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HomeMy WebLinkAbout2701 ~ ~ ti 22~64'70 ~ - - C. - . ~F1Ca=?. OF DEATH ~tprd~ert oi :.r+~14 aad Re6il.ilil~Ure $ervices tTATE FIIE AiO. . ,;;v~:,on ~~~.,~.n~ F L O R I D A tr?E. `va ?t~NT IN ~"~~~~LQ~'~`° REGISTHAR~S NO. 4 i~ ?ttNCAt•:tNT INK ~E~p_N~ ...,,;i,~ SE7t OwTE Q` Ofwiq ~ YOMiM~ ~1~~ 1 S(( hAap100[ F0~ ~rsreucra.z , John Lee Ball ,Diale ,October 5, ~97~ ~11CE vrwn, wlGq. u.~tKU~ u+O~w, AGE-~~fr uwe~ ~ v~.~ +u.r~~~ i o.• D47E OF ~ItTM ~rOraw. Mr. COlN1iY Of DEATH U602 Rc. ~ wcu. ~ auwo.~ ~ ruq ~ ws. ~ w.t ~.:n+~i ~ ~w i .w ~ . White ~,70 „ ' ~ I,July 7 1901 ,.Saint Lucie Cm, towr+. oe ?ocatww of oEwTM ~ w~a~ c~n MOSt~TAI OR OThER WSTITUTION-NAME ~r ~ot w t~M~, GM s*~e~~ uo .Mrwt~ ~ ~•~~~••~s,•~,~ Fort Pierce Memorial Hospital „ Fort Pierce ,,Yes SiwTE Of 4tM ~ r..ot w v.s~~~. ~~u UTtZfN Of Wn~T COUnTQY ~uRC'EO, KErER nMRRiED, Suiv~vNG S~'OUSE ~r .rw, or.e rua. ww ~ • ~q^.n., I W~wED, M+~ORCED ~ wc+. ~ ~,~,,..,,,o,„« ~ Virginia , li.S.a. ~larried nivy Mays ..i.e we~.sta SOCuI SfNaTY MIMiER uwwl OCCUr~i:Ot+ ,e.~e .~+o o. .w¦~ w~.t ~w.we ..os~ a KwD Of wSwESS OR Yi01JSnT ilr[D. N M~M JCCUa~FD w O ~ ~ ~ u~e. [+tw ~et~~f0 ~ „577- 7- 9 Sheriff Prince George Co. ~faryland .lS~Ot~Kf M~W! a++ls~o... ItES~pENfE-SiATE COIiNTI CrtY. TOWN. OR IOCAT:ON Mw~ ~p+ ir~? SitffT ~u~ID NN~.NER ~ ~ artC~n ~~s b .w Florida St . Lucie ,,.,Ft . Pierce Rural 1~u no ~.Rt . 2 Box 3020 fATNER-w.u~f ?~nr rwae us* MO7MEt-~u~OEN wM~E ~us~ ..ea~ W~ „ ~latthew Ball Louise i,fhite INfOW~NT-NnME j w~4~ w3G~E55 ~ain~r w~.~a. .a.. cm a+o~+. u•n. ar~ Ivy Ball Rt. 2 Box 3020 Ft. Pierce, Florida 33~5~ ~?no~~.~ e ~w [ vu ?AtT 1. p(wiM WAS CAUSED ~Y: {fMEt Or~tr Or~E G~USE IE~ [wE fOt (6~ wND (~)1 ?er.~~.. orse~ •~+o ne.n~ 1~. w..~a.n cwae ~ fy ~ S' i dt ~-~~~~:~z~ l~~-r ` . o~H ..ci o.. . n i / ~j , co»o~r,o.i. ~r / ~ ~j(.LL: ~ ~ ~,(f i ~7~5 ~D / J , a J~•~ ~ lcul~ cc ' rrtO~~tf C~Yi~ ie~. I py~ t0. ~ COwXWI~+Ct ~7 j S1~tIM0 tw! YM~l~• ~ \~IMO C~V3l l~lt y fwlT u OTnER ~ IGWT CONDrtiONS~ ta+auo~~'cow~~~.,r.~.;; a i.iw ~.r »ar n..*to ro e.~te rut ~ ~n ~?UT«Sr Y YES'r~~e nwo~wes ew+- 'j"f / ITl3 W~~ Ma~~O 1M MT(~YIFIMG UY~ K tc- ~w Y ~w -Z ' /~/~/~ilt ~%GLlG~ L(/J 7v l~r~- W.{.