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HomeMy WebLinkAbout0134 - - - - - - 2-i 21 ~ i~)~(3 ~ °~CS~~I~~ P~GE 6 1~.~ f Lf AM , OAYTONA BEA~H ?~tAOQUARTEAi ~~C~E ~~y~~~g~, , ROCER vo1TRA= " VOLUSIA COUNTY HEALTH DEPARTMENT AECORQ YEp~F1E0 COUIIT ~ a.o s. 6e«n st~eet s. T~k~ zs2.~.~, Ju~ 16 1 a~ !'M't'•~ OJ?YiONA BEACH, FlOq1DA 32011 ~ ,~+~'~~e`~ =`e- iTAT~ .o~RO o~ Nr~?~„f CERTIFICATE OF DEATH ~ 7~ " • YUR[AU pF VITAL. /TATIQTIC~ tTATE FIL[ NO. FLORIDA " ' P7RTH NO REGI57PAR'S NO. c..;rrlp ~•ar. ul~d '?~C< Oi O(ATM COOE ?i0. 2. YSYJ?l A[/10[MCI/I~w~frr~ah.~/ //~rhwt.w~ RWw~br~/~wr~) • n i • 11 1 ~OCA~• O • STATE A. CObNTY • ? i ^e ~S~tid • ' ` t'~:'1"_~ ~(1~11.'lO ; n p~~_ A. C~Tr. TGMM.O~ \OC~7qA :S ?I~CE O• O(~'N GTr, TOMN.pII IOCATIOM K ~ES~O(rK( .?~ent r n ~hSi9f C~TY LWITS! iwS~OE C~iY U~~is~ 1. .:(i1G'C rESCr ~•O~ ~ I!~~ rt9~ r.p L . ~~~E ~ V` ~/J Nt ~w ~Np~fd, pft ~btK ~ttrn~l [ STREET ApD11ES5 ~.C~S?.T~t OO ~ i~iT~T~tq~ 1 .'f . i . ~ ' . . 1 ' .t~ 7 MAMt O• I~vM Al~,fdJt L~a( DATE Nowf~ D~1 Yro occusco ~ , - , _ or yr. a.. ~_~u.' 44 ' 1 .,f~in , ~ ~ ~ l : 1 . S SEX ~ COiO+~ OR IIACf u 7,yAAA~O wEVif1 llAilplEO'~„j ~ OATE Oi i1RTN 1 9 ~6E (/A ft 1 < WOlA 1~W UcpEAt~ MS. ~ ( . ~ fut Syt~fq) M~M D~w N~.n Mw. Y r ~ s a • - ~ '_'C : f ' : ' rnoow[o ~ ~~ti~cpc[o ry , / . 1 ::.i n 1~ IQ~ ~Sii?i OCCI:?~TqN IC4[ t~~d ~(rM~ b~r 1~. ~(il~0id ~uS~1KS50N ~MOJSTA) . 11, ~.RTMI:AC( ($(dt M f1ItyAC~Ywfr~) IZ CITIIIM Of nYT QOUwi~t~ . i c n ~~n~/ a~w~ ejrwt~al6/t. ~st~ i/rdrrd~ ~ _ if^f(~~ ' ~ ' C. f r k 1 pk ~~TNE11 S~~wE • _ ~ 1~ YOTNER ~5 MAIpEM AAME °T r 1 ~ ~7D~~rilsr ~l _%i)._.fj. ~ ~ ~i _a~:: ._i' ,~J-~ .:l If SOCIµ S(Ct~R1T~ NO '17 `1M/OAMANT ~ tiQNATYw~ A!{rtN ~ '~-l~--_- i J~ ' . ~ -r t_ . ~ ~ ' - - ' E F.. r~? al i~ tAQ1i Of O[ATM j~wta ~a1~ ~u nrtt prr l~w~ ~~A( 1~1. .D~. ~ci.j ? IMT[RYAI ~fT1NE[N I a ~ •~IIT 1- O(A' N 11rA5 CAUS(D ~Y~ / J _ a - OMSET ANO DEATN ~ • _ Y t f f 1 • ~ ~rrCOUTE CAYSE ~~7E L~-r~! -~~e'.