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HomeMy WebLinkAbout2093 1 V~ ~ ~ ~ , 22604 4 r~~~ e.- nwTC sowRO o? Mu~TM CERTIFICATE OF DEATH ~ cu~~s a •UR[AU OF YITAL fTATIf17C~ iTATt FILt h0. 1eR•~ fLORIDA - ord ~Aeo _ BtRTM NO. REGI6TRAR'S NO. p r o p~ r l~ 2- YtV AL R[MOCMtt ( Al~. Mrd i..i. U:w.~e...: Rr.f..r W,.. N..wir) ei~eut~d ~U« ~ATM COD6 NO. •n6 ¦fll t. OOUNTr . STATE ~.OOUNTY Sti• LZ1Cle e. ,~.~.a St. '~ucie 66-12 Florida ln p~t- A. C~TY. TOMM.011lOGTqN t. ~S K~CE OF OEATM t. GTY. TOWM.C4t IDCAT1pN t. IS IIEStpENCE a~O~~t IMS~DE C UYtT57 INS~O'pE -C~ITY IINITSI Ftr. Pierce YES ~ NO Q YEy~ NO ? rii.. lUME Of (l/ ~rl 61 ~M~ihl. /iM ~bMt ~IhrM) IEMGTN OF 1. STIIEET A0011[SS . ON A iAl1Y1 ~ T~T~ T iN1e 012 Oleander Ave, ± ~ 012 Oleander Ave. l~i~irs. w?wc o? Ft.~t Alultr L.rt wrc Xwt1 DaI Y~a occusco «v~.•v?r•~~ Nancy Eller Welch o~*N "ar. 11- 195b ; S. SE7[ OOIDA OA IIACE 7. MAllR1f0 NEVERMARIIIEDQ DATE Oi NRTN 9. AGE Ih~ 1~I i V~DOI I TW UMOE112~ NM. / irUfq) ..u4 Rwn Xi.. . ~ t c• l~.sle Wh~te Y/IOOMIED? avoPCCO July 11~ 1876 ~ ~ ~ p t• i¦ 1~ IQ~. usuu xcw~Tiow (oiK tid yr«t 4.s 10p. Kwooc wsc~ssoR wousTar ~ 1. suTMnwc[ (57.u Mr~+ owwr) It. anuw as .w~i ao~w~wrr .?cA ~.r- Iq/ wl~tNr~r}~*I~.~~/~t~?d1 ¦~n~st IlOUS6 ~1I6 ~illl ~OIIl@ L'~~.011~ N~~r'• U~S~A• ~l~ek lek ~j, (A7NER'S 1tAYE 11. MOTMER'S MMDEM NAME ~,,...•s.~ Jose aller Elizabeth Kirby . IS- WAS OECfASEO EYE11 W Y. i ARMED PoIICESI i~. socu~ sccu~~n ?a. n- ~wro •~4+~?T~ ~eanette W. Andrexs 1 T~. r. wkrwl Ifl M wr ~r MY~ rwrl No None ~+u?~w eLhe`sda l~arv nd Pua~~ ~1 1~. CAYK K Y[ATN (A~ta ~a!/ ~wt erra yr? fi~t/r (El. sa~ (t).~ IMTEIIYAL tETMfEEN ~~I IART L OEAT11 ~AS UIa[D rY: OMSET AMO DfATM ; d1Net~~ 1yYE0MTE CAYSE Corona Thro:nbosis ¦u~t Ill• t4• e~r- ; ~~*1O•~• c1~tiN.,.,r~„,, o„E,p p~ Arterio Sclerosis ; .le~ t~• r~kl ~ ru~ b . ' 1 e e a 1 ~Dnt tawt l~l. j r~slstr~r ~t~tiN tb r~Irr- pyC Tp (d • . ` Iliy nur Iat. •ftpl• T7 Z . WASAUTOKY ~ O ~MT IL Otlf~ SIGItICANi CO~(T~016 WMI~1/f~IG TO OEATM ~Uf ?qT REUiED i0 TM[ lUIrYML DISEAft WM0~71011 G7YU~ M/MT l(~/ y Nov~• •f- ~ ?EIIfORM(DT ~ t~t d~~t\ s YES ? NO ? or D~f~r• ~ l , -~kf~j •a~ t~. ~xa1~E iq1M INJUNY OCC~NIlEO. {Et~fP R~fVt ~/n{JYry b P~Rf JK PYf 11 ~/iltA /I.) ACCIDENT SYKIOE MOYICIQc ~ •pe~!- v ? ? ? " ~ .oe •f J~. T1YE Oi I/MV lfwt?. D~1. )i~r ~ led~. s WuRr . - E ~ w. $ ~~l~/ NU1i11T OCW11~E0 ~It. HACE OF IIUUIIY (t. I.. M~+ ?~oal AOwt. ?l1/. CITY. TO~M. OR IOCATIOM CWMTr STATE E - MMKE AT ~ MOT MM4E ~ le~. J«~Mr. ~•ra, o~a otN.. uc.l WOIIK AT r011K ~ 2i. l~ft~nd~d tM d~~wd /rom 2~27~56 , to -7 ±-Z~ _~nd b~f w~ him ~li~~ on ,~~ll~5f] - ~ DN~A occuit~d~t 12: ~n p- m on th~ d~t~ ~t~t~d ~Aorr. ~nd fo th~ Awf o/ m~ Ano~l~d/~. from fh~ uuNa sf~uJ. ~ ?H f l~~• j~. HCNATYO< (Dtpa N f4k) I2A ADORE55 Ilt. DATE 51f.AE0 ~ •r• to D• ~ ~a¦a~•~• • A.h.Sam le M.D. r^t. Pierce r~la. -1 - b •CCYf~~~. s j~. ~lat, CR[r11Tq~ jb pAT( 23[. 11AME Oi CEMETFRY OR CRE~ATORY 23/. LOCATIOM (Clf~, [N['~. M[Ni~f/) ~6t~f[~ ~ mrovu (Syrn/~1 Burial Mar. 1- 6 Ft. Pierce Cer~,ete FL. Pierce Fla. : V. s. /639 j4. ~U~~~ pp[ OII ~S SIGIIATUIIE App11E55 25. OATE NECD. LOCAL REG. REG15TM11"5 SIGMATURE ~ a.,.1~66 N lto `+J aai -17-56 Anna Lee Denison d.r. ~ ~ y - I her~by aertify this to b~ ~ t~'t~ and aortetl oopy af ths Loml - Ro~t:tr~~s rooord on fils In th~ S~ t~uci~ County Heshh Dspeef- FIlEO ~ND aEC0RDE0 - msnf ~t FoA Piero~. Florida. - - ST.lUC1E COUNTY FtA. (Wuniny: Not valid unl~ss ratsed seal of ths St. Luci~ ROCER PO!TRAS ~ - Counfy H~alih Dspktment is ~ffix~d.) CLERK G~~CUIT COURT • , _ RFCQR~ VER!fIEO , - . N. D. MILLER, AA. D. MAR ZZ IO 35 aN ~~Z Camry H~alth Offic~ b Load Rpistrar ~ • . ~ • oZ ~ ~ : . - D~ D~p+11? t~! R~olitrs? _ ~ . . ~ 22b04 4 - _ . ~ ~ ~oG~ zoo P~~~ zo ~ ~ _