .ow _ oum ocwdeo o» re wn .'w eYa a rwa c:ustu~ s~.no. 11 ].9•] 0 r~ 22~ CFtT~ilER-trtiwE ~rne w ru»n ~ 5:.',- ~ o~ete p nne Dw S~GNED ~.wu~. w~. ~uu~ 7S~ ~ ~ r+UR SS-CF TYE uu[~ oa t~.o. wo. / Gn u.4 iv ~a ~l Nort~h ~lth Street F t Pi wsut, us,YU~not+. ~r~ov~ retr at c:F.uioar-N,~u,,e ~ou un a w.~. s..u " n"" „ } ~ ~lra Beach Florida N.._.emoval- . DATE ~ row~w, w*, +w ~ RAVEiAt NOµc-~Wr.~E ~ ~DJiESS ~ ttaar o~ u.~. ao.. an o~ wvu, u~n, w~ . ' v. 12,1974 - aird .~'ur.e a~ ~~;P.901 V. 7th St. F.P'e 33450 v. S. s612 fu+E~w tkG~ST S~GrutwE ow n~ sr ?ocw? tta~uw a.~.~s+~o ' Y . n.. ~ vZYlber Zs 197D i F.~r~fsy curtity this to bo a trus cnd c~;art ca~y c: l.~1 . - R~istra~s record on file in tha St. Lucb Covr.ty HaC: ~~,:r„ti~ _ . ment at Fort Piaru. Ftorida. ` - , • (Warning: Ttot vaNd uniess raisEd scal of t~a S:. lucis - . < Counry Heatth Depirtment is ~ffb:er.) N. .D. MIUER, AA. D. . _ * ' County Healrh Otfics.r L Lc~i F~i~t~u ~ ~ , a.j ' D~ta ~ Doputy Lxal Rcgistr~.t ' . - - , . y _ ao~ 188 ~,~2343 ~ ~ - - ~ ~~,~,w.<.z;~: