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HomeMy WebLinkAbout2840 _ , ' t~~s .TwT~ OOARD o~ H~?~,~+ CERTIFICATE OF DEATH 202~g ~ ~ o•• s. ~u~~~v oF vnrw~. s~r,?,r~s~nes F L O A I D A sTAT[ FII.[ NO. i.t.~.•e- • . •rd •Atn H NO. Rt016TRAR•i fi0. prop~~l~ 1. ~IACt O~ O[ATN COQ[ IiO. Z. YSYAt IltlIOtNC[(r~w~f~swdtwl I~MNM~IMA. AM~IAYMi~~~M41WI •a~cut~a 3TA?t QOVNTY .,,a .,ii '•0°"""' ~../~7 _~lorida 8roward s. ~~.~.a ,~rou~ardy 1 n dt~, TOMN, OR IOCATqN t. a K~Ct O~ OfATN t. CITII. TOYrN.OR IOC~TqN t. K RLS~O~[KI •~eent q1S~Ot dri 11Y1T51 IhS~O~ t1t11 llr~ttl rsi.. P1~?n ation •~s cf7 ~a0 Ft.lauderdale ns t, tMM[ OF l1/Nt i~ Aefyifd, ~it~ N?tN ~1trtN1 iTI1i~T ADOntSS [ Npy1TAL OR . f ~T~*~*p" poctors General Hos ital 121 N.E. 45th. Court ~ «R~uc os i~h++ xur~. t.~e wtc x«c~ o.~ rw ~ i?ir~«~.+.~~ Mamie E. Tierno o°u~TN Jenuary 28~1969 . f~ll ~ OO1011 OR RACE MA~III[0 ~ hEY[A MARIII[0 ~ pAT[ Oi ~UITM ~ 16[ 1/~1 /W~ 1? Yr0E11/ tW tM~OtA 2~ Mf. M~ Aire~./1 nr.,u. p.~, ww,. Xr.. • r s e• ~ rnoowco orvoRCCO Feb.24 1883 85 f i a i~ t~ IOt YSU4l OCtU~~TqN (Qire ti+~ drpt b~t WU KIri00F ~YSIN[SS OU ~MOYSt~r 11. ~IRTMKACE (S?~!t ~It~Is pYi1h/? • tff~2U101 ~tw1100~vm1~t • f t~ r- farty wNt y rwt4/ hJt. K~~ rNutJl O~p~A~ House+ui fa ~ O~n Home P~nns lvania U. S. A. ?l~et !wt ~ ~Ai1tERS MAYC 1~. MOTNC~'S IWO[N II~M[ ~~P••~~~•~ Harr Severin Liz2ie Peters ~ sou~~ s~cu~~Tr oo IJ tNt~1R~?1AMT~S tIGHdTYAt wu..., N.E. b5th. Courjt ~ Jose h Tierno ~ F un e r~ 1- 1• CwYt~ O! OLATN ~E~e? ~e7~ ~+~r t~~ir ptr li~t /Mr t~). (~J/. te1 (tl.) 111T[RVAI ~ETKE[N ~ART l 0~?TM MAS tA{1StD ~Y: Y1I • An,i Ol~tT AMO OEATN d 1 t~ t t O f W MLOMT~ G4YSC `~Z t _ - M tcet til! ~ ' ~C~~~I~M~~-' ~ t1l• e~i- : ~ 1 cine.e• • ' ~~;,r~ ~ L 4rT r~t~ C?~lity~i. ~/~~t. pt1E To - - ~5,.._! ~^C ! • 1 t 1+ t N ~itl prt iut N ~ I • c • 1 ~tt c~ax ~ . ~ ' ~pollp YERIii 0 r.iiser.~ +~•n.~ ae aeftn ~E TO (t)~ /~~Vn(C~1i1~ {/o Y~ e• :lenia ta x n"~ ~•K 1ut. O MRT u or~u s+wrrxurt ta~ar?xa to~nuwn?