%' Ctt ~ e s w o..,. f ~i. 1~DEM. 3u~OE OATE WJiJRY ~.o..rw. o.~, .e.~ ~ MOUi MOW INIUtY OCCURtEO «~w~~~ ~w r.n ~ q• uer ~ ~ ~py~:C~ ~ p2 tiIIOETEWMtED ~ I io~M ~ r.. M :or i IN711RY wi WOIdC ?UCE Of W1WY ~or. srnv. ~.c.w., iOCwi~pn ~ snen oa ~.rs. .o.. an o~ ro~.. aun ~ $ ~ vie~n n s w.w ~ w.u wa~., eu. ~ vee.r. ~ ; ~ ~ ~ 'N! 4 i CEtT~fKwi~O?~- .o.nw w~ ~w .a.n. a., •i.i ~.~•o ~.sr s..~ .wi.u u~+e on ~ ao~wo ..or •w~+ w DEAiN OCWUFD .i r.~ n.ce. o.+ swe ~ # ?nrs~uwN: T~ ~ .a.rl w. .w i ~ow .rnS .n.. ~nw~r i o.n. ,.m. w nr ~es. ~~niwOtY twl ~f ~f t c 1-7/ /77, G ri [M~.~OGf D:+! ~ tfa wti•~eo r•or / 2/ / 0 ~71! 1~ J 7 1 ~tt. G ~ / It~ J 71•. M. *O ~w Uwu~s~ sr.*eo 5 CERTYICIITION-MEDIC.A[ fl[A/AWEf Os COROtrER: o~ r~.e ~.s~s a s.y - oa.n. + w eea..~ ~.s rw.~a:..no w ~urr~~T~pw M 1M WOt ~rilG twt r~~11~WnOM. w r~ Wr~.on. l / I rOM/w~ C~~ ~l~~ wOU~ j Ol~~N OCCYYfO OM M WR ~MO YY! p M(~uSt W ST~*l0 3 S Z - ~.~.7 ~ M . ~ ' 1 ~ CEQT~f1ER-N4Mf ~me a rwn SiG~v~ ~ , awt~ r ru D~TE O i.o~+~, wr, •w~ ; " ~ ~t ~ # ~ Me~vin Wolkowsky, M.D. ~ t. ~ ~ sru~: o~ . ~ o~ uo o~ to... ture rv ~ ~.ult w SS-C[RT~f R - ~ r~. ~$O~Nort~i 7th Street Fort i ; ~ iUQW. C~EMATION. REMOVAL CFMfiEir OR CREMATORY-Nf.,uf IOCATION ~ ~ Gn p~ ~p.~w sutl : 1 S?K1I~ ~ ~ Removal r~~ }iount Olivez 2«.Frederick, Montgomery Co. Md. ' ~ - DATE i.~own. wr, n.~~ WNERAI MOME-N.t~+f A7vD ~J~iiSS : sT~eer o~ ~.~.o. .ro., em ~OMM~ Si~ ~r ~ ~ ,N 10-6--71 ,~,Fort Pierce Futieral Home 10~ S. St. Ft. Pierce, Flr ~ V. S. f 512 flRd DItECTOt , TUlf / REG: ' -S+GN~i~iF OwiE ~ECf~rED ~t aOCwt ~EG~STitw~ ~ ~ ~cto*~~ 5 , 1~71 ~ a.~.i9~o i ~ ~~Y,~~:~ ;N ~ o-k ' ~ ~ ~ ~ ~ • ' 1 horeby oertify this to be s true end oort+ect oopy af tfie Lccal f ILEO AND RECOR~~ ' - Rogistrars record on fib in 1fis SL Ltxi~ CouRry F3aahft Dt~,uf~ s~. 11CfE COUMTY - , - ment at fo+f Piera~. Flortda. ~OCER'OITR~i . . ~ CIERK CNiCWT Q . ~ (Waming: Not va~td unlsss ralsed seal of the St. Luda 11ECOR011ERIftEO ' County Heahh Department is affixed.) ' ' ~IAR ~ 8 3~ ~ t~ ~ N. D. MILLER, M. D. ~ County Fiesltfi Offiur b l,o~+) R~Istror ' P~ _ ~ , / ~ ` L • ~ ~s ~t~~ ~ ' , ~ ~ ~'2264'~~ ~ ' ~ ~ ~ Dah Depvty ca1 Rsatstnr ; E~ - ; f:~ - 2 , ~ ~ i : l _ ~ ~ _ _ _ _ - ~aa~~~! ~ - - , - - - - - - ~ _ _ ~