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HomeMy WebLinkAbout1403 NoucK. ~ ~-t,~15 ~ : ~ y 21~436 `";~"U F ~o~Y ~E~. Y ~OGE~ F01TRl?i ~ OIE~IK QIRCUI~ OOVRT ~ ~*~~c IIECORO VER1il[0.~..~~ o j1~ 11 t~„ De- ~TAT[ BOARO o. N~?~Tx~T ' CE TIFI'CATE OF DEATH co~es • oURUU OF VITAL fTATIfT1G fTATE FIL[ NO. ~~x•1 FLORIDA ord ¦~ee B~RTN NO. ~ REGISTNAR•! NO. pro~e~l) 2. YfYAL A[f1YtMt~4~~~~~+rdM.r I~~~M~N~~ RMl{~M~Il~~rWM~ S ~~~~~~~a 1. IUC[ OI O[ATN CODE MO. ~ ~NTM • STATL ~ COi1~T~ ~ an~ •111 Ct •e 7'10Y• ~ D• PI~e~O F lp 0~~_ A. CITY. TOM~N,OA IOC~TQM t. i5 ?i4Cf O~ DEATN t. C~TY, TOiYM.OA LOCAT1011 f. 15 RES~D(NCC f •~e~et ~ ~MS~M UTY UH~'i~ ~MS~OE UTr IW~TSt f11~. F v[5: uU~ ~'E5~ NO? j t. M1YE O~ M! A?N~~. pt ~f~ttl ~Nu~l ~EMGTw Gf STIIEIT ApDA(SS 011 A f?AY? 'y ~?,T~l OA ST~Y aK ID ~ YES ? ~O ? . _ urST~TUT~ow ~ V ~ ~ ~ MAY( I~ult .Vll~fs LYl G~T[ XMN Dq Yfp ~ O[CUttO ~ _ rnv « s•~•n Sudi e g our~ 2 1 60 `.y S. SE% ~ COIOA OA R1Cf ~ MnNl11[~ C hLVEN MAAMKO? ~ DAT[ Qi /1ATN ! AGE I/~ Ke~ Ii 1~D(A 1 FW - JMO[wN /MS. Jrt AYtI{q) X.Ma. A~w Nwr~ Yu. 4 r? c• F@~Tu31@ 'h'~:lt,@ winowco~{ wwacco ,.arcr 24 Ivf52 Nl 1~ [~LL~fI~~ ~ 10~. USU~I OCCUMTiOw (Qw ~~~1 ~Jrwt l~~~ IOS. KVlOO~ ~.iS~M[SSOR upuST11Y 11. ~111TMR4CE (57~ft t I? a*~uw or ~wr m~r~rorr ! • 1 t ~ r- t..i.~ .ar N w.~i.~ np. e~t~ i~ rHvr11 S " •~n~oa Housevif@ .1:ilt.e Vs~K V3TOZ1Z18 U.S.K• ~ Ol~et fwt ~j_ ~~TNF~ S MAYE ' 11. YOIUER~S YAWEN MAYC o r ~n•••,~•• "r.dxara 3ice ~arah iCinlar: ~ IS- M~S DfCEASEO (YEII U~ U S. AIItlED fONC[Y 16 SOCIAL SECcA~Tr 1q- 17 ~M/O ~ N4MATYK J~~ ~Yates, : ~ r... ~ .......r n« 4i.. d ...u.~ ~3 ?;o ~~u~u Ft.Yierce Fla. ~ 1• CAYK OI KwTM 16a~n ~d~ ~u r~r~r prr h~w /v ID). an~ l~;.j IMTE~VLL {CTW[EM ?un~t~l OKSET ~!W OE~TN 4l t~ e N~ ?~AT 1. OCA~N MAS C11U5[~ iI~ n t• ~ ¦u~t fil• IYr(OUT[ CWSt l~l .~grr~r~_~.