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HomeMy WebLinkAbout2815 ~ . :-'~.'•;ORANGE COUNTY HEALTH DEPARTMENT . ~ ; . , •,'.'~~.1 q! WEfT CENTIAI ~OYI[VAtD..• . ~OfTOifICE ~OX ~1~~ • TE~~ l~1~Ii11 • OR?ANDO. R01t10A ~1~0! ~ / ~ ; 2 0613 9 # STATE eo~ao oR HewLTM CERTIFICATE OF DEATH ~ 6UREAU OF VITAL YTATIQTICB F L O A I D A ~T~TE FILE NO. ~ HtRTH NO. REGI6TRAR•S NO. ~ . ? 1?lAt( OI oGTN ~ CODE NO. 2- YfUAI A~f10CNCC~W~a~lae.rNAwf I!~VhMW' RY~I~AMJ~~~I~y~y~~ COUMTY STATE . 1. COYNTt o.~c~ , s-~ Ft.o~ a r~ a. ~~TY. TO~MN.O1l LOCRqN t. K ~IA~E Os OI~TN dTV. TOMN,OII,IOC~iqN K IIESID(NCt INS~O[ C17Y UM{TSi IMSIO( UT1/ lIMUS~ 1 ORId~IdDO res Ca7 ~o O QR.L~lNDO res O w~d _ ~ f. h~wE O? 1// ~N iw ~wyw~l. I~+~ ~frcrt ~II~•H) f. STRCET 110011[SS ~ HOS/~TAI JM INSI1TUTqN 1.~CY A~.DICt1.L C~'Z`E~t 6 Fa~v~•r avE. 3 NAM[ Oi I~ud Alrlrlt LW ~ O~T( A(Mf~ Or1 )f~~ (T/pt~?P~iwf) i'i1AlYl1LL'~ J• VQIlt~SVl, OC~TM ~~C[~ 2g~ 1967 S SE7( S CO:ON ON MC( ~ MARII~Ep N[Y[R MARRKO OAiE Oi ~IIITN 1 ~GE rt~a ~ V~OE~ 1M~0(.1 t~ ~MS 1~;:1IW 1'.~iT~ w~oowco L7 avo++cco O SEPT'r~B~ 11,~ 189 ~w~~u.N x.,n. a.. M.... x... la USWI OCCUMTW~+ ICitt kitil ~/r~~1 les~ I~D. KINDO~ aUSINCSSOR ~NOUST~Y IL ~IRTM~IAtE ($!Nt M/~rtyw tNt~fr/) 1~ ptIlE11 ~~IN~i QOUNI~T~ Irri~~ ~~u e/ ra~ul l~/t. nt~ iJ rtfiit/1 D^,_.ALi~..'R ANTI 1JE Fat+::SYLVAi~IA U. S. A. ; 1). 1A7MI11'S NAYE 1~. MOTMCII~S MAIp(11 MME # . i ~?.R`P~iUtt G. JOH'i~ISOP1 DOrt'TIE UN~!VAIL~IBLE ~ , ~6 SOC~AL S[CU~ii~ up 17 ,INFONMANT i HGNATYR~,~ ~(~/rp~ ~ ~ / .?^?-?l~-Oo0 C--• ~ . -!t . 6 Fairvieti,r Ave Orlando Fla. _ , ~ 1~ CAY~f OF O[ATH (t.w/t? ~w// ~~t t~~K yt? hwt , i~l. 1 ~ INiE~Ylll ~ETM1I[N /M17 L OE~TM M~5 C~US[ D W. ~~-{}e ~ _ ONS[T Mlp O[~T» - IMMEWATC CAUSC (~l - L.LS/_~-~ _~~~JL~L)1~(~YILt_~CS---- - s. { L i ~ ~Et e Cond"uio~s. ~l~sl. ouc To (61 r 1 ~ ~~~~t`~C.iV~ ~ ~~~~~~c - --I/~_ f r~ed o~rt r~x fe .r1wt t~vu - atsl~~~ f~r r~Qrr- Ot~C TO fN ~ s L FQ•' ' ~~I- ` . i~ ; 7 r.