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HomeMy WebLinkAbout2395 220155 ~ ~ ~ ~oiss ~~~~~5~~~. ~~~EA PQt l~~t Q~~a~ $iHt~li a rn R~~ _ Re v~R~F~ 7~i. e~- ~TATE wnwo oR ~+uLTM CERTIFICATE OF DEATH ~C ~I 4 37 f'~1 ~o•~• • ~uRUU OR ViTAL tTATlT1q srwTC F~~c Ka :.6.~ FL08IDA ord spen BIRTM NO REGISTRAR•S NO. ~6~ ;,y.:.-: j , v~vw ww..wa..~. .._.~~_~~s__-_-_ ~ 1. K/1Ct O/ WTM ' CODC No. eaetnt~d a STATE OOI+MTY .~e .1~1 °Oi'"n' SL. Lucie 55-Q25 ~ F~orida St i~c~ e e. ~i•e•• s. IS RES~OfMCE 1 o p~t- 6. t~Tl. To~. d1 l,oC~TqN l. K K~CE O~ DEl1TN trtr. t'owM_ o~ wuT~o~+ INS1~7E 11Y1T5/ ItiSlbE CITr 11Y1TSi ill~°` FL• Fierce .ES~ ,ap ~~hite Cit•, :~`L.P~erce rural .cs ~o I. MM[ Of 1IJ NI q~M~ifil. Irt adle[ dL~W) STREET AOdI[SS F'L. Pierce ~:e:n. Hosp:Lal 100^ WesL 1 sL. Street 3 ~u?~c or ~•r et~ucs I..u wTC x.+u n.s Yro otcus[o • os ~7yPe M ln~t1 j. p OEATM i S. SEI[ ~ COtOi1 0~1 1tAGE 7 MANR~ED ~ MEYER MARAf[D ~ E i11iTM 9 ~6E (1R Kd~ ~ K~ ~~A H MRS. L lrt 6rAW ff! rr..w p.~. etw.. xi.. ~ 1 t ~ j,+ i1fi00MED ? Dt1~OkCED ce^t ~ ~ ~ t'~6J G~ . p i~ lr3 J ~a. usu.~ occw•r~ ~v.. y...: i.,~ iJ6. ICML3i wS:AESSOR .'itw'STRY E=RTMlL~C£ i.i~f![!! fR~lVA CIYM~/1 12. ClitiEll Oi ~IM~T OO~M1~i . ~ c A p~ r- 1s.ial wwt d wti~I h~r. sn i/ rdir~l~ ¦~n~nt r t ~ Dl~tk l~k ~j, iATMEA'S iY1YE 1~. MOTMER'S MA1 • M~E •f ` ~sr..rlt.r q g f 1S. MAS DECEASEO EVC11 W U i AIIrED FOIIG[5~ K SOGAL SECUA~Tf NO. 17 ~MW • L NGMATY~[ ~ 1?r. r. ~~nlrwl Il/ /.w w~ iW~ ~I rws~ S~~. lt~h e ~ ew.., ~ e e ~ ~C: r 1~. CwYK N KwTM [Swta ~wt csWr pr? G~ w lal. /D). awt iti.j {KTtPV?L ~ETrrEEM ~ P~n~?~~ fiMSET AwD O(ATM dir~cte~ ~~ATL OEATMrASC?YSfD~v 1 , ~ Yi trrcp?r[ t~us[ ? .~~t f~l• t an• e~r- z ~fficat• ~~~fyW.ilAI. p~ Tp (~l , e e e a. r?,r+ p.r .u~ a ~ : • e . 1 .ee.r c..a . ~ r~6latr~r ~t~tiy t?t ~a~er- . ~1.@31T- r , n-- v~.^G~aC ~ r~:!' ~ < rn.r r.r ouc To tri I.r ~ : .?aes• sa = w~s~uTOxr '~s~ O rMT 11. 0~~1 SK1ilUllf OOiOfi06 C01fIlWTII~G 70 DGTM qR NDT 1!L'Ji[D TO TM[ T[IlY11fLL DIYASE COI~IiD~ WYE/~ W?YT ~ERiORM[D7 AOY~f •f- = a••~• ~ Conjestive ::eart ra~_::re, S@\'E: e::eahro-scle^osis .cs(~ w0 or p~ter• t ~D ocSt~N[ Mow wu~r otc~aa~n. (F.sro w~twr y~?~ is Pot 1 r P~rt ll ~JY~ 11.) ~ •aki~i ~~7 ~ ACC~DEMT SYIGOE MOYKIQ p~~f- W Q ? ? ~ s •f T~rE Oi H~ar ~/wt1. Dr~. Y~ bed~. ~ rU~11Y a. a. = p 1• Z 20~. pU1iAY OCCURRED ~Ot. ~LACE OF IIUU~~' (l. 4 M~i41 ~1K. ?LIJ CITY. TONN. OA IACAiqN C01lMTY STATE VMII[ AT ~ MOT 1M1/RE ~ /~K1. ~btd..~ ay.. d[.) ~ MOIIK AT rO11K ~ ~ `7O •nd /ut w~ A ~ ~lir~ on - Ov 21. I~tt~nthd f!w d~oward /rom . to DNtA oceurnd~t a~JOli ~'2 P. m o+~ tM d~t~ ~~~t~d ~Do?~: ~nd to tM 6~at oJ m~ l~no+~l~d~~. lrom ih~ uuNS ~t~ud. ?71 1t~~• IIt. aTES+G~+ED 7l4. i~C1YTY![ (IXI~a M tYlu ?ID. ADDnESS •r~ so 1• ~,.,1.~.. J.H. BaLsc:,e,;f.D, i 905 ~e~a~are 9-21-cb •ce~r~t~. jy R~iyu. pgy~Tpti j~ pr,TE 23[ wAYE O~ CFYET[11Y OR CMEYAT6A~ 73/- LOCATIOn (Glf~. [rt'f. M t~r~t/) ~`c'~e'ir~~'' 9-79-bo ~:=te C~t~ Ce: eter3 F`t.Pierce, (St.Lucie) Fla. - ~ te V.U.r0~9 2~. i~lriutiiw~f 01i-SSi~iATi17tE E .?A7ER'aCD.SY:.rti,A:R's:. i2fi. R£615TR1RS5!6!~?uRf . , 100 "3:" '3S 1 ~ p...1~D6 ~o~er L. ~*rd. rL.?~~erce ~ 9-2"-bc A.-ina I.ee Ilea:.s~n c.r. ~ 1 hereby csrtify this to b~ • trw and corrxt oopy of the L~ocal - Rogistrs~s reoord on fik in th~ St. Luci~ Courtty He~hh Depatt- . _ - mont ~t Fo+t Pi~sro~. Florida. . - - (Waminy: Not vaJid unl~ts ralsed ~al of the St. Luci~ _ County Hsalth Osputment is affixed.} , N. D. MILLEjt, M. 0. . ' H~alth Officw d. Loal Rpktr~r - • : a~ _ . • - Od~ D~uty Locsl Reoish~ " - ~ - ~ ~ ~ 600K1~ P~(~~~~ :>:3 - - ~ _