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HomeMy WebLinkAbout0371 . f - ~ ~ E R T 1 F I E D C O P Y_ . 222~82 w ~ WE HEREBY CERTIFY~ TML~ COPY REPROOUCEO BELOW TO BE A TRUE AND CORRECT COPY OF THE OR~GtNAL ,R~~ORD ON FlLE iN TNE BUREAU OF VITAL STATISTICS OF THE STATE OF FLORIO~.`~`D6PAATMENa''Ol~:'~IEALTH ANO REHABILlTATIVE SERY~CES. DIVISION ~j OF HEALTH AT,•:TA43~C~dNVILLE. : ~LQRIOA:.: ` = ` - INOT VALID UNLiEQ1~'!i~`S~L OF THE, ti (RpRIDA. DEPARTMENT Oi HEALTM ANO REHABILtTATI 'A h~ =~n ' r SERVICEB. OIVi51D~O~~fiEALTM Is AFFIXE'p.l~'~~~;~E~r. d-~ -~?~Cm ~ ~ : 't ;r•4i~.s. '-~t~'.[)t: _ C `L~ .Z.: f . ' ~ , _ . l~'~i~-~~'t' ~~tir'V"11~~V_ ' - f~ _-4 Y r ' _ ~ ~ F ~ ty~ .F.. ~ ' Vi •~.1 . W ~ CMt[F, 6UREAU OF Y~TAI STATIfTIC! - 'Q sa' -~i ti D ~ i • r• t rT. ~ •h7 .i j', J_ ~ • ~ • ` • ~ N J N `'1 . ~ ~rVWiQ ~ ~p O L- ~i. - ~s . . sT~n wcc~sTwww o~~cTOw. orv~s~ow ~r = c ~+v ~ ~ ' MtAITi ~ O[~ARTNEMT Oi MGLTN ~MD r ~ DO ~ - ~ ~ ' ~ ~ ~ R[NAS~UTATIY~ SERVICEt . .~r ~ ~ . _ . . CERTIFICATE OF DEATH Dep~e~~ewt o1 Ik~~l6 and Reba6ililative tier~ia~es lTATE FILC NO. u~.~n*~~~t~A~n~ FLORIDA ~1~0 EI ~RLL R~1~~O REGI6TRAR~S N0.4 OfCfASEO-NNNE ~~~s~ r.x.t ~~ir Sfl[ DAiE OF OEAiM ~ rO~tw, D~t, ~eu ~ ~ jr1ILLIAM O. JOH`STON ,Male , October 8, 1970 f itACE v~un, «ecw, ~reuc~M IMOI~M, AGE-l~SI ~~cee :+ue u.oee ~ d.~ OATE OF WRTM ~.o.,rM, w~, COUNT1f OF OfATH RC. t 3~lC{Ill ~t~lMD~t ttl~~1~ ..OS WS (.~0{MS rM ~U~1 f ~ White 91 u K i.7an. 27, 187 . St. Lucie ' C(T', TOWN. Ot IOCATIOl1 Oi pEATM ~~soe c~+~ ~r~7 ~•~MTAI OR 0111ER NSTRUi10N-NAME ~r wr u~ f~twi~, 4~.! SnEe~ ~w ~uru~ i srecu. .ts o~ ~.c ort Pierce Yes Fort Pierce i~iemorial Hospital SrwTE O~ ~tRiri .~r ..oi u s~., w~rt CIi1IEN Of MR{AT COUNi~Y w?RR)ED, NEVER ~bED. SuRVIVNG S~OUSE ~ w.rre, c~n r.w[~ ..,rf . y cowm ~ (wDOvVED. 01vORfE~ ~ sr[cv.. I ~ Tenn. + U S A ~u Married Diar aret (Broc~ne) Johnston s SOCULL SEGURIItl lAil~6ER USUwI O«UPATqt~ ~ c~~.e i:~~ d.c~¦ eor.[ o;:e~.w res~ o~_[Wp Of WSWE ~ v~OUSiR~ F 1wA[[N~G [YEw ~i ~[:itM 1 ~:269-09-7678 Soa Maker ~„Proctor & Gamble ~ RES~DEwCE-Si~1E COUMTY Crtr, TOw?