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HomeMy WebLinkAbout1201 ~ ; t _ ~ 225412 C: i 1: i:.~;.Z E OF DEATH ~eyulwtwl o~ 1 ~e~~if~ u«: ~'rb.~wiit~l~vt Se~rices ~ iTATC FILC MO. iu~ ~v~i~ i~r ~i.n~ : L v a I D A 61 Tr?E, Ot ?tiHT iH ~~MmLLR~~~ REG16TAwR•i NO. ~ilMANiNT INK ~~EA~_H~ ~~~s~ ~.ft ~I( DATE Of pfAM ~•o..+w, s•r, ii•~ ~ SE[ WYDi00t f01 ~ m wstwclwrs ~ G~::ct*w Y` i T'; . . ,13 ~ . _ , ~ t ~ U1CE rwnl. wfGq. uY~KUi ~wu... wGE-..?~ ~•:e. ~.._r. ~ o.. D~TE Oi 4tM ~.a+m. wr. COfM+TT OF DfwTn j nc. i srean ~ ~urw.r ~ n.a ~ y .oi :..r. T~a..i : ~e.~ ~ ~ ~ " _•c,='~ s. ~ s? t; ~ r'', Q 1 ~`!19 » S~ - Y - 6~172 GTY. TOwN. OII lOGT10N Of OfwM .~~se c•-r .,..u~ .,057.Tw: O~ OiMER NSirtUT ~-nnMf ~r w~ u. ~~~we~. cm ur~~ uo w~.wu ~ - l~~CUt rEa O~ rU ~ . a ry D~:.}.I~.~ 7. ^ _ ~If ~n. .~l r.~ _„r~~, ~~^e-.-_y-1 ~ STATE Of WM ~ u nOt xa r s~.. ..~w GIi~ZEN OF wNAi CG~.iv:iY -fiwwTitED. t~lEVFt ~YLED. ~SUlV1VM~G SIOUSE ~M . on~ M~qr .rw ~ cawn~ ~ ~ vV~OwfD. DivOeCFD ~ wcrr ~ ~ ~swi ~e1Ww(~ _7~ • r' :0 T ' a Ill. l. rwtu oe.us..~ uws u•w SECUtliY MiWflt USUnt OCCU~wiiOn ~ a.~ a~..a o~ .oec oa.i ow...c .os~ a KWp pF MlSYiESS pR Wp175riY OCCY\~tD W r04~ ~~1~. t~fw M~t1~ftD 1 Iwll~IYt~OM.G~M 'r 7~~~~Y~~1 •17 ~y • .ri~.'_' :~5±'~ nrwnce wwr ' " ' , - wswe c.~r ~+ns ST~fFi wr~D r+ur~Et •o'~'?~'o". lESIDENCE-Sf~tf COtlNilf OTY. TO~. ~z lOCwtlOt` 1{?fGVi M MOI a,~ + I . ~u~`/.~.c ~a~nQ',ti.,.a~q (`,,.._,i ~w • 2 ia J.• i':~. i~: fAT?1El-HA+rE ~~u~ +.oo.~ - ..ir ~MOTMEY-AUWEMHAMf ~ra~ .~oae ~.s~ E~, t-•--,- _ - ~WOU~~v+7-H~wE - ~:ru~..u:G wOGCESS ~s~u~~ w~.~.e .w. cm o~ ~o..... s~.n. ir~ _ r,.,,.~ r.; *.,.r,~ - o~~• rn v~ i. :i Qi; ~ - - ~A~T 1. ' _ . . , . - - •~~W~~.ull ~w:kaiY Ofwi/1 Wwi GUSED LY. ~EH'F~2 vnir Oivi UUSf ?ff lwE iq (e~ (OL ~urD (c11 ~en.ee. o~ur ~w./' D:~Tw 1~ . ~.rs.~n c.~u ~ " te, ; ~r s t~ ~ -1, ~ .~••'f .1~:se aJ~ 3Yr~ . . ~o.,.o~.~:, • ~ `o..o~no+f, n ..n, i .c. c.re ~~s~ .p ~ le) . r.eo,.~~ t•~fe .a, ~ To. q.s . co«xo~e~ct o. i~.nuc r~~ •~ot~- ( .T.wa c.~~a wi ~ 1 1~1 ~ ?IUT M OiME~ SK,N1f1CANt CON01T10N1: cu.ar.d.~ ca.~¦.w~.~.o ro ae.~w w* wi uu*io ro cws~ cne. w IYi ~ w~ wt1TOTSY ~ If YES .[~e .~~a~~os :a.- ~.u o. +o~ ).Dl~ID wu.....