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rn~. ~ RATt ~w?wo o? Mu~r+ CERTIFICATE OF DEATH
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FLOSIDA
ord ¦p~• OIRTH N. 11[G tT11A •f NO.
prop~rl~ GOO[ NO. L YfYAL A[stO~NCt(~~w.rwn.~A.r. !lwwwew: R..b.rMI...Ii,w:w.)
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l• C~TI. TO~IM.O~ tACATqN c. a rucc as oun~ t. pTl/. TOf140R IOCATqM K IIFS~O[eCE
•~~~et S l~uaZ+t ~ InS10t CI?1 IIMITSI Stual,•t IMS~OE CITY UYITS7
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' I. IU~ME Of (IJMt i~ ~M/ih1. /i~ K?qt NhsM) f. STIIEET A0011[SS
"°S"T•~°"'ia Hospital Route #2 -
' MSTITUTION 1~ rtin ~:em.
~ MAYt O? Firlf A/if/b Lyt 1. OATE Y~U D~I YrY
„ RUTH G. CLEMONS ~,T„ v;ay 11 1969
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. . , s . Female White .noo«co orvo.ao Au . 1910 Y•M•• p••
~ 1~1 wl ~ t0~. usuK ott~M~nO~ (Oir N~t yw! Ias IOe. Kuwof wiu~[ssoa w~ousT~r 11. w~TNrua (3rir a~nys aa~rn) . arua as wwT aawr~.e
•lt~ ~~r- I~rtalawt~(r~rWlh~r.awai/rdir~ ~1cA
Housewife Own Horqe South Carolina ~~t+ -
~ ?l~e! isk 1~. iATN[t'S M~WE YOTNERY M~IO[ll MAri ~ .
f Homer But :•Samie Cox
f ,t socuw staN so. n. a uawru~s .tu.s..
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. s cni~ 7! ~ tART 11. OT~O'AiliiYM~ G01p1i10~6 COMiM1IfMC 10 DUTM ~{R 10~ 11tU1[O10 1ESMOMI OtffA3[ COM01110M ~1 ~Mt 1(u . WAS AUTOKI
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or D~[~r• Y YES NO?
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i 20/. NW1111 OCCYRRED mt. ?UCE Of wW11Y (t. I-. ia M?~wf VAS. mI QT1. TOKM. OII IOCATIOM 0011MTr STAT[
Miwt[ ~T ~ NOT Yn~ME ~ Ms. IkfMI. ~ntd. s~ct Ei1/.. dt.1
. ~~IORK A7 NORK - ~
~ 21. J~tr~al~d tlw New~ /rom ~ . ro •nd fut w~~_~/i~~ on
~ fA occurr~O ~f ~ ~ G 9 m on tM d~b ~I~t~d ~Dw~~: ~nd fo tA~ 6Mt d my t Ndp, J~om tM uu~s auad. .
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~ ~ U~C C . ) -1 !Q'L 11 69
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•eerr~t~. ~ ~Wr~o~. 2~1 o~t[ t3r ~arEOSarEttRro~e~cM~Tair 23~. ~qewTq~~G7r~,t~sw.~r~~1 (Stt~ta
Bur'~a~`'°""' S 14 b9 Fern Hill Cemetery S~uart rlorida
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a... i..s f~ ~ l3 ~ ~l~ Q.~.ua.r1 -
~r i breb~r certify tfiis b be a true and oorrect oopy of fM loui i AN Qo~ot~
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g(jtrors r~cord on file in the Mart;n County Health Dop~?h ~
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~~\~,i ~ ~jr ~ ,lA~nt M Stuart, Florida• ~!k CM4Ylt
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' : ~ ~3 (Wsrn:r~: hot valid unless reised seal of the Martin ~ '
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~ F . ;~;~~,s,.~- " OpC I8 11 ~9 ~M'11
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• ~ N. D. M.tll~D, M. a.
• ~ 20~'313 ~
' 7t% ~ Cou~ry Health Officer d. lo:el R~gistrar
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~ s~ ? a p~p„ry tocai Reg ~ c~iar ~~.7t.~ PAf~f ~a7 V V •
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