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HomeMy WebLinkAbout1513 T?,:. ~~n ~~o ~ Nrw~TM CERTIFICATE OF DEATH g.z3,~u ~ 1 ~ S a L r ~tl11RJ1U OR VIT/1L RATIl~1q e o.~~ ~ ~ tTATt llLt NO. ' ~ - --T- • ..a .e.~ a~ T N. i~.~iM~`7~Iz+ F I.O R I D A ) J w• ~'°°~~1~ w?c~ or ~un~ co~t wo. 2_ vsu~a ~n~e~t~+..~.r...r f/ MN.hiM~+R~f/~whM~~eW • ~ • e u e ~ L Co~wTr ~ / a. sT~Tt C01N~Tti . •ne •ili ~ ~la~~~ 1 a. ~~t- GTV. TOwM.OR WCATIOM t. MAR OI 0[A111 t. t1Tt. T0~lI.OR IOtA?10N t. 1! IIEi~Ot n~ e t MIS10E CITr LIYIT=1 INl~Ot CITr 11Y11'ft rti.. ri: No0 ra0 I. MAM[ 0~ (/I NI b~M/MQ./~f M?Mf N~11M) L[KTM C/ ST~[tT AODI1[Si ' ~ ~~~TU ~ STAY 111 1~ OM A IA~Y/ i ' IMSTITUT 1 rts Q MO ~ 7 NAM[ 01 Flqf ~/1yq Ly~ p~~ ~V pp y~M ~seus~~ a t~1a rw) ouTN scx ~ ~ oow~ o~ iucc ~ wnMUCO ~ McvcR w~~~ca wrc a u~trN ~~E tt. K..• •vion ~.wr „ !MI NrfN~t) IfwY~ O~ Mww ~Ih.' ~ i e• ~ A ~noorco avo~cto ~ t~~ n 1~ 10~. usu~t octws~ (Ot~e ti~ y w.k Miw 1~. KMIOOF ~YS~MESS hc 1110UST~Y 11. NATiM'lAC[ (&W w ANM1 ptAh~) t cmto~ ar w~u oournirt • f t~ ~~r- f~~1w~ ~t y wrtb/ hJe. eK~ 1/ ryli?Nl •~~~~t a 1 s e t 1 ~k 13, ~ATNE~'S MAYE - ! MOTII[~'i MA NANt or t~~~~~1t~t ' 1-~Af OtC[AS[O [KA IN {I. A~MtO /~p~[St lpCYL SECy111?~ Mp. 17. • N~IM 41~. r. ~ wtr~l Uf w. w w~~M~ rwd - ~ ~ wMu~ ~ r~n•ral 1~. CwYi[ N~fl?TN (L1~en Mlt ~ arn /w fly/r c~1. t~). ~a1 (t).1 INT[11v11~ d 1 ~ t~ t ~4~T L 0[ATM MA! GYl~O ~r~ a "x ' ' ~ OI~T AI~ 0~ iMr~ou.~ c~ux w_ LG.~`L r t<-~-r~ L+- c ~f i sr~t tfl• LS.- ~1 t!• e~r- tltle~t• ~~.1/Mt. py~ Tp (~1 •1ta t!• p I • ~ • 1 it t~aNt~~). . r+ t 1~ t r~r ~f~fMy W r~1er• oYE TO (t) . ait~f~ 7S ~ ~NM nbM 1~1f. ' 1 o u r. . t- IARr tt Ot~M lI~IIrICA~n OO~wil0ls C~OMINUIM lY Ouf11 ~Yr Mor 1~u?RO 10 nR 11MMYl OrrAS[ 00~~11~011 N1IE4 rl M~t 1(U ~?EIlfO11M[Oi t~r d~~sR r~s No • r~~`~r~' ~M. ~?tuocMT swna ~rcw[ ~ otst~rt wow wnM~r ottu~~co. 1a.ta ~~n y~.~ h Aut ~ M I'w / ylhn .ati. t~~e~i- ~ ! .ee •f . TIYE OI fJM? a(MN, Dq, YtM i ~.s~. ~ wuwr w. - - s. . 741. IMIWr oCCUMlte ~r. NJ?C[ Ot pW~11 p. M a.swt Mne. ~J pTt. fo~11. a~1 t+Ot~TIDM OOtM~Tr lfA/t MOwR AT ~ A1 MOIIK t~ ~M1. Y?MI. ~ M~I Mt.l ~ - J ~rt~wMl tM dNwwl /nw~ . ~o ~ ~N /rt ~lw ~w Dwt~ ~eeweN ~t w~ ~n ~N~ I~t ~t~bt ~~n; ~w1 t~ tM MN d a~? lwwl~IN. M tM wM ~t~~ ~ w~s , «aw, t~. ~oo~css 9 Ol"ange A~enue ~ c. ~ ~ % ~ M D oOkled 0 t e•~•.t~. 23. new*n~. i]~ onn !]r. r[ a arerc~t ae e~r~ro~r 2~1_ ~ou?TqN (G~e~. a~. r swM~) (aw) aro.i~ ~s~t n t Y. ~~1~ = iU11E O~" 2s. WTE 0. M ~[G. ~EWST~'! l~s~ ~ Q 11 ~ j~O~mAt (i000A ~ .~r ~ i' i L- f ~ ~ ~ ~ - - - - - - - • - ~ - - - - _ . I HEREBY CSRTIFY THE ABOVE.Tp gg p TRUE AND CORREGT COPY OF TAE RBCORD~ON FILE IN THE LOCAL RDGI~! S OFFICTs IN THE BREVARD COUNTY HEALTH DEPARTlSENT. ~ _ . :,`t~:~. _ - ~ ( No~ ~4_ ~ ~~";:1~i~a1 of the Brevsrd County Health Dspartment i~ affixed) ~ ' ~ ` " ~ ~i3= ` ;tE,; r . ';t, 't~ , •f yl~ ~ . . ^s• ~ : ` ~ ~ L.'.- ~ `w { sy~• • . Deputy Regiatrar ' , • ~s, ~ ~ - ~~r= Fi~Ea ~y~ ~FSOaoEa ti~r ~r:•'`i'±'~_ ST.IUClE C;,UMTY FIA. ~ ~ +e-.~~~#~ ROCE~ F';)o'RA$ t ' ~ -~i~.-j%,-.,x_ CIEnK i~"~LUIT COURt RFCORri y': ~ A~~ Jy IZ 2s PH 'T1 , z~02 t B00 PACE~5~~ , ~ ~ „T _ _ - - . , . y r `a ~~~`a~~~..~'' ~