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HomeMy WebLinkAbout0262 CERTI~ICATE OF DEATH • Dtp~Iltalt6 and Re~~.i~ilatl~e $e~~itd fTAT[ FIL! NO. o~~e+u~ ~~r ~~r_a~.r?~ F L O R I D A . tt?E. OR ~tlNi IN ~~°~~u~~~~O IIEGILT11A11'! NO. ~[RMANlNi INK O:~f~SEO-?+.wE ~~~U +wa~ WI SEl OAIE OI DE~?TM ~~orrw, r~~~ ~ SF f Ri W IOOt FOf •snuaart ~ WARREN ' ~ . !AC! ~rn~. .IOw. ~..~~~c... ~«o~~r, AGE-uf~ v«w~ ~~~.t ~..ol~ ~ e~• DA1E Oi ~1tM ~.w.m. N~. COUn11f OI OfJ~TM ~K. tY~:~~~~~~~j M~twO~tl~Wf1 ~Of. Mrf wOy~f rw. ti~l ~ ~11iLLtie S~ A k • ~1_ ~~9,~Q ~a ~I'O[tSl'd . tOr+?~. OR ?OU1~JN Oi OEAM ¦.fwe Cu. ~~.~n NOSN)~l OR OtnER r+S~fiUT n.wE ~u .q~ ~w ur.~~, cn~ f~r~~ ~.o wuue~ ~ ~r0 fntrs w »o * ~.Qrt~I.auderda N _~i(ZLY CROS,~I~(?,~PITAL 3TATE d ~+RM . w..o~ ~ f•.. ~+~t GT~2EN Oi wHAi C01!/rTt~ wltttEO, NE~E~ w~RLED, SUtYrvNG S~ONSE iy ~~n. ONl MNM W/N 1 twan ~ W100wED. WvO~CtO ~ vKr~ ~ - vw.a ~eaMdC~ ~ /l~f'L_1S[l.il-_._ ~ f2.~~A N. , ~ (ll. vM.e oeu.s~e SfCU~~T~ NUw~~ER USU~I OCCU?~Tq~ ~w.e a..~ o~ ~on oo.w w»~.w ros~ w itlll0 OI MlSwf Ot u~OUit~~ N a.a xc~e.eo ~ ro~e.a un. nu. u~et~~a ~ a ~..ti~ry~~., OM 12 ~tiG~1~Y7 . 17~ YQ~ ftL]f~if M~OM •a~~~?b'+ lES~DEt~CE-S?wIE COUNTY CITT, Tpvirn, O~ tOCA1IpN waq~ un ir~n TREET wN0 nU~JE~ ~ ~wun~sww ~w r da B ~w fATMF~-N.WE ~~~fT ~IOOI~ YyT MO1MEt-MAlOEN NAME Nly rqOl~ 4M A A a Not Availabl~ I WOU~rrT-etAME MA\wG ADORtSS ~smar o~ a.r.e. wo.. cm w ro.... sun. iw 3305 IH a N1~T 1. a?rWU.. a. vn Ofw?i+ w~S UUSEO ~r (EHRt pvt~ O+rE GLLSE ?ER twE iOf (e~ (D), w0 (c)~ NtiflM pwf(t ~N ~t~M N r.ea.q u.use Acute Congestive Heart Failure ~ hour , . . , - cor~moMi. u / ! /t t~Q~ •rwiCr....,,.~.o J~s, HypeTter.slve Arteriosclerotic Hea~t Dlsease ur~0ui! C~Y1~ u1, I ~ ~O. O~ ~ WrYO~lKt p. ~t~t~M6 tw! 11r0t~- 111M0 C~Y1l f~lt ~A~T M. OTNER SIG?+~tKu+T GOn01t10N5~ eorw~no~f cawu~~maa a~a.n~ w~ .wr ~eu.ne q uus~ anu. w..n ~ w~ N rES .~n ~~rMr6f CM?• ~ 17tl O~ MO~ O~ OUtw ~q~•••w~0 4vf~ ~w 1 ~CUD SuK~DE A 1WU ~.o..tr, o.s, n.