HomeMy WebLinkAbout2223 filED ANO RECORoEp ~
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I~irIrA1~ CIERK C~RCUIT COURT ~
RECORh vEP~~iED~_
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eo~~s • ~YA[AY OF YIT/1L fTATIfT1d fTATt PIL[ N0.
t~s~t r~e- FL08IDA '
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."e .'11 St. Lucie ~_02 L STATE glorids °0°"T'~ St. Iu c'ie ~
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Fort Pierce ~,rcs(~r p Fort Pierce ~ Mo? '
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I, IUME OF (/J yi b W~1. /N ~OrNf N/rttl) 1E116TN OF f. STREET AOOIlESS OM A FAIIMt
"~T1R10N 808 Oran e Ave. BST~rs:~ 16 N. llth. St '~0 M0~
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Colmon Gaines ~?TM P4a 7 196
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. i s. Male Ne ro woo~op avaecco ct. 22 ~ 1891 ?l i ,
,••1i1~ tOr: usu~ocu+r~noM Otretiatyw~t~we 100.KWDOFWS~NESSORIMDU57RY 11. WITNMACE(9Yt~r~NtM~~~W~) t cnuuarw?Tmxn» ~ i t
.~e. .rr«,~..rw..~.ynw•n ~:adison Florida U.S.A. s
.....s ~`ommon Labor pomestic
~i.a¦ i.t 1 /AT~'i MAltt - 1~ MOTNER'S MAIOEN 1111ME ~
~~,..~s~.* Wash ton Gaines Roddie Jose
~S_ w~s ocawsco cvc~ w u. s. ~co w+~ccs~_ u. socu~ sccuR~Tr Mo. n. u~ro s s~du?nnu Samuel S. G2ti.nes '
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No - - A~~ P.O.Box 8 t. erce a.
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Fua~e~l ~ ~ET AIfD DEATN
air.sc•r ~""r~°E"~"~"sc~~corr' ACUte Cardiac Arrest ~
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` ~i~~~•~;~ ~ o„E ~ ~+~Arterio Sclerotic Heart Disease
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¦~~1~ 1•*' r~i ACCIOEMT SYICIOE M0111CIOE
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. ~ 20t. MIJYIIY OCCUIUED 20t. M.ACE OF INJU111I I» 'a a a~t ~Ca[. 7D/- C1TY. IiDMN. 011 tACwT10N COYNTt STATE ;
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?1 ] it~~s t2a i1OMATYII[ (Dr/nr ~r tYk) Ao0RES5
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~..,~.s. • Melvin WolkoWS M.D. 80~ Oran~e Ave. Ft.Pierce Flo ida ~
•s ea~at~. Z3~. MIMY. tatw~t~dl 2~. DATE 23c_ ~uwE OF CEMETEIIr OA C11E~uTGl1f 7lJ. 1ACATqM (Cit/. f~w. M ati~tp
$`uYOrWi`a~i'~~' S-12-63 Pine Grove Cemetery Fort Pierce, Florida ~
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a...~os~ A.T. Stone, Fort Pierce 5-~0-63 Anna Lee T~enison d.r.
I henby asrtHy Mfis b b~ a trw and oomset oopy of ths toml ~
_ Re~lstr~a rooord on flk in 1FN Sf. t~ud~ County Heihh D~par1~ 1
ment ~t FoA Ptsta. Pbrid~. .
(VYuni~q: Not valid unl~ss ni:ed ssal of ths St. Lud~ ,
CouMy H~sith O~pa~tmsnt b affix~d.) . ~.,?~:~'r
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N. D. MILLER, M. ~ l
County H~ahh Offiar d~ Lood Rp~tr~r r' - ;
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