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HomeMy WebLinkAbout2753 _ ~ ~ _ 214~39 r~~. !r- 67ATE BOARD o~ HEALTTt CERTIFICATE OF DEATH :~a.•s • BURGU OF VITA6 iTAT1iTiCB STATE FIL6 NO. FbORIDA M °r, A:R~H NO REGISTRAR'S NO ~aW ; ro; ~rlr ~aeeutel i iLAt[ Oi OCATM ~CC~L i:.~. ~3S:.~C AZLiaU~C[I~~.~.c.rMb.r[ !!w:.~.~.w.- to,~..~W~.y~w,~,~) ar.d • t 11 a. :ikwT? ~ s ST~7E S. COu~TY Dr pl~e~d it~L~.GI~. ' ~:1_~~-:i ~ F 0 T'}~. S1. I.~C~I~: Sn p1t- 0. C+iY. TJ~ti.JR~OC~TqA ..S P~~C• Oi Gca'r ' t. GTt.TOrw.011 LOC~T~ t. IS l1[5:0(~CE ~~n~al ,~S.:n C~7Y _.u.7Sr ~ ~ IAS~DE C~Tr Uy:Tg• ri?.. FT. Pl~~~'C' i -fs:3 `i. Pi:'..R~~ ' rts~i wi=.t ~a~i Jf `~II *~t ~a+yit+i. Jat ~:sr~t Girra~. linSi.. 'v: L. STA[[7 ADpN[SS 1 MOS?.T4C :1N 1 S~4Y ~ A f1~M1 ~AST~T~TAN B'~T ' :~',r . - ~ 2 ~ _ 2L~ DEL~'.•: ~?.E ~ rES ~ w ~ 3 NAM[ oF Fd~t .Va:ia ---Lut t o~tE • Alxt.~ D~r }'ra? D[C[41[O r ~ ~ C l T1M M y/Itf: ~`~..J.~.Jri T^ 1.LC~a G ~ OIATN Vli l• 1963 ~ S S(X f COiJR OII RACE •'7 ywqa.f:..~ \i~iR V~Fw-t./~ S G~TL Oi ~.1lTN ~ ~G[ iJ~ ~tO1 ~+.~%~~i ~W ~~x~i~ ~AS ~ IYf ~:rf~i~j! Alw~a. a~. Nwr. •~fi. . . ~ . ,r { k ! ~..:•:E~-~ GCT. 30 1St34 ~ ?8 , ¢ 1~ i n 1~ 1~ LSJII JCQ:~ATiON ; rK[ la~j YJ/t Gilf . I~ w.~J Jr i..:.~~i5 JR .~J..STqY j 1: Y.ATMV~~CE ~ 17~ft r J~rty~ fN~lr~l 12 471tU l1f rwT CO~qT11n ~ 1 C n p~ r- far~~~ a~a~ N?w-t7~iJ G/t, eeo rrt~rr[: t ~ •~A~nt lr~~LJu. 1~'~.~•~ 1 ~..'r 1 • . ; ::~'..IIIZ.:, I~~D. USK Dl~tef lnk t~, F~T~1ER S MYE 11~ MJTh[R'S r~~JE~ MME . ~1V~~rlt~r L'J.riinF t1~.'1.1.. - i :a:_~~.1''.I:~ '3i.~ft`~ 15 wAS p(C[ISED EY[A ~M U S ARYED i~7AC(S~ +14 i~~.~l $(CrR.~• IM1J 1) iM(OC~RAN ~{ICNATYA[ perry Ci1 C~L~i ~ Yr. ~ ..?r..~ U/ w- wr .~v ..1+~.. ~r .~s.e.~ i ::0 ' , .{iar~., ~'T. PI~~C~~ ~..y i 1{ G~ULC Of Y[ATM F:+ltr ~s: ~w c~~u: r l~v ~r .a,. aaa : 'r ~n11 ~ 1 ~ I ~ f Iti~lAl'~l !E'MIeCw 1 i r~~~ u ~ I~RT L OEATM M(~S CAI.SE~ BY ~ i~ ONS(T Aw0 A[ATM f •ust tl1• IMY(OIATE C.WSf ~~i .'_'a`iv... ~l Cau.S~i~J ~~~A.~~IM1i~ LSIa Cff- - - (lflf~[• . - • •1tA tU• C+Sa•wv.