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HomeMy WebLinkAbout2958 _ ° l L~ 4 1 O~/ . r r • ;p_p ~ ~i. ~ r f~~. ~ !AW OFFICES OF ~ ~oCER ro~r~~s RETUR.N 1'0 » yViLLIAM G. Ml~t'~?, v~~s CLERK CIRCUIT COURt ti ~ECORO vER~c~fo.._:_. , 546 S.E. 3rd AY ' Ft01~ IZ 2S P~ ~7Z 1T. LAUDERO"L~. FLR. 2~'4~•?.5 CERTIFl~'Al~~ OF DEATH ~ tk,.,~~~~«~,~ ~r i i.~at~~, .,,a ti.~E,~i,;i,~..~~.r F L O R I D R BTATE FILE Ho.------ - Irl\t.lt~\ lN Ilt ~I 111 ' , ,?i ?t~Nl IN ~~wua~.n.~rnrr~x~ ~ REGI6TRAR~S ?:O. ' ~[rr~AKENI INK „~f~ " StA UwIE Of D[win , o•~, • •:t rt\:IuGI iQt OECfAStD -ti~t ~ ~~s~ruu~c~s ~ ,lC!N': l.C`~~LIE JEt.LI"GS ril_E ~~[)EC'=~':-'•ER 3U, 1~?1 RACE r~nal. MI4~~. a..luc~ti u+l AGE -~.s~ ~r.t~ ~Tt•~--r .cf~ ~ D.• T/E OF S14TN ~.v+~w. D~~. ~COtiNIY Ui OfAiN nc ~ s~ec~.. ~ •.n~o.. ~.u~e: ~ ..o~ i c..~ y »c,u~a' ..w n•~ ~ I , i 1. r~ 1 3n~ nr~~~~ :e rd ~ ~~~h•'_ tn s. E_~1 s. l i~, ~:'r - - - - - - - - - - - ~ - , ' , Cti11. TOW?~, OR l(XAiiON Cf DEwTH ~,o~ e~n ,~..~.f HOSPiIAI UQ O1n:R NSI~iUl:pr~-t+ua[ ~n ..vi ~~„n, w.~ e,.te~ w..~..~~a ~ s.u ~ .es o~ ~o n ~ Hol Cross Hos .it.al ~nrt ~ auder~~~~l e Ye~ Y . . - - - - - - ; - - - - - - - ST~~E OE ~~~ni ..o~ v s•.~•~~ CITRFN Of WHAT COUNIRY IYtAPRtED. ?~EVfR wtwRRiED. ~SUlvrvwG SPOUSE ~n~ w~~ counn. ~ w~OOWED. U~vOaGED ~ v~cr~ ~ ~ h~~rrled 1„ Hazel Thomas ' .eu l ~rk , USA ~e - - - _s~_.: ~es~ee..a ~ - - - - ..~~.e ce~e.se~ - ~~i~.N SOCIAI SECURITV NU~'.E(R USWI OCCUPATIOtV ~G~~t ur.u Or wpn [~O..f oc~n+G rOSt O~ KIND OF WSWESS O2 INDUS~RY ,r~eD ~r wO~~~~.G frl~. U tlr~t/o ~ f~'~ 071-14-'LG~S u, C ~ 1 Arti>t Signs - - - or~ma.rci~~ ` - - ~+s RES~DE?r~E-S/RTE COUNIY Clll', TOWN, OR IOCATION ~wa~oe un ~u.~~s ZSiREEi wNO NUMSE! ~ ~srtc~.. .is o~ wo I Fl~ricia E~rt~~::~rd ,w'~iltcn :..c:nors Yes `:~09 'iE ?_7th t;;;reet fA1MER--NA.N( I~~SI r~pOll 1~f1 MOI„ER-wai0!~+H~~'E I~~S~ r~00.! t~S~ ~ „ John Jellin.^,s Nora F3i ~t~op INFORM/wT-?,lAAnf buH~NG wOG¢ESS ~s~ue~ o~ o ao . un w~o.~~, ».f~. i~•~ G~ ~ Gir Hazel ~ellinqs 509 ?_7th Sir~~et, Jilton f:ianors~~'-a Flo~da II¦ ll H l~~~~ PARi 1 pQATN WAS CAUSED 6V~ (ENifR OMLY UNf C4USE IfR UNf ~Uit (oj, (D). ANO ~~~p Or~y,wD OI~~~ I, WaY0u11 Uu51 ~ ` ~ • ~ ~o~ N ~J Nt ~ .f1 ~ q ~ _ . ~ ~~~a~..~~ , co..onw~s, ~r •.n, . ~r~ ~ .~n~ .,s~ .o ie~ ~ ~1- ~ ~ ~.riu~.fe uust w~, ~e w. o~ ~s . cd«uout..c~ o. - ar•~~..e rwe uNOU- ~ tr~wG (~Yfl ~wit i ~ tART M O1MI! S~GNNKAHT CO?rO1T10N5 ~a~T~~l COM~~UYI~MG ~O M~M ~ur NO~ !IU'!O ~O CAYl~ GnfN ..