HomeMy WebLinkAbout0341 ST,tUC1E ~OUNTY FIA. ~
ROGcN P011RAS p
CLERK CIRCUIT COURT ~
' RECORD YERIFIED~.....~.~. J / '
~~j~~5~ fEe 10 I I 23 aM •7 i 20~~~~~~
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RE: Lot 5;- less the East 115 feet and less i
also the West 15.1 feet, Block 19, A. C.
DITTMAR'S RE-SUBDIVISION as per Plat
thereon filed in Plat Book 1, at paqe 27,
of the Public Records of St. Lucie County,
Florida.
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DEATH CERTIFICATE OF H. P. ROOT
~ CERTlF1CATE OF DEATH
F L O R I D A RwT~ No.
BIRTH NO. RE616TRAR'f NO. ~ ~ / ~
1. PLACE OF D TH cooc Ho. ' i USUAL RES ENCE iwf.• ~w.a u.a, u ~,.u~~~: ...~a.w. ~..rw~
a. couNn C~ i ~ ~ ` $ . sTw~ ~ couHn~. ~/'~-Gc~GC.e~
~ CITY t~r .rt4 YCaatl c. LENGTH OF , c CITY tu ~auW ~~swy~ u.~~..ru. a~aV.~
'g OR ' ~ STAY cia tet• at~u) ~ OR /(J
~ TOWN • rf~-~~! CJ J:'t
l•p. TOWN /j / ~(~Cie/
~ ~ d FUII NAME OF ltt ~ b w!W ~r lasuwtMa. [i~s avrt ..Ltw ~uua1 ST0.EET ql A+4. sfw McNlr1
HOS~iTAIOR ~ AODRESS ~ / C J~j~.
~ ~ INSTITUTION d ~Qi~ -
'b' NAME OF ( ' ) A (Yisdle) a (L.t) t oATE u) (Da~) (Yeu)
~ DECEASED ' 1~ ~ ~ ~ p~~ [ O
llYM P.iwt ~ J ' ~ I ~
~ L SEX COLORQI tAGE 7 ARAIED, NEYEA aIARtlEO, QATE OF SIITH A6E ~~a ta'i ~~~p ~.wc~ ~~+u
~ WIOOWED, DIVORGF~ ;g Wt .+~st xrtr Dv. 1?wt. L:i
g (.c~.~~ ~ , ~ t f ~ - / S 6 ~ ;
M IOa. USUAI OCCY?ATIOti~p~.~ afse d wrl 100. KiND OF i1751NESS OR IN- 11. {IlTlSHACi (Kw ~ wMS. wu~~ Ii. CtTiZEN O~ WNAT
j'~ ~or N ~t d watu~ OtA w+~ It ntle~) DUSTRY /'1 . ~j GOUi~?IIIY ~71''
q ,!L:- :?`,C./! ~ .2 . a i ! F'. / / / .1 / ~ ~ ~ . ~ . J7 ,
Q Il. FATHEt'S NIWE 1~. NOiHERY 14AIDEN N/WE
q ~ I ~-f+.(~.u ~~L ~ -
N~ IS. WAS p ED ~IEA IN U. S.AUAED fOiCES? IL. SOCIAL SEGUtlTY 17. ~NFO TS S16NATt~ , ~7
W ~ (Y~~ 1rkMU 1(~I M L1N ~if R O~tM ~C Mirkt) NO. ~~.~-Z
p ~i ~ ~ ~ ~aotESS _ ..crG Y--~
j"' i~. Cr?usE oF cEwni ' MBDICAL CER7tFIGAT)ON ~INTGlVA{, •=.w~u.
