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Home My WebLink About2845 ~ ~ iT• IUCiE COUNTt FIA. ~ ~ / . ` ROCE!i POITQA3 - CLfRK C~RCUIT COURT RECORD VERiF1Ep.~..~~ ~ - _ _ - Jwr. Z---2 2~ ~M't l . _ - - _ - CERTIFICATE OF DEATH F L O H I D A ~Twrc FIL[ NO. i SI NO. R[OIlTRAR•t NO. ~ ' 1. PLACE OF ~/1TH coot No. L USUAL RESIDENCE iw~a. a.e....~ n..a u c uu~w: ~..w..~. wr.. - a. COYNTY u. / L ~ SiATE ~ a COUNTY t wt..wi. . ta - l.L l~ Q.J 6. CI7Y ltt w~w 1W~ ww sos~tl a LEN6TH OF a CtTY Ot w~W~ ~erw~r u.~~. •.w auaaW ~ ~N / _ . ~ fU?Y (w uu We.) T01NN yU . ~ ~6r - ' f ~ • f -L .t Wtl NA11E ~Oiv rt 1~ rNW ~r ~uwt N~w ~r lw~tW d. STItEEi Iu ~4 dw 1sat4~f- ~ ~ ~ HO?im mo+? ~f'1~f 4'i ~ "°°'~ss / Z G . / C ~ . ~ 3. NAME OR ~ phst) 1. ) a(Lst) 4. DwTi plonti) (DV) (Y.ae) ~ ~t ascews~o ~/`1 aF p M ~Y - l~ t- D~TI~ _I t y i. OOIOR OR RACE 7. IIAtR1ED. NEYER MA~RIEO, DATE OF t14TH ~ 1. A4E (t~ n r~ni ~~au , v~~~u u u~ ~ ~ ~ ~ WIDOWiD, ~IYO~CED t~~) lrt 1~t~rr ' D~n' IIwrs ,!u~ >P t~u. ~ A ~ .l~ ~,t_ - ~ P- / .3 I 10~. LSYAL OCCUfAT10lI~pM tw ~t IN. KINO OF ~YSINESS O! IN• 11. t1~TH?LACF ~ p~ ~n) IL CITIZEN Of WMAT + y ~ iw~+ti.s..a.twu+s r..uwq OUSTaY ~ / 1 4.(,~E,~+ .(.1/- ? ~ :?y • ~-t?-O~-ai.+ ' OUNTIri ~ . a~ ~ u. Fwm~Y ~ ~a, aomEa~s wu~r~ wwi _ ~t ~ ~ ~ • ~i(.~ - (~C.C.~t~~V /'f~ - ~ ~ tJ 1' , ,~-!it%l~' - Q~! ~ l~. WAf DECEAfED IN Y. S.ARMED FOlCESJ li. SOClAI, SECt1tRy 17. INFORMANT't SICNATYlE y (j~ M/R ~ta~~1 11f 1~ i~w w[ 4 i1M d M~1~ 1 N~. ~f ' ~ e I ADDRESS . _ . ~J ~ t~. Guii OF OEATM J~A6DICAL CERTIFICAT[ON uRCwv~ ~a~wiw S~t~r e~. ~ aaw 1. DISEASE OR OONDMON ~ ~ oNUr rueo orwrn ~ ~ riw 6e (~I. OIRECiLr ~b?DIl14 TO DfrATH'~~ L~i ~-t~~i .~-t it.~ ~i (s) 3 ~rc~?usES .~t}--u.~_.c L _.~c..t..-c:-t._~;..7'12.~_~ d •17t~ w~t ~ww Y~riti awlitiww~. tf ps. /f~iMDllE TO .7 w s~~ N jr~v. a t~ ~M.~ ~nw (s/ wt- j - wsa ~ A~srt 1«'M+i. . ~K~ /iRJv~i? W W w+w Lrt ' ~ DUE TO e) ~ j ~ «.s+~.er.. .~~.a u. orHEa stu~tkc~?nr conomons r' ~ ; .....i d.re~. . C~w~;ti,~, ~wbi~aay a u1. teui i.e w.!'~" ~"•C~z~ -~.A~ -~GC~yK.~-~+n~e-~CJ f o s~dabi M tA~ ~iae~w e~owlitio~ esrww ieat~. _ 7.' .t t J_ ~ E ~ n.. ow~ of on~ in. ww~oe HNa~cs of o?~u?noN M. AYTOKY~ . ~ r ~ ~ ra ? No ? ~ E ~ q7~MW1 /aNd4) 21?. lLACE OF (NJUlY (a~.. ta K~Do~t 21c (CITY O! TOWN (GOUqTYI (STATE) ! 21a. AeeloswT ~R tr~ M~q. Kn~t. Mn ~rit..u.) u wu. wu 1tB7uL1 ' ~u1C~Di - ~ p 211. TIME t1vtU ~f1 (TVl lHwrl 21~. IWURY OCCUlREO tl .?i D! IWU ~ , ~ ~u?t~T ~or~w~u ~ INJUtY a ~o~s ? ~r ~o~i ? n. I henby certi/y e1~at 1 al t)K deceaud Jro~n •!/19~to %~!`"'~-'~S`_ 19~ tJwt ! fas~ ww the deceossd ~ alive on ~ s^ !9 ~ m~d thot deolA otcurred ot ~m., Jro~n ehe eaasu and on the date s~oted above. ~ t3~. SIGNAT RE (De=r» oe tit~y„ 2~b. I?DDRESS Y rie DATE SI6NE0 p , r~~i . ~12if~1'[~( ) - ' . I _ f 1 ~ 1 t' ~ i 7`~~ / 1/C f ~ V~ ~ A CtEMM 2A. OJ1Tf i~c. NAME OF CEMETElY Ot CtE1AATOlY 2W. LOCATION (Ciy, tes~, oc eoony) (SLa) ~ il RE!/OYI,~{~r~M ~y / h ~ ~C-tt..Lt.~ ~I ~ ~ - ~o .t y~ DATE t[C'D ~Y LOCAI tE61ST~'S SIGNAT{?Rfi tf. FUNERA~ DIRECTO~'t S16NATU~ O,tESS & ~ ft C/ y ~EG. y~ i i ~~,Q ~~1" - 0~-~ t'..f-tL~ ~l/ / V /`_1-~tl/i.L- 1 .t/~'.t - .`j~~-ti(.~,c, ~,(,1 . ~ ~ 1 h~rby o~rtF(y fl~h b b~ • trw ~td coRret Copy~ cf ths toad ~ Rplqn~s noord on fif~ b 1h~ S~ t~ud~ Ceumy Hsilth prp~/? ~•f~'~~ ~ I~Mflf N FOA ~f0~ pOf~. , - e:~ :k; , s x~ '1r ;Y -i'.~I~. ° r. ~ (WafNflQ2 NOf valld t1f11MS fa1Md fNl O~ t~f~ Sf• (,IJCI~ r' .4 : r•• ~ ~ Ca+mY H~+Ith O~pxtm~m M ~fWc~d.) ~ . 2 ~ ~ ~ ~ N. D. MILLHt, M. D. ~ L' , 'r•-+-:~` ; ~ CoMM~I Fi~aflh OffioK i~+oo~l Rpktr~r c; ;~.r~'; rr - i , ¢ t ~ . ~~~`~`~,~,:t~ sf;`: ` 1"d`.,~i, r:.~: i - ~ ~+M ~ ; ~L` ~ ~ r~. . ~ i~~. ~ . ~ ~ _ ~ooK 192 ~39 : ~ - - ~ _ . _ ~ . .