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Home My WebLink About1608 - - - - - - . ~ . n~- sT~1c BOARD oF Ku~TM CERTIFICATE OF D~ATH 2/~+~S6t) •"S • sUPEAU OF VITAL fTAT1~T1C~ lTAT[ FIL[ NO. ~ ~~s•i FLOAIDA ~ ~ •A~n ptAtH NO REOI~TRAR'! NO. n T t r 1 r 1 tIAC[ O~ ~[A7N COD[ NO. ! YfWI R[{IO~MCt (~~.~.Ia~rd hwf tl...~.ht.~' ~rdw~ ~b+wf~.) • 1 P f U«d ~~.nU„TY I • 57~TE A- COUNT? ! 'nd droward - ~ I Florida droWer.i ~ t• p 1~e ~d ~ C17Y. TOwM. OA LOC~`10M f~S ?l4CE Of OE~TM L CITr. 70N'M_ 0~1 IOC~Tqlf t. 15 R[S~OtNCE , ln trr- •~n~nL ~ INSIp[ CIT• LIYITS~ ( tNStp( d~r UMlist ~fle. f OTt Lauderdale .csa ~p ! i,akland i~ark .rs~ Mo ~ 1. M~rE O~ l!J wN iw ~aDlt~f. /i~t ~lrrM dbr»I ~ STRFET ~ODN[SS Mos•~T~? o~ 12C~ h. W. 33rd. Stroet . INSTi7V~WN Holy Cross Nospital ] N~Mt Ot FhH M11Yt L~st t O~TE Ms~l~ !H~ 1i~~ °ri~'•~~r,~"r? JOhn R fVOWlin a'T" August 5 1965 S Sill ~ CO1011 0~1 11AC[ ~ YA1111KD ~ hfYE11 Y~1111~(p? ` a'TE O~ /1R7M 1 A6E (I~ ~t~?I I~ II~D(R t~U~ V~OE~H MK. IYt Di+t~I~~) X.aW D.w Mwr~ MN. ~ e• t(iale i:lhlte r~oow~c? avo~ccn ~u . 11 ~ 1d93 71 T 1~ 1 n 1~ IM USUaI ^fNO~Tpw tCi~r fin/ yrv? ~set 1~ KINOOF ~US111ESS0A INDUSTR~ 11 ~t11TMK11CC (Sldt M/~r~i/~ t~ttqtr/) 1 M~ZE11 0/ ~nMT ~UMA~r • 1 t T (.er- /n~in0 ~worf ej ~rut4~ h/t. iit~ i( rNirtt~ E~ ineer Hoad Buildin California U.S.A. F1~cY 1nk ~j f~Ttif05 M~ME I~ MOTNEA~S M~IO(N MAME or tts••~~~•~ ~1111(1(i1 TdOu111(1 ~ ~arria GreenWOOd !S M~S D[CE~SED EVEp tM U S•AMfD ip11CCY 16 SOC~~t SECURIT~ NO 1' IMI~AMAIfT • t10MA7Yw[ ~ ( t/'n. e. .Jr.w~ ~l/ r.. nr ~ M~.. ~4 L:,._i. 'a J K` ~a l t L No - ~~9~-u5-721U ~«~•42UN.W;3:Srd.St. Oakla~d Gark Fls. F ~ n ~ r~ 3 - 1~ CAY~[ O/ H~TM ~Ewttr ~~1~ es~ t~ru pt~ hwt Mr o~/ ir! ~ lrTEav~l ~ETIMFEN _•'If/~v_4 ' OMSE l1~ OE~TN e~.~rcor ?~~t ~ pEATNMfA5CAU5[D!~ N,~ , +r..Ea•Tr c~vsc ~•t , .uet rf~• tr~ c~r- ~ i i f ! : e ~ t • !'en~na'u. U ~e~. p~ t0 (6) . ; .stn tAe r~lr~ /~rr rue te ~ ~ . . - 1 e e• 1 ~~rN ' r~~fatr~? ~tsi~/ r,1r r~~~.. W,£ ~O ~tl l~in~ t.ru t..r ~ ~ - • i t R l f1 T'J I~R~ OtKll SK~K~Mt CMOtipMS COK7~IM!?1R t0 O(~TM ~!i 1ql RCUi~O T, iN[ 1Wl MSUSE C'Y~II~ON GMA M?M7 1~~) . Yr~S AU OtSV ; pe~i~ •f- F . . C~(~' 11FQAMEDt :sr o~~lr. i V ~'~1L~~/1i ~ Gli` ! =t~~'==+.. Y[S Q?10 ~ ~ : ;ctera ~ , r~ •.f'-waob , pESC~~H NON ~lUf1~ CCtu~RFD (Ewi R~[ NiwJrr~ M Pnf 1~r Psrl IJ y~t~ l/.