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HomeMy WebLinkAbout0428 T~,. rrwT~ w~eo o~ Ns~?~rn CERTIFICATE OF DEATH ' - - ~ _ , ~ ' ~ o a•• • ~u~uu oR vnn~. ~r~r~ncs ~ F L~ A I D A ` Rwn ~u Na c , ~ ord •h~s T NO. RtOliT11A11•~ NO. prop~rl~ 1. KwCt N~tAfN COOt NO. 2. YWAI w[N~pIC[(IMr~~wrNliwL /1iW~.M~ S~wMwMh•~M~irW) • t~! Y L~~ oou~Tr BRISVARD : p ~ S~ORIDA cou~Tr BR~/ARD •nd •lll b• pl~e~~ t n P~~- tITY. TOwM.O~ lOCA1~ON c. a ru?a os oc~n~ t. CITY. TOIrN,OA tOCAiO11 t. K IltiIOCNCE ••°•°e TITUSVILLE ~~sjQr ~~i~a~Q TITUSV'II.LE u~s~a t~tr ~w~rs~ r > > vcs i'o~_ 1. II~M[ Oi ~IJ wM 1~ ~M~ild. /W M/Nt dbtN) STRECT AOOR[SS JESS PARRISH Mt~IORIAI. H06PITAL 115 BROMMING AVE ~ NAMS O? !'Urt MIMft L~M oATt ~IwU? Dq YNr n.~«; OTIS NM. HOLBROOK « T~ JANUARY 26.19'~0 S. SE% ~ COIOA Ow AAC[ ~ YI1~R0 NEYEA MA~KO • OATE O/ NII?N ~ AfiE IIA ~fM~ ~{~0[~ 1 ~W IMO[~ N 1~: 1 M~1w O~w Mwn Yi~. ~ t • ~''uLE ~TT 6 ~~,co ? avoa~o JUN B l~i ~ 1 ~ ~ r. a f w 1~ 10.. usw?? occw~laM IOM. u.r Nw.t M~e IOe. Kwo ar wsw[ssw wovs ~+~r 1~. su~Twt~ (9w.. M~M~ ar~n~) crosa a ~w?r oourm•~ .lt~ 1 rl ~wf~' w^r~1~IhN t~rl~d~eQ O•S•A• •~nswt ~~~~Al~l.~ M~.Sn,rS ~ 1 w e! I~! 1 /ATN[~'S w1ME 1~ MOTNE~'S YA10ER NAYt e,..:.,~.. NL~ HOLBROOK EI.IZABSfA AONPHt ~ socw secuR~Tr ro. q. s sNw?~ w~r.« •.z35-10"~58 VIRGINU HOLBROOR 115 BRCJWNING AVB T .~p...i uws «~a?TN t~a..~r.•• ~w.. re. ti.. r t.). c~~...~ ca.! , urtu~u ~crrccN ~•~T a~n~ wws c~usco rr: ~u ou?n~ a ~ e s • • wrcou~rc csusc pl ~ L ' ` . l - " L-~ a t C ' !t /ciL~ ¦ust tli• te. e•r- ~ c i r i e.~• c1.r;tw... s.r. ouc ro c~) ~Le' ~.i l .t ce e~• ~k~ ~ ru~~ l• 1 o e • 1 r~s1~t~~f ~fYfy Mt ~~/t?- py'E TO It) . i t A 1~ 7 i s ~~iy nr~r fwt. O IMT 11. OT~EII SK1r/K~Mt 00r101tq4 0p111~R111{ p pyM ~Yr 1101 w[47f~ 1'O h4 RM1MMl 01ifAf[ OO~OII~011 ill~ M NMT 1(W Aour• •f- ~ /[~tO~M[01 ~sr A~~t\ Np~ a r e. to~• ~~r acu~ao ~t:.r,...rr.. yal.n a r+wr P.n u yw. ua •~tl~~ •w~ ~ID[MT SUKIO[ IqMIC10E •P~sl- v ? ? ~'i n •t J me. ?wE oi Hwr ~fMM. O~/. Ye~r o~ d~. 3 INl111111 1A. ' a ~ m/. auuur OCtY1a1t0 mr. KAC[ o? wiullr q. i~ r~t w.w. m/ dT~. tOwN. 011 lOCA110M COYMri fT~Tt MfM~( AT ~ 11pT MNR[ ~ N~A. Nt~N~. ~tsN1. ONI~. Mt.) , ~ MO~K AT MOIIII ~i =t . 1 ~tand~ tM NcNMd /~orn ~ . to ~ ~wI lpf r ~n ~ FwfA oca r~d ~t ' _A. M.._ rn ow f/w I~t •t~t ~w/ f~ fM M~t a/ q1? N/M. /~~vw fM uwN ~t~N/. • i i s~••• tt. 1 ~ cu~w~. tte •oo~css 1309 GARDBN ST. . rts. a?re siaNCo ~ / ~ 1`2?~i~~ ~o.~~•e• • . I ~ / • e e u r~ t~. ~~i. ~~T~. Z7~ at[ 27r ~r[ or urcT[~r o~ t~tr~ro~r t31 Wu?iqs l~. twn. M asMh (~l B~~~~';`P"~h' JAN. 29.19?0 BREVARD H9'~ORIAL PARR ~tS11AND COUI~Y. FIJ1. r.~. I e~• t uNc~ 'cTo~~ s~wu?TURC gMI'1"1~01lR1N ~AL HO~ME n aTC ~cco ~Y wc~ ~ca KTiu?~~s s~wurw~c a... i oee i:l~ 7 /-~T 7- 7a .~~e~Lt.e ,d~+~L - - - - . - - I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF THE RECORD ON FILE IN THE LOC ' 'S OFFICE IN THE BREVARD COUNTY NEALTH DEPARTMENT. "x. . ~ i f: ~ ' ~ . j' t Ng _ . . f r, '.:the seal of the Brevard County Nealth Department is affixed) -~~yL ~w fi. -'.".i..~r: ~ ~ - ~F~ ~ ± i .1; `~=r- ' ~ ~ ~ ~ a . `•f ' f-.._,...~ . ~ - ~;~v`~':~~ Deputy Registrar , . ~ -~a~• ~i ~~r.. ' F~LED ~h~• p ST. WCtC ~OiiNtY fEA. - s- H':r~ ` ROCf:R f~C+fi~A; Ct f~K ( i.' ~~~t CDURfi ~ ~ . rn R. .:r~aj+ ycr r,c h-_ 1'A ~ Mar 9 9 ~6 AH '7Z 2~9029 b00K P~Gf ~~O ~