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HomeMy WebLinkAbout1710 • CERTIFICATE OF DEATH ii~r~rS'~sa3 ' • ~~yrdwwal .J (lrrll~ ~nd 1I~1~a1.11i~rtlvr ~rnh~. fTATt FIL~ NO.. - - ; • IM\hNW~M ~N..~~~~ FLORID1l ~~`~•.{~i.~ ir~t. U~ /RINI IN ~'"`~•nu~'~"~'•~ R[OISTAAII'• NO. ?ItMA1~NT INR ~E~-~E ~~~s~ r,ow~ uf~ ~x OA1E W OFAM ~ roNtw. ~at, ~tu ~ SEf IYNI00~ F0~ 'KTM~1016 ~ LBYI HART2LER DICE r Mp~ JANUARY 15, 1972 lACE ~w~q. rww. ~•unc~~ ~~rouw, AGE ~.ft u.a~~ ~ nu uwotr ~ w. UATE Oi ~fH ~ rai.+~M. 0~~. COUNTY OF OEA1H nc ~ s?ecn~ ~ 4~twO~t ~.e~~u roi wn wwn? rw ~eu ~ • iiHITB 69 i JULY 27, 1902 BREVARD / J Cm. TOMM. W LOCAIION Of DEATH ~~sw c.n ~~..~n aOSMI~I OR OTME! NSTITUt~O~+-?~~uwf ~~r ..o~ w ~~rre~ c~vt v~e. ..o ..uwe~ ~ r ~ PATRICK AIR FOBCE BASE ,.M~~~~NO UNITED STATES AIR FORCE HOSPITAL PATRICK ~ ~ - - - - - - S1ATE Of 4R1M ~ u ro~ w ~ s~. N~re CITIZEN Oi wMAi COUNiRr MAlRItD. Nf~ER MAt~1E0. ~SURVIVNG SlOUSE ru*, on~ r~~ti ~urt ~ cown. ~ W WOwEO. DIVORCEO ~ srec u~ . I j ~~~o ~ PENNSYLVANIA , ll.S.A. MpRRIED - BERYL JUSTINE l100N- - ~ :~.eo o p~u~ ~CIKITf NUMlER USUAt OCCU?ATION ~c~.e c..o o. .o~a oo.~e ow~»c rou a RNp pf lUSInESS p! IrpUSflr - OtCYtlfO w ~IW~~~+6 ll~~. ~Yl~ u ~II~ffO ~ ~:~I-~?-~~j2 1`~ „ LT COL RETIRED UNITED STATBS AIR FORCB eevo~.~ce ~erae .~r~if:o... lES~pENCE-SIATE COUNtY CITt. iO+vt+. (M lOCwllOrl ~MVw c~n.errtf STlEET AND NUWE~ e vtc,~r qs o~ .q ,M FLORIDA ,y BRBVARD SATELLITE BEACH YES 2U6 GRBENWAY AVB. fATlIE~- HAMf ~~n: y~pp~ i~~r M()lMf~-MAR1tHNUNf rMS~ r+Ope uSt ~s WALTER JONATHAN DICE BELLE ROSS FRBED ~~MORAU?M-?~~ME wuKaY ~DGRE55 ~suee~ o~ o.a. cm w~~.+, s~~n. [r~ ' i BERYL JUSTINE DICE 206 GREENWAY AVE., SATELLITE BEACH, FL 32937 twRr ~ pEwn~ w~s cwusf~ ~r ~rNrr• or~~r oNt cwse ?t~ ira uHr ;,r. re~. .,vo ra! ' - - - - - unr~eN oMSa ww etaw . WrtOUq UWf - ~vy Q~ j~ X 1 S ~ ( ~tlOYlM! ~ ~ GOMDIt10MS. ~I •M. • rM~Cw G~?~ ~~fe ~O (b) r~. r ~_.i • _ _ ~r1N0~~1! i4V!! 101, yJ! 10. Of ~S ~ CO~SlbVf'KI O~" " ~ " ' ' - fiwtlM4 IN! YMOf~- inwc uuu .~s~ Icl ~ARi p O1HEt S~G?~~~C~wi CO~+Ort~Or+S «a*~o~.s co.n~~~ot...c •o ou... w~ »o~ au~eo .o c•use a~.e.. .u~ ~ w, ~a5~ K IIES wrUe nwo~NOS ta+ ~~lfW rq~ fiYl~lO IN WI~~WMIMO C~YM M O!~?M ~ S ' S p..~eb1~~ ACC~OEHT, 6VICIDE Ot • aF W) Y`~..p.rw, w., ,e.