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HomeMy WebLinkAbout0884 ~J6'c~~o V Y' ~ / ; 1 215022 ~ CEf2TtFlCATE OF DEATH ~ ~r~~ ra~ No. ' FLORtDA ' S~ ~BIRTH NO. ~ RtOIST11Alt•• HO. PLACE OI~ DEATH ! coas No. USUA RESIDENC6 ~rrr.+wa..au..a u~..uu~w.:...,a.~.a.r... ' ~ COUNiY T ' STATE COYNTY St. ..ucie I c:.-_.. Floria~ St. Luc~~~' s, cin ~u «~.w ...~...w ~w~.. ,~..~4 nu,~., ~f.yGTH Of ~ p CITY cu .Yw.. ..,...a u.~~.. rua;i, ~ OR ~ SiAY S ul~.+ta~~~'~ OR ~ TOWN Fort F:erce ! r~ E rowi, Fort Pierce o ~ d. FUII NAME OF Uf ri t~ iwst.w or t.ruwu~o, s:.~ ~=reat ~i:cw ~ locatlmi d. STIEET lit e~eJ. sln M~tIMI + HOS?ITAL OR ~4 + ADDtE1S ~ N+! INSTIiUT10H ~ t. Pferc~ . ~~i~i2'.:+1 1_~tzger R~rw ~ ~ ~~tYAME OF lFint) b. l~i:dJt4) (i.fat) t DATi (){ontl) (D~) (YMr) DEGEASED c i O~ }~ifiarii~ ~i: a5 ~ n~~.95.~ £r y (Tr ~r Priwt H'rTIIi.:21 1 DiATN C~ W r+ fiX GOLOR OR RACE ~7. MARRSFD, NEYEi MARRlED, ~ DATE OF ~IRTH 1. /16f ~t~ ~wn u~~~u ~r ~~~n u.~~ ~ n~ WIGpWE0~01'~URCED iajrr,in ' i~ Wt 1 ?'itwn ~ av. H y~ l~.nle `~hit~ ! Ju_f 3. l~~iu ~T i- 0 ~ i 10~. USUAL OGCU?ATION~v~s~ uwa a.V.ti' ~~b. KtND OF 1CStttESS Op IN- ' 11. ~IRTH?LACE ~suN ~r t~r.tn a..us/ 17. CITREN OF WNAT + d~r~ Jur s~ l:t• nM u nurai ~ySiAY ' COUNT rt ~ `~,"1~~~~`~~ari ' "o~:~ci:,... i Zudo~~ici. G~or~ia ( t•. S? 11. iATHEI'S HAMi rl{. IAOTHER'i MAIOfN N/Wfi P Q` :~lezanner L. Knight ~ "i~tie dddie Sallett~ ~ ~ t---- _ - ~`-1 ~'If. WAS OECEASEO YE~ IN U. S.A~1AE0 FORCES) ~ 1~. SOCIAL SECURtiY ~ 17. INFO~1dAHTi SICHA7Ut[ CI'CI:fA !11 t~ ~ 4y . ~T•~. ~r ~tr~r~l tlt )r. p~~ s~r K d~w d~en~avl O. ~O ~ %~E~~-a':-~~~~7~ I AD'JlESS • O~~ 1~. CAUSE OF DFATH MEflICAL CERTIFICATION '~Nnwvw~ ~mri[N ~ Eoter oab oo~ uus~ DISEASE OR COHDITION „ I o 0 oswn~ l~ per lia~ tor DltECTtY 1FA01N8 TO DEATN•~~j ~~-`rGu. OV09C110P fSCCZCir:1t ~=~g~ ' ~ ~,1 ~nd /a) ~ 1~ ANTECEDENT CAUSES 'i ( ~ •7':.u dosi w~t ~usw ~ _ . DUE i0 (b ~ w lA~ wad~ ~J lwwp. •Y~?Lid tond.t.uw~. anV. Y~r:nJ ; ~ '7 ~ ~rcA u b~srt Ja~lrr~.i~ f~ IA~ ~6ure ~aya (aI sr,tt- - j ; R.fA~ni~.ete. ltwnw~~~sy fA~ rwd~r:yfwp caus. L.~t. D'JE TO c~ `~~:tl ini rTtCt:on D:~~s ~ f i~, tAc d..~wR iw)rry. or, ---~1 ~ ~._~'S ~ h eowyl;eatiow rAi~A OiHER S16NiftCANi COlhDSi:C.`JS ~ r+.0 Y] I' n~usd JcatA. Cowditio.u cu:tr:Li'.n~ to t.' •.:~'1. L~: ao• f ~ ~ ~ ~ ~ fn~.d (o tF. .i~...... r.r :.r: : ::,,_^1_'.__~' ~ N~ OATE Oi 0?EAA- N6. MAJOR fINJINGS OF O~G~L?TeON 20. AUTOtSY? ~ TIOM r 6 I - rn 0 No ~ r--- ~ p ~i'+w+bYl I~su+l7~ 21D. tLACE Ui itlJUiiY tr. r.r s~.,.t ; Ilc. (CITY OR iOWN (COYNTY) (STATE) ~ _w~.., 1'. 21~. wcc~otMT . ( crs.. t.ro. t.~cw~. ~:...c. ~t:.~• e:.:t. ac-. ~ f It w~l. ~uu lIILl.l - ~r Q~ i1:iGID[ ~ QI ~~-23oHIGlnc I y T___ _ ' " 71d. TlME ILwOI IDv) ~l'wi~ ~IIu~~ 2i~, {tU~RY OCCURx:~ ' 1Tl- M6M7~D1 ~U U v~ i ~F ~ sr:t[ ~T a ~.T »i~t ~ v INJUtY ~ ~o~a ~t ~o+a - f ~ ~ ~ ~ 2z ! herc6y urliJy li.al 1 at~e~ulcd Lhc dcccaYCd ;rom ~~'+_;~i9`~' , lo ~~f=• , 18 5' . lMt I fatl sam ~A~ dtua~ed ~ ` . ~ ! a/ir~ on~ ' J.4~~ f _ - 1 a~.~l ll.itt drrs~h ncc.:rred ~~t P~ m~ ~u~n the cawu and on tAe date atated aboero. ~ f' I7~. SIGNATURE IUq~r« or t+Wi j21b. ADDRFSf 21t. DATESIGNED ~ ~ 6tn. t. ^t. Pi~r~~, ~lr~. :3/^~.. ~fcn~+rd F. SianoLt ^ ~ '~~c S. 5 ~ 24~. ! U R 1 A L, CREMA-'14. DATE • 20c. NAME OF GEY.EiERY OR CRF3AATORT ~1W. IOCAiIOk (C{yr, towa, ot cw~y) (8t~1~~ ? TION, REMOYAL (~t» i f ~ ` F.~~ri~sl ; e~~7~~?r_ _ ~-;rt :-iPr~• : ?ort Pierce. :1z. ~ ~ ~ OATE tEC'D ~T l0~ I~tEGISTtAI'S SIGNATUAE I ' v +25. FUNERAL DIRECTOI'f SICNATURfi ADD~SS ~ IP-~n-:J~: ` J~21P.:3 :.~C .:c'!1: 3. 1'1?L7`l ~"1:Q F't P~r~'~P, }~~'t i ~ _ • . w~~~~w~ ~~~l~ I hCtOby OO~ti~/ itflS 10 iT11~ ~1K~ COff'ACt OOPy Of th~ l.Ot0) _ ~ Rogtsrr.rs reoord on fll~ In th~ Lucl~ Counry iio~irh Dcpart ~ ~ ment ~t Fat Plera. Fiorlda. f11E0 AN4 aECQ~~~~ - ~ - ~ S1. LUCIE COUNTy ~ • • _ , ' ~ (Wuninp: Not valid unl~s ralsed ~al of the St. Lucl~ POGEa POITIII~s r,;:°Rl.,~'` CouMy Fi~alth O~partrr~t Is ~fffxed.) CIERK ~~RCU?t COUII ;c,,•: i4 ~ RECOaO VERIF{EO ~ ~ N. D. MILLER, M. D. S~ 1 I Ol ~~~~r, ~ Coun H~alth OffitK d~ Locs Wgt:trar ,~~i,.~~ : ~ ~1Jr~~1 r • , oe~xn~? bc.t R~tK.a. . . ~ ~ . ' # , p p J ~ • ' IOOK 195 PACE O~