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HomeMy WebLinkAbout2523 ~ ~ 226344 . ' ; ; = = ~ : ^ CHARLOTTE COUNTY HEALTH OEPAATMFNt "^-^~N • ~ ' ~ ~ ; ~ ~ ~ 514 E GRACE STFiEET ~ C' : ~ ~ ~~~~~'ti;...r~ J;' oUN'fA ~UNUA,-i~~UAioA • 33g50 . ' •i~, ~f . PFIONE NE. ~~7 ~8~ rMwww M~+t' hont ~ . - CERTIFICATE OF DEATH ~ (~..~.K~i .t 1 k.1~6 .MI RrA.lrlu.~~.e G..icr. fTATt ra~ No. iw.~aw~~ ~p~irn FLORIDA ~r?E. OR •~1NT IN ~~~~~~`~~~~0~ RC61i~11AR'8 NO. ~ / ~E ~ ~t~MANINT IMR rypu w~ ~ St[ IU~0100[ FW DECEwSED-NI~M[ ~~~st SER OAfE Oi OEAM ~ roM~w. ~~i. ~t~~~ ~ ~ , aow~ L. xcnor~ouc~ ~~e , Marct? z~ 1972 ~ ~ t~CE .~•Mn. MOW. u~lnC~M MN~w, AGE-Mft w~ee~ ~ nu w.a~ ~ wr D~TE O~ ~1tTN ~..o.er. wr. C011HtY OF OEwiM j nc ~ s?uw: ~ u~me . ~.e~p~ ros rn ~ww~ n•~ ~ . White s. ~0 ~ k ~A . g 1911 Gharlotte ~ Crtr, iOwN. O! IOGi~ON Of OE~M rs~ cm ~wns MOSMIAt OR OMEt NS11M -?+~E ~r .~o~ u. ~nw~. c~n snt~~ ue .~we~ ~ ! ~ a W~Yes Saint Jose Hos ital ~ ~ Port Charlotte , STATE Of ~1lTN ~ u wot r~ ~.s w~re UTIZEH 01 wlNT COtR~TtY MA!lIED. f~VEt MAtbED. SURVIVNG S~OUSE ~a .r~N. o~n rw~ wiY ~ ~~v.~ oser«n ~ N6N YOl'~C couaa~ • U~S~A• ~ i~I'~~twcr~~ ~II4Y'~titi8 ~e~ ~.wn ~eu.ae y~tAl SECUl~1t MWKR USUAI OCCIJ~AiION ~aw aw a ~o~ w.w wn.w roa o~ 1tl1~ Of MlS~SS p WUSil11 ~3 „•~o r a.w~ .rorw~o we. MM r~w~ ~ f GNlu~NO w r ; ir~m~a.. a~ „059~1~~J ~~.DOOI70N1 11~ Apartment Nouae } .~~.w..u Kw.e .o,n~sw«. tE51OE?KE-SfAIE C011NT~ CrtY. iOwN. d lOG1~ON ~s~e cw~ u.w~ STlEEf ~ ~ srean ra o~ ~+o ~ Florida ~p Charlotte Pbrt Charlotte Yes g5~ N.W. Summitt Street ~ IAi11E!-NAME nyt r~M~ ust MOTIrtt-MADEN NAI~ nqt rMif t~W „ ~ ( Unlmoti+n ) ( Untaloti+n ) IwWMAMi-NAMF MAIRKs AOORESS IMlt1 M~.~.~. n0.. CrR W ro~M. N~R. t~l ~ , Loretta P. HcDonou 65? N•W ~ttST. Port Q~arlotte Fla. 33950 , • run DEw1N wns GuSED ~r: .~E+~rE~ d+tr oNE uuSE ?ER ur+E ?d NL AL ~ kA M..~~e« o»r+.w M.w rrw carst ~ ~ . . (el / S S ~ 1/ , ~ / (~t /YO/l/~ y ~ • I~ (QMO/t10Nf. 1/ ~M~. . ~ rMICM G~r~ •If~ b ~ ~rr~O~~tt C~YS~ 101~ 0~ «.s ~ ca.s~aw«a a: Sf~~IMO ~M! VN~l~- ~ \i1N0 ~~YN l~{t MtT ~ O/NER SK~rM~KANT CO~~iIONS• CdO~FONf COM~tiYhMO b Ol~1w Nrt Mpf MutfO M UVff GMM wi ?Yt ~ q1 ~ ~ES ~~n nr~~wof tow~ 1 : 't' ~ ns w w~ s~N~ee w. wnwrww twN Or ~u~w ~ ; C,~c.S~„ ~1 ~ ; ~~r. « r il~ ~'<rrri+ l t.