~~o c..iy M D~~~w Iti ~~d ~ ~ct-0FnT 5:7K~ A f WJiitl~ ~rowrw. p.r, ruu ~r!OWt MOW INJUtY OCCUItED ~twe o~ ~wun ~w •.u . w r.~. .~er ~ MOMKiOi: Ot {M~O~.fIYUiED . IS,robl _ _ ~ • 2N i:.t M ~T7C ' tNIUiY Ai WOlR hACf OF WXMY ~f wp~F. /~b.. S~HO, rKt.~.•. ; IOLASiV7i ~ s*~tn w a r.o. +o.. un p~ ro~w, s'•*e ~ ~ snon a w»o ~ o«Ki ~.sc.. nc. ~ snc~r. i ~ to. 7w ~ "y CERTIFKwT~Ori- ..wr. w. .t.. .o~r a.. .t.~ ..w~..ss s.r ..r.i..t~ u~n o~ ~ o.o/o.o .~oi .K.. n.t DEwTw OCWpED r»~ ?uce. a+ rr u ~f rnrs~C~ww: ' w»~+ w. au ~~oor iu w.n. ,.,p~a. o.re. ...o, ro u.~ ~eu ' •nt..DtD tMt ~j 1O ~ ' 7 1 O~ r~ u+Or~~. ~ ! tl~ wtt.uo uo+ ~ i7~ '7it i l~ ~ / ~ 7~~ ~/:<< ~1YI '11~ M r0 U~St,i~ sL CElTIF1Ui~ON-w~EDiUI EXAMlt~:ER OR COROhER. a+ *.t uus w~~t ..o:.. or w~T+ !'^f acta~' v'3 .~o"'a"'«a w~o ta~rw~r~p.. W wi! q0~ u+0i0~ tM ..nEStw~s~,;«. ~r prn..0'•. ; ~+M o~~ ~t.~ w0 ~lQ . r Dl~tw pCCW~f~I OM F! M~f w0 OV! q M! 4V5(~SI li~ilD / M `r~. :,2- S' "l/ / ~ t:. ~ ~ . CERT~f1Ei-N4ME ~nn w••wn ; 5.',rah:~c ~ O/Glft Mt.:u O~Tf S~G~:F9 +~Y~L~. D~I.~EVi ~ Bcrn~zrd D. Rosf~ ~'•i D ,r-~-~ ir. ~~k ~t/%3~~/ ( : MAflIAG ADDRESS- EfTIf(ER lt~Fe' O: ~ I,D wJ. ' C~n' W~O'r~+ S~~it !~I ~ 7~. Port S~. uci Shor,rfn~ ~ ~ wiiAL. CtEMATqN. REMQVAI Cf/~ETfFY Ow' CR[MA2:JwY-N.w.F ~IOCAIiON Crn q q.w 1c t ~ YKen. ~ O~iE y F~ '.o~nw. o.~ .t.~ ~ ' fUl`E4wl MC~+tF-havi .~.v~ ~~}2E55 : sr~e~r o~ ~ r`s. wo.,~un o~ rov..ns~.re. t~r ~ , ~ ~a1~ ~ :~1 - _ •n . ~4 _ - =-i ,.t v: - ~ - - - •^j'-[n E 7N ~ ~ 3 / 2S~ ~ ~ - - ' - i Y. S. ~61Z F E~A[ ~~4TECTOR-S1G~dA . RE . f~v:~ :~:.-i~GVA7UQF D~TE IECEtvtO IOC~a ~fGtSTV~ t x li~v. ~v~u as~~=-,l'... _ :i j~ ~ zw FebT`ua1^V 17 1971 ~ ~ i hereby urtify this ro be a true and corrcct coYy cf 1'r:i l.G ~ ~ Rv~istr~rs record on file in ths St. tucie County :~eoi.a ~~~~rt- ; ~ rrtcmt at Fort Pie~~r. F~arids. ~ • ~ (Yllarning: Not vaid unless rais~ ual of th@ Sr. Lu:.~a - ~ County Hea!th Departme~t ~s affi~ced.3 . ' ~ ~ r: . . i', r ? ~ • . ~ : N. D. MILLER, A1. D. . ' - K County Health Officer 3~ Loc:! R:g~strar ` y:. ` ~ - , ~ s- . < ~ , ~t.x^ ' , DDls DeputY Lou) Roaisr~ar • . ,c . = ti~~'s ~ . L . . ~ , 1 .:a . 1 ~ = 225412 - ~ f~~EO ANa ~ECOROeo = ST. LUC1E CUUMTY FLA. ROCER FJ~TRAS CIERK C~~CUIt COURT 'x RFC(1PD Yr:,ift.p ~ f~c = ` s ~ADK~ _ ~ 13 I a3PM 7t - - ~ - -