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HomeMy WebLinkAbout0290 ~itEo ~NO aecoROEO ~ :T. ~uc~r couMTr f~~, r,t QtERK C ACUIT COIIAT ~ ~ ~ ItECORD VER~fIED..~.~~ ~ M+ut 1Z I 4~ PM'11 ~ ~ 0 6 4 3 9 T~~s Oe- ~TATt ~OARD or Mu~~x CERTiF[CATE OF DEATH co~es • ~UNGU OF VITAL rTATiff'1G~ fTATt FIL[ NO. ~ FLORIDA ord •~en B~RTM NO~ R[61~T11AR•! NO. ~ t prop~~l~ CODi NO. i. YtYwt KNK~lwwr.r.rw !!awwr: R.J..~W~.w..w...) e a~ e u c~~ 1 t4~tt OI K1?T11 ST~7E COY~Tr } .~a .l~l °0~",~ St. Lucie 55-Q2 Florids St. Ia:cie s t~ p~t- 0. C~n. TOMM.011 IOC~T~O~q c. K?L~CC O~ DEATM c. C~T7. TOMf1~.0~ LOt~T~OM t. K Il(S~0(htE •~~~wt uS+Of UTY u~+TSt ~~S~DE C1tr Ur~rp f,,,_ Ft.?ierce .cs~(] ~00 FL.°ierce ~cs w 1. IUME OF N! ia M~rf~l. I~ ~ftNf dltta~l I. STREET AOO~fiS rq5/~T~l OA MST~TUTIOM ~.pierce :~:em. Hos . Rt. 3 Box 163 Co enhaver Rd. 9~u?~se or si.r N~ettr L.n I aTC u~.r~ D.. s'ra °Liyn: p~.r~ RUTH P. °ATT"rdtSON oi~*M Marcr, l:, ~ 967 S Sfx ~ COIOA OA ~AC[ ~ YAAR1fD Mf V[A YAIIRi[0 Q s OATE Oi ~111TN 1 ~GE (1~ /'fp1 i II~K~ 1~W l/~OCA 2~ WK IW ~M1) Mwv~ Dan Nwn Xr. ~ a. F w innowcot'~ aro+~ccr Sept. 2~ 1912 ?1 a f~ 1~ ~0.. uw~u occw~Ta• ~ow t+.~ y~«~ a.• ~OD +cu+oos wsu~css oR wousr~r ~ t. ~:ATMKAGE (.ANI M M~M~ CN WIl 12. ar~u,~ os w~.r oa,~mn .lle ~•r- ~a wNt r nk.nrwiJ.dbd) ~e ~e~ O~..n Ho.~e Greenhead,Florida USA D.aet 1wk 13. i~TM[II~S ~E 1!. rOTMfQ'S M1~pEM tV1YE Monroe Wilks `r?icinei• ha~cy ~:elcha t lf SOCULL SfCYR~TY MO. 11. N1iOA f~ICNATYA[ A/4ta 2b1.-16-8278 uss. L.k'. a:r~in Ft. Pierce, Florida Yrn~/~l 1• CAVK K~LATM (E~fO ~~fl ~wt hWt ~t? b~t Jd (~1. ~,1. ~w/ ~[l.j O IhT[RV~L ~[TNE[M •ir•ccor •••<<~•*N+.sc.osco..~ Termir.al $AOC~C ~2 LO ~TU~ooc~TN ~rr~ouR cwSE i w~t fll• 4 Severe aSC~'D with ChF and : ~ t a f f t~ a• s~i y~u. ~~a : OIK TO ---~21CT:0'~ Y: - 3 ' •ft~ t~t y~ ~ ( } ~ ~ • c • 1 ~t taqt (il. 4 ° r~Ristr~r ~k r"~- q,c to «I Severe ~ :8SC2TC8 - _ lr~y r~~x f~t. - ~ • i t ~ t~ 72 ~ ?iuT U OMa SKw'v~Wt Cawpi~Ows Cw1~uMlrurG i0 Dutw M MOT R[Ut[~ t0 iw[ ~Uru~ OKFAY COio~TO~ Gw[R :w Iri M~S A~TdSY ( ~ lour• af- ~ KF ?ERip~MtD~ : ~ . .•r e•+ce ~ ' ~ or s~t~r• rES? NOG g = 20~ ~p"~? 1 70D otx~~~c .aw u.~wr occupato (Ewl~ ~~trrt ~J~{wr~ h PpI l~r Rr1ll yL~~ 1/7 •~klA~ ~ ~1p(~T 51i1C+0E MOYKtOE ; •p~~f- v ? ? ? _ ~ oA •f T~r[ Qi Htir Xe~t~. D~/. Yrar . - ~ee~. ~ uuu~r a s ggg o ~ ~ ~ 2W ~Nlu~?OCCW~[O mt ?I~CE O~ iwlu~Y ~w a a~yr! ?~~e. 20J QT~. TO~M.OII l0[Ai~OU ~ COU~tY ST~TE ? MN~I[ AT a ppT WMK[ ~ ~w• ~N7. ~~r~H. cQ![t Gl1~.. tfr.) ~ MOAR RT WIIK ~ :1 ! ~erend~d eM d~eNa~A /rom . ~ C1VO . ro . h •nd bst w~ A,~ di.~ oe~ ~.8'~ ~ ~ ~'J F ~ : Dw~A oecu?nd af ~,i~. i~nt o„ rn. m.....r.e.so..: ...a ro rn. e.,r ~.b.~~.. /rom ~A~ e~uNi ~t~tM « •~t ia... i x ~ MCIMTY![ (Uryrt~ M tYk~ 226 ADWI[SS 22t. 6~TE S~Gw[D t y •r• t• N ~e.,~•~. a D.M. 9leech, IK.D. ~ 3-ci-b7 ~ •ttof~t~. ~~iqw j]D p1?TE 23[ ~~M( Of C[MET[N~ ON CII[r~TOl1• j7/ IOCATqiI (CY~.lMr1. M[Nt~) = a"°""„ _ ~ , Pierce Florida • a~ - 6 F?i:2crest ~:er. Gdns. Ft. ~ ? Y. /612 j~ i4~[~Ul I pi S S~6M~TYR[ Alli ~i~~ftri:l • Jt. 25 DAT[ ~ECD. ~11 WG?l ~EG 2~. ~tGKT1U~'S 51GAATYR[ ~ -r - "••.'°s6 ~s~ton w. naird F`t. P'~erce, =1a. ~ 3-~-67 Anna Lee Dezison, d.r. ; ~ t?~r~by c~rtifY Mis ro b~ ~ trw ~nd correct copy ov ths lc:.s~ r~ Rpistr~rt noord on fii~ in th~ St. luci~ County hoalsh C:,?art- .r.~nt at Fort Pi~.u, Florida. • _ . ~ (Vlhrninq: Not vatid unitss taiwd ~al of the St. luci~ . Counry F~i~a~th D~partme~t is affi~cedJ - 'e~ . . ' i'{r:.,.s~ .i , . ~ N. D. M1LLER, M. D. ~ • ~ ' . ~ F County a~th Uff~cer b L8ca1 istrar ~ ~ ~ „ d ~ ~ '?~.~~.~1 /~/Q1L R . ~ ' , : ~ ~ ~y ~+O~S~~ ~OO~ftr{? ~ : ~ . st 1; ~ ' -w . ' - , • ~ J ~ ~1 ~ ~ ~ ,`~.Y ~ ~ ~ . ~ bUGII ~91 2~~ - r ~ . ~ - _ - = _ _ _