~/ . _ - c~t- / ~ ~tc~e• Co~~i~~~_r/~a~. Dut To (~l ----G~tii-liL,s~^i)LI~--`~` ti:.~ G( L.A . i: r. tA• r!k pve na~ ts - - c c . 1 ~t csr~r `a). r c~~ s t r~t K~tuy !4 rw/~r- ~E TO fc~ - ~ = ll~a/ cuu !wt - 1. r~~~ fa 0 ?A~T It OiK~ 51f.tit/I(,~wT Cpwptwy6 COwT~/~{Ji~wG ~O GUTp ~Jf 1qT R[UtIO TO TN( 1[~rf M fMT 1(~1 MAS ~UTO?$Y ~ n A ?[Rip11MEOT : ~ r 3 ~ ~ t ? V C~~i 'r ~'TL` rES ? MO ~ ~ t !f~Of• = a : ng •wy ~ ~ 4 ~ ~ ~ aX~+~ ~ow :MJ~ C~~a[0 (E~ft~ ¦ r • w~rr~ is P~ Yr~ l~J CC~DEw~ S~.C~G( MO~K~Ot ~~o~t- v C V ~ ~ ` ` /~Q~ : : o n e f ~ - E o d~. 2fk T~rE Oi /Ixr YMf~. M~. YfY V i11J~I11Y w. , ~ G I~ y = 201 H~I~~Y OCW ~~I~ 20t ?UCE Ot rhJU~r It. /.~w a d~aW ~ow~. + ~M l Tq11 COUMTI Si~T[ w+~~li ~T ~ wOT MH~It ~ /~~A. htfN/, Nr=d.=Au cra~ . nc.~ ~ / j S ~ ~V ir'v.7K AT MK111K ~ ii / ~t~~nd~d tA~ d~c~~Nd /ror» ~~1~:~ . to --7~_~ ~ • N~ ~ m on f ^ - ~n ~ D~~th ocwn~d ~t m on rM d~t~ ~r~t~d ~Do.~: • b~ m~ tno~/~d/~. /rom fM u~~~s ~hf~d ic~~• t2a t~cwwtu~[ ~ • r• to p• ~~I~« N ~?1N Z1L •GDA[SS 12[. pATE SWIKO 1 y~yt _ f A c~~l~t~ ~ V~'-L~~:t!'-TS ~•~r/f~-Ci~i''_ ' ~~~l.I •.•4 1 /~-LY% ~l.' .~~U- ~ O ~ L.l ~ ~ acc~rat~. ~i i.:ai~l- Utrsiqw j~p paT[ Z:t b~YI O~ UM[T(Ar OA CFCY~70A~ ~ jj/ IOCAT1pi1 lC~f/. lNrl. M tlr~fl) (.S~dN r; M~ovr i `~prn(~~ ~i _ ~ ~ ~ ~ 7 . . . ~ ~ - . J 1 . / ~ t i . . ' s . 5. ~GI] 2~. lJ1f~~l D~ 011 S Sh:M~ADO~[SS ~..u .J: ,.I _ t2S DAi~ =U ~Y =OC~L 11[G tt A( • AAR+S `TYA ^ A ~ ,t..:~6a ' ~ / / G~ tttr~n.~2 ~ 4: _7'~• ~ :.~s.- ~ ~ CE~T I F 1 CJ COPY , ~ ?~.erc;,y cert i fy th i s to be a truo ar.d oxact co X.` af'~ al ~ F. ~ s'rar's racord of death on f i(a i n ?h i s of ~ ~ t'.-.- va~ ~C un1oss tho sQai of the Volusia Coun•f,y~~~ ~l~ti~,d~j~artment ~ a t f i x~ Q 1 ; .b'S:Ld~!'. : ~ • ! ~ ~+t~'~,` : . ~~.t ~ - •r~ ~i? `1~`r' ~ / " ~ _ ~r/L ~c~ . ,~a :.oputy ~~-Rogtstrer , cai Rogi-strar Bu~.! t ~ i ~ ~s4 ~3~ ~ ~ ~ _ ~ ~v- r - ~ -.-s ` . J ~ _ _ , _ , _ - , . _ ~