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HomeMy WebLinkAbout1656 U - v - 21~44 ; ; C.- .:1FICAT: OF DEA7H ~e/rA~ew1 ~ 1{e+~lll~ u~ ~.'e6.1.i1N.li~e ~etrltr~ fTATE Ft:C AO. i FLORIDA '~>E. O! 1UNi IN ~~~'R'~~'r"O REGISTR:.R~S ~o. 533 ?[RMANtNT IMR ~~p_~µ( rWt ~.x.~ ~~ti ~.SEY ~DwiE Of OEAM ~+Ortw. s~~, nu ~ SEE MYWIOOt f0~ a~i1D" , Chnzlotte Kr, I7 ~ twCE rwn. »eow..,r~.cu. ww., wGf-..i, .••~e. ~.e.~ ..~ue. , o.. ~ D~TE Oi WTh ,.~o.~.~. w.. icou+ir a o~rh b V O~ RC. 1 YIt~ ~ NHMG~~ 1~l~~f 1 rJ? ~ Y~i :+OMf . ~N ~ 1W ~ ~ . Negro s. ~S 'k ~.M i ~ tm, TowN. oa ?ouT~a+ a oEwrN w~. c~.. .~,.a MosnTw~ oa ornui wsnr~raN- , ~ w+ .~4e., c~.. u..~ ,.e .w..e.. s?~c.n .u o. w wFort Pierce Yes +H Enster Manor Nursin~~ome SIATE Of WM ~r .o~ M Y.~ MY! UT11EN Of WriA7 <Q~~I:7t)' ,MARRlED, tiFvEA MARtttFD, iS11~V1Vl~Cs <r ~.N, OM ruee~. ~rr ~ cow~ ~ ; WUOWED. OIV~D ~ vetr. ~ ~ ~s~.,.~.«..~. • Nassnu . U.S.A. `H Widowed .-..en ac~.Le .~.eo r w.w SOCW SEGUtlin MiWE~ USU~u OCCiNwtiO++ ~u.~ a+.~ o~ .w. oaa ow~«c rou w~[WD 0? wDUSTRY o.cux~o w ~ ~o~rt. ure. ta~ .twea , N;; ~r ~a Retized Housewife None . 'o.u~iWr.. ~ESIDE - A/E C011NT~ CITf. TOMM. W IOCAhOH ~nss~ trtr aras STtEET IWO NiW~E~ j~ vecMV ns W MO ~.Floridn ~w Saint t.ucie ~ :«Fort Pierce ~ Y • ~ fATHEt-NAMf raif woal ul+ i MOilfEt-MA1DfM N~Mf r.tit yp! uW i Justin Wilson • ~s James Pratt St I~MOIW~ubT-NAMF '.ev~YwCs ~1DC,i:SS ~smn w~ r.o. .o.. c.n w*o~.... ~..n. tr~ ` ~ Nathaniel Knowles 200 W. 143 rd•St. NEW YORK N.Y. ' ~ r~ut L ....o,,...n ,...i.... E DEATf WAS CwUSEO ~r. iF++TfR ON: r Ot~E C~USE IfR :NE FOa (oL ~TL ~NO tcl: l~~nreer owf~~ .ra w.*w € i \ S q r~yN~R C II~~ i( ' i ` • ~ ~S COM11A1NKl O~ "F~ . ' COMOIf~ON1. 11 ?II~, ~ ~ 1f+- • `r~cw ~•v~ .~s~ w J (~l v E eo~.re c•uae w~, ~ St~~IMO TM~ VN~}F 0~ ro. ~~S ~ COMKaRMC~ a ~~~MO C~YL ~ } f ?ART • T ! SIGNK ANi~cQfiplT ~ t r,d.s [owr~.~~r,.,;, ro p.* N~x u..rta so c.~f! a~rlw x+ ~.n ~ w~ wT~r K YES ~~wo~'.os co..- / ~1~lf O~ ~+Ot ~ LDlffp ~w 6ltffrlMtMO 4YL p Ot~lw S~ ~iti ~0 11? t P.aeeW i EM. K~OE Ot OA NN/R1 ~ ra.~w. a.~, ~e ~ ~ MOUi . NOw IlilUlt OCCU~REO_~l~~*e~ w.Twe p ari~n r.a~ ~ o~ r•n mr ~ F t5wal~i ' OR ~Mi1EIlWlIiD ~ ~ ~-C~~A'+N " 2 _ ~ ~ f, / ? ,C~,,,,,, ) r ~C-c ~ I ra 9- 2 0-~. i r+~ M~~o, i.