+. O~ tOUItOt+ ws~ ~~R •~.RS STREET AND NUrc6ER ~ Florida St . Lucie Ft . Pierce "'Y~~" 1609 Florida Ave ~ ~ ~ FAtHER-NAhtF ~~n7 r~00aE ui~ MOiF1ER-MAIOEN NAMf r~ef~ reppt uSi ~ John Johnston - UNOBT ~ ,s u t WORMANT-NM~f iw~tuY wDGfFSS ~s.eee~ o~ e r.o ~+o . c~n o~ tc«.., s~.re. tu, ~ ;,.Margaret B. Johnston ~,,16~9 Fla. Ave., Ft. Pierce, Fla. 33450 . ~ ~~T DEATM WAS GUSfD ~'I ~Eh'+Ef OMIy ONE UUSF IER lWE fOt 'ot ib`. ~rnon... ~ '~7r', ~ ~lTnNN O+~S~t ~ti 7~~'w ~ 1 WND~~~! C~Ul! • _ _ ~ +l! <<,~1.~ - • G-- ~ . , ~ ` GU ~ ~o~ ~ ~ . =cL4 'l~- L-c~ . ~ If'~ .w.s•co u~+ceor COMD111OMS~ ~M ~ ~ ~,r .n~cw c.re nse ro I 1!1 ~ • ~F~l ~ ~-"f , :~lC - i ~~~~Dt~i! C~VS( ~Or. 'I D~! TO. • ~L• ~1fOYlr'Kt Oi - - - - S*~t~NG fM! UwDt~~ ~ ~ = li1MG C~J1~ l~l~ (~I ( C.~ ~L " - VAR~ ~t R SIGNIFiC~NT tONpl cd+a~ cynr~u+~~ ~e.*• ~,n n r c /~y ~~••n ~,~L'`/j ~~r If YES .e~e r~r.u~wcs ~ ~ O~ DF~M _ ~V ( ~ ~ t. ~ ~ 1~ fi ~ ! ' / !"•~i~~W IA s w o ~ 1* euo ~w otner~..nw ~~st 1?ebel+r wCC~OfNT. SU~CfDE OR A~E i UiP/ i rpn!~. c~•. ~e~~ ~ tiOtR HOW IN1U~Y OCCURRfD ~ tu•t~ n~ru~e O~ u+~~n u. ?~tr ~ O~ ~~~r u, ~ttr ~a s~K MSO~M hOE. OR uNDE1EUMINF ~ u ~ yd ~ M j7~/ tNJUlY AT WORK CE Of WIURY.~ wore ..¦r. s•et'. •.c-:~. ~ fMC~I~ q3 O~ w0~ prK! NOG .OC ~YK•~ i . l«A?ION ~ S»t[i O~ ~ r o tio . un o~ ro.r+, s*•rt r . 70~ 7M ~1 t ,~z~ E~S CERTRKwT1pN- ..o•.r.. o.. ri•~ ~ .a.n. y : D~• •rO uS~ Lw MW ~.~(t ~~n~ ~ OW ~'D'O ~+bt ~~lw M! p~~TN p~(UffED •i 7w~ ?y~,~ ?MtSIC1/~Y: D~• 1!Y 1 n~ n•m ~wLY~' D~1~. 11M0. t !f fi, ~ ~nlwDlD twf / ~ ~ t0 7 l ( ~ ' Il~ C[Cf~SED ~~Jr ~r C. ~ ` ~ C~ _ / `1 . ~ ~ ~ CI r1 [I~p~~OG! 0~/( ~ - _ ;~4 < L.~ .2~, Z~.l M M ~.u,.,f~ . ~ERTY~GTION-w~DlGll fx~ur~ER OR COR(XrER c~ n.e ~.s~s c~ -.t ..p.r p~ p~..., ~•e ceceoe..• ..s •ro~cvwc~o oe•c . ~..a~w.no~. o. r..e ~co, .r.a~o~ .we c.a.esTw.rw.. p.,.. o•., ' .~+rw ~ .r.• n0,~. . ce•n~ octwno v.. n.~ p•rt u.o ove ro-wt c.uu s~ s*.•to ' • ~ - Ils M ~ 7h - ~ ~ ~ ~ ~ -x CFRTIfI ~ '~?i-•. ~ 1 54N• - cwne e~ rn.~ DATE SK',NEO ~+o»n.. w r~, ~~r~i ~ , S. r~ ' f' ~ /N ~ - MAII ADDRESS-CEir4iiiEa snee• ~ • _ ~ ~ ` ~ - ~ esr. ~ ~y ~ !j " ~L(t y!r 2C'~ _ f fs? - _ !j'I ' ~ . S'~O ~UflAl. QEMAiIOPI. REIM~YAI EMEiERY pR CREMA -NAME • l AiION C~n p~ ro,... Sr~t~ : Removal-IIurial S rin Gro :w Mount Healthy, Ohio p~TE ~ o~r ~ fI~NERA~ MO wM1E nN0 Sf ~ srnr o~ ~.r •~o , on o~ ro+., s~.~e. r~r ~ - 2 ct 1~'~ ~Bairc~ Funera~Home, 901 N. &th St,"!'t. Pierce Fla. i~E A 'R -S: tUR~ ~ yL?.~,ttUff DAR ttnC t~~ O t1 ~LOC~~ tlG~StU~ ~ ~ ..~~L-f~~ Y~ 2M )N ` ~C~nIWr' ~ F~ i i '~"'rl < _ _ . . . : . . . . . ..._..._s~~ti