•c ro oc~TM ~n ~ auno m na Tuw ? . NA AUTO/SY Rouro •f- ~ . rE11iO11M[Ot a~.c? ~ ~ltC~tr~a~~ ~~~.d.~ica~ ~r~ttti' m? ~0 ' .r a.r.~. l a~ / 20D pESC~tiE MOw uuu7~r Octu~~tED. tEsltr ad~rs ~/i~jrr~ is Ppt I M PaM yiltw 1~.) . ~ ~.?tps •e~ ~ ACC~OENT wK~a eorK~oE - ! di.post- v ? 0 ? F c f o* ~ TwE Os Hwr ~f~~tR, [?q. ~ i~r - ~ ~odj. ~ ~ W{illr w. _ . S I- E W EC ~ IO/ w1uRr Ottu~ato me. ~CE Os uuuRr ~e. iw r~+st ~a.u. mJ. GTr. TOWN. OR LOG110N ODIIIfTt STAT[ ! 1RtlK[ AT NpT MiM~IE /VA. ~~?I. MRtl.1~[t ArIQ.. d:.) . ~ F r' T MORK ~ AT MORK ~ r 1~tttnd~d fA~ det~~s~d /~om J~• te J_~laZB - 7 9fi9 •ndl~at a~~ A,~ ~li?~ o~ • - D~~tA oeeurr~d at _ 7 S Z S p. ~n en tA~ d~t~ at~r~d ~bor~: ~nd to tA~ A~st o/ a~ kno.~ledj~. /rom tA~ e~us~~,st~t~d. ~Il l~e~a jj~ f1OMATYRt •r• te 1e 1 ~aPKMtVfd 2m AOOIIESS l2C.anS~G~[0 ~••P~•a• • ~t~ lrt4tcr-~1Cc'I?'~ c•~•?~r 3~~c ~t~. 8.c~c~ns~ /~l,r..~, ~i.lk.,GnG.: . - 30 -b 9 i s t c rr a t~. 2~ ~L_ ~r~rq~. jb p~T[ Zk NANE OF CEvETEAr OR CRE~+AT0111f 27l tACAT10N IG~1/. ba'~. M t~sntl) ~.9~~ft1 INroru 130ec~/~l nn. 1 1969 auderd 1~ Memo.. Park Ft.lauderdale lor t.~.~Oj2 j~ i4KfR~lOUIEtTp11SSK.h~T4R[ ~p011E55 W1TEIt€CO.~TlOt4 R[G ~-~GIST Il'S T~ ~.~~R F R«.i~as ~ Kalis funeral Nome y~~3~~~~(oQ j! / r CERTIFIED COPY ~ I hereby certit`y the above to be a true end correct copy of the Local ~ 8egistrar's reeord on file in the Brovard County Health Department at Fort Lauderdale~ Florida. - ~ . ( . Yarni ~Qt valid unless raiaed seal of the Broward County Health ~ :i•.;`~~=_~~`~e ar~m~nt is affi=ed. ) ~ i ~ , . 4'.,:,_ _;~:p< . , > =`1'~ ~r . 1 ~ . _ ~ • ti+~: t . ~ - s E r s• -4 ~ ~ ~ . w ~ ~ ~ ~ vhjv~ 4 ~ . ' • . . ir: ~ sv+. ~ • . ) ~ _ ~r.~; ' ;~~1~~~ ConntT Heslth ticer and Local Regiatrar : ~ ` - : 'a;,+ ",,,,,~~,tt ;'`Y ~ . , ~i.~. . t • d r.. : ,4 ~ . : l ?h•.= aG • ~ A . +~~~~iK~•:;, : ~ \ • .+GGZ~ ~ ~ i~ ~~.'„•~r. ~.y~ V ~ / Dep y Local aegist - ' . . sQ~i88 ~2835 ~ . . . . . ; ~ ~ - ~ , - ~h~ . _ -