-. ; ~ _ r.~ •nT ~ _~.~i+~r SItFC~DF n~yKW[ ~ e LS~;o~1- ~ i' f1 - ~ r e s o n e t v L: u ~ - - ~ 20r t~vE os Nod• Mewr~. Dst. Ytn It 3 roe~. u :e~c~r • w ~ ' ~ p w~ } W q ~ ~ INJU~~ OCCUpREO tl4C( O~ iMlU~~ 't M M~eul ~Owf. mJ C~T~, Tpw71. OII LOCATpN COUMT? ST~7E $ MNIL[ RT ~ Ip~ KHILE hr,w. lKlO'I. Mr~rt. o~f~t ~ill0.. d~.1 W0111f AT NG11K r F 4 ' _ _ 2i I~l~ended tM d~c~u~d /rom . ~?~-1l to KliC~'._ ~~b * 7 y65 •nd Lst s~~ h~~lir~ on ~7 ~ ~ r D~~IA occur~~d ~r ~~0 m on ~h~ d~~e ~t~t~d ~bo.e; ~nd fo rhe b~~t ol m~ Anowl~d~e. /rom fh~ uu~ss ~Nr~d ~ ` ~l: ft~~• ~ I2~ •IOMATYAC (/rt/rtf M t~•(~~ IZD RDD~ES. ?l[. D~7E StGNEO ~re to p• ~ ~y)/~ i D ~ ~ s ro~p)~te ! . ~/1J i V ~ ~~a ~ ~`+6s ~ a[ e u r~ t e. /yy~~~y 23/ l~J[~7iOp 1 Cv . tKw. w~~r~t/) ( Ct~te) ~ IIt iUA!Il. CAfM~TIOh Z~ D~~C IjC h E O~ Cl KQPi tt[~I1'i7 ~TONY ~ . RFrO~'~tl~~ptt~/i~~~~~~~ ~q~~ ' aUd.~~~E'fL0•~ ~h8U501bU~ Fort 1.auderdale Fleriaa ~ „ 1~ . 9. r 9 ~ 2 j1 NNEA~L D~ EC ON 5 SK.N~TU11C ~pONESS ZS G~TE RECO •Y LOCA~ IIfG Ki. ~GIST~M 5 51G T R E ~ ~ -+t/ r:a ~ is Funa: ai rio,;,e l~J , ~ ~ /.3J . _a ` F... 1 o5c _ , ~ ` ~ .il ~ = z-ri . - , ~ a. r: ~ n~ l _ l' ti ~ ' _ ~ ' ' ' . _ ~1-~ F , ~ N 1~~ ~ ~ < w ~ " =LLN~ .Z~ " '~s l].- r- i,:,i;^_ T r'IF.D i,C~~'Y _ ~ ~ V ~ _ r _ _ N _ = , ~ ' ~ nvre~y certify the ahova to be P true anc correct copy oi the i.ocal Regietru.r-!e record on file in the Eroxard County Heeitt+ Jepertment at~ > - '~JCQ' t'ort ti~i=ci,el'dele~ Florida. - ~~~;Zt:~J:i~, . _ "H t~V = Q-~ (Wa}~r~1,t18,s~.~1~Q~_;i"alid uniess raised aeal o: the Brovard County Health _ ~ E~O~q~iar'tmgt?t is affixed. ) ~ - 1ip = . t D - ! . - - - - ' _ ~ . s ~ : ~E~t . ° " W, y~. 4 _ ~,y - . f • : - v• , _ ~ d ~'t-4~,t ~ • E ~ • ~•~-~'4 te':' - i. ~'..':fL~~~-. County Health Officer and Local Regietrer --4~*;.•' ~ i ~1 c1 i ar Ytt?~,f= ~ ~ ' • ~ . . - ~ ~(Y.c,.~. l l d _ aOpKlc70 PACf~~~ Deguty Local Regietrar w.