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HomeMy WebLinkAbout0196 ~ ~ ~ 222655 Tn„ De_ ~TAT[ YOARD or Ncw~n~ CERTIFICATE OF DEATH c o.e s• ¦UN[AY OI VITAL iTATIfTIC~ F L O A I D A sTATS Fitt NO. Ie~sl ree- ord ¦nrn BIRTM NO. - ~ NEGI6TRAR•! tYO. pro,erlr eiecuted I ~uu 0/ ~[ATN CODt NO. 2. YfYAI ~iNO[MCtl~~.nM~../M./ I•.M.~.u.~, t~d,.~,~y.•.M,...w) ?nJ •111 ~NT~ fO j~ STATC 1. COY11tt be pl~led • (o • • 1 n pe~- A. GTY. TOMM.OII IOC~TqN t. K K~?CE O~ OEATN t. QTr. TOMM, p WCAT~pM t. ~S RES~GE~CE a~neat MSWf Gri Ur~TSt ~w5~0C C~TY Ur~tSt r i 1•. res ? ~oo res M+~ME Oi UI Mt h~lwpql. Iw~ ~6tet ~flnM1 I. STREET AOO~fiS NOShT~I OII IMSTIT~TION R t iir 3+rw~et oI 17pf Nilrt~ !wd ~ o~rt XNN D.f Y.o ` occuuo ~n~ «~.~u, ~~M ~ S SEX ~ COiO~ p~ RAtE 7 YAR~IED ? IKY[~YAAwI(D? ~~TE 6~ i1ATN ! a6f 1/~ ~ea~ r •i y1~(A2~ MRS. lrt MrtLq) M..w D~w Nwn x.,. t~• F e m a MIOOIREO ? dYOw[E ~ ' p 1~ 1 a 1 y 10~ USU~I OCtut~TpM lCre ti~~ ~(rMt IM~ 1ps. KINOOi ~VSwCSSOR MOIKTIIY 11. NATNIUICE ( ~tt M/W[y~ t~t~trl 1 pi~ pi ~rw~7 COu~i~ir ~ ~ slt~ p~r- Iu~~~.Ni~N~~•ti~In/e.~?r~~~.etud? ¦~n~nt Re ~ } Q2~ck tnk FATMEA~S NAYE 1~. YOTNEA'S MAUE1111ArE t~p~~r~a~r . s~ Unk~own 16 SOCIAL SECURITY h0 17. INIOR ~ SICNA~T ANrtp ~ 7 7- 3 2- 614 9~'~w Z~-zti=-%'/J~i F~n~r~l 1~ CAYKO/O[ATN(E~lt?wl~qtctlcN'[?fi~tJrl~).(A).~~/ltl.~ ' A Ib7fRY~i~iTMEEM 3 t e t o r ~~~T 1. p(11TM ~~S CAl1SE0 ~Y: OKSET AW O[ATM ¦ u s t f 11 • ~Mr[OUT[ CAYSE ~/~•p9~.~./4_ tne eer- t t f 1 c a t• C~~[Wy~~. ~ 70 ' •ItR LA• ~?K~ /vr ru~ l~ - - ~ . o e ~ 1 ~D~et e~wae re istr~r Kw~I t4 r~(rr' , f~iK c~rar fu(. ~ TO (t) ~ Aou tsA ~ ?AIIT 11 OiW SK/~fW1T CpNpily6 CpNi~Iplflli fp p[~t7~ w/t 1pT 11(UiFO r0 fM[ TWfYYL plfGtS[ COIIplilip~ ~ y~ 1M) . MAS ~~TCK7 ~ cer deatn ~ << H~~~[^O~ , YE r0 Li ' u r De fo r• tRW? 1 mp. pEX~ifE ~pyl ry p~CURREO l~Ia w~u ~ n r? pW /~r PMt !I 4rw U.) ; i ••ts~a •n~ ~ u~~p(pT SUIC~DE NOY1C10[ ~ ~ j I ~ ~ dl~post- W ~ ~io~ er ~ O G D j Do1). TIME OF l6Yr A(~wt~. pq. YtM ' ~ ~ uuuar s. ~w. o P• . ~ 20/ IMIUIIY OCCU1111[D ~1[ ?I?CE Oi INJUII? It. ia r~f M~f. m/ CITY. TOMI1. OR IOCAiiOM COUM7Y ST~TE ~ ° f M..iu ~T ~ w0~ wN~?c O la~. f~rt~r/. ~trrn. ~ce Of1/.. dc.) WOAK A7 ti1p111( ~ ti /~fqnd~dthsd~eua~d/rom_ ~ ~~b4fo •ndl~s~a~r M~ ~/..~on ~r• !~i/ S~ 60 i D~~tA occurr~d ~f - 9: 4~i A ! ~ - in on fM d~f~ ~t~t~d ~Dw~: ~nd to tM 6~at o/ m~ lao~l~d~~, /rom rA~ uuHa at~~~d. ?ll 1te~s ~ tl`KATYR[ ~ .re to D• ~ ` (~I~« N tY41 2?b AOORESS IIt. WTE S.G~.CD ~ l r coa?l~te k ~ ; aeeur~t~. ~ Z7o 8um4. U[r~iq~ t30 p~TE 27t MiM[ Oi CEMET[II~ p1t C1IENATp11~ j3/. IOCATqrt (CdI. twrw. ~r pssJ~) (S7i'~~ ~ , R[~u(~jKrinl ~ r ~ ' . ' 1.9.ld3I j~ J LDI TOIISSWNA UIIT E- c BRISSOI~~~I~RAC H0~lE ~~TE RtCD. ~Y IOGI ~E6 [61S7MA S: T ~ nr..l~os .y` C'j ` ~ ' ~,QG~t ~ ~ . .(i~C/L/,~-~-.f7. ~ ~ . CERTtFI~D CO~Y ' ~ ( e Th.i.e .i,s a ce~cLi.~.i.ed copN, S.i,led .in ,the os~ce os .the local Reg.i,a~,an, San~on.d, I~ Semino~e, Flon,i,da. ; i ~ FfLEO Awn 3ECORDEp i ; Th,i,b Copy .i,6 not va~t,i.d un,~¢eb .the ~¢d sea,~ -i.b ass.i.aced. ST.tUCcE C~tu~TY Fl~ f. ~ . ROi.F~ ~a~T~A3 ~ ~ ~ . i . ' . c~ tLEKX CI.,LYIT COlII~T~ ~ ~Mt.u~ii~ y'4M~v~ ~,JYCtn'i~ G~~G /~`J1~ p~COR: Y£i iE~~~„~.,~i ~~~~~*CO.~~%~. eone, . .c~e. 1 ~ ~ ~ yQ ' ` ~ R~~~ y ~ t+rr4?~+~'f,'~,,~' - ; ~,r . ;t~~~~!~` ?~'7~.s' ~sr#,$~;~ ~j~'s . - . : v-y~ ~ Te. > ~11~I~s~ . ~ t;~" f~n;~!~~i~ey;~!S • ~--~r~ ` o „ n ~iy ~ F { j L ~ 7" I f``J7 ~ ~ ~~.i .~-I ~ 7 _i i~ ! I~ _~T Y L~ ~~w.C/ , ::h'~` ; s 8¢a ~ac."¢ tou F~ . eP N eg~~~/ . :~,~,,~y. ~ . _ - - - ~OOK ~~7~7 PAGE 1~ , . ~ 1 ~ ..v ~ - _ _ _ : , -~x