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HomeMy WebLinkAbout1718 CERTIFICATE OF DEATH N ; ~er1 ~1 I h+11~ ~ Re1rb11N~IM Se~rkw STATt I{Lt NO. av~w~rH?_un~ FLORIDA -1 trtt. Ot ~f~Mt IN w~r~~wu?waww~ AtOliT11AR'f NO. st~MAHMt INK ~CE~StO-N~wt r~~s~ SEa OwiE Of OtwiM ~•o~~,, o•...~.~~ ut iurol00l f01 W~'~'~~ t]'~lA ~ ~Cti. Z~ Z.9ra ¦stt~awrs ~ CLARK C. ~ACE ~vw~f~. »16q. ~W~K~r wOUM. AGE ~l~~t YwOf~ ~~f~f ur.01~ ~ O~• OATE O~ ~t~1M ~ rO~Nr. Nf. COIMJTY O~ OEATM fK. 1 WCM`~ Lae N~I~O~1 I~l~~fl r0~- Mt~ wOY~f rW. ~~y~BL• 1()oI 1• ~ ?rIl w v~ ~ A ~ r ~ ~ ~ Hrt7ward . OMM. O~ L OEA N waw cw~ u.~n HOSMUI Ot Oi?fE~ IwSlt - ~a w~ w u~w~, ~~+e ?ra~~ .w «w.u~ ~ s?~cw .is w ~.o Plantation Yes N Doctor's General Hospital S/AT[ Of ~~lM ~ r wo~ w v.~ Mart CITIZEN Oi WMAi COUNilY wW t~EO. NErE~ ~u?RdEO. ~SWvIVNG SPp11SE ~ u~raf. oM n?e~N w~w ~ coww~ ~ wIDOwEO. OIVO [G ~ sret+~ ~ , Ie~diana , US~1 » I~,arri Cohrean Branch s~.~~ orc~.se~ ~ULL SECURITIf NUMtER YSUwI OCCU~ATION ia.~ ar.~ w.w~ oo~.~ wa..~o wst o~ KY+O OI WSwESS OR IrrOUSiRv V.to u q~ly OCGU~~tD 1M r04~~0 UN. !Y[N Y Ht.tlC 1 ~~t~~~~~~•~^~ „ 348-09•9014 Shoe Re ir Sho O~mer Shoe Repair .~roK ~a+~?sb+ RESICENCE-S1AtE COUNT~ CITY, iOWN.OR lOCA110N Cm aw~p STREEi ANO NU~?iER ~ ~ WtM? »f W MO ~M Florida Bra,rard ~M Fort Lauderd~le Yes 2229 S.k'. 13th St. ?AIMEl-N~IME nn~ rbae uu M?Ot~ER-~wOtN NUwE rw~ r+oae uir „ Philli 8. Walters Wave tiuffer INfOW/?rii-ruiw~E MARR+G ~?O~iRESS ~tmu w~.r.w ..o.. c.n w~o.~... ar.r~. tr~ ,k M.rs. Cohrean t~lalters ,n 2229 S.41. 13t~? St.. Ft.Lauder~ale. Florida ~3~12 ~ ~uer pEwn~ wws uusto ~r: (ENrt~ a~nr oNE uust r~+ twE fat 1a~, roi ~?+o t~N .~wuM oMu.:~e a•~. ~ • wwa. NI v'v~^''~ c 1-1Y~w~+~-~ COMNi10Mf. 11 ~M. ~ ~ ~ ~~(~i j •MICM O~~e a~e ~o ~~YN~T~ C~YS~ 011! 10. O~ ~f ~ COwY011b+p O~: f1~11M0 fMl YM~~F \~~NO C~YY l~ft " ~ ~.~/~t id Ct1.•~.t.~.: ~ ~ART OTIIER SIGNYICwNi COl1Wt10NS, cwMwws co.wrw~wo q a.w w~ wr nu~n~ ro uYfe o~.er ?~n ~ w AVTO?S~ N ~ES •eu nMO~..as coM- 1~lf O~ NO~ Ow~l~iM °~qa.uw~qa Gwse n.. NO ~w Ot Y?~lTUrwED ~••oMm. M~, ~W ~ MOW IWUIY OCCLtREG I lMlt M~wl~ W Y/Nt~ IN ~Vi 1 O~ 1~~ mr ~s ~ . ja, Mt M lY M1Jqtt AT wORK ~uCE Oi r~luRr »o... ans.. ~.aoer. IOCwDON ~ sma w ar.