~.,. r.,f • -L - t - - ~ - - - 1 - - -_'J ~~I ~c~~ ; o ?~~T o~.~, sw ~~c.~. co~a,w~s co~,~uwnwa L p n.~~w asu O~W i1011 6MM M?Mf 1(~I I~[~RS~iOyUTC~SY ~ ; ~ ROCER POtTRAB ,rcsQ"~o0 t tr`°°.eyl 2M D[st~i F.'w/n rrri y~ajrr~ i~ I'~r~ I r 1'ert !I y4rw I~.) ~ ` 4 "a'a"T S"'~'°~ "°"K'°E RECORD YERtFI ` O C; ? - ¢ ~ Xk T~ME Of H~rr Al~~l~, !N/. )i~r ~A ~ i~~u~r ~w. ~.7Y 2 0 613 9 o D- W ~ ~ Nd IN11iOY OCCUAN[O IOt ?UC( O~ tb/U~v ~t y. ~n or ~brt Aow~, 20/ C~T~. TOr?N, OR IOCATION COUMT~ STATE ~ MMII[ A1 O ?.pT KMtIE ~ I~~'~. /~rlN/. N+~ef. c~fiu DIQ~ . N;.) . W011K AT WORK ~ J ~ttended fhs dec~~ssd /rom ' ~ _ _ ~JC_ _ , fo _ ~nd Lsf u.r m •lir~ on _ ~ D~~th occurr~d ~f _ ~~15 _p m on fhe d~r~ ~f~ted ~Aore; ~nd fo fA~ 8~st o/ m~ kno+bdp. /~om ~h~ uw~s ~hf~Q. ~ II~ ~IGNATYIIE ((M/II[ M lYJn 22! ADON i ~2t. O41E S1GM(O - 3 ~i~i,~, ~ ' ~ 4 ~5~1 ~ ~-~z o l'~r _ ~ ~ ~ " ~ Il.~ Y.a:~l Uir~r~ 'J:. .~~il ~k N~M[pfC[i+tt[~ O~CAL~4TURY~ j]/ lp~~TqN(C~~.f«rs.Mt~r~!// ~.~rll s R~r~~i~ C f1~I~ / o CRi:~~..:.~f;~; ~-_3,31 67 FAIRCNIID C.R~'4:?''i'GRY ORLliI~'DO FIA. ~ j~~i~bi A D~p[CTOP S S1GN~T4~E/~ Appp 2S O~TE ~CC.7. tOC~L IIEG K. A ~ AAR' S1GN TWE - ~~a~ •hild ~ryra.~~~'or.Ze, b~lando, Fla. t,;AR 301;~~ . ' 1L,//CF. ~ . ~1~~L f~!'~ ~ . ~ - ~ ~ C~::FZED OOPY - _ - , - ~ . , . Ls : hereby certify t::e above to be a t:L~ and co::ect copy o~- ~t~itlcar's ~ record on file the Orznge County Y:ealth De~artmwat~ Orl ~a,r' ~ ~ ~ ~ ''M~t J • ~ r`,. 3~ t . _s . ~ . ~ /~.~n~//s ~~„~Z"/\. ~ _ - ~!.[`~'~~~t tj"` ~q. r• s ~t;} ~ . ~ . ~ R ~A.-~: i Y F k ~ t ~l. ~ ~,lo~. I ' { ~ ~'.~e~, 3~ t, ~~;:nty iiealth Officer and Local Registrzr S ' ~ L ~='~~K~h~..R~ ~ s~ fEB 2 5 1971 •4,=-~~ ~ Date Issued d00K~~ ~'~pQy sr+i`u ~ - = WARNI\Gs Not valid unless raised ~eal of the Qrange ~ Couaty Health Department ic affixed. ~ : . __...F_,_ .__s _