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HomeMy WebLinkAbout2305 a r ; ~,3~5 • ~ _ ini. s.- sr~TC ~o~wo or Nsw~TM CERTIFICATE OF DEATH eo~es a !UR[AV OF 1IITA6 fTATIfTIC~ fTATt ~IL[ N0. FL08ZDA ord •Aen BIpTM NO. R[GItT1lA11•! NO. p~eP~r1~ t YWAI A[N~[NC[(/M.fr~dMd ff:..nwna• R~~wwN..~taww) ea~t~t~d 1. H,I1C~ OI ~[ATM GODC NO. • n A • l 11 . a STATE COUMT1t D~ ~l~c~~ - ~ iq 1~~~ A. CIT1I. TOMN,OII LOCATqN a K KACE OF OEA1M e. CITr. TOWN.011 IOGA~IOM t_ K IIES~OE~CE ~ .•a•¦t ws~oc cm uriTU ~~s~oc an uwrsr r 1 res ?w O res ~oQ,_ J. ~urE OF (If w~t 1~ N~/itd. ~i~t WM Nfrurl STREET A0o11Ei5 ~qSrIT~L OII YISTITUTION ~ w?r[ N Fir~f Nitlte Lw wTE XwM pI Yw eteuss~ os ellie 1~cMickle ~T" Au st 18 t 966 S. SEX ~ CO1011 011 MCE ~ MAR111E0 NEVM MAQ111t0 OATE OF ~1RTN ~ ACE U~ Mtl1 1i 1/rOp 1 YW {Fp(~ U Mi IMf AYNM~I YwN~ O+M Nwrr afv. •<<• Female 11e ro .noowco ~ aroiecm Nov. gth . 189 6 p 1~lwl ~ 10~- YSU~L OtCV~~T10N (Qf/t ti~t~/~Ntt ~p~ 1~. KMPOi W5IMESSOA IMDUST~Y 11. N11TMR~CE ($~ft ~?~1?tMA tNtUh~l 1. Oi11610f ~f1YT ~U~1*Yt •its ~~r- Ivty~tNwrlWh~e.uewyr¢be~i ¦••••t Domestic's At Home Oran ebur S. C. U. S. A. ?l~Ct 1~! ~j. ~ATN[11'S NAME I~. MOTNEII'S MAqEN N~YE °j~••~~~•' Durham Bell 4 Cellie Weeks ~ 1~ 7pCY? SECy11~TI Ip i7. IN • NYMATYIK A/bn~ Luella Desse 10 N. 9th. St. F'~.Pierce Fl,a. r~n•r.i ~t. wvst ~r ~utw (B.R..+f~..r n..s ~n li.r p. t•1. ls~...~ (N.1. ~Krcev~u ~wccN { r~~T ~ oun~ r~s uusco ~r~ oMStT rN ~~~coun wnc ~u Probable ' ocardial Infarction ~ en ce• e~r- t 1 f t e~ QMlifi~u. py[ TO (~1 r f t\ t?• rah~ /we ru'~ b 1• e• 1 ~bat cawr l~i. ?~sl~tr~t ~~M fk pyE TO (t) .scai. ss rr+w nwr t~.r. t~ o u r• a o r~~T orw s~c~nwr ao~orrna canrwrtwa ~o ourw wr ~or auno m rnc ~w asusc taano~ cwra w?wn w~s ~trtwsr S rc~saR¦cor c.r 6~.c~ YES ? h0 er ?~t~r• ax~~K ~ow wlu~v otCUaRCO (~Lto wrwe ts P~rt I~r Art ll Y~~ ffJ •~tfs~ •w~ ~ uCtOEMT SUK~O( ~K~pt / N _ 3 •~~~1• y ' ~ O O D 1i~~. ~t ~~Or i~rc Os H~, JYwtl. D~~. Yer ~ uuu~r s. ; p 1• . Y ~ = 10/. MUUAr OCCU~EO 7Af ?LAC[ d IpHl~Y ft. I~. ~a M?MY/ M~It. 20/. CITr. TOwN. OR IOCATq11 COYMTr STATE ~ YMK[ A7 ~ MOT MN~LE ~ ~A. hd~?1. M~[N. ~~tt 0II/.. dt.) wORR AT MIOIIK I ~H~ndW tl~d~c~~wdl~om J1u16 fo AuA• f •nd/~atw~ A ~ ~li?~on ~ ~ ' D~~fA occu~ g• QQ A rn on tM d~f~ ~t+tW ~6w~: ~nd to tM Aat oI nyy tew~hC/~. /rom IA~ uua~s af~t~fl. A11 lt~~• ~ ~Q~iV~ _ (DysetrlYk) ?20 AODRESS 7It. W1TCS~GMEO ~ • ancis J. Carbonara 8-26-66 : ' •ee~r~t~. j 23r R~eu?. C~Kr~iiO~. 2b OATE 23t w?ME Oi CEYETE~Y OI1 CR[MATpRY Z7~ LpCATq11 (Cy~.lMt~. M te~~) (STdt1 ' 11[rOO~I (Spttt/rl 'a Au . 21 1 66 Pinegrove Ft. Pierce, Fla. x Y. ~OIZ j~. hIME4Al OMECT011 S S~iIUTYRf ADpIttSS 2S. pATE ~ECO. /Y IOCAL ILEC. ~GK71U11'S SYrM4T411E . ' R...,osa e c S. Peek 8-26-66 Anna Lee I3enison, d.r. : ; i ' f LEO AMO RECORDEO ~ ~ hsr~by o~rtify fhis to b~ • hw ~nd oo~rrrct cvpy vf fht Locd RO ERCPOITRAS i Repimara noord o~ fll~ In ih~ Sf. (ud~ Couhty !~{s~hh p~F ~«RK CtRCU1T COU11T m~nf ~t FoA Pl~rw, Flor(d~. RECORD VEa~F1E0 ~ (W~rninp: Not valid unlas n(sed ssai of th~ St. L~ud~ 3~ . ; Couny H~elth O~putm~nt is affix~d.) . ~ ~ 4 N. D. MILLER, M. D. Cainry H~atth Off'~ d~ Looel Rplstrar ~r*~~~i.~~. ~ t ~ ~ ~ ~ _ • . 4''~' ~ c .c. -~j. ~ . r ' ap~Ay t8~0IMraI _ , ~ . ~~Y.` . ~ ~ ` . ~ ~ Y i , ~ . . " " ' " ' _ _ k _ . . _ . . . . ~5.>-.