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HomeMy WebLinkAbout0521 , ~_yt%~G-c= ~ t' ~f' /~t ~:1~{ - ~l c'/lrt'L ~ ~ 3/C.~efi `s r :~t `L ; ~ : ~ ~t~EO A110 RECOR4E0 ' ~ O ` O st OC[R~~OITRAS ~ ~ = ClE11K CIRCUIT COU p 6 5 9 0 £ RECORO YERIFlEO tat, .T~ Z.o,?w g~~,t~ CERTlFICATE OF DEATH ~o,.s . wwuu or vn~~ ~r~nimc~ srwt~ F~~t wo. 1es•~ FLORIDA erd •h~n BfR7H NO. RE61iTitA11•• NO. P~operly 1. KACt 0I ~tl?TN COD[ NO. 2. YtYA~ wtfiftMC~(Ia..I..n.rArt I/i+.ar.wa R.dr~s....r.w...) e:~t~t~A CGVNTt a STATE COUMTY and •ill s. ~i.~.. ie le p~t- b. dT11. T t. K~I~CE Oi ATN t. QTY. T01MM.0~ IOtAT10N r. K RES~OtKE ¦~e~et ~ IIIS~OE CITY IIMiTSi NK10[ C~7Y L~YITSI f t 1~. ' YES MO ? YES MO~~ NAME ~fJM! iR ~MNhI.II~t «rMf MhtM) STR[ET AOOAESS NpSMTAL O~ WST~TYTION 3 w?Mt e~ IYr~t At~Nlt b~t wTE ~(NN D~ Y~~? ~7Ylrr « MiM) ~EP811~. ~TM tJ ~ 6 ~ 9~ S. SEX ~ GO1011 OII ~IICE MARR~ED Q~.fY[II YAltl1~(O ,a j~. MTE OF NQTN ACE Ih ttr~ ~ tM.DE~ ~ iWt u~0[A 2~ MS /rt6kfW11 Mwu~ D~w Rwn Mi.. e. g moorrco ~7 o~voRCCO De C. 1$ ~ ~ i• i w 1~ ~0.. uw~~ oaw~TaM lO:re r~.i yrr~ r.e~ IOA. KIMD Oi WSINESS OR urOUSTIIY i~. u~Twn~a (strr .r ~rey. asae.r) t cYrua os rwt aaa~n.r •ft~ Ivi.~.«~Nwrt~dk.~tayrdirNf A t Insurance IL U.S.A. ~l~ct iwk 13, il1TwE11'S w~E 1~. rOTNE11'S r~pE11 IUNC •r s»~.ras~r vIlAV811Ab16 1~. SOCIAI SECURITr MO. 17. IN S i1YMATY~[ d~6iM ~ ~ 6 -0i-6868 Mdreu DeP ul ~ f an~ r~ 1 1~. CwYft M KATM (b5~fa wl/ Mt ewu rer h~r F? 1S1. t~1 (tl-) INTEllval ~[EN ~l~~tt0~ ?~ATL a~rnrwsc~usco~r: °'acTU"°°E"T" .~•e ti~• ~rrcor?n cwst Me e~. e.r_ ~ s i tf u e• C«~ifiw, i/ ar. p~( Tp (s1 ~ •It~I ~l• illt~ /Yf /~~/J L~ ~ • t • 1 ~DMf t~tlt r~6utra• at~tiy Nr tnft'- pYi TO •ltal~ 7i M~ ~w fW. Ue~i f- ~ /MT M. OTIi113K1i/iTtMt Ca01TqN{ Cprt~NU?wG 1p OLatM MR NpT R[U~7[O TO M 7[irwt pOI~S[ Op1~11qM i1YO1 M~Mi 1(~1 . MlS ~UTOKI . ~EAFOIIMtD7 Nf d~atY •r Oef~r• 3 io. ~ ioa. ocx.uc ~aw ruu¦r occ~RRCO. cE•+w..rvs N:.~.?r A..r r« ~ u yr.. ria ••t~¦s ~ ~caocrr wK~oc ~K~oc •~Pe~t- v ? ? ? •t ~Or T~rE Cs HNrr ~lfirt~. Dr1. Yarr ?~d~' u lMJYR~ w. `o r. w• . W = 2W. NUWt OCCURREO 2Ot. tL~CE 0~ tMJU11~ i~ a~I A~At. mI CI?r. TpMll. Ow IOCATIOM ~ MUMYY STATE 1n~Nt A7 ~ nOT MMIIE ~ NUMt. ~vtd. ~n NI/.. dC.) . MOIIK AT MOAR 2i !~tt~nd~d t/~ d~cNNd/rom ~ 9~ , . ro dea t~ ~nd b~t w~ Af~a~ di~~ on _J DtifA occ~ind ~f p~, - ~n on fA~ d~t~ ~r~f~d ~Do~~; ~nd te tM b~at d m) ~norMdN• I+om tM c~uwa H~t~d. ~ NaNATYA[ ((X/IMMlYIt) ~ ~~E~ g02 North Seventh ~-~TEW.KED ~ •t• to 1• a Melvin Wolkows l:.D. Fort Pierce Fla. 7-19-bb •lc~1~~t~. 27~ MM~~?.G1[raTDM. Z~ MTE Z7t MrEOiCEMETE11110RUEYAT01111 Z3/. IOCATl011(GY~.fMrR.1?lMN/l 18~tri ~ Ce~ete Queens unt N.Y. e~iova ~ Jul 18-bb ut . St . r. a. r e~ z z~ ru~¦u cro• s s~wTUec .oouss ?S DATE ~EC4. ~r IOGtL REG. REWSTIA~'S SIGM~TY a~..~oea Jack J. Y.oore, Yates F1u?eral Haae 8-8-66 Anna I.ee Denison d.r. ~ ~ I hereby certifY this ~ be a true ar?d cwrect oopy af tfis I.ocal i Re~istr~s record on file in th~ St. luci~ Counry Heaftt~ D~part- ~ mM?t ~t Fat P'~erce. Florida. _ ~ (Warning: Not va:id unleis nised seal of the St. t.uci~ ~'L. County Ksatth Department +s affixed.) , . " ..r!, . ' N. D. Nt1LLER, AA. d. ~ . ~ ; ~ ~ : Cpw! ~tf1 ~KOf Si Q~Q ~ ~ f t', ~ t;: istnr , : . _`~~4. ' :.t . , ~ . ~i l~_y /'3~/ p ~ ~ - , {,<Y, t7~ , . . D~'1~ ~h ~s) RM7lttra/ ~ .~.;s._s`~j j~. ~~~~t z ~ ie t~`~~~~ ~ ~ . BOOK 191 52p . . _ - ; -