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HomeMy WebLinkAbout1524 ~ 207231 ~ CERTIr ICATE OF DEATH SYAT< FILi M0. FLORIDA Q ,~BIRTN NO REOIiTIlAR'! NO. ~7 ? ~ 1. PLAGE OF DEATH : Cocs no. 6i USUAI. RESIDEHCfi tww.w....a u..a it ~w: r..w~. ~.r.n a. COUNTY i ] ~ STATE _ i COYNiY .s.rrf~e~. S'- ~~~.is ~ : i'. ;l/::~~..ri.'/ e. CITY lu ..uw aww.~. u.iu. triu aL-sut.l t. LER'8iH OF c. CIfY Ot w~.W ..~M. u.u.. .AI. tVa~w pR STAY iv tau We~) Ot ~ ,owr~ ' : ;:;i~.i, mvvr+ a~~ti ARr..^. R ° a Fuu ruwe oF ~u u wur uwwu.~ w....a.s.... K~+.u a. sr~Er lIt t~n< dw r.~wu ~ ~p ~N°ssr~inmo°~i i..Lla:i :'i~Vaii L?.= t~c i ~ 1. NAME OF a lPSist) b. (YiZdL) a. (Lst) 1. OFTi (llaata) (DV) (Yrr) ~ M DECEASED , ~ p. fly~ w Ptrfwt !?L, ~.:i i.. f~i'a ~:.1.. d L'.:c>t.i~ GEAiTI j r^ vg L Sp( COLOR O~ RACB 7. MARRIED, NEY£A MARRIED, , L OATE OF tIRM 1. AGE (L v s~~ ~ tau ~ o~~r~~ T WIOOWED~DIYORCED tgMctt~) ~ ~r ~ ~ ~ :.t71'11'i ..~~i. i.L J:.1t: ~ .IW. USUAL OCCU7ATION~atw kf.a .t ..rl ~Ob. KIND OF tUSINESS Ot IN• 11. i1RTNfLACE tM~w ~ 1~..~~. we.~) Ii ClTIZEN OF WHAT rr wes.s ~ K w4M4 ?it wi 1t n~led) I DUSi~Y COU NTRY 1 ~ ....;1~~r.c~ ~::I~:,STr:i:.L D~:~:~_:,nli ti~ cwni~~s w??~E e~ woni~t~s.wu~~ ~uwE `~~j`-~ :.I.~icT J:.:.S~ : G~~ ~li WAS DECEASED E21N U. S.ARMED FORCE57 1~. SOCUL SECURITY 17. INFO~IAAtJT'S,SICMATURE ~ _ ~ lL~r. r ot~w~l IU sM. [~n.~r ~r Oua d wnlavl ~ NO. ~L•'_ t~ ~~i ~ ADORESS O~~ 1~. CAUSE oF oEATH MEOICAL CERTIFICATION tMT~wvw~ .cswc=a ~ 1. DISEASE OR CONDITICN „ _ ~NT °wT~+ n u Enter oekr eat aa~e ~ D~ Lne for (a). (?l. DIRECTLY LEADIN6 TO DFATH•~~~~...l.:.v..•.; N .va c~~ ~ ~ ~?r~rccFO~ cwusES „ - -r . ~ ~~rm_, 7 ~os. ; ~ i ~ ppp@ •f:~u d~u wt waw . DUE TO (b`' ~ ; ' ' j _ - f~ [le weie sJ jYi~Y.=l/~r6id aw~dition~. asY. rie+xp . , - - ~ ~ ~ .T r ' J~ ~~~f ~uA u Arart laitrsa,ri~s te W a6s?~ aa+us lai ~ut- :i~:.:iV:1..,~. ~ 1"'~LI~.~T._~1a .Lvts .*I?v ` ~w tA~ sw~rli~~ ta~us LtC. . r ~ -q u:?~,a.. ~:e. • a ~ i' Kv: LGw.. ~'v5 ~L lvi~ ~ ^ i~ tks li~eo+R iwia~Y. ~r' DU~ TO (t) : I~ ~yt;eat:ow r~ i c• OTHEI S16NIFIG?NT CONDIilO!