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HomeMy WebLinkAbout1143 t??~ s._ rrwTS .o~ o. Ms~.TM CERTiFICATE OF DEATH t,~ / • eo~~s • ~YR[AU OF YRAL RAT1ff'Ip lYATt Ri{.t N0. ~•a•l ~519 ~FL08IDA erd ~Aee BI T N. N[OISTIIAR•• NO. ~ 8 proy~rl7 1. KACt 0/ ~fl?TN COD! NO. t Y~~~[sIKNC[(~a.rM~rdliw~ 11~ A.:/ww?rw~4.:u:~ ec~cat~~ ~ ~TM .•d .~11 .SL. Lucie 66-02 Flerids ~ St. Lude - - i¦ p•r- 0. cm. TowK~o~ wu?1aN a~s ?u?tc os oun~ e. dnr. rowN.oR Lot~rws s. a ~[S~DCMtE ..o..i ws~oE cmr ur~rn ~~oc arr ?w~rn ri 1.. For~. Piarce rc: ~i w? Watton rE ~o ~ ruwc ar cN•~ ~+«1~. r~ w«t dbe,.) ' ST~ttT ~oo~css ~ ~T~+ FL.Pierce Nem. Hos ital 1101 Rid e Ave. ~ ~c or str.e ~r~ l.Mt 1. W?Tf x..r~ ar Yfp 'i ~~«i~t.o MA:"fQLDE - HAAISEN o°E~~?TM M~y 18~ i96?' ~ S_ scx s ao~oe oR ~ 7- r.Ra~co Mcvu w~~co a. w~ as wrn ~c q(pI~¦ rr.~. x..w c«+ x.... x~ r e. Femele Wh3te w~oowco? o~vaeao Au6• 17s ~89? ~s! *t.iwt~ 10~. YStIAIOOCWAT1011(OiMti~f~/W~ltwt ~.Kwacs~sswd+ous~r 11. ~urNR~a(8rs..p.~Msa~~rnl t. arac.os.nwraou~mn •l ~"'`1~51~`a~i~ y"""n Own Home . Norwaqr USA ¦~s~~s 11~et i~k fATMER'S WYE 1~_ MOTNER'S YAeOEN NAM[ •t Gabriel I~fethiasaen Karolina Festevoldt ' ~7OCtA1 ~~""'TM "i0~ Reeeived :^flram ~ ss anaen None R.C. Jo~.na 38 St. Nueholea Ave. . k'esLw~o~d, Y.J. ~ r.e. r.i ~a a?w~ ~sarN ~aa...rr..~ eaw ~o?ii.e p t.~. ~e~..d u).) ~~rtuv~ ~rrccN ~•ei•r ~MT L O~ATM wl?f CAYSEO w: AMD OfwTN ~ r,,. ~ cu Multi le f'ract8rea houra e~• e~r- ~.r.~.e. ~,,,,,;~,,,.,~p,, Auto !Jlccident 3 hours •tse t~• ~ N„~ ,i~ a~ ouc m(N 1 e e• 1 ~Dw~ t~ur t~). t~atitt~? ~r~/ dt ~att?- OIiE TO t •ltl?1~ 71 Z « rMf. ~ ~ ) \eY~ f- O IART 11. OTl~ 9i1/K~Mf CaplldfS COIrI~1lfYli /0 OGTM RfI IQT 11El~lED 101fE IERM~MI aSUSE 001~1110M GMEM M/IMT 1(~I . MAS AUTOKY t~t~A~~tl~ /ERfORM[Ot V rES ? ~o ? •r D~ter• ja. ~~~~~~~r«N~RED. (~lt(ptl~htie aatte~ a¦~ ~acwcwT wK~a iwrK~oe N~v b Prt t n Pirt II ytrrr ~t) ~ p p Struck by anather car ~i•• •r 70c 7~rE Of l/wr a/wM~. D~t. Ys~r ; 6:20 P.He=~ 5-18-67 ~ mf. wluRr a0wat[o mr. h~CE OF wu~er l~. aa r Jwt ~si. 20/ Cm. TorK. OR laGTqN aDUNTV STATE 1R~K AT ~ p.o K~ M~}/.up~~d. Ma aM•. ee.) Fort Pierce, St. I.1iC1E F18. rugn 21. ! afand~d tM ~Nd /rom , to •nd bat w~r h~~ dir~ on DutA aoeurnd ~t 9:15 P. u~ on tlw d~a ~t~t~d ~Lo?~: ~nd to tM b~at o/ rn~ FswrJ~dN. /rom rA~ uua~a ~t~t~d. ~ll it~~• u •r• t• ?L NCMATYw[ (DryrrewWftl 7Ib. AODRESS - ??t. OATESMM[0 ~••D~••• k William H. Keyer, Jr.,H.D. 706 N. 7ta. St.,Ft.Pierce 18-67 i ate~r~t~. ~ ~ j~. ~YEOFCCMf7EMORC11fl~wTO11Y ?d/. ~ppTlOw(G~t/.f~rs.rr~~ry) (8tdrj i 11[ ( Sy~tc~ ) j ~emova'~ 5-19-67 George Washington M~m. Paramua, Nex Jersey ~ r. s.~ e~~ 2~. suMCU~ s s~uunu~ +~wcss a. a?rE Rcco. ~r wc~ ~cc. tc. Rcc~srru?s-s s~c+uTURC - a.•.,ose R.C. Johna, Stuart, F1a. 5-24-6? Anna Lee Lenison, d.r. - ; - - - - - - - - - . ` ^ ~ j[•~: , - • iRF~ ~?!u ff~+0~ - ST_L~CtE t~MrM T~P R#. . ~ : 1+f1«'.~` .~s~ tNe and COrreCt COp~I O~ th! LOCa~ !!~'Lz;;'JR~!?~ ~i~ i s' fib fn rhs St. luci~ Coimty Htahh Dspa~f- lLEiiX CthG+At'C~lMT ~ ` . `~t Tor~; ~;.Norida• +t~t~trtl~a;s~~ ~ . s ~ ~ -lw ~ 'vatid unl~ss rsbed wa1 af the St. Lucie ~ 3? D,1~ t ' - `~lth p~p~tmsnt is affixed.) ! r~ ' :r . 4 ~ y ; . . ~ , ` . : • .~;~'~«r,' ` N. Q MILtER, M. D, .~~9 # ' " ~ - Gowity H~alth Officer i~ Local Rpistrar ~ . . . - - > ~ ~ (o `~p~ T Drpuer toeal Rpimar , d ~ j ~ g00K~~ PACE~~~ ;3 x~