~~~±a:'~~~Q@Ilti 2 CiOIiT$ U• e~r- e• i. C~~fYMw1. rI ~~I. py( TO (01 __Lli rG~1Q3C~Q: QSiS ~ •!t~ ts• elic? Ne~ ru~ 4 ' 1 • e • 1 ~Dwt t~rat `~1• r• l~tt~r Ut r~4r- a l~~w/ t~rat lut. DGE TO 1~'•----~~------ s 1 thf e 7~ 0 ?A~T 11 pT~il[ SK~lK.W* COUptiOwS COK711WT:'K i0 OCaTN ~tlf 1qi RW1iiD TO ~n[ 1LIIrtN1~ dSUSt COMO+f~Ow GMM w?Yi 7(~) . MAS ~~TOrSY ~ \o~r• •t- F KRSO~rEDt _ c•~ e•?u ~ resD ~o _ .r e.rer. ~ ~h ~ ~ ~ eE$~N~Of MOM .IU.,AY OCCUR1lE1? ~FRfH I~~fY/! ~~M}Y/~ IA ~I~ ~M Pf~~ ~~~~(tA I~-) •~k1~t •w~ ~ ~C~OEMT wK:a NOMICIpE ~1~P011- W C ? ? 04 u J m[ TIYE O~ ~~NI ~(fl~ft. a/. }~fM ~~A~• u NUU~• - O w. ~ 2(~/ INJUA7 aIUM[O ~If ~~ACE OF .MJ~A~ ~f 0.. tA 0+ t~o~ ~O~I[. mf CiTY. T01fM. OA IOCAT101/ C01JMTr ST~T[ f _ MH~IE AT ~ spT ~1w.lE ~ Jv~- lactor~, r(~ttt. s~'!t~ 6'S~ . dt ~ WOAK AT MOIIK ~ ~ ~ 21 !~ft~nd~d tlw d~cwNd /1rom_ ~~7-CiJ , ro •nd Iur A T~/n~ on 1 - W~fA oceuri~d ~t j~' n• _ m on M~ d~t~ ~~~td ~bo+~; ~nd to fM ewf oI m) l~no~l~/~~. I?om fA~ uus~i ~tat~d. ? _ 111 1{t~• jj~ MGIMTYR[ (Lrlrte M ii~:l, 2L~ ADD~1[SS ~ WTE SKN[O : ?r• to ;;.;,.r.c~e-^id i ~'t. Pierce, Fla. 2-18-60 . •!!Yf ~t~. ~~~4. ~~~ip~. j]~ pATE 23[ ~AYE ~ CEY['l~Y JII LRCYATpII~ IOC~TIp/1 ((1f~. fK1. M fM11~fJ1 (y~) ~ n[r0•~a Syrt~/~1 . ~ . curiaf 2-1~-60 t 'r t r_er:;e C~.TeLe:y = L. i'ie:~ce, r ~OT1Ca - i Y. S. / 617 j~ ~~~~~1 [WA~OII S 514M~T~IIC •DDN[SS 25 i.~TE R[CD ~r IOC~LL ~[G 2f- 11L6~STlAl1 S Si4N~TU11[ ` ....,~se iiOSc;~f. N. Yates, rt.Pierce,c'ia. ~ 2-:y-60 ~:u'.a ~ee ~e:,ison, ~.r. . =i~~ I haraby osrtify fhis to b~ • frw ~nd o0rrecf oo¢y O'F 1fie IGCe( Reflistr~~s roo~ord on fii~ in Ih~ Sf. Luci~ County Heaht~ Oepa~T - - m~ent ~t Fort Pi~ra~. Ftortda. - (Waming: Not val~d unl~s ralsed ~eal of the St. Larci~ ; County ii~alth D~partme~t is affixed.) ~ ; N. MILLER, M. ~ _ Cotxtty Fitalth OfficK b Loal it~glstr~r ~ - . a jf"' i ~ / ~ . _ , i i _ = Dsl~ O~puly Raoist.a~ : . ~«1~6 ~14 _ 0~3 . ~