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HomeMy WebLinkAbout0696 21~89t3 21689~i ~ v ~ Fti~E~ ~4:• aEGOR~E 6T.luc~E couKTr L RGG~K PO~TR~S ~ CIERK C~~CUIt COU~t ; RE.CORD VE~~F~EO ~ i~~s ~e- BTATE eo~ao oF H~?~„+ . CERTIFICATE OF DEATt~~j ~ I ~~I.Z PH ~~I ~ co~~~ • BUN[AV OF VITAL RATIfiTiCf STATH FILC NO. i~+~•~ FLORIDA ord •Aen PIRTM NO REGISTRAR'8 MO. ~ pro,atlr ei~cuted 1?lAC[ OI p[ATN `GODE NO. 2. YiUAI A[NO[Mtt(~?w~MerNAw~ Uwe.Mr: R~dwwW~~M~w~w1 •nd •l11 •.COuMT~ , ST~TE ~ CWihTY 0• pl~e~~ ~ ` i • • ~ ln pe~- A. C~T~. Tp1MM_ O~ IOCATpw .•S I:~CF G~ Di~'n ~ t. GTY. TOMM.OR LOCATiOM t. K 11[S~D(tiCE ,:Mi~~f C~TY I~MtTSi ~ IIIS1~( C1~ 11Y1T1/ ' iii:p` rt. Pierce ~ ~ES~~; ( FL. t'ierce res~j nop ; h~YE O~ ~ m~Ny~t~1, /v~ ~daH dtnui ~ ~CRGTN O~ ; L STREET ~pO11ESS qr ~~~~y~ MOS~iT~I O~1 ~ - ~ .~iST~T~T T4 .h t~ + ~ ? - p'Ft. ?ierce :-en c'.oso. _~rs. C2 So. ind. Riv. Dr. 'n~ ) N•r[ or f~..e • :J~ace t..r O~TE J~l.,a D.r Yra a 2 occ[~sco o? s <T'•a«,.+u! Jose~h i'at:ick Fl ~*M Au st 1 1960 ~ 3 atr ~ CO1011 O~ IIACE T YAiifilCD ~y hFYEN VANRiE~ OATE OF ~~11TN ~~6E (!w nO~ ~~a~ tiw0[~i~ MS. ' 17 1J73 IMt Sr~~ N.r4 Da. Nwrr M... f 1 t• ::a2e 'r+nite ~ WI(A'.W[D;~ Jlti^vkCE. ::ar. y1~1o1~ l0~ bi~~IOCCW~TOMIC~Nt~~/~/rwtN~t IOD K:NDOFieS~~ESSOA~~J.,S'NY il {iNT11KACEl~~tMh~fyAC~Y~h~) 12 GT7IfnO~~fMTCOWri71Y~ ° - • 1 t A p~ r- turu~ wwt y rrti~l l~/r, ruw ~J rrtvrU ~ t,ssistant =~ana~;er Port nut^o:^it~~ , ~lizabeth :~eW .3. li.~.A. ; pl~ek tek i~TN~~ S N~y~ 1~ YOTMEi1 S ~AID(M N11Y[ > et i ~rr••~~~•~ Edwtrd Flvnn - { Rose Go~eins ~ 15 ~~S DECf~5E0 E~ili li~ Y S. ~RwED iQ11CES• 16 SJCtAL S[C~R~TY I~J. 17 INM~ t~IQM4TYA[ J.~1. Yates ` tio ~~k•~ -F`t. ierce r a. ~ 3 1• CAY{[ 0/ O[ATM ~~Jftr ~~I~ ~~t urlt y[r l~wt f~r ~9t. ~w! ~tl.) IMlE11Y~1 ~E'T1ffEN Fun~t~l ~p dfr~eeor ~~THM~SC~USED~II y DEATM _ IY~EOUT( CWSE _._yti!a~, rCl::v::2~ ~.et.2$t.cZt1C ~ 1I'• „ .u~t ffl• - - 'i t~• e~r- i 21i:1 ^y: ~::3Z';~ 2: COlOlI = ' tiffe~a• Ca+luaM.