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HomeMy WebLinkAbout2254 b~d~o ~ r~~EO aEC~tR~E~ sr wc~t cau~ r . ROG:+~ ~'91TR~?f ~ CIERIt C.:t;~11t COtMT RtC;,~.^. ~l~~ ~ !E 9 ~ 05 ~'~Z . ~ 2-~ 6 H s ~ 6 CERTIFICATE OF DEATH ~ ~edwewl ~ ~~wlt~ ww~ R~I?~~~i~it~llrt Gtrins lTATt FILt NO. FLORIDA tr?f. O! ~tlN1 IN ~"'~N~~'~R~1if° I~tG1~TRAR•! NO. ?[~MAN! INK O[CEASEO-NAM[ ~~~ft r•oo•1 Wt ~f SEl OA1E 01 OfATN ~ rOM1M. 0~~, ~1~~ 1. 1~ ~ r'r~ncis X. Moore ::ale , ~~n. 10 1972 il tACE ~A. Ml6q. ~r1~K~M NyYM, AGE-a~?f1 ~~Of~ ~~l~e u.~Mt ~ O~t DA1E ~f ~1fM ~~O~+~w. M~. C~UI~TY OF OEATM . y nc. ~ vetr. ~ ,.n, ~~~M ~•ws~ .w. w.s ¦ows w. •w ~ -t~ ~ ,...ite ~0 w . , ..ov.l?_ lII~l iiro~~~rd C, TOwN. Ot lOG1~ON Oi DEATH ws~~ t~ ~w~o hOS?1T/?t OR OitiEa It~SittU1~ON- ~~r ..o~ ur~t~. am s~rn uo »uwe~ ~ s.ecw. .~s w ~+o ~ ~ ~-r_ 4' ~ 11^sdale Yes 901 ~ ~~'err. STwtE Of w~rn ~ a Mo, v.s..., ?iare CI~IZW OI W/1Ai COINiiR1l MARRIEO. NEVER MARRIfO. SURN1VtK' SlOt16E ~r v~~. OM r~i0ew w~w 7 1 ~ WIOOVVED ONORQ ~van~ ~z~.~~~.~« .,.a~sac?~lise~ U.S.A. ~~~trie~. Lillian i]icholas ~ .~ve oece~see SOCU?t SEGVRIiY r~UMlER USUA1 OCCUIwT10N ~arvt ~we a Wwa ooae ax~.w .oa w KWO Of WSfdESS OR p~OUSiRY inen. u w~s ~ OCCV!!!Y N rO~~IdO UK~ MM Y{~M~ 1 ' ' _ Ca tain " p I,atin C~uarter .o+.~ssw... ItESIpENCE-STATE C01NiT1f GTTIf. TOWN. OR IOCwT10N wsia cm iwrti SitEEi AND NYWE ~ ISHCM~ ftf p~ Mp ~ ,y lorida ,p. w~ro~•.ard Hzll~ ndzle ,~~Yes ,w 901 S.'?•1. ~it~l ~~'e~°P. IwTH[R-l1AMf ~,yt rippe us~ M01HER-AMIOfN NAMf ruft ri00/e Wt ~ „ I~'rancis t~~oore i•~ary Unob IWORMANT-NNUE MA~ING ADGRESS ~stetn oa ~.r.o. ~io., cm o~ ro«.., u•n. tr~ I:illian ~•~oore ,,,QOl S.:'~ . 4t~ Terr.Hallandale, r~ia. ?nitr i- oEwrn w~s uusto ~r_ E~R orar a+c ausE rtr iw[ ro~ e 1 a ( 1(b~ ~v+D (cp arricN oMso •..s ee~w q. rneo~wn c.us~ ~ `~c:,~, lsi.~~/ . . ~ ~ . coNe~rw«s, u •M, 1 ~J ~ ~ wMKw G~r! uf! r0 v(r IrrlN~t! C~Yt~ bl, ~ t0. W~S COr~StOYIK! O~: ~t~tIN6 iM! YM/(~- lnMO C~Yf! t~f1 " • fART OTMER SIGNMKANi CONWTIONS: eoranors cawawn.q s w.w wn wos ruae ro uuse aMM w..n ~ a~ IWTO?Sr ~ ~ES vn~e nrwwas ear ~ ~ns w_ ~.0~ YO!