~T± ~ ~ !~,.~oW~I KUOE ~OE A a~o.nw. w~, ~eu ~ NOW CURlED ~~Mrt~ .unir a~wN~ ~r r~Gn -i/p r~n we ~ iy{ 5 , ~1W~ucC~OE: OR IROEiEW~t?iED - ! ~ ~ Q~l ~~~1~f~ (f/JI['+ ~~~G~+~ i ~ ? - ~oe ~M ~ tli ~ d ~c 7h ~ ~ ~ir !Y 1 INJU~Y Ai WORK rU?CE Oi ~+lU~~ wor. .•u, sr~n. r.cron. LOC~~ ~ s~ne~ w~.r ..w., an w ro.r, s~•e ~ " 1~I~C~n ~f M NOI QN1U rOG., K M11 / • ~ f ~ O ~ ~ Iq C~~~ ! ~-a~G"?^/.J : ~ : r • { CEf~~fK~T~ON- ..o.nw w. , n.~ ra.+M w. nu u.o us~ s~. wriw~ ~~rve a. ~ as/ae .~w vK.r *r o~wn~ oeeuhto w.r n~cr. w r ; ~MISKI~N: ~W~M Mt ~l~1 ~ON N~~M. ~wpy~~ ~~R. ~r0. ~O M MY h ~~nlw0t0 twf T~ ? p rt IMO~R~~W. Mli ~ ~ II• wct~uo ~~o. 11~ !1~ lq. IM ~ Mr~o w~e cws~~s~ suw~. ~ fEtilflUilON-MEDKJ?l ExA~INER OR GO~ONER o.. n.e us~s or ny wow d a.u~ tM! NC~M ry ~pwp~KfO ~Ey ~ i ~ a t~wrr~~wn d w! we~ ~r~0/M nef ~Rft~Wtw~+. n~ w M~~. _ ~s O~~M OCCYM[o Or' M O~A OM 1D M 4YMtf1 S~~~IO ~ ~ L, ~ ~ ~l1 _ CERDFtE!-rvM~E n o~ ?w.n S ~tURE ~ee~u ~mr OA D ~.o»+~. u~~. +w~ r~. Ylo / f~ . ~ rn Cc'- / - 7.z ~ MwKNC, SS-CEfi~irtl~ L~O sr~ w r~ ..o cm~D ~ n ~v~ 7N .J /7 33~~ o ~ ~VRIAI. CREMAiION. REMOwAI E1ME1ERr OR CKMAiO~~-NAME IOC~?T~ON an o~ qrw fu~e ~ ~~oy~ National Ce~etery Long Iala~nd, New York s ~ ~ATf ~ . wv, .e.~ ~ WN fAt M w~Mf ?~M OO+ESS sr i o~ ~ . u w s~•. t~r ~ ~ ~ l~arch 2~ 1972 1~ays~neral };ome, P.b.~ox ~~g;~ort ~ar~otte, Florida 33950 ~ v. S. ~612 fu+ i~? Ecto~- j~RF~ tEG~sr -~e~~K'.?+~ltntt _ e~re ~~eo ~t 'agsn~. ~ R~v.1970 ts~ ~ ~ ~ ~ ~ I hereby certify the above to be a true and correct copy of the Local Registrar's ~ ~ F record on file in the Charlotte County Health Depa~tment at Punta Gorda~ Florida. ~ i Not valid unless raiaed seal of the Charlotte County Health Department ' _ (Warning: ~ i a af f'~ xed. ) ~ ~ ~ a r ~to ~ho +~ec A o ~ s~. ~~~~f ~oU~~Y gE~. - : . - • ~ `~a ROCER POITR~t c~ ' ~ `:-1. CLERK C~RCUIt COURT L_0 'i~{ ~ ~ ~ ~ ~ t...:. rt.A- ~ . ; !1[OqltD VER~FIEp , 7 ~ i ~ g County Hea 1 th~ Of f i cer d Loca 1 F~egi st ~a r _ ; r~ r~ io z~ ~ ~tt=c _ ~ _ . J • 3' r ' • ~ 1 - - "L . - _ ~ ~ ~ y, , - . ~ ~ _ , l~ _ , ~y~ Date , ' - . ( Deputy Locsl Qiat~er~ I + ~ . • ' ~ ' , 8 = 2~~.fi344 ~ ~ ao~ac~ ~ - _ . i ~Y - - - - - ~ s~ _ - ~ _ _ _ : _ . ~