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HomeMy WebLinkAbout1561 ~ - V~ 215496 . ; tA~. D~- ~TATt ~OARD Or ML1LTfi CERTlFICATE OF DEATH • ~uaiwv oR vn~ ~rwn~nw srwT~ r~u Na =•t•l FL08IDA ora .~•p e~rtTw NO. R wa•s o. 22 p~OP.~I~ 2. VsW?t.tN.[MC~c.....~........... ,~:....rr.: t.i~.«r.....io:..> ' •c~trt~d 1. KAC~ ~I ~[ATN GODC NO. ~ •°a `°0°"'r St. Lucie b6-02 ~ STA F1orlda ~ St Lu s. ~lae.~ i w ~.r- urv. rarr. o~ wcaTaN C. IS ?LAGE Oi GEATN e. un. o~ wcwra~ a ecs~ocMCc tii~~~ ~ Ft. Pierce s~ ~~w? F raQOm~oO I. NAUE OF (/J M/ h wt~ihl. Iif ~traf ~//rta) IEnGTM Oi I. STwE[T AOOIIESS ON A/MYt . : T;R,w Ft . Pierce ldem. Hos oital Ap~i: "15'D yrs . 1910 So. 30th St. .cs ? No Q ~ MAI/t O~ fYM Ni/~fe LYt OATE ~/W~ ~ Dq Yt~? ~ s~~ T~Til2ia:n ~ Theodore Ke June 24 1 62 S_ SEX OOIAR OA wACE 7. YARIIIEO ~ NEV[A YAM1[D WT[ Of WTM ~(l~ M~Y~ 1D~~w rw~iwQ Y'r~. • i e. llale 9Yhite rncorco0 o~varcco ~eDt. 26~ 1893 ~ •i~l~ IO~. YSYALOCCWATIONIObfliAIN1N?~IMt lOO.KYtOOFWS~NESSORIMpKT11Y 11. ~tRTN?IACE(b7WMMW~pYWH 1 p1RO1~MIMTWIMAt~ ..p..i•~- ~y~~~`.~y•`~r~ ~adison Count Fla. U.S A F~oreaan State Rc3. Deot. ll~et !wk {3. fATME11'f w~rE 1!_ rOTME1t'S rAlOEM lutr[ ~,,..~.s.~ ~lilliam R. Kecap Addie Fletcher ~s. w~s aansco cvice w a: ~~rco soRCCS, it. socu~ sccuR~n ~o. u~ + s~ow~Twc grank She arer ~ (/~a r. ~r ~lr~l IU M~. ww w~r iW~ rwW no 6l~-0?-b9l~5 •~•a~•• t. ierce la. r~n.r.l 1~ ~wus[ M~tATN (B~hr ~+(I Me c~w Da tfiw/w cA). o/ (c).j Ufit~v~t acTwECI~ d 1 r~ t t~ f t~11T L OEAT11 MAS CAUS[O ~1f: 016LT AIO OEATM ,~,~o,,,.r ~ A ute Corona Oc u .~.s tti• ee• a~r- tifie~t• ~~~.i/pI. ~ • 1 t \ t N ri~ q ~ ~ ~ j 1~ s• 1 ~Dwt cwt (i). j r~tf~tt~~ w~~I t~t rw/n- MiE TO ~ fliy drn lrt. . M~S AU70ISY ~ • f tAf ~ T~ fAAT 11. Olw 9G4f1GMf OOMO~T~0~4 COM~IMRIfwG TO DGM RIf MOT RWT[D i0 TM[ IUt~IwK 06US[ OOIpT10M GIYG M fMi 1(~) leur• •f- F, K11spRw[D7 j t~r A~~t\ s 1fES? ~O? ~ er 1~~~r• t aoe. ocsu~.cMOwuuu~roccunnco. ~s.r....rv.y.y..~~.r~wrrrarny~r~.~~a ¦~tiw~ ACCME~T SY~C~DE MOYICIQ a~.°..t- v O O U ~ ~ ~ 20t T~rE O? Hwr XW?, Dq. Ytr wu~r S i. ~ 20/. IMlY11~ OCCUIIR[D mt. hACE OF uUUtY (r. i~ r d~wt y~t. 7D/. CR1f. TWrM. Oll LOCAT~OM GDUMTr STATE WM~I.[ AT ~ 1~OT MMiIE ~ ~A• /~M~. N~tq. 1~Ct OJ/I•. dt.) MOIIK AT 111011K l~tt~nd~f fM~Owa~dlrom Ju17e 2~ 2~62 . to Jli •nd/utw~ A~~ ~lir~on D~A DwtA oootrrnd ~t 2%~Q A• m on tA~ d~t~ at~td ~bo~~; ~nd to tM 6wt o/ a~~ ~no~Nd/~• Iiom ~h~ uuNa ~t~t~. ?11 lt~~• ~ Wo~T~ c. caau.. rru? r~ 616 N. 7th St. tt~. wre swNCO , ~••rl•~• • Alva D. Orr ~.D. Ft. Pierce Fla. 2 62 •CCU!'~t~. M~K.~wT~ jj~. NAYEOSC[METERY011UCY1TOIIY 23f.lOCAT10N(Glf/.111?A.MtMU1f/) I~~I ¦OV~I (S 1 ~uri June 26 1 62 Hil2crest '.~e:~. Gardens .Ft. Pierce ' Y. S. ~61~ j1. NMEIIAI ONE 'i SKIIATYRE AOOp#SS 2S. G?TE RECO. ~11 WG1L REG. REGKTMII'S S~GMATYME A~~.libt Y8~R r uneral Home ~ - Jose h Yl. Yates Ft. ~ierce Fla.. 7 2 62 Qi nia N. Borland • ~ ~ . ~ ~ ,n~ 215496 ~ Replstrars rooord on fll~ in th~ St. L~uci~ County Hedth OspM~ FJlEO ANO RECOR~E4. - mrnt at FoA Piera, Ftaid~. SL LUCIE COUMTY LA ~ (1M~rnin~: Not valid unlas ralssd ~al of tfie St. t~ud~ , CIERRC~I~CUIT CApURT t ' Counfy H~slth Drpartmsnt b~ffixed.) RF.CCRD vE~~iIEO ` ~ ` ~ ' z ~ 3Sy 1 ~'~i1~'k . N. o. o. S~r 13 . 12 4i PM'7~:.: r~~ -t - co~?~? off~ a~ troo~ a.~~u~K . 1 o~C~y3 ~ ~ r . . , o.i.. o.~? t,o~.~ rt~i~n?.. 15~. - : . _