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HomeMy WebLinkAbout1777 ST-14,271 ~L ~~~~f i:~ ~ ~ CERTI FI ED COPY WE HEREOY CERTifY TIfE- ~1? Rlf~RO~UC[O SELOW TO BE A TRUE ANO C01~1~~CT COPY OF TME ORIGINA~,H~~ L IN TME BUREAU OF VITAI STATISTICS OF ^`E _ STATE OF FLORIOA. ~`1CFir ~ ~~},A~.TH AN~ RENABILITATIVE SERVIGES. OI~ SrON OF NEALTH AT JA ` ~ ~ ~NOT v~L~O UNLESS T ~ ~Z ~Tfi ~I?W~qM• OErA1~iMENT Oi NE~LTN wN0 REMAitL17a•IVE SEIIVICES. OIWSIpN OR 1 ~ :f~~ , ~ ~ f ~ ~ 2^ 1~ ~ \I~L.~ ~ . ' « = v~ ' = :a: ; ~i ~ ~w vr'- ~ • ~ CMI~i. ~UA~AY O~ V~~wi fTATIfTIC• . • ~ : r ~ e C`. 'y r ~ . W W~ . f ` . • `,~v•' . W/~i~61~~' ' ~ sTwrc wcc~snu~: o~RCeiae. o~ws~oN b~ ~ ' `-t"~ ~~~rN - oa?w~Trcwr or N<AITN nuo ' wsMw~~ut~nv~ Kwv~u~ •rwT~ lOARD OF M[AL711 `'.I• tFICATE OF DEATH • - ~ ~ .uRC~?u os v~Tw~. .TwT~.~ncs F L O R I D~ ~TATE F~~` ~9. `i I I_ `_t ~ ~ SIRTH NO. REGIfTRAR~S NO 1 KAC< OF KATN CODE NO. 2 YSYAI R~tIKMC~ ~ r~,.. ~.p...r t...r /:.va.na...: R•d.~~ v%+..r.,..~. Cous'r ~ 2"E"1$i ~ - • ST4~F l~7. • ~ CCCY~? .:~i. a.-.~.1° ia - ~ CITr. TOMIN.OiI tOG~TpN t. 3? pi OEATN t. CtTY. TOWK ON IOCATqN , e S AfS~_E\CF Titusville ~.~vs~ot ~ir ur~rsr Ft. Fler'CG ~s x u•~ ?+~.rs ~ rF~- MoO -cs0 ho~ p~TU Irl~7~Dl~t!4~i~'iYf't°Y~hsit IENGTN OF 1. STRFET ApDqfSS p'_ x ' • fA~Y• ~sT~1~~.0.H. i:o. brevard :iosp• riT~rat~° it =~c~th Fed~ral.:i~y. .ES~ ,~o~ ] 1M~t[ K rirM Vi~Ye L~! ~~~~f Nw•1 Z~e! Yaa ««i?„~? +~'ILLIAH EI7WIN GOcT~-:E a,,, Dec. ~Os `~~9 SEIf t COIOR OR IU?CE ~ W?IIII~EC NEVER MAlIRKO • OATE Of NATM 9 RGE (h fr~?! i U~0[A t~[1J ~pFR t~ titf nale / wnite 6 Dec. 1~79 ~°i•~~••? x••°• x... rioonca ? avo~cco {0~ {~SJ~L OCCU?~TKYI IGa~ tiw~ sj r~r! Iou 1~ KIMDOilUSINESSOR IMOtKT11r 11. /IRTII~IACF lS7~ft R/O?tt/A a'N~fl~) 1. GT2il~ ~ wNT OqA~it~? i..:~1 ~wt yr~rtiN 1~/r,.... n•H:,•~. itrua geching pla Hamgton Co. , S. C. L.:. i. astchman 1~. ~ATN[11 S MAYE 1~ MOTNEII'S MA10EN 14Mt Geo. R. Goethe unobtainable 1 ~~S OECf~SE~ EKR 111 t; 5~. AR~MED iORCfS+ 16 SOLCI~I SEC~RITY 110. 17 !N~ORMA 1 NOIfATYR[ (I'+.r.~r~dwv ~//M•~V wMMi~f~.iv• un~Y~lY~ble ~ n~ .lq7tN IR CA{M[ 0/ ~tAtN ~wf/ ~iu ~awt yn li~t /n? (~1. (Al. (t).~ ~~TEw~AI ~R~fEEM • ~~IIT 1. OEA~N WAS CAUSEO ~Y~ ~ ~ET ANp OGTM INYE01ATt CM~SE ~ d r o/ J R~--~,~~-;.~j-}Z----. ~.r+.,.. v•• ~ o~c To ~si _ cSr~_~r~ ~Q ~~1~ s ~ o w - - S T - '7.~. , •~It?- 04E TO (rt_~~: ~rd• ~s ~ ?~y c...r r.n. Qr t I/ ~i~ ? MIIT n Oi1EA SKA1fIWf COMOliqkS COM~UwfO~G 10 ~TI ~ MOT R(UTED TO 1141ERYMMI qY~SE Cq~IT16N GMM Yil r~RT 1(~1 ~~5 4uT0~511 S _ _ ~lsp11~ED~ ~i~oL ~ 20r ~ ~ 2~ CESCRitE N01N tNIURY OCCUQREO tF.iftr w~trre ~/~w}a~~ i~ P~rt I p Ppt ~J4~~ 11 ! ~ y ACCIO[M~ SUK+DE MCNKiDE I U ? ? ? _ ~ mc T~rE Of !!wr 1lsnt~, D~i- Yru ~ ~ ~wlwlr a. n. s~i1 p- ~ i j~ ~IUUIII/ OCC4RAED ~It ~LACE Oi 'rJL'AY q M?~1~It AOn~t. ZOJ CtTll. TOMp. O~ IGCATqF COUMTr 5T4Tf MMKE AT p~ wMKE ~ Ia~. /~of/. M!ttf. O;~[[ Gf[~.. HC.I I ~ORR ~YOIIK - V ~ 21. I~trend~d th~ d~c~~a~d Irom ~ 1~ , to _ ~~nd lut s~~ ti,T •/ir~ on - - ~ D~~~A occu~r~d ~t /.2 m on tAe d~t~ st~t~d ~Dw~. ~nd to cAe 8sat o1 m~ kna~Nd/e. /~o~n tA~ r.aua~s ~t~t~d ~ NaNATYR ;Drptt M • ~ 27D ADDR[SS ~ ~TE S~GpEO , Zitusville, Fla. 2~/2~/59 : ~ ~ l3~ Wf1~4. CREWTrOw. 23? i.~TE ~k h~ME Oi CEMETERr 011 CRE w?TCRY j]/ IOC~TqN r(y~, fw~w. ~r ha+~t~l tal~ttl ~ ~l t ~ move~=ou~a~ Dec.j9 rt. rierce Gemetery :'t. PiCrce, F1~. j~ ' IIA: OlRECTOR RE •CDOf Si 25 OATE REC ~Y lOC~1L G ~ RAN S S~GN~ITURE ~ ~ Titusvil:e, Fla. Z ~ ~ FIlEO ~ND RECOROE~ ST LUCIE COUMT~ R~l \ G.~~::= + i ~'~AS l ' C: =~K i:-.VWT CCJRT ~ 3 R~fQ~~ YE=I~~EO ~ . + ,1s~ 30 2 39 PM't I- r 'z'11:'~f~:~ a~~ 1y3 1775 - _=~-~,f _