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HomeMy WebLinkAbout1514 21~498 ~ =~~~s~ R04ER'01 t CItRK C~RC IT OdIM1 ,2~'7~98 A[OOAO rt+~~~~~e~..._.. a.- oT,?TC eo~no oF x~?~n+ CERTIFICATE OF DEATH • BUNGU OF VITAL flATlQT1G RAT< ~IL[ ti0. ; :~~•1.•~_ FLORIDA ur1 •Men B1RTH NO REGISTRAR'! NO ~~opstlr ;~v~L I:J. ~2. USUAI R[!!O[I{C[lR?.n~+~~./~.r Ilwt.w4w.~ Rrr~wh/w~rwr.) rucuC~d 1. ?U?C[ O~ OSATN ~ Q. NwTe COUNiY •nd .lll Wvr.TY ' ' . ; ' ' . ''~~v _^1 ~3 C' ' Dt yl~e~d ~"`~"'2 - . ~ t. K RES~DCACE a 0. CITY. TOwN.O~ IOC~Tqw ~_~LE J~ .._a'ti C~TY. TOwN.OR LOC~T~On 1n •r- ~c. ,S ~ ; p ~ . IAStDE C~Tr l1YtTS? •~ntnt _ C:TY U~~'i1 - rii.. ~t. =-e:-ce =~i ?;erc ru~ wp y I, h~+~E vF ~ ~I~ p0I 11 LWDY4, ~Yf tIl[[I i.Cf(U) J f~ :EnC.?n J~ STREE7 ~'vQRESS OM A FAQM) MOS7~7A1 OR , ST~I l~ ~ ' ^ .,t YES~ MO n.: ~ . ~ twST:T~TAM 1..:~~2 C@1n--- ' ~ { 3 MAM[ 0? Fir~t ' _ .V~',.~t - _ --Jlas! GATE NMt~~ IN~ YtM , O[C[AtW ~ TN ' ^ C i ITIDtMpiwtl . .~n: ..P vL~G 2 ~~~G~ S SE% 6 CO~OA 011 RwCE• 7•M~qR~i~ ~ wE~EA ~~pa aC'~ 8 D~TE OF ~iRTN 9?GE !1R ~ttq ~ c:ett~ ~ rw u~DEp 1~ wn. :j !Yt OYlu~1) YwW D~~ Nwn Ya~. i e• ~lE: ' 2~ i w.~o.c e~ ca~e: i i ~ ~ ,~pir ' 100• •~S~~~l tkC~MT'JH 1(iwr,t~~! o/swt ~JSt ~ 1Q0 n~~~ Oi 6w~NeS10~'.h~~~TqY ~ tl. i.RTn/~I1'.E 1~~t r jat~ qY47q1 IZ 4i32L~ Oi sw~t CQMtfR . •ItA y~r- Ian~i¦eaN-r/~cxc~sfh/t.tu+~Jrtbitl)~ ` s a~n~nt i.:.ti',n:'FZ~ ~1..?" I i.. ~it?'CP. ~~8• ~vs~ - OL~G1C ~pk (ATNCN 5 w~~E , Il MpTwER S MA.pEF hAME • ~ OT ~ ~t ~ ^ i t~ys~~lt~~ l~~li=c~' ~.a~:` _ ~ -*,i„ ~:L'~riJl~`'^ IS M~S OECE~S[8 [i[~ ~1ti U. S. AA~CD iAAC[5' t6 SC.C.~: SEC~.,AiTY ~J 7 OlfO11MAMT f~IGMAYYR[ • t at~$~ ~ Y.. w. ~~.l.~..i J/ Mw w. ~ Mw~ .l r..w, ~ ~i . i i .O i - _ : _ _~ed•os gr c' ' ~ 3 •Si CAYLC 0/ O(ATN [Entn oaly ow~ ra?u ys~ Nr ,a~. ~:,..nS .r..; INTER~i~I 6ETNfE[W - F ~ n~ r~ 1 pMSET A+W OtATN - ,~~~«o~ ?411T~.0(~TNW~SCAUSfD•ri tuft T11• IMYFDlATF C4USC ~t) _ tA• e~r- tlfic~te - - ~ - ~c: c Confuwwi. iJ a~t. D~( TO ~G: _ - ~ -n~~--- j..