~ ~ HdA MOW INIUR~ OCCURlfO ~~MFf Wty~ p~ruv~• n. r~n ~ w ar ~i, Ofr ~ lqMKt6E. OR ~NOEfEW~NfD ~s {Spcilyl . I iaol~ ~ to~• n A i n Q~ •e R 4 e-4K r DA ~l~w4e'L.A~ . ~tlo Ac~ , n~, ~w T::n/ / ~«l;•:.c~:~:..:M ~ ~ INAM~ A/ WOR~( KACf O~ W 4JRr ..~..t ~.j6 sren, r..~ :a.~ - -~nu~ u~ ~ r o ~w . cm w ~o.M. vur ~ ~~Ma~n r~~ O~.w~ w~N~ ra..~~ ~s.~c~n~ ~ f"'.Ain.Ar.A VC ~ Ib~4~A~1 I i~:M~a1! AF~iI r_+1'~ ~ ~1 ~ \ ti 1~ ~ CERi1HCAiqN-- .w•~ e.• .eu +.cw~. o.. .~u .••o s.. .....•w~ une o.. ~~oiae wr . e. nw oe~rN oecuu[o •r w~e ruce, w n~e ~ ~N?SKUN: rC..~w w. nu wo~ .ne~ a~m ~ wov~ ~ o~a, ua. ~o w rsi ~ ~.nl..oeo the ~ w r. ~np~rit00t. W! ~ tl~ 01[f~SlO qOr J11~ " }II !4 M~o me c~uf~+b a~~~b. ~ CE~TIFKAT1pN-MEDiCAI ExAMWf~ O~ CORONE~ Or Mt~t O' rw~ Mp~~ q~ q,•ti we oecea«f r~f rK»:ou.K~o o~.o ~ lilWM~~~ON O~ TM! ~OD~ ~~+D/O~ iMf W+vl3t~,~f~iw. en r. p1~q•~. ~+O'+~w O~~ rl~~ wOJ/~y. ~ ~IM O~CW!!O OM M! W1f Iu10 011! ~O tM! C~USf'1~ 51~tfD i/ R ~IA'7`?I~. M~}}~ ~~i~`~ j.~ oA M ~ CERTIfIf!-NAME ~i~?f O~ ~tn~r~ ____-._rSKsNATUlE ' DlG~t[ M r.n1 TOA O ~rOM~M. W~,~IY~ ~ ~M JOHN B. ADAM~ON n? ~ j=-~~y---~•er~*~M.D. i,,, JAN 17 1972 z MA0.RiG ADDRESS-CfRiM 1 srre, o~ ~o c~n w ror~ su.e [~r ~ ty 33~ W. ORANGE AVENUE COCOA BEA . 2 ~ {URIAt. QEMATqN. ~FMOVAI EMElttll Ot CyEMAiO~r-NAME IOCATIOH un w qw~w st~t! ~ S~!( VT r ~ tw I?P~v~zl H. Fln ~t AL~n~ir,tcLt i'a~th H,:''.i.c~n~ /..bde o. Ftviti.r~Ga DAtE ~no.n~. w~ FU [Al NA~wf ArWi if ~ srMn w~.r.~. cm a tun. tu ~ ~'nraia 2 ,,.~i~i.o une~ra.c ~r.re ` `o~f ~teviaiac~~ici.ve l~~f~vcutn.e f.~u. a ~ 5. ~612 iu+ERA~` - j ~.I IIEG~;;wt- SrGr+.nME • ~r ~ ela~~tw 1410 ~ H«v. tw I.. 4 • v !M . + ~ ~ ~ • ' ~ I HEREBY CERTIFY THE ABOVE TO BE A TRUE ANU Ct)RRECT COPY OF THE RECORD ON FILE IN ~ ~ THE LOCAL REGISTRAA'S OFFICE IN THE BREVARD CUUN'TY HEALTH DEPARTMENT. ~ ~ ( Not vsi.~~i:~~~9~s•the seal of the Brevard County Nealth Depertment is effixed) . _,t y. ~s~ -4?v _ - ~vi';`::Y~''~i':.~ . ~ !,~'.r•!',` ~ . ' ` ~ ~ ,~•i~~, Da'fie ~ea'.' ~ :~~~Y ~ ~ ~ ~ • - ; ~ • "i Deputy Registrar ~ . ~ .y-• .~e s~~ ? r~~~ . 'r~ Y;I~ J." J.j.~y'•~ ~t ~ ~t~• ' fILEO ~K~ °.=~~RDEO 4~ ST-LUCI[ L~uMTI FIA. : r,'-~.,~.y~,i~~';. ~ _ : ,--c d ~'>~ifi~~~+~~ . R"vG~ . .~Z.~$ ` CL£FK:....~i11~ GOURT~. ; A,FCha~ ~fE• ~~_1.~.~.~..~ ~ Mas 11 I i 1~ ~N'71 ~ 80RX ~~0 ~ ~ '~~3 ~ ~ ~?~f170 y~ ~ ~ _ _ . ; ~ i . . ~ . . . . . , r`i - ' - ~ .;-y;a ~ ~~1. ~ - ~~~.=%'x`F'~ ~-L'av'?' ~ -+s.~` _ . . . , e...-c ,*u'~.~; 8cz. ~br„_.~