1. D{SEASc OR CONDtTION .~i ~ OM{[T AND O[ATM ~
. ~ ~ w+ tiM toe l~). (S). DIRFCTIY LEwD3N6 TO DEATH•~+) . i ~ ~ ~ ~t"-C"" ~ - 1
asa is)
~ AHiECFGENT CJIUSES I • `A, ~f;
. t/2 ~ ~ 'iAf~ l~sr wet .~esw OUE TO (N I ~ _7 ~`tl. -CA/.t~.f1/ d` l~'~.(J?-' Q,~~! _
~ y~ W sol~ ~1 iri+W. YorDid cvsditiow; il aw1~. O~tinD J
we~ ~ Aesrt /a:irn. riw b t4s abo?~ n+w laI uat- ~
y'O ~ ut~s+~it. ~t4 /t wMwr iy t~ ~wdtrlriwP taw iut.
r A ~ry. K DUE TO (c
(y ~D'+a~* • R~~ a 11. OTHER 516NIFICANT CONDIT~ONS
AI~N~ 1Hf~. COwd+twla MaLRbUIIRQ W IAt d~nlA b~tt Mt ~ I
~ related a!A~ d~.ra~e or to._.::ticx ccusiw dfatA.
~ Ifa. OATE OF O! O- IY~. MAJOR FI?~DfriGS OF OfeRAiiON 30. AUTOISTJ
~ I r[s :_1 xo LJ
~ iPraa~abl lBNesfsl Iib. /LACF OF IN.UfiY tr.c.. tn.r.twx i 2ic (CIiY OR TOWN •(COUNTY) (STwTE}
T~ 6j 11~. AKIDpT 4~ma. fara. tacta~7. n+eet. a~s~ O~L. ~ts.l ! I[ eur~l. Nau iVLLI . .
P j~ suic~ni i
( O I~ =Id. TlME l~r~) 1nv) ~T..q ,G~cr~ i 2:~. iNJULLY OCCURAED i I: . MO DID IWUR Ylt
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i ~F I wH~uat.-~ ~oT~.:icn :
~ ~ ~ INJUtr ` soac ~T~cac :
~ i-, .i ~~ry
~ ~ 7~. I liereby~terti/y ll.at I,e,.pter.ded tF.e actrasid ~rom .1 19~L, to_~~~~ 19~. lf.at 1:as: sau~ the u~.:~~.;c~?
~ ~ ~ alive on ~v 1~~ e.:d t?:at c?Frs.A occLrr~v ar . U O~~., /rorr? ~ cau+tt and o?. :At cafr t'alcd ai~n=. e. _
~ ~ 3~+. 51 U E ~ tDecr.e or tit2c) I30~A DRESS • ` 23c DI1iE SiGV~J
~ ~ ~ ~ . ~ y ;Y ~.r, . ~.,c~t~•, . u.~, i •y ~ = ~ 9
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i t,2~i. 6 U R 1 A L, CREMA- 2~b. OATE c. KAI.~E OF CF.VCTERY OR.CAEMATOtY !2~d. IOCATiON (Citf, w~?~, ot eouab! (State)
~ ~ ~T'QN, ~EWD~A~ ,a~.x:,~i ~ /j / _ ~ - . ; y~ _
~ r ~ . . , : ; ~ - r? ~ ' i ; i~ t i/ ~ : ~.:~.cl ' ~iJ2 ,1"!. _!lJ-XJ f ~ . . ;
~ A ?t,DATE REC'D tY IOCAI'tE-6-y1STMY'S Si6NA:UYf 1S. jUNERAI DIR OR'iyS?GNAjU/tf~~ /~DOLIIE~SS ~ ~
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~ I h~reby tertify Mit b b~ a ftw and GOrt~Ct oopy a~ fhs Lotal .
Rpistr~t t~eoord on fik in tM St. luti~ County Heahh D~part :
s ~ ~t:~~-
m~nt ~t Fort Pie~u. Florida. ~ s: - ;
~ ~*`r ±r r~`%- , i
No ~ ~
(Warning: No~ va;id unless raised sea! of the St. lucis ` ~
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' Cpynt~r Fi~alth D~partmMf is affixed.) ' ~ r' _ :
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~ ' ;,.~'~r~~. ~ '
~ N. D. MILLER. M. O. . ` i.-'~~r-. ' - .~5:_ ~ '
County H~atefi Off~eer d~ loul Rpistrar . ~i;,•. ~•'~f ? ~ -
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