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HomeMy WebLinkAbout1764 . ~ ~ _ , . . f ; _ . 'a DADE CCIUNTY . DEPARTMENT OF PUBLIC HEALTH ° MILTON S. SAlLAM/, MO, MPN. 13d0 N. W. FOURTEENTH STRHET DIRECTOR _ r_ - . ~ • MIAMI~ FLORIDA 53125 ~ - - ~ . ; • - , ~ . ~ ~ . S CERTIFICATE OF DEATH D4~l.e.~ .t tic.tl~ ..a Rei.MkbH.rc Se..+a. trwTC r14t No. av~s+oN~~w~n+ FLORIDA 2~3~ rr~e, Ot ?dNt IN ~"~~""''R"O"° REliIiTRAA•! NO. n~Mw1~NT IMK ~A~,N~ nu, rwat i.s, ~X DAiE OF DEAIH ~ roNtr, o.., a.~ i SEE IY~100! f0! Claude M. Desbrow t Male ~ Feb r RACE wN~t. Meew, u+e~c..+ uen..... AGE-usi uwe~ ~ nu w+oce ~ oer DATE OF ~1RTM ~ro..n.. w~. COUt~ItY OF DFwTM M_ ~ y~~y~ ~ NatMOwt 1 rEUi l rOS. Mr3 MO~MS r/a- T4~ i . white 70 A k ~Jul 1 01 Dede . q1Y. rdWli. OR tOCAr10N OF OE~TN r.soe em ?rurs MOSMAI OR oTH~ NSi -N~uuE ~u Mor iN Emie.. e~ sitn u+o «ws[. ~ . a~, / s?ecm ~ts w ~o Nialeah Yes Hialeah Hoa ital ' • • STATE Of NRIN ~ r No* w~ u.s.~.. w.rc UT129d Oi WFfAT COUPIiRY MAR~IE~. lIEYER MAReEO. SlRY1VMlG S!'DUSE ~ r rre, e~re rw~ .ure ~ cow~n? WIDOWEC. WVORGEO ~ sncri ~ ~w....~ Wiseonsin USA Married Helen Ni el - MM[4 DKl~3~D SOpAI SECURIIY NUrNER USU~t OCCWATIOt~t rave ea+e a wou owE oun+w rosT or KIND OF N!SlESS OR It~US1RY : no n oe~n~ v+ons+p ur~, er[N ~r umeo ~ occueu0 w ~ - ~t 323-14-7920 ~L. Ca tain Nite Club ,o.~~ssaa+. lE51DfNCf-S~Aif COUNTY CIT1f. 10wN. OR IOCATtON ~ ws~se cm ?rrts SitfET ANG NUM~ER ~ srtun ~ES w no Floride ~p. Dade Miami Ye ~w.8181 N W So River Dr. FATNER-l/AME naT rwae uu MOiF1ER-MAIDfN NAME rrsr ~ ~ w~oae ~ ust ~s Eerl Desbrow Chri$ti e D' - INtORMAM-NMIE Mwtl1G ADORE55 ISiMEi O! l.~A. NO., cm w row... uaR. tri Mrs. Helen Desbrow 8181 N W So t R' D , ?ART 1. DEI?M WAS CAUSED . (ENTER ONLY OI~ UUSE IER tMIE fOR (a/. (A/. AJ~ (cH ~[~wetH oi+fn wM0 OE~7M ~ Y~rfoui[ cwvSE . . C.Q- ~s c. - N:~ 7~' ~ ~~'l,~~'~""' ~ , w1 ~ CONflOYErKE O : - ' M CMtG~t[ ~If! p ~S~ ~~re~utr e~use ~m. OY[ 10. O! ~3 ~ COe~SEOUE~Kf O~: ' {T~i1MG tM! YNOEf• ~nMG C~Yff I~ST IARf 11. OTNER SIGNIFICANi CONW~IWaS: co.~no.. ~OMMN~wG 10 ~~Yf NOt ~EURD t0 UYSE GhlN IM ?A~7 1 101 ~ rES r!!! RMOINOf C~- I~FS Q~ MOI 40!\!O IN OIT[l~MM11/O C~Yj[ .L Cd-L -r c-' ~--~-°-'~-c-i~ iw. No ~w.°`~.M p~a~ ~OE Oe OA ~ra+rw. w~, n~a~ HOl1R HOW INJURY OCCURtED.~ e~nt~ wTwe o~ ~Mwn ~N rut ~ o~ rur n, Rer MOMIC7DE: C! 1AOEifWINED ~ M? 7k M, tM. tIt~7RY AT YVORII ?IACE OF lUUR11 Mo.e. ~•u., sr~[r. r~non. IOCATON ~ sn[~ oa a.~.o. Mo_. em o~ rovrw. s~Nt r ~ s+mn .es w.a ~ a+~ee nee.. ex. i s~ean ~ 1R MI. rl CHf~ICATION- .o.nM w~ aw~ .wr~ o~~ ~ru MO I~ST LMI MW/IR~ 4111E OM ~ so/ao wt v4w oe ptwtM OCwutEO Me wia, a+ ~M ?Nrs~CUw: T~ .a.iu nw~ ruu wori ~n'u ot~w~. ~ ~ ow~t. ~ro. q se ~!w a~ ~ .~n.a~o ,we ~ ? 9 ~f' :N. / ? tic.` oZ / ; /YOJ'~_ w r. a~o.uoa, w~ t1a ace•seo rw+ 7 tb. ' M. ~o w~t wat~s~ sL~. CHfiiG?iION-MED1CAt E7[AMINER OR CORONER: a+ n~[ a?s~s w me MOU~ w o[~m rMe olCtoerT rwt nOMO~n~[to OG~O ~~ArN?~~ d Brt ~007 A~IOf /1~ M~'ESfIGAf10~'I. IN ~at OIM/W~. MONiM WT f~Y IIOW p~1N pC(yrlp pN IN[ p~l~ ~Mp WR M~w[ UYSt111 Si~tEO. ~ m. CHTINER-HAMf imt ot ?uwn . -y~ 51GH~TtlRP_~~~~ „ J.~~„ nnt ~?E SiGl~O ~ ~w? t1a fl.t~/1~ .[•/~if'/T~ /~Iiv - A1Al1iG SS- i1F1Et . snen w .o - . w eowN ~ sua :~r t1I F'.~ i i s•. . N~tAI. GEMAiIOM. RfMOYAI RY OR CREMATORY-NAME t iION un w~o.r.. s»re ~fletrt~ Hurfal ~ ' ~ Feb. ~~,1~~7'•~~'':~= ~arl Slade 3~5 49th p t,i,~ ieleeh Floride u+ ~e e s+ r, s. ~612 F - - e~s • Psv. 1970 •f ~ • tM. _ ` . ~ ~r, ' . ' - - - - - ~ f~ s I% . I.NBRSBY CSRI'II~Y TE~E - BB A~'~ COPY ~ THE LOCAL REGISTRAR' S ~CORD OF DFATR . t ~ r ~ , ; ~ r .t~ :T ~;e.1 ~ S FIARNING: ~ ~ , : • E (Not valid un "":~th " ~-x~' . : xncZST~? A sea! of the~ '~,~±.ViTAL Ii~CORD6 UNIT L StAti8tiC8 i1 ' D~DE COUNTY ABALR4i D$PAA~O+iT , • ~ ~ ` ~ } MIAMI, FLORIDA ~ ' , ~ ti.,,~ ~ ~ _ _ ~ ~~t' F 1 } -a ' - ~ 5:,~ ~ 1~-'~Ft