~/~~1. D~E TV ~SI__-__.~1C :5'C s~!:A ~~lt r~K IJ _ 1 O C w 1 • Y:.Tf [CYK l~l- - r~~:str~r Ki~'+! 14 ie4r- ' ip:c~ ct~.u :.v[ J.,E :J _ . - _ _ _ . _ _ _ . _ l~ 1 0 71 ~ ?MT 11 OT~EI 51G~riYJ~(T C:AT: rAS CO~!71:l.~T.~. 'J " c1'.~ E..: ti.J:i:r':. 'nF 'I~rtva :r545[ C~1wD~t~Ow WYEw u/Mt :~~1 M'~S 4~'GMY nuur• •f- F - ~ t~i 3e+lh ~ ?ERiOayF~• •[S ~ 7~0 L. ot D~ior• - .L`r 1 ¦~i1ns •n~ ~ ~ ~23'. LcS::~~E~::w ~._a,c.i~cat: F~.rn~aytire~l~R/rr~~~Fo!/MPY[l!e/iir~U.) w~C:GE~T S..K~DE M:.~..-'~[ ~ ~?os!- ~ on et u "i - Oo~ i~ T:rE os 1l~ar Xau~. La~. Yro. - u •w~,:xr n. ! O D ~ W = 2.i~! .AJ~N?OCCaaqiJ ' i:[ i.a~I C .'.•-.r. ~ 2~~ CT1/_ TJww. p11lOU~iU~ CJ..~7• S:~T[ '.~n~.E ~T r^ NT M..:.I f ~ - . i.•rrf"': .~t '.'J . t'` ` r vrOaw ~ •71nJAR `J• 21 ! ~~t~nd~d tM d~ce~~~d /~om - - - ~nd l~sr s~~ A~m ~1~.~ on D~.tr occurr~d ~ n. .~n t!:e da~e a[.t~d .L.are. ~nd ro td~ b~sf o/ m Ynort~d from tM c~u~~~ ~t~t~J _ ~ ~ .i. - 7 f ?)i tt~~s jjs LKMt.TYR[ •r~ t4 L• i.K~'tt;~ r.r •_;;q[SS i?2~. J~7[S.G~CJ ~~•a:••~ • ~a.cis J. C=: bc:::~: a'" ' j10 Ave: ue a 1+-<1-oj •cc~r~t~. ~ 1i~ e.r:~. C.<r~r:,~v ! 2b J~'E i ax ?~v; _ c.'t ~~R ~e,~::.Ar ~ 23r .xwTti, icY~. ror,. r tei.q; ;sa:., a:.:~. ~~~rr~.~. . ~ . ~.~Y.u , ~~~.a, i:. • ; la''7-~ - - - r~.:,. r :I`z:.C~, ~;.C:iJr J.!61L 2~ {~y_aA~ J.RilTJ1t S SN:A~T~NE(` '1 - c!t~ . ]V ~ i~ Y'L.. • v ~ ~ ~ ` ~4: _ 111~ ~~JC~I A[y 1 (p 11[{~.5'il~A S S:~i1~A:~N( ~ :.er..~SG .~i.0: rJo1~d ~'1~. 1 t-'~~:?~ nl:~d LCC ~iC:~~SJI~~ (~.I'• -'a ~ ? her~5y ccrtify tfiis to be a truo ard cocrc:t c;,p~r Cr~ ;`:~-~..,,csi k~;,istrars racord on file in tfis St. Luci~ Couny Fia~~ti~ C,:;,;.~- ~ mortt ai FvA Pieros, Florida. pECDADED ~ it. tuc:t couNtr Ft~_ ~ (YVatning: i~tot va:~d unless raisec seal of tho St. Lad~ ROCE~ ?p;TRAS County Fksa~th Dep~rtment is effixed.) CIERR C~~CUIT COU~1T~t~ RECORQ YE~.~F~Ep~_ ~ N. MIILER, M. D. MW "r ~ U 4 os PM ~ T' ~ CONflrr ~~ifl ~K~Af Sc ~OC3{ n lStfal ~ ~ ~7 ~ ~ ~G."~ ~fl~? ~OCaf ROOISt?Ol ~ ~4~ ~ ~ ~ ~ ~ e Rr a~ 194 z7~z ~ ~ -