~. MpW IN1Utt OCCUtREO ~~"R~'+~~ a~~wn ~M nn ~ p~ r,u~ n, p~YK~~; Ot UNpf/ElM~NEO t ~ ]A 7h M 1N i p~WRY ~T wO~t ?u~CE Of wxXr ..o.a. srrn. ~.oo~.. lOGT1~v ~ ss~en w~.r.~. ro., un w~orw. s~.n ~ ` L VlU~' ~S Ai ..6: J~I~(i /~OG-. tY { 11K~~' • _ ~ ~ i ~ (~RTM1~A~10N- +0~~~~ Mt tW ~pAM O~~ ~W ~M u{T L~ Mr/~!~ un! OM ~ aore.o w. nr oe.n~ occuneo ~t Iw! hKl. O~ IMt ~Mtf1C~~N~ rO1~IM ~Oj~~~7 ~l.V wo~ ~m~ a.m. ~wor~~ ~?A. w0. ~O NSt ~~ntr0lO n~f TO G/ ~Q nQt O~ [MO~M1lOGf. OW n r. a~~.wo 5 21 68 +~u 5 17 70 4 M.o ~.w.,u.~.~. ~ CERttHG?T~Q?~-iwfOKJ~; E~w..rH~tE! OR CCRONER o.~ e~.e ~.s.s o~ n.e Mpw pr w.e. rw~ we~.n ~.s ~~o..ou.~eeo ot.e S fW~.~~~~0+0~ ~ WOs ~..~'C~ tr! un`!1•~G.•0.~, .w r~ O~w~W.. ~0~~11 M? ~t1~1 a .R 1 i~~ew OU~MN Ow 1Mt W:e u.0 Ou! q~! 4VSl ~r~ree rn ~ O io M t - , t ~ CE~TiilEt-WM~f ~mt o~.~~•.n 1UtE ~ Mo~e~ Oa n A fl ~.O~n~. W,rW~ ~ r,. J. F• gerry N D r~ n. ; ~ MAIIWG ~DO ESS-CF~r.! ,a ure~ o~ s w. ~ cm w rp.r.. fw~ ~ ri Intr~coastal ~r. ort Lavderd~le orida 33~~ ~ ~ ~Wiwl. ~~EMAtipn. ata~~.w~ CFw~ETEir OR CREMATORY-Hw.wF tOUT~ON un p~ q... . u•n ~ ~ /YKM~ ' B,~.ial _ H? ~ p :k Fort Landerd e Flnrida OwTE ~.w*w, o.., n.ei WwEtwl e+O~wE-rvnw~ •w0 ~ODxfSS ~ ua~. o~ ~ r e+a., un o~ ro... u.rt. e~r ~ ~ r+ Ma~O 19T0 ri• ~ ~ La 0 wa Fort Lauderdale Florida Ql ? M. S. 1~ 1'1 fII~E~t ~EGTO~S~L.~.~'u~f ~ REG~STU?R-j,t.fi~i f ~ ~ o~i! 1!`t_r!D ~r ~OC~a ~lG~Stt~~ ~ ~"7 i ~ ~~v. 1970 ~ " ~ ft'~ • _ ~.h ~ 7N ~ ' -~1 ` r I ~ ~ ~ERTIFIc.J CO^Y ' . ~ ~ - ~ • - . ,r~ . . I bereby certity t2ie above to ee a true•and correct cop~ of th~ Local - ~6iatrar's record on file in the Brovard Couaty Aealth Departoent •E : - r~ Fort Lauderdale, flori~a. . ~ « _ ?A. ~ (Yara~:,;, ~4! ~-~li,d unlesa raised seel of the Brovard Count? Bealth ~ _ ~ E P 0~-'~~~t ie• aftixed. ) . `u . ~ :J _ _ _ = . 2 ~ ~ t i ~ P 4 i' • :~'~~G4' ~ ~ - . ~ ~ / " sso (~~~~1~ V _ ~ ~ c a ` '-T i~~ l^:~'° . ' ~ unty healtn O~:icer aad Local itegistsar ~ ' _a . . [ C'' ' -:'y _ • . • - `t~~t . . ~ ~ ,N n ~ ' - - 8-12-71 ~ Deputy .dcai negis c r 2 •J ~ aoRK197 ~~E 26~ . - - ~ -