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HomeMy WebLinkAbout2595 - - - ~ 3'-si..~..~6.tt.wl~- - - . 7t.~~ D._ aTwT~ oowno or Mu~Tx CERTIFICATE OF DEATH k ~~7~p ; cu~es • BUAGV OF VITAL RATI~'T1Cf s7'A7E FIL[ NO. '°a•"•~- ~Z,~,~~'. FLORIDA ord rAln PIRTH NO REG~6TRAR•S NO prop~rlr ~zetYtfd 1•?AC~ Of OtAiN CO~E fiO. Z. VtVAI A[LID(MCt(/~n~fsrdFrl //~v~.M.w~ Rr.Iww?d~~~Mww) •nd ¦l~~ COUMTY ST~T( Florida C~hT? Broward p~ D1.~.. Broward ; ~ ~ A. C~T~. ~ONiN. WI IOC~TiO~+ l. K~t~CE O~ D[ATN t. GTY, i01MM, OR IOCA~IOM t. 15 11E5~ if ~C[ : tNStpE C17Y lIM~1S1 ~hS~OI CiTY lW:TS~ 3 Sea Ranch Lakes ~,~~p „op Sea Ranch Lakes ~~Sx ~p ~~..tt~~ r~i.. 6 ` I. N~w( O~ Il/ Nf M~~IDitd. /~!t ~htN ~II?tNI l. lE~1GTN O! I. ST~[ET ~DOA(SS OM A F~11M1 ~ Moir~~~l O~ T r~M 1~ 24 ~+ig u g Road ~ ~tis~~ruTaw 24 cayuRa Roaa ~ 9 ~ s YES? 3. MAM[ Oi FhI[ N~qft L~t 1. W1TE M~wU DaI 1ts~ ~ T;a«~.~.,, E1~nla (NMN) Rimelspacher ~ TN June 27 1964 ~ ~ S. SE7f ~ CO1011 011 RACE ~ MM111[O ~ MCK11 MAlIRKO? ~ DAIE Oi •~RTM ! ~GE 11~ 1tV1 ~ ~wxq 1 ~WI f ~+_4~ '~S IYt Mrl~(~I) Xw.w D~w Mw• X••. r~ i a• F9ID~l1A White ~~~op avo~cco NOV~1.8 1869 p 1~ 1 al ~ IG. ~SU4l (KCU»T~ON lQiet R~~f ~/s~rl ~~~t 1~. KtNOOi ~UTIMESS011 tMpUST~Y 11. ~~R1wK~CE ( atl~ w p.~yw nrntr/) 12. pt~tta Os wwar OpuKrnr? • f t A y~ f- Irnw~ nW r~~t~~~ /~fr, ttt~ i/ rtfud) Housewr~fe Own Home ~ lend USA D]~tr 1Dk ~A?MEAS NAYE I~. MOTNEA~S MAIDEF MAM[ ~ O~ ' tT9..~,~.. James Conway ~ Sareh : IS. ~MAS OECE~S(D EvEll IN U. S. A~y[O i011CE5~ i SOC1Al SECU111Tr MO 17. IM~ORM4MT ~ tICNATYwC I Yr. r ~slvw/ 11/ ~r~. F,. ~v ~ /Mn ~wsw) ~ No Not~e . ~~~~~•24 u a Rd.Se -c~~fl :es rl~ 1unt~al 1~. CAYL~ 0/ OtATN (Er/tr ~s/I ~~ttw~e ptr f~~t/M lDl. lfl.) ~ t1T[R~A~ eET.AiE~ - d f f~ t t~f ~~AT ~ aAiN MAS CAUSIO ~Y~ ~ Oh ET AhD DEATrI IMMEOIRTE CMJS[ ~ ~ •u~t fll• . e ' tA• t~f- • ~ t 1 f f e~ t• G~Iiti~w~. i/ ~w1. p~ TO I~) i .1tn u• .