~r r~m AUTMSY If ne ~~MOING~ CON' ' 1~f1 O~ w01 3'D~ ~w Ol1lrM~nG C~USI ' 0 ~ ~IM O I 1?roEoWrf ACGDE~~T, SUtC~DE Ot DATE~~~JU Y~-~ ro~+~w, w~, ~tu ~ NOUR NOW INIURY OCCURRED 1~M\~~ M~IW~ O~ ~~w~~ r•~rlp~ nn u, i~ i ( iAAFIGDE. OR li~^Afif~MiNfD A lioo'~`~h~ lk wt to1 ' - - ~p INN1R~ A) WORK PUCE Of ~1~RY ~..~+1. f~eel~, r~Uva•. IOCAIiON ~ fn~lt oa ~ r 4. ~+J . Un O~ lonw, iT~tt r ~ i ~ilfCih' ~~f O~ ~+0~ O~~K! ~tOG,~~= ~S~et~~~l c t` CERi?fKwt~ON- .a+~ o.~ n.~ ..cw~r~ o•. ~u .~u us• s.W ..F~ .,~.e o.+ ~ DiDi e•~o •.oi .~ev r..e u[~~„ oeeunFn .i ruce. a. *we rNrSK~~H- ra+~w o.. .eu ~oo~ ~~i~ a.rM. ~~ov~~ n~n ~~o. +o +a ~ef~ ~ ~ a~t~OfD ~/1 ~ P T~ Or r~ ~..~'~r•f[4f. :.f 7 ~ 71• o[t NSIO nOr / ~ f :1~?_ f~~'_~! S Q 1 C7 ~~t~- ~ E' ~ C' tl~ h=:4 1q~ ~ µ.o c.,.x s, e~.•r_ L ~ CE~11f1Uirp?~-M.ED~CwI Exwi.tl?+ER OR CO~Ot+ER o« ui~s or T..e ~.ou~ or u oFC~ce~ ~+~7 Ip.~Jr~(~D Ol~D ~ e..rn..• o« w f~e r_o. ~w0%O~ Tnf w~~s~~..•.c.~, or~..,p., i YOMTN D~t 11~~ MOJ~ ; Cl~Tw p((u~~ft~ ON O~TI u~D DIIF ~O ~MF C~uSl~1~ S'~~/D e .'1~ ` _ . M' ~ M~7Tt- sn -..oar~, n•...~.¦~ ~ CERTIf~EA-N4NE ,mt o~ rr...n - ~ - + S1GN~i~~s T-- ~ o~oree ~rn,e -'D~iE S~G^+_. . , , ~ ~~k; 3/ - 7l ~ Dr. Luis .i Elias ~ L1D ~i ~h+~ J N-~ ~ St~ffT Ot r ~ o.+cj c~*+ o~ *o~.~~ si~•e ~ MUqWG AODRESS-CfR11iQR - j r, O: s F 1 o ri Ci~- j J~ rJ ~ 19~i5 1 tcr^ :~ri~~t. ltv ~ ~ iUR1AL CREMAT~ON, RfwtOYAt CGMf7ERV OR CRENtAi04T -II.~w~f lOC~11GN t~*• o~ ~o.+ s~•n g ~ srec~n ~ ~ _ ~r ..~~.t2O7l i~? ~Qy~~l Cc ln ~r~ -~L,r~~ N: ~~G_t'7;:nG ~'E:::Cf'~1-- Flf1T_'1 C'Fl_---- ~ DATE ~ r..o.+~ . o... +e.n fUNERAI „ONtf -~r~Ari!E ~r~D RDCRESS ~ sne~~ a~ ~ r o ~o . c~r~ o~ To~~, s~•~F, r~? ~ ~ J l~ ~ ' :u ~ 17:: n.:!ALiS F!I:::."tt; l~~r [^i~= C)_Y.;a H~;~ F~ L;~t~~~r~:':i~ c-ls, ''~zr'~ j. fE 1~ FUNER~I O~REROR-SiGN4TURE RfG~SiRwR-S;G~+t'~~E ~ _ji DA7f tECl.vfC ~t ~UCa~ ~:S'~~~ Fev. l9TC t5~ ~u`C i~ i tN ~G~< 'i ° ~1i.~ ~ -'~i 1u ~yL C. . rL ~ ~6 ~ Li u ~ ~ CERTIFIED COPY , ~ I hereby certify the above to be a true and correct copy of the Local ~a Regis trar's record on file in the Broward County }~e~lth Departu~ent at ~ ' Fv~t~ Lauderdale, t'lorida. 1"'a _ ~ ~ t q'l~t; , ~ _ v~~~rri~g~ ?iot valid unless raised seal of the Broward County }iealll~oROrorMO~s~~~4tRfCpR'`SBpp~ R' { ° Y t*'~•.. Departnent is uffixed. ) a eaow.RO eo~hr. F,o~,~, ; . f ~ ~ .rACK Ft~'f. ~ ? X A ~ _ ~ 'F'F•[,F,1~ - ' R q'~ { ~ _ D/ ~ CIERK Of C~?tCU?i C~~Ri ~ : : ' '•,.m - CI..*.c~(/'./~r~y'~~t~~~=.~ ' YC ~n~J`~~~-~t~.' County iiealth Officc:f~ a:~d Local riegistrar _ _ ~ 1 ti p" • _ ' c•: r: •a•' ~~~~~~~~if/ ~~1~i1/?" C~ ~ • - ~ ~ `~'j t:' ' Q` ~ ~.Q ~ _ , ! ` - , 1-3-71 Deputy Local Ke~ictrar _ } = ~2~i7 ~ _ ~ -r .