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CERTZFICATE OF DEATH ~ '
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s60,1 fACE ~+Mn. ~+eOW. ~+MlKw wOUr. AGE-uft ~ n.~ . ~.oe~ ~ o.~ OAiE Of WiN ~rD.~r. e~~. COIJNTY 01 OEATM
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, trmite ~ 68 ! ~s, ~ ,~Aug. 26, 1902,,, Saint Lucie
tm, towN. at tour~ q oEwrn ..~+w c~n .~..~n ~hTwl O~ OTMER NSTrtUi - w~ u*~e~. oM s~rt~ ue ~ure~ ~
vau. .es o~ ..o
n~ Fort Pieree ~'es rort Pierce Memorial Hos ital i
STAiE Oi 4[M ~ r ro~ ~.s.•., ruu UT2EN Of WNAT COM+TRY wJtR~fD, rrtvER MJIRR~EO, SUtVIVNG S~OuSE ~ r.re. o~n .?wr wr ~ ~
Ne w Yo rk `'OY"°" USA ~"~~~o, on~cEa +.a.. ~
„N,.,„~„~~ , . ,~arrie~ Harold R. Pursell
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~ES~DE?~CE-S«?L COUnTt Uir, iOw?+. OR IOGT~pa
,y Florida ,y St. Lucie I,w Fort Pierce ~,,,~~~o«p ,w 120 E. ~
Aldea '
FAi/1fR-NAME ~~qt rwp! uN MOTMEt-MAbEN /i~ME rYW rOpt W~
„ Aticheal ~ J. Ryan Ellen O~ Neil
I WWMANT-HAME MAitt~('r ApQif55 ~vue~ w~.r wp. e.n O~ ew~~. s*~R, tr~
Ha old R. Pursell ~~n 120 E. Aldea Fo Pi F ida 33450 ~
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~ n. a~~.~.e~.o. 9-19-70 prescnt +~~~24 Se ~t ~70 did ~~d0:30 M~o~•~•~•~•~•«o.
CEtT~iKAT~ON-MEDKw1 ElAMWEt W COlO?rEt~ a. n.~ a.s~s a t.~ ~.o~. w u.n. ~ r.N eaew«+ r.s r~o.~w..cto oeu ~w .w~ "
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10: 30 p• M,n, ~~it• 19~ 2970 10; 30 p• M
~ CE~nf~ER-?~~ME ~mf w r~wn ; SK,t+?~E ~ / ~ w rmt Ow E SfGt+EO a~.
z n. John N. Sims, )t.D.,P.A. ~n?..~Efl~;~r y -f~... ~/~4~J f.rk 25 Sept. 1970
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~ Strcet Fort ~~er~e Flori a 33450
~ WOAL. C!(MATION. ~EMOVA? ~CfMETfRY O~ CREMATORY ~ IOCATION Gn p pw~ u~rt
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~ Burial ,..Hillcre t~~e:norial_ it« Fort PiPrc~ Florida
O/?TE ~.o..~., nu ~ fUMfRIy MOME-NAMf M16 ~JIidFSS . inur p~ ~ ~.o. ..o c~n u~o. sur~. r~
r; ,y Se t. 28, 1970 Yates .~ur,eral iior,.e, ~ox 777, F~t. ~ierce, Fla. 33450
~ Y. S. ~612 f WEW - Wf ~EG~57 SK,/~wrutE o~tE t cE~veo n tOW ~~tcaTau ~
r. A~v. ~970 -~y-~.Z~ ~N ~eote.^.?ber 29 1~7~ q
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- Re~istrars record on file in th~ St. lucb Ceun t y Hoohfi p
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5 m~M ~t FoR Pience. Florid~. . ~
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~ . FILEO AN~ REC~I~~E~ ~M t, r~r~~`' .
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~ Counry Hwith D~pa~tment k affixed.) CIEFiK CtRCU1T C . c~~~
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` N. D. MIUER, M. D. ~ =
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