~~c~ p...u~ a - ~ li). r~jistr~• Wv / k rwJer- ~ TO (d ~ Z f~u/ r~~u f~N. f • 1 t A 1 w T~ O ~AIIT M. OTM[11 SKtii1CYrt COMOIi~0~4 COMf11MU~K /0 Ot~TM ~1fl ~UT IKU1E0 TO TR 1E11UMML dSfAY C0~~017~ON GMM M~YI 1(~1 . M~S ~U7015Y ~ \our• •f- F /ERfONwEC~ ~ i.r e..e~ ~ • F YES ? ?W ~ [ • r f~?• ~ 1iy ~ ~ pEX~l~E 1qM 1MJU11Y OtCV~~EO. IE1f~r ~~frs~ ~/h~j~r~ h PW / tl Paf Ntw 11.) ~ •~klw~ •w~ ~ ACt~O(NT wK~a NOMKIOE } ~ df~pe~t- V ? ~ ? tton •t ¢ 20r 1~yt O~ H~~~ MnU~, Oq. Ys~r ~ ?~d~• y I~UUII? w. p y. w. ~ = Nt w~u~r otcu~~co 2Qr ?ucc os uuu~r (e_ es a a~.w bns. aD/ aTr. mvrM. o~ ~oc~T~ oou~Tr , sr~rc ~ M011K AT O ~TWaiK t? hr•• hw.?r. rrtN. yk~ aq.. de.) ~ ~ 21. l~tt~nd~d ~A~ d~cN~Nf /io~n . ~o ~ nd l~~t w~ ~~.~l;r~ on ~ D~~~A cun~d t +n o A N ~t~bd ~Dor~: ~nd fo tM 6~~t o1 rs~r l~nuri~d~~. m tA~ uus~s ~t~t~d. ~ ~ _ ~13 1N~• jt~ Q Y t (Drpt~~r I2D ~DD~ESS 2].t. O~T[Sw~fD ~ ~ .1 • r • N 1 • ~ ~3 ~CiGGC.~ ; ~ ~ t ea~pl~t• ~ ~ . a t t 2 ~~~~aL C~[ W1TqM. jjp pATE 27t. NAY[ 0~ C[METE~Y O~ C11[M~TO~Y j3/. LOCATqh (CY~. f~r N to~M~) (Stat3 ~ ~ eirioddl'h' 6-29-64 East Orange New Jersey ~ ~y ~ v. ei9 t~ .~ccT R wN j~. 9A'1~~" ner a Olri W~E 11ECa. ~11 IOCAI ~EG 26• REGtSTll~11 S~c ATyAC ~••,s~ss a O B9aCt'lyFlfl• .t +V~~ ~ - - - _ - _ _ ~ - - - _ _ . ~ _ - : --r ~ ~ ' ~ • i ° ~ - - . CERTIFI~D COPY ~ - I hereby certify the above to be a true and correct copy of the Local ' .Registrar's record on fi,le 3.~ the Broward Couaty Health Departwent at . . i - - Fort Lauderdale, ~ F . . ~ • ~ ,'1'"~ ~ ~r. ~ . ~ IA _ (Yarning: ~D~? d• ~td~~ss raiaed seal of the Broward Count Health y ~^~~~nrn~+ n - nt i8~'a,ffixed.) ~ <~~l4° ,~.r ~ - _ . _ °"y~"o • ? - ~j/~~~~~j !--Q~ ~ ~~sS',~ ' 'f ~ ~ i7 ~'f ' . ~ i~ ~ - _ _ ~_'~~r• i1'~`'"`~-' ouaty ~ealta Office.f aA3 Loca1 ~esistrar ~ ~N~~ ~ ~ _ . ~3~~'~~~ = - . ~ . . • N - • l/1.~:~1/"-t'~-/ Y . ` € 2-1$-,~ ~ - ° R ~ J T _ T~~ Deputy Local ~egistrar s,^-r ~