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HomeMy WebLinkAbout0705 222966 t.~. ~rwrt ~o+?~~ or N~TM CERTIFIC y A~A~/1/~ °OtMI t~yJ '~A~.,E eo~~• • ~YQS/1Y OI 111TA~L RATf~fOil O$/a'~uu IrV~T~ ~f NO. 1~=~1 e~~. . . . . . . . . . - . s?d e1RTM NO. R~O ~TRA NO Prep~rl~ 1. Kl1Ct 0/ OiATN COOt NQ` 2. YfWI A[NOIMC[I~V+M+r~~ Ilw~+: R~d~.W~n~w~++) ~ •a~e~t~d ~MTr STA OOYNTY ..pa .sll Indi~in 81ver 41-X ~'lorida Ind~an 81ver ~i.e.s n Rcs~ancc i. e. ar+r.TOrrN.oawuTaN e. K rua a rn e. arr.~o~.o~ wuno~ .....e ~NS~oc unr ur~rn u~a arr urns+ t,,.. Vero Beach ~~:p MoE1 Vero Beaah ~O ~o~ I, NAYE 0/ ~IJM! 1q ~M~1h1. IMt ~trM ~lbeN) l(MGM 0~ I. STR(ET AOOR(iS OM A IAIIW uos?:r,~ o~ sT~r ~~s g10 6th Avenue "~s~ N°~ ~T11~*~ Re s ~dence 1 v rs . ~ ~u?~t er lYnt AfY~le Lot aTt a/wM Dn Yw n~`~+•n Julius ~ (none) Wouters ~?M Se t. 12 19 8 . SEI[ ~ OOIOA OA MCC 7. MM~[0 ~ M[Vt~ YA1tRK0 ~ OAT[ 0/ h~TN AO[ ( /fM1 ~ V~Op 1 rW lr0[I1 M NK. Male Wh1L6 ~oo+rcop avo~cco ept. 16 1$$1 ~••t ?7n~ ~..w w. r... x.. r t t • > 1~1 ~l ~ 1Q~. usuyuy octu~ryAnwo~M t~y~.?e yt~.I ye«~ w.e 1~. KIM00~' ~USIM[SS OR IMOUST~Y 11. ~MTMRAC! (~~ff M~/t1~ pYAd~) 1, qt1IDl ~ RIMT OOIIMf~~~ 'l1et~`Z'eQ"[7I'`bvey•Vp•~, 2' Belgium .S.A. ll~~t !~k 1 ~ATMt~'S MAM~ 1. roTNE~Y rruoc~ w?r[ " Louis h~outers Unknown to informant e»...i e•. 1. wu acc~sco Evice w u. ~~rco r+o~as? socut sccvRm ia. . u~n s~ow M rp Woutera~_ 11w r. ~r w~trwl tll w. ~w w~ IW~ d rwr? f' n ~ ~ ~ J No -9~3 r u. enusc er w?rK I~••••rr.w. s..« ~r? tasP? t.>. ce~..s~ t~).1 ~Kra ~ rcrwccn !r.• r • 1 d~s[i /U~D DuTM atr••s•• ?~sT~ a~TMr~suuscow. Carcinomatosis ~wrcou?a uwc c•) .wt rtl• t?• e~r- eir~••c• ~1.tkN,~.~/~+r, ouc ro lN C82'C171JIri~a, COlOtl •it~ tA• r~ /w rl~e q ~ 1 • e • 1 t4 ' r~si~tr~r t~fy naw /ut. WE TO (e) • 1 tA 1 O 7~ ~ ~A~T M. Or~E1 SK~i1CJIR OOIIOIT06 OOM~MIlfM 10 OUTM M 110t R[Ul[O 10 TME 1WIIMLL OpGf[ ~If10M CIIIOI M?Mf I(O . MA A \01~f• F ?ERfORM(D/ e.~ e..a~ ~ res0 ~Q or r•r• ~ 7~. l00. D[SC~~~E ~w+~ nuuRr o[CURUO. lE1te w~Ar~ y1~v~ h P~t I r Pirt J/ yit~ ~tJ •~tlw~ •w~ ACCWENT 3UKME NOMIC~Q •~~~t- Y ? ? •r ~ 20e. T~rc os x... uw~. n.,. rp. . ~ed~. iwlullY A. S . ~ 20/. 1MJU11? OCCURR[O mt. HAtE Oi 1NJUIIII tw ~r ~Mt wr. 2D/. Cm. TOwR OR LOCATIOM COYIfTr STATE wNr.c ~T ~ ro~ wwKE ~ M~./~~. ~tred. ~n e?4-. ~trJ M1011K AT fIORK 21. J~t~~nNdtlwd~e~ewdfroin to •nlh~fw~ A~~ ~li~~on 9~12~~ Dwtf~ ooourerd ~t S~ 5 P~ rn en tM d~N ~t~t~d ~Do?~: ~n/ fo tM A»t aI aV ~no~Ndp. /wu~ tA~ e~uw~ ~t~t~d. ?ll ~s•¦• t?a s~aNATVIee (D.nte«wk) t2d ~eoRCSS 77r. o~nsKMCo •r• s• 1• ~...1.~. . V. L. Fromang, M. D. Vero Beach -1- K •Ct~t~t~. Z]~. M~enl. p[rat~Ow. 2.b OATE Lk. NAME OF C[YETE1l~ OR CIIEMAT011t Y!/. lCGT10M IG~tI. fMS1. M Mtwhl (Stdt) ~ nur~S~'~ 9-16- 8 Crestlnyvn Cemeter Ver Beach Fla. F ~Alt I~. FUNEr1Al 01~ ~S SIf.MATUfIE ADOA[SS IS. DATF RECO. ~11 lAC4L REG- RECK~~AII'S SIGIIATYRE ~ ~...~.as ~;.g~ Floqd Vero Beach, Flz. g-17-58 Georgiana_;B. . Denton G ~ . . i - . P A f ~ "I hereby certify the above to be a true and correct copy ~ of the Local Registrar's record on file in the Indian ~ ~ ~ River County Health Department at Vero Beach, Florida." ~ z,o_~ 4 r~,if rnSr ~ 70 . ~ O ~ R? ~ This is not valid unless the raised seal of the Indian r, T;~~ ~ RivQ~- Coux~~y Health Department is affixed. C~ ~ c~ = cD ~;t . ~ ^}i; ~~~i. " ` ~ ~ ' z rn-*!'i 0. ~ ,Q ,i. ~ ; ~ ~t c > ~ J. ~ . ~ ~ ~ ; : c^ ' . `!`''~~~'C CJ) O . ~ -i; ~ ' . . ~ ~ q ~ c. County Health Dir. Local Registrar F, ~ ~ . ~ ! : : ~ ~ ~ _ c~ ~ ( I ~~~.~"it ~Q~HQ- ~ ~ ~ • . ~ ~ - ~ Deputy Registrar ~....i.=.,~~' ~ z;i SY ~F ~ zzz9ss FtL~~ AND Ka~oR~~e = , SL LIICIF CUUN1? f u. ROCEF ~~ItRAS CIERIt CI~CJlt COUr T ~ Rf tOR~ vER~F~~D .-----r_ 31 9 4i AH s7[ ~OOK FAGE t ~ ~ . -