~J~~I. # .tcn ce• wt ro /D~ - - - - ~y' r~~n1 prf n~( f1 ] O ! • 1 i~~Jff [~YN (~1. ~ , ~:3 ll~l~w/ f~f ¦1~/t~- r~~1~tr~r W,E TO il,__ Z 1/i~/ t~ru [~K _ _ . _ _ . _ _ _ . - - • 1 L!1! n T7 ~ ?AAT 11 OT~ SK~VIfICMT COAOli7('/.S C4MTbMR.A~: T~ G(+1"M OI;T .~('iT F(~T[D TO iM[ ~Ar~M~I GS45[ COMW ~70~1 WY[M M IMT ~ M~AS ~UTQRY ' Soti~• •f- F ?[~fp11YED/ ,,i ~ a•r a•.ce 7[S ? I~O - or O~fsr• _~~~i~ ~ 2pG ccsca~et rh,~w .+~„ar ucc.wFi~ ;F.aro ¦~r.~ ~J~w~tr~ i~ Paf !r Paf yYn~ tl.) - •~tln~ •w1 ~ ~CC~OF~T SU~C~JE MO~.CIDC ~ •~,yo.f- v ? ~ ? is •f J 20t T~r[ Of !bv Mw~, [k7. Ytu - ~~d~• v uu~llr n~. i~ O D. ~ r - ~ IO/ .wJ1;11r OCl4~~ED ~It I~~CC CN iwJ~~r ~i. o~ ~'ak Aawe. 20/ C~Tr. TOM1~. W lOCA1~pM COUMTI ST~TE ri~~~[ ~T r'~ +.pi r«y( ~ N•'~. 1+ctort. ~tr~G. o?!rt ::/dl.. dr.; MO~K V AT MOAK u I s': 21 !~t~~nd~d th~ d~c~~Ndl~om Se~j_ ly~`L_ . to ~ •ndl~~t w~ A,T ~d~~ on~~~ 1 ? y~ - t~~~h oceur~~d ~t r m on tA~ d~t~ ~t~t~d ~80~~, ~nd to M~ M~f o! mr ~no~l~dl~• lrom eh~ uuwa ~t~t~d •]1 St~~• jj~ MCMATYR[ . - •r• t0 1• ~([Ml~ts ~r t~:r~-_ i 2ID ADOaESS II[. O~TE S~GMfD - • :i ~~a.-- ^t ~ vb S btn. Ft. Pie e FIG •tC4f~C~. j}~ S.inK•CRir~/M Zb WT[ ~'a.j[ ti~~EJfCE~rE:[~YJNCNC~ATON• Z}/ IOC~TAAI~lf~.fMfA.MfKA!/1 (S7dI) . ptuOrLL I~1Dff1J/~ { ':..~~[.al- 1_ t-~-~ ' ~:-T~t.e~ I'NOOdbri~'~e `~c;: ~ersey - Y. ~617 2f fuwk~Al D~iECTplI 5 SrGh~TyeE ADGAESS ~•I2S WT[ RfCO ~11 ~n[+u ~fG ~ R[GSSIUI1~S~iGw~TN11[ _ P~~.IJSA nco+~tit ~~i c i%: ' n ~ c ~ - ' • = t hereby oertify this to b~ e trw •nd corroct oopy aF the trocsi _ R:gi:tr.rs record on fik in th~ St. Luci~ County Heattl~ popa~t - ment at Fon Piefc~, Florida. , . •F-- ~`~L • (1Msrnin~: Not vaJ+d unle:s ratsed sesi of the St. Luda =~{'d ' County Fiselth Dspanment is •ffixed.) , fj . - N. D. MILLER, M. D. Count~li~air~ Offiar ~ lnca) Reglstrsr : . ~ . ! . ~ / y • ~ ~ D~ Orputy Lcc~! R~ai~t•u ~ = f~ R ~ . = ao~K ~ FxcE 6~ ~ _ - _ :