~S t a'a ~ °~"'~1 ~u' Cowditiow~ coMt~itr::~g W the dcat~ b~•ct xot ~ DO ~ sr&ctid to tA~ diseawe or er.r.c:tlcr. cc'~;irs ~'::tA. ~ ~-g ~ Ha. DATF OF OIERA- ISb. MAJOI FINDIN6S OF OF~AATIOli 70. AYTOKYt ' ~ ~ ~ ~ iION ~ ra? No~__ ~ . ~ j~ ~prmwU~ 16a~un ~ 21b. ~LACe OF INIIiAY i~.G. ~ w~~Y : 2lC. (CiTY O~ TOWH ~(COYN7Y) ~STATE) li~. wee~o[Mt ' wo.. r.rs. t.c+ocr. suen. aew e~es.. ael ` L eir~l. ~au iQLLI S ~ ~ fVIGiDt . ~ T • H~~ ~ , S:d. ::«:c ty:usl tDV) ~ren:) ;tTCSZ+ . 2!:. I!rJ~RY O::.UPxEJ , 21f. H OID INJU UR : > ~a OF r;~,u ~r(''~ Mos sti:u I ~ v ! INJUiY ~ soac :,J aT row[ ~ ~ 1 ~ - ' ~2. J hereby ce~li/y lhn~ I auerwed tF.e decea:ed';rom i'~ 19 5i, !o fe~•2~ y/9 ~2 tAot 1 Iait aav ~3~t deteassd z atit~e onEeD 20 1~~`~, ard lia! ~cr'~ o^c ~rrcd at ___G~`f. :-•F m., /rom !he tawes and on tht date eeoted abotk. € ~ r p 7H. SiG.~iH7Utlt ~+.czr.s or ut.ei :.'sb. ADDSFSS '~e ^A'L S:G!.: ~ 8 _ i ~ Ft.Pierce,cla.2-22-=2 ~ yZ L. D. Yan TIL.,., :G ' : . ~ ~ 24. i U R I A l, CRE1~A-jNb. OATE 2ac. I.w~.tE OF CEMETERY OR CRE?IATOtr L N(pRt. ~wr~, ~r eoaatt) (8t.~) ~ : TION, tE1dOVA ~p~ef4) ~ A:u1 Arbor' ~:1C~ A!1 :{2ClOVa~. ~ 2-22-52 ~ f ` DATE tEG'D ~r IOCAl;RE61STRAR'S Si6T/ATUitE 2S. FUNERAI OItECiOI'S ~IClIATUti AD~~Eff ~ ~ ! 2-22-$2 i+nita Richar~son, d.r. ~ Joseph Yates, r t. Pierce, Floric.a t herebY ~e~Y Mis fo b~ a trus and correct copy of the Locel Re~istrars record on fil~ in th~ St. tud~ Co~nry Heatth ~apaA- , ~ rr~t ~t fort PiNU, Fbr~d+• (Warnin~: Not va:id unless raised seai of tho St. lucis , - ' ~alth p~paAment is affixed.) , • ~ i ~ D. MIILER. Ah. D. ~ • t ~ ~ ' . , _ N. . - County Ma~th Officer b Loul Aoqistnr . ~ - ~ , = ~ _~~r.~.~u,s l • • ~ _ . r ~0~7{/1y {AC~) AOG{StrOr ' •i ~ ~ . . . ~ `~y •j.~'i.~' ~ I~QCROFIIJ~ ~F2d0 ! 0 p ~(l~ ~`J~~ ~ . - _;=~~ibi lity oi writing, typing 60(:Il ~7 ~ ,~rinting ~,~Aatisi8~tory in s rt,i = d~~cu.~~r~t for micr~tilmittg . : . ; . ~ - ~ ; _ ~ - . - - _ ~ ~ . . , , . ^