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HomeMy WebLinkAbout2936 ~ CERTIFICATE OF DEATH 23~ Deparl~wnt o( ~~~s~th anJ k~l~~~.ilit~li~~ ~~~~ir~s ~ ~~~icw,~ ~r u?. u n~ F L O R I D A fTATE Fi~c No.- TrVE, OR ?RIHT IN ~"'~"""'^°Q'^""' REGI6TRAR'S NO. vfRMANEN~ INK DECEASEO-N~wf ~wo.t ~•i~ SEX OATE Oi DEAiM ~ ~o..~~. 0•., .e•~ ~ SEE ~WDIJOI FW ~s?~ucra~s , Oonald George 8rev~er ,male , dla '!0 19?2 RACE MM{t~, NfGfO, ~~Lf~CtN ~..o~•N, wGE-~~sr u.a~~ u.wt~ ~ o.r DATE pi ~tRTM ~ro.ar, o~~, ~p~~TM p~ pEATM l1C. 1 Yltu~ 1 ~~~tw0~~ ~~l~tS ~ rpS. Mt3 MOU~S ' rM. fl~~ ~ ~ White ~.55 s~ k . ma 29 1916 Brodard GInI, TOWN. OR IOCATION OF OEA~H wy~o~ ~m iw~n HpSMAI OR OTnER NS1rtUiqN-w~E ~u ~.oi w mMe~, c~e srat~ .,+o ..wuu, /5 / ' S~lc~n rtf Ot wo ~ `''r'' Ft. Lauderdale yea Holy Cross Hospital STATE OF WRM ~ p wOt ur u f~., .~~rt GITIIEN Of 1NHAi CO(pdTRY MARRIEO, NEVER MARR?fD. SURVrvMKs SlpUSE ~a .vMt, arve ~uq[N wwt ~ cw+m ~ w100wED. WvO~Cf~ ~ srecNS ~ ~5~~,~•~s~~ , mass. • U: S. A. married Po11y Mla~rofrides wr.te! OtQ~StO ,~•t~ oe.,M so`a~u sttuaTV nuw[R uw~t octv!wrqr+ ~w.e ...o o..o.: oo..E ew~.w •.os~ w Kwc ot ws~+[ss o~ u+oustar OCC Wl2D w ~.ouwc uie, e+e.. u~enuo ~ ;t~ ~L Real Estate A ent Real state cr,ss~oM RESIOENCE-SiAtf COUNfY GT~', tOwN. OR IOCwTtON ~MSwe tm ~rni SiREEi ANp N1M~{ER L~~. ~S?Et~n res Ot w0~ ~ Florida ,p St. Lucie ,.,Ft. Pierce no ~«'t305 St. Lucie 81vd. fwt?eER-M.aa+E r~nr ~p~ i.u MOTNER-nU~OEN N~ rusr ~ ~s Arthur Bremer dlary Pfper 1?+FORM~trT-N~wf Mw~WG AOGlESS ~s~rt~ w ~.r.o. ..o., cm w*o.rn, a~.n, er~ (Ars, Polly Brerer ,n 2305 St. Lucie Blvd. Ft. Pierce Florida ?ART 1. pEATH WAS UUSEO (ENTfR pIVl11 pN[ CAUSE /fR ItNE Fpf (o~ IbJ. ANp (c)) ,rnw~.~ u~ wrtOUt! UuSE ~~tiF~M ONSII ~MO O~~~M ~o, S'i' i' ~ C ~ 1 1~.~.~ . . . ~k~,..~~ . : : ;o ~ ~b~ ~ST~I hfn'l C RR.~~ (N ti? ~ . ~rrtOttlt C~YS! ~0~, ~ Ov! O~ ~S w CO.~StOWr+t! p. ftwi~wG ~M[ YMOlf- li1Mp ~~VSE Ut~ ' PART • OiNER SIG~r{1FKwNT CQ?aW1YJNS: co.wano.~s co.ueuun.a~ ra, o~.n~ ~ui ao~ Huno ro c•ust c~rt» n. r.~i ~~a~ AUiOrSY IF ~ES .re~e ~~~o~NCS co.+- `''lA~~ ~ ns o~ ..o~ HaeEO u. oere~.~..~NC uusc V tA ~ O n? oE.i~ probobld ACCtOEM. SUKIDE OR ipAiE l1JUltY i ronr~. o,.., ~e.e ~ NpUR MON IN)UR1f OCCURRED ~ e~~ ~n+a or ~wu~. ~N r.n ~ p~ r.~i u, ~nr !?Jh1K~6f: Ot twDETERMU+ED ~eoM ~M 2k M 10! IWURY Ai wpRK ?U?CE Oi iN1tMtY ~ort, ~.~r, a*.en, r,ncn, ~p~wnpP~ ~ s~~en w~.r.o. No., c~n o~ rorN