-,~~~ •-a~` l.-- 2 ~?~lUtt wt wORtt KACE OF WXltr .or. ar~n. ..eTOn. ~:OCwTtAt+ i.en w~...o ~+o ,~cm oe ~o+r, sr.e : ~Ntonnsa.w~ ~ow+nwc,nc .sna..~ 7a. , ~ -Yr.~C_ ! ~~s J~J ~ 9 ~p9~tif t.~. r~~l. .cE-(. t-E . ~ CERiR~Cw7~ON- .~o.~*« w• r .a+r.. o.. .e.. ;...o :.s. s.....,iwe~ .un a. iao.+o. .r.. w~otwrw OCWtlED nu r:.w. o.y +«e ~ ' ~wtSK~~w~ TO / ~ ..~..rw Mf Ru ~ ~SO~ ~nt~ 0l~A. `~NO~r~~ D~Tl. I?~D. TCi M Hir . , . .~~~.o ! 1 ~ 6 ~ ~ 7~ ?-s~ ~ a ...~4~.. ' 74 oett.s~o no.. ~ 7U ( 7~: Ci / /~i ~7~~ ~)t. 3,,,~ i0 M! C~uSf~i1141ED. ~ 5 CERTiKwTqt~-MEDICwi EtwwNE! pR COtO~+E~~ d. r.~ ~.,s~a o~ nr -T~ oe~'e ~ ~+.s .w+.ou..ceo a.o ~~.ON W Ye•rw ~~~rM~T~ M M q0~ ~~10•'O~ :~e 1~avlStK.~iOti. w r~ MwW~. . , rO,+tw O~~ ~i~~ MO.r~ . M~111 OCCYKfO O~+ W 0~1f ~MO MR b nR GVS1U~ S~~ilD ` j :2~ M :17Y M . : CERT6IER-w1h~f IAR W MMTI AT i' weNe o~ n~.e ~ DATf S~GNfa . ~ rw, ° ohn B. Sullivan D .r,~ !i//~~~ r.v~k 'ff s~ut~ w~.r o cm o~ w.~.. s*.n~T- '-7~ € `~`"Ib'~.-`~~i St. ~ Ft. Pierce, Fla. 33~~0 - ~uR:wt. CRFMATIOt{ ~EI~pvM ~CfMETElr p~ ~wu7pR1- . ' ~pUT~OM on a w... sc•n ~ ~~rial { N~ Pine Grove Cemetery j,., Fort Pierce, Florida 33450 ~ ' DwTE i.o.nr. w~. ny ~ ~ FU~+Ft~i HWMf-lv.~anE ~~lJ ~DJCiSS s~~u~ o. a.r.o ~o . cm o. ro~., sr.n. t~r ~ . , ; 74 Nov,ember 21~ I971 iT~, ..p ;!0 72 A ' erce F o ' 4 : ~ Y. S. s6 i2 Iu+ftw KT i' RFG~S' -S:GK~r;, / n.tt ~tit~r[o .ow aco~siw } - a.~.19~c 2Si ~ >n ru ?wver~ber 29 19~1 ; F hersby aertify thit to bs • tn~ ~nd oorrac7 t~py efi the Loca! FIlEO ANO RECQROEO . T aeg;strers rooord on fil. in H,. Sr. t~,ct. Counry F~oaki, pe~a,ri- s r. ~ u c~E CouwTY fU?. ' m e ~ t ~ t F o A P i e r o~. F l o r i d s. ROCER PO{T R1? S t r:.=",` ; a, ? ...r.. , r, f t. •:,y'-~ i- .i (Vllaming: Not valid unlas raised ~al of the St. 4rc3~ CIERK CtRCU1T CO t K'.:. ~ County lisstth Deputme~tt is ~ffixed.) REC{?RD vERIF1E0 ~ ~ ~ /y ~ ~ Nou 30 t2 zZ PH'11:~h~ N. D. MtLLER, M. D. - . . Cax~l~r IieaJth Officar b t.oal 1t~istr~r ~ ~ ~ : ~ . ~ ~ ~ ~ c~ ~ " ,~r t: ~ t' ~ ' a9.i97~ ~ .~'~j`1 ~ o~. o•w~,? ~ ~.o~s,.~, ~~7 t ~,~:#L~, ~ , ~~44 . a ~,i~;.,., aooK 197 ~~1654