~. .a.. an w ro~. u•w ~ ~ vwn ~tf a ..o ~ ow~u ~c.. ~K. ~ wc~n ~ 7M- ~ ~R~K~,t~~1- .~T.aTw Yi ~W 4~M M~ 7W ~M~ Yf~ f~~ r~/11l~ ~lnr~ pN 1~/OM wOT v~lv~ 1M! p/AiM OCCYNtO ~t 1wf hKl. d+ NIyKUN: /1~ y ~~0~ Mi R.~R WOt ~ITlt Ol~1M. IwOU~~ O~~l. ~~.0. 10 M! {!f~ ~~r~frMO trf ~ ~ ~i ~ V41i• 1 1(~~ ~ 10:4~ W w cwO~r~loG. a~! . !la Mte.se~ ~wr ~1 L 1~. ~ 711 tec I 71~. 1b. n~ ~o wa uus~e~ u.-~o ~EtTIfKATqtr-MEO l E=wwwEt OR CORd+El: ow nu ~.~a a nK .ow or w•r rw~ eeceet~t ..s rw..ou..ceo oi.o •..rr..nw. d wy we. ...o~o~ *Ma wnsnc..w... o?..w~+. ra.m ws ~w wn~ ~e.w~ occuuee w••e o.a ..a oue a nr uusew u.ne. ~ hl M CH11f1ER-ruME ~r.n o~ ?w.n eec~ae o~ nn~ GA SN',NEO ~ra.n.. w,. •w~ Ge or e 0. Perraud D. Q. rn 4,. ~^--~t' ^ ~ r~ , MAIING wOORESS-CFlnsr[R s~ee~ w~• .w c~n w... s. r~ . ~ 31~?1 Davie Blv~. rt' au~ erdale ~'lor~.a 33~?~ ' ~~y?tqH. 11EMpvwt tE~EtERr OR CeE~rORr-H~E tOCwi10N an o~ ~o.r.. s~•u ~ ~ vurs ~ r.. Removal Anderson Itr.~iana i pATE ~t i,ro.w~ e..M.w ~ fUwEULL MO+.~E-~E ~tv0 ~DOtfSS soen a~.r o. r.o.. un o~ ro~.+, sr•n. :u ~ ; Zy. • L• 1ClIi ,s.Fairchild Flin..ral o:~..s. 299 ?~.Fed.E:wy.,Ft.Lauderd~le.r~a.3?3~1 I r. S. /612 itIiERAI~ ~S lEG~stRwR S~Gn.WRE y` ~ ~.rE et:,el+e4tr tOC~. ttc~s:.,yt/~/ ~f t a~.19 70 ~p. J~, i t ~ _ 1Ls~'RL~uC tw. f ~ i ~ CERTIFIED COPY E t ~ { ' I hereby certify the above to be a true and correct copy of the Local ~ Registrar's record oR file in the Broxard County Health Department at ~o i Fort I.~qde~le~~.+~'lori3a. ~ . ~ ~ . p~, ~ ~ .y . ~ (Mar~i~ •~!~~~~'a~.i~ unless raised aeal of the Broward Count Aealth ~ ~ Q :GtBipi~' ia affixed.) y ~ ~ - , . ~ ~ ~ ~ " ~ ~ ~ ~t~.~..c.1. ~i : • . i T ~ ~ ~ ~ ~ ~ t_ : Couaty Health Of ` cer and Local :tegistrar ~ ~ y~t~~' .a~- `~~i'. rY1 I •~fs~~l~~~yS\ ijJ , ~ ~ •~I~~ ?OC ~J~ . ' l~~r' a REOORDED IN OiF1CNLL RECOROS S00[ • ~f of sROwu~o cou~m. rio~?uR ~eputy ' ~~a Rep,is ar ~ JACR WHEELER . _ ClEit!( Oi CI~p11I OOIRf• . ~ ~ • ~ zzs~s9 ~ ~ ~ A o~ ~WT~ ~RIX~~~~ 0~31rf~1 i7 ~nmmZ -7~~nC ~nco~~ s_ , O o~p~~ r- p ~~e = ~~r~ ys ~ ~ ~ ~ ~ ; £ ~ ~ i" - ~ ~s • ~ ; ~ ~w~ ~ ~b~: ~ a P3 m~~ . ~~,~-.a . _