~i_y~r_~ - .scn cn. ceo:,? ~sr~ .uf r~ ~ ~ 1 o e w~ a.',xe canu ? r• latrar +~y~+/ 1~t a~4r- pi,E TJ ;c~~ - ' - ' - 6 tl~c~ t~au (wt ~ . _ ~ ~ : } ;a:C vF~.-i o- ir3 • 3 t h1 D'2 O I~FT N O7ME11 W.NiKAwT Caw~7Uh5 Cc7.:R'~;i~ti :~.::f~•w W ~t.' FFJ'E~ TG•iME 7IAY:W ~SfAS[ CO~L1tT10~ Gf'~[I~ U1 ~Mf l(~1 W~S ~i :G~SY - Eour• •f- ~ ?ENfON~EJ/ t~~ d~~tA v vES? b~ = or Defor• - - _ •~\~n •e ~ ~ ~14~~~ L[S~R~einJw.~;,,~r;,.i,«rtED i6~+:rrrorrr~~/~~~tir~~~f'u(1KPut!loJ~~+~l1i a ~ ~ ACC~'vElrT su;c.x ~~~c:x ; w~~Ypsl- u ~t ? !'1 } :,1 11 O~ J J L: _ ZQf T~YE O~ lIYY• V~~f~. IN~. ~~fY £ . d~• u ~~IoAY a. o. _ p y. s . - W ' - ~ 20d ~wi~11Y.XC~4Ai0 ' 2lk ~~~CE Ci ~~...Ar ~,r ?:t r'~~:; 1~RU, 2D/ C~T1l. TOWN. 011 :OCAT~JA COUMTY S7~TE . nw~tE /1T ~.JT wM~l[ lo•~w. :+ct;,ri. ~:rtrt. c;':r ':Sj.. [f: i i i ~011K • i rpRK y . } 21 0'.~::i_ ~:_i toa ~7`..~~~ •nd b~t wr Ae~ •L?~ oN Fi'1- I: f-~ ! ~tt~nd~d th~ da~u~d /iom _ . - p~~ ~ D•.an occurr~d ~r - m<,n r1:s Jare ar•r•d ~Lo.~. .nd ro tM 6~st o/ m1 kno~/~d/~. /rom tA. uu~~s anr~d _ ?11 iN~• jj~ tIGMATURt . 2I[. D~TE 5~6~F0 (lir~.rr ,N ti•:e ~ 1:1 ?_::N[Ss •r• to 1• co~pi~t• • - - ~ a.Y' .E='..E ~la~ ~ ~t.:':F ! -t~l •seuraa~. ,v~ c< ~a cctwa-::ar 23a 6..a~~~ Ca..~-w v`2b o~r[ ~ ~ 23f IoC~T~('i~ ,Cr~. t~w N ca~~t~~ (J[~teJ ~z::i r+cr~.~5yruj~~~ j , _ „ - - . _ ~,v_ : 2y i~ - - . ~ ~r~~ : L. r~e: ce, ~ la. Y. ~.ICIJ 21 i~Ain4. J,..F::'vw 5 SwwA7..Ai '~wnui ` T~~ .•'E nF eY.wt.:sG r.£L!S?RA~ c~w~Tbll[ _ ' 1 _ ~...i~sa `_~',cs - ' - - n~.r,~ ~ee .-e.^.`so~.~ _ - - , - . ~ hc:oby oertify tfi?s to b~ e true end corr.:tt ocpy af ~ Lo?:al _ i::.~istre~t rvoo~d on file in tfis St. Luu~ Cou:.ty l;c;:;:n 6~,r;.rt- r:.ant et Fort Piero~, Fbrida. ` (Warning: tiot v~i;d un;asa raiscC seal cf the St. Luc:o _ County Fba~th Department is eff;zad.) . - N. D. MIILER, M. D. Coun :lth OffitK d~ l.ac~l ~.:,i „ar ~ :,"-t - ~ -`o OoFxrty LoCei R~aistra? _ ~ _ ~ ~ ~a~K ~96 P~~1513 _