\!C ~M OlTIIWMIM6 (iW~ ' IV p OI~1N A. I, O IN. ~qM~GDE: OR INLE~/EWI~~iED A ~r, tt~~~ ~x MOW INJYlY OCCUtRED IfMR! IY~{~ q IMIYIi IN I~~1 1«~Yt 4~ aer ~M ?M tQt M Md ~NJURr wT wORK ?IACE O~ v+~t~.i w.e. .u.. sr~en, ~.e~ca., tOCwllp+ ~ suen o~ ~r.o. ..o.. an oe ~o.n+. srwn ~ ~wan ns w.+ol ow~ce Mu..tx ~snur?~ M~. 711 „1 CERT~ICATIOPI- rOr1M O~~ ~tY rOM~1 M~ tW uO Wt f~~r ww/~It ~aM Ori ~ 00/Or~~ ~nl~ DR DEATM OCCYqED h1 w~! MKf. Ow 1! ~Mf3KUw: / .ro..m O~r ~!u t00t N~te Ot~u~. O~R. /u~0, q~! ~lfT ~ ~tnwot0 rre 1 f I~ ~7`~ TO ~,i ' j . ~ / . 7~ ~II ~ D Ile. M o Me uvu~s~iao ~ tl~ oicuuo nor l ti 7t~ tl~ /Tltir CERTIf1UT1pN-AKDKAI EXAMUNEt OR COROtrER: o« rwe ua~s w ne ~ o~ pe.w rMe otceoE•n ..s ?~o.~ou..cto oe.o tauww.npn W ew ~oo~ u.o/w ...resrwwno... ~M ~r~ O~.~W~.. rO~+n~ Wt R~t wOUe ~I a.M ocewno a+ we w~e uw oue w me uust~s~ s*•tto ' i zH ~ rn M- ! CERi1FlER-NMtE m o~ r~w SKaNATURE ~ otuee w t~ne OATE SIGNED ~+o«n~, w~,.w~ [ " ~G ~ !'11~1 k/~/ti'? ~ ~ , .~i ,'v~,,~.~ ~ ~ - ~ w?w4 w. -CFYT srner a e,r o«o. cwr o~ . ..$.n 1 r.~ ~ t~1 ' _ 1a,` C ~ , • - G~ . ~ ~ T G'Z tUR1Al, C f iqN, REMOVAI EMFTER OR QEMATORY-NAME tOCATtON c O~ to~ra s•wtt ~s~uin. • , v~ tN _..•~T3to' :~?*~ent ~out ' ern i•_e*yl'' .Fc^.r~C N~ i•~i2~.'?i, ~'lorid~ OATE ? fUNERI?l M -NAME ~np Apptf55 ~ snen o~ e.r.o. Mo.. ur. o~ ?o~.~ rne nr 1 ' ~";'~9~ ~ ::~dl~in~ton .^re~~;~r.2~1 :~:.~c;:.~~.zcd.~alland~.le,~'la. v. 5. ~612 UNERAI REG -SN'.NwtutE.f owrE ec c~ to sr iotu ~[eis~e~~ Rev. 19TC _ ~ Z! A / - ~ ~-t a"' tt~ _r.a-~~. ~tca~C :a'/ 1{b Y..- v - CERTIFIED COPY I heret~,}t:R~~ify'~_.~he above to be a true and correct co ~o Reg~,~ ` e ` ~ py of the Local ~L~rd~ on file in the Broward Gounty Health Department at For }Ld ~orida. _ . ?A. ' . UO _ ~t! t ~~~~~i.~~ ~ - f~,l~~= S unless raised seal of the Broward County Health , ~ ~s+en is affixed. _ ~ ~ p~ ~~.Q~ ~ ~ ~ . . ~ ~ ~ ~Fi.tA~OtPO~tE; L ~ ~ ~ ~ ' ~ ~ ' F t 0 R ! 0 A ~ . ~./~'i'~~~~~V~~~ - v ~ • ~ ~ - . - • y • . - ~ • J, ~ 1~ County Health Offic aad Local ~egistrar ~ 0~•• ~ _ ~ - . c~f, ~~~n.~~_1~~ / • r ~~~~1t~,\ Y . : • /~~1~ ~.G . ~ ~0~~~~~~ ~ ~A~ ~n~ 1-13-72 Deputy Local Registrar JACR WH1~SL~$ ~ERl~ Of f~llqNT OOI~t i 6~ ~ ! - ~ ~T < u~, e ('o. . ~ ~ ~ ~ r ~ ~ ~