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Home My WebLink About1925 Avvv.+v ~C~~~tTiF1ED COPY WE NEREBY CERTIRY ;f{1E,~ ~Y RER,!lODUCED SEIOW TO BE A TRUE AND CORRECT COPY OF THE ORIGINA~• . O ON Irlt~t~IN TN~ dUREAU OF VITAL sTATi'JTiGS OR TNE fTATE OF FLORIDA. ~~~~~NZ;,OF H LTH ANO R[HA6ILITATIVE SERVICES. OIVISION ~ p ~.r OF NEALTH AT JAC~~Q`~'1 Y~t~ t~}4~ ` ~ ` ~ • y~ ~ O[rAi1TM[NT O~ N[ALTN ANO 11[MA~ILITATIV[ INCT VA110 UNIEfi LM~~AI.•OR:ZNK1TAf~~O~ll~• •tRVIC[t. DIVI{ION Ott`il~T{F'~tAFFIX~OrI.~ •r ' . • ~ ::.~i j ~ • . . j' ~ ~~a~ ~ ~ _ r... ~ sr " ~ n'~.' O.~ y~ ~ ~ Cl11tr. WAtAY I Vlfwl RAfl~il~/ • t~Y : ~ T ~ i 6 ,y ` Y ~ ~ , 1 • • ~ wi+~,`x ~ • ~TAR AlOI~TwAAi WIIlCTOII. MYINON ~ Y • ~ NlAITN OIMATMtNT O~ NtAIfN AMp • K •'~~~~~G~,- IKNA~ILITATIY~ KR11~C[S . . _ . - ' .E~ . . • - _ ~ , ' ~ • l.t"'1 l : "y: - _ ~ ' f7ATt eowwo o? Nu~TM ~••GERY~RICATE OF DEATH 69- 0 017 3 8~ .un~?u oF v~Tw~ rr~rirru• ~ F L O R I D A sTwTe F~~c No. _ B~RTH NO REGI6TRAR•8 NO i 1~LAC~ Oi O[AtN GOOE NO. 2 YfYAI R[SIY[NC[ l r~w~ ~~rwd I~rN l~.titd~..~ Rr~r~tv N~~.~ ~«wr~w1 d a CO~KT~ ~ACj2 ' • ST~T[ ~ C,~~Mtr . . 23 -184 :'l~ricla .?dr.e = ~l. CITY. TQ1NN. OR IOCAT~7M f. IS KRCE Oi O[~TN C~IY_ TOWN.OR LOC~TqM t;5 4ESIOENCE ^ INS~DE iY Uw~T5/ S• rS~?E CtTY UW f9 Atiasr.i i2each T .FS~j '-i~-~:i l~e~ ch _ ____~__vr5 NO ? NAME OF t I/ ~M ie ?o~j+'a. ~[t ~'~[tt ~J~rtu> / STREET A~URESS ~wsnT~~ o~ (:n~11riS r~V@ • ' tMSTIT~Tqu Dit J12i81 _~3 t81 I _ 3 MAM[ f~r~t Villft LW ~ D~Tf A[onf11 Loi 1't~r _ KC[AltY . y_: T=~I:U D~EFnTN J STlll? I'~ 12 1~9 17yPr er pn~Il S~X 6 C0:0~ faC. ~ MaRRiFO NEVCR MANP~EDC • OATE OF SIPTM 9 AGf ~/s ~tar1 M U~UR t rWl ~pE,t2~ MRS `~ept. lb ~ ~391 ~•,r nar~t.r? x«w n.,. N..-. x., ~~,81e in7:l ~@ vnoow[n ~ avcpceo 77 , 10~. t15tl111 OCCU?ATMJM lG~n kia,~ oJraa fe~r fOt K~hDOilUSINESSOR INDUSTRY 11. ~tNTMKACE fSYUt p/ortM~ tor~t?rl 12 C~t~2EM Of wKaT ~JOUy~r7 ~ Ir?Js~ woM ~/rarb~y7l~k. trrw ~!•ttvN' austY•la l: •A• President ~ ~Ptll~O~ Cil t~urner Co. • Il. iA?MER~S M~ME 1~ wOTME1l'S MAIDEN NAwE • i~:eier Thau L'ertha (tinobt.) 16 SOCIAI SECbR~T~ NO i7 IN •~IONA?YR~ Allrrs~ ~ Gel~a au j455 Cellins :~ve. :.iami Heach, r'lorida 1• t~uf[ oI O[4TN (E~r wh ou c~~u yer li~e /4r 1a1. 1~~. 4•~ e~l.j INTERVI1l 6ETMCCN MRT 1 DEATN M~S CAUS[? ~Y~ ONSET AND OEATX , IMYfOUTE C~uSE ~isecting l~neurysm oF TNoRAc~~___ AoRTq_ Coduiou. ~I pI. O:h rb: - - - - - - - , r~it~ /at nr~ ro : ~tiotr tar~r ti). f(~ttR/ f~ ti~In- G.E ~O Z f~iA~ t~ax luf. - - - - - - ~ ?APT ~I OTIER SIGhY1CAM' C~7?.ITph1 COMTRMUTW6 TO OtATN ~If NDT R[IAtED 10 TNE T[RMI~I 015EASE CONWTDN 61YEN IN ?MT ~(O) wA5 AUTOPSY i rf~RiONMED~ ! < 11E5 pl MO ? - I V ~ p~ 1P~W~eb1 ZOD OESCRIOE MOW IN/URY OCCUAREO ~f:wln ndrrt eJta~ur~ ie Pat I w Pa?t 11 o/i/ew /jJ ~ ~ ACCtDENT SUtC~OE titti'C:^E Q r V ? U :...J - aoc ,~re o~ l~o.• ,~~c+?. :.o~ n.. - '~iNOT''„ATE$IPFQit1GfATfOl~i-- - ~ - SECURED AFTER ORIGINAI WAS FILEO ~ p. ~~1/ WUR1I OCCURRCp 1(Ir ?t~CE Oi iNJUl1~ (r. i~ w a~er/ ~oett. IOJ C1TY. TOWN. OR IOCATION COUNTY ST~TE MN~LE AT ~ NOT wH~~E 1ar.. a~a~. u,..~, ~Sfu Dlt/.. Hc.) . MONK AT YIORK ! ~rtended tM dec~~s~d /~om 1 ~ ~ . tu - •nd /~st a~~ h~m ~Iiv~ on : 21 - t D~~eb oecurr~d ~t _ ~ m on tA~ d~t~ at~t~d bo~~; ~nd to • 6~at o1 mr krw~s'/Mp. ~~om tM uuNS r~t~d ; i ?2s SIOM~ ' (1 p~ tblef OD r ~ ?It. DAT ~ p . 1 r 23~ M1q~~l. r~ ~Ow 23~i D~TE HAMf CEMETERY OR R wl ORY 23d LOCATqN ~C//, fNra. W t01tilfr) ( W~~ Bur~ ~D` 3ar:. lj, i iit I~;ebo Cerrietery Miami Florida j{ s1MtRAl OII S SK.NATUIIE ~ i~pllESS 2S 0~1iE 11ECO. ~r ~Otnl IlE6 iKT~A~'S :~veraide Memorial J~.13 1969 ~ v ~ u~ ~ _ ~ .Pt o~ ,-N.~~ r w 9n pf'ti2 V ~C~CT NI o a-~ Z C~ ~ 7o-~O W -o gN,~ • W = ~ >o ~ ~ N L . ~ 600K PACE19~ - ~ . - °e..