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Home My WebLink About2376 ~ = ~ . ~ y ~ ` ic'~~.4150 • ~ , i , ~ ~ CERTIFICATE OF DEATH ! F I.O 8I D A ~*~TS FIL[ NO. ~ •BIRTM NO. REGIMRAR't HO. 1. PLACE OF OE/lTH conc uo. t~ USUAL RESIDBNCE ~~v~.s~w.sn+.a ui..uaww;n.w.~•~.e.r. ~ couNn sT~rE couHnr ~ ~ u~i~, ~ s. c~n ~u ..w zc~., c, LEN6TM OF ~ cir ar .M.w n.«.. ..w ava.u ~R _ fTAT <t~ Yb 1ir~1 OR SQWN iOWN 1 ~ ~ d_ FUII N N /it rt 1~ M~tW ~ 1ruNt1~ pn Krwt Mi~w oe LntlW ~ d, STREET IU nnl. ttn i~ealr) ` ; ~ HOT~IiAI pt App~= ~ j INSTITUTtON j l. NAME OF L ~Ptcst) w ptWdle) (Lst) l DOFTE (1fa~t~) (Das) (Yre) DECEASED ~ r?'ry. « P..wc cE~?rn ~ ~ ~ ~ ' ~ L SE7( COl MARRIED. NEYEt MAW pATi OF QITN t. ACE p~ v~~ ~~w u~~a~ u¦u ~ WIDOWFD, QIYORGFD (~t4) rr ?~+uaar) 1t~ D~n' ~r~ ~ ~ 10~. USUA OGGUTATIOl1~p~.. tly d..s IOb. IND OF ~YSINESS OR IN- I1. ~Il CE ~suy ~ ti„y~ s~~~ C(TIZFi( OF WItAT ' ~ M~ d llt~. w~ Y wtln~l DUSTRY OOYNTlY1 ' ~r~c~ ~a er Congtruction _A- , ~ ~ Fwm~~s wu~ N. MOTHEt'S YAIDEN c ~ ` Seth Mock ~ ` ~ I ~ IS. WAS DECEASEO E~ IN Y. f.AWEO FOtGE57 1~. SOCIA~ SECUtITY U. INfOWANi'f SICNAiNRfi L~. ~ ~ ~:.......~~...U turia.....~~wr«+.~e.> H. GY8 D. N:OCk t ; O ~ ADDRESS ; G~+ .99 1~. G?USE OF DEATH MEDIC/lL GERTIFICJ?TION ~ EatQ oab aw e~w 1. OISEASE OR CON~ITION oM~sr wMO orwnr ~ yQ y~ ~(~1. /s). DIREGTIY ~~rADINC TO DEA ~ {e) ~'j ~ ~ nn~c~r~r ca?usEs ~ ~ 'Tlii~ w~t aww Y~?iii ewiiti~w~. 11 a~y. ~:.:.,auE ro w.ai. N 1ri+~o. a w ab.. es... rsl .uh wd ~ A~sr! /~ilrn. . r utA~s:a ~ta /t.w~ w~+*1n6~M a~ ~ pUE TO e ~ ~ ~ ~ W jiM'<N. ~Jr*7. M ; ~r~a~N* • A i~~ 11. OTHEI S16NIFICANT C,ONDRIONS ~ CQ ostiri irstA. Cw~ditiow~ erwtribrtiwy u tA~ isatA b+u wot ~ ~ rslatsd f~ tA~ diuaw e? towdiliow oawiw diati. ~ lf~. DATE OF On~ 11~. MAJO~ HNOfN6S OF O?ERATION AYTOKTl ~ •u ? Mo ~ ~ ~Prat~Lb? tMRYS) I16. ?IACE OF IHJU~Y (ar.. te ~r ~ewt 21c (GITY Ol TOWN (COUNTY) (STATE) 1~1. ACCIDL/!T 1rr, I~n? fadwl, fU~M, ~LL.. Ka) U Net1. MM~ lITLIJ . ~ tiy •UICID[ ~ w ~ 21d. TIME tWrU ~DV) (iw) <8~v~ 1t~, INJURT OCCURRfD t1 N W O D WU~Y ~ OF ¦Mlll ~T ~OT 1MRl INlUtr a •o~c ? ar~o~[ ? n 1 hereby urliJy eMe I oltended thc deceased jrom~.,la_, 19~, to ~~2U,=, 19~, t/wc 1 lcrt rnv tl~e deceaud ~ aliL~e on 19 ond tlwt dcatA occuncd at • m. sont llit tavae~ and on lh~ do[e slottd ebove. ' 7l~- SIGNATURE ~Desee~ or rit3~) y71b. ADDLESS Ik. DATfiSI6NED ~ k. ~ ~ ' ~ ~ ; 2N. t U R 1 A L, CIIEMA- 2sb. DATE ' 2sc. NAME Of CElAFTEtY OR CtEMATO~Y 2W. LOCATION (C/t~, tow~, or eo~~t~) (Stab) ~.710N, ~EIdOYAL ! Rur~ ul T~ne 7_ 9~3 ~ Ft Pierce ~ Ft P~ er A~ Fl a ~ ~OATE ~ECO ~Y LOCAL tE615TRAl'S Sf6NATURE i2S. FUNERAL D!lFGTOR'S S16NATURE /?pplESs tK. ~ 1 f1Ar~'~/ prfff~/ 1f111 10 1111~ Nld OOfT~Ct OO~y pf ~~~0~',~ ~ ~ Reptm.rs rooord on ftw ~n th. St. tuot. Coumy He.kh p~p.~* 1 ~ m~M at Fort Pbe+o~, Florida. F1LEp-#NO RECGRQEO ~ ' ~ ST. WCIE COUMtY fLL ' ~ (WWninp: Not valid unl~ss r~ised s~a) pf th~ $t. ~,y~~ ROCER POIiRAS : ~+MY D~pa~t~'~^t is ~fflx~d.) CIEaK Ci~CU1T COW« ~ ~ ~ ~ RECORO VER1f1EO~..~n..~ , - ' , ~ Cot~ntY i°~salth Offio~r d~ l+ood ktr~r r~ ~n i ~I ~ , , / a ~ Z' ~ ~ D~pwr t~ood ~.orst.« , . ; 224150- . ~ gooK 1~9 p~~~2~~5 ~ . _ _ _ _ - ; a . _ _ _ ~ -