HomeMy WebLinkAbout1524 .
• ~1546~ ` v _ . 1
. . . . , ~
e~_ •TwT~ eowwo oF Ku~re CERTIFICATE OF DEATH
~,,.ra • bUREAU OF VtTAI. fTATIfTIC• 1TAT[ fILE NO.___~___
FLORIDA - - -
91RTN NO. REGI~TRAR'8 NO
~•roi~e~~~
~~ecuttA ~~~Att O! O[ATN CODE f~20. 2 UWAI RLf10[NC[(I~w~I.ewdt...~ I/~MhIM~M R~..f.rM~~.~M.~.uwl
an4 •111 • ~U~NIY Brovard • STAT ~p~NTr
x F orida Brovard
~ ~ y~~_ A. CITY. TOMM.O~ LOtA/qtl t. K?I~CE d OE4TN C~TY, TOMM,OR IOtATpM t. K R(S~DENL(
e~n~nt xO~~ MOO~ INS10C CITY tIY1751 IMS~O( QT~ L~r~iS?
•tl•- !1 y •E:O ~Q West Holl vood Miramar ~~5~ ,~op
rurE O~ (IJwet i~ iwyitd, ~ire ~h~N ~ltr~q) e ~E~rN pi I. ST11E[T ~DORESS
NpS~II~I OR ST Y ~ tA OM A fARM•
MISi1TUTpN go.Florida StateHoa c~a a 6538 . K. 27th Palce rES? MoQ~
3 N~nt eI f'b~t NIfB. L~af ~ a~TE Jtf..t~ p~ 1'es.
'~~Np'~'~ Frederlck Pearaon ~ TN Jan. 2? 1861
S S(X S COIOR OIl 1UCE ~ Y~RRIED MEVIA MAR111E0? ~~T( OF ~IR~M '~GE II~ ~tO1 r w«R 1 fW UMD(R t~ NK
i e. ~'ItlO Whi te wioorco D a~ro¦cco .T~D. 2 5~ 1887 r`~` ent~•r~
F 1 a 1 R 1~ ~a USU~~ p~CU~ATql1 (Cu't !~w/ ~JrM! IO~t 1(IND O~ ~USINESSOR tMpUSTR• 11 ~IRiM?L~CE (ST~ft r~s?t1/A COY~Ifry) ~ 1Z CITIIIII Oi RINT ~IqiRt~
• i t A P~ r- far(w/ ~wf y r~rli~/ b/t, ~rrR iJ r~tirrfl
Car enter n t n Svedea OS1 ~at.
A 1~ t~ f lrlk fATM[A S MAME - 1~ MOTMEA-S M~IDEM IIAYE .
.,p..,,~.. Per Pearaon - . Greta Alatroa
IS ~MaS Dtt[~5[D EvER ~M U S. ~~rEO iORC45~ If SOCI~I SECU111T1/ Np 17 iNt'~RMA~iT { H~MATYR[
t Y.~. ..lrw~ UI r~. nr .v ~~ra d r~..+~
n 031-18-13? wa.... So. Flor a a e opa a.
Pun ~ r~1 1~ CAWt ~I K4TN (E1f~r N/~ p~ tasat pt+ fi~r /~r (~1. (A~. ~~f lN.~ f I~E~ AND INTt11VA~ KTr1EEN
~ t ~ c, ~ 111RT ~ p(~TN wAS CAySlO ~ iT, E COUNTY FIA. o~aEr ,u~o oc..N
~.~.c r~~• ~rrcvun c~usc ~tAiia 6 ai~a
^ t n• e~ r- ' CIERK CI41CU11 COUR
c ~ n~. - c.,,~;,w... ~~.,r. CORD VEa1F1E0
. ~ ~ n e~. r?k~ ~w , u ouc ro c~~ _1QII~ei ~~IQn~Fbt.i~ - - - -~-~a= s
' r~ s i~ t r a r ~t~tb~ tk r~kr- puE t0 (r) _ ~ ~
' ` ° . ' s~ 13 10 ~ AN'] I ~
. i~ n i n 7~ ~ ~t~~I ~~~~e J~ar.
?AAT 11 OTId SK~6ICAIR (',Ollplllp6 CpN?wl~l/?ML lp QAiy ~{/f pT REU?~p Tp M 1LRY GIY[M M?YT 1(~) wAS AU?O?SY
' Rour~ •f- ~~~P~~''~
t~r d~~tL ~ ~ G0~ ~ 1ffS? QCE~
or E~for•
~ ` ~ ~ OESC~I~E Iqw IIUlM1/ OCCURR~D. (6f~lf? Adr?t NMJr~/ IA P~?f / M PW /I YM l~.)
~ o a k 1 n aw f ACCIOEIIT SU~CIDE 110YK~Ot y
f dl~po~l- ~ ? ? ?
t f o n • t pw. Yrr -
~ ?eE~. ~ ~r TWE O~ Hwr XMN,
~ ~wu+~r a. s. .
~ a ~ ~
~ ~ 20/ 1MlURr OCCU1l11E0 mt KJ1CE O~ ~1tWllt (t_ i~ K dvrf w~r. ~1J CITr. TOMM. OA IOCAT1pM pOUNTY STATE
$ 11011[ AT ~ ~T ~'O~K ~ ? W htiN/. ~t?td. ~~ct DIM . rtl ?
•
~ ~ f~tand~d elN d~M1 /rom _!I8 D• ~ . ro a n• • •nd Jut w~ Ai~lli?~ on
DwtA axy~nl ~t ~n on tA~ d~~~ ~t~Nd ~Aw~: ~nd te tM 6Nr o/ m~ ~no~Ndp. /rom tA~ u~w~ ~t~t~d
?!1 tt~~s
a r• t e ~~I~K M f4te) 220 ADORESS ?7[. TE S M(0
~..P,.~.. M~(~..~,.r ~ ' ~r,D 80. Florida State 8oap. 1~?~61
• t c ur ~ t~. jj~ ~uYC OF C[~ETEII~ OII C1IEMATOII~ 2~/. LOUTIpM ((7f1. fw~. M tM~~l/1 ~9W1
f+ ~11[~ y[n/r1
v. 7./ A 1 t j L1E. M E W S S~"~+~'L ~O S~Oy d ~ 8 2S 11CC0. LOCLL IIEG. RE TR~11 ~WUT E
~ • .
er H m 3o i9 (
,
• CERTIFIED COPT
.
~ '
~ „~-h~ereby~certify the above to be a true and correct copy of the Local
' Atgtatrar's record on file in the Broward County Health Depart~nent at
: _ Fort~Laaderdale, Florida. ~ ~
~ ` . -
(VA,rning: Not valid unless raised seal of the Broward County Health
~ ~ . Department ig affixed.)
,
r . .
r~ ~ Coun Health 0 icer and Local Registrar ~
Q~.~G~Z~ _
o R 1g5 ~i~ ' ~
~ eoa~ .
Deputy Local Registrar '
~ - - - . _ .
~ . w Y'- T
- / . . . . • ~ - ~t'G S'"q..~'~..~~v~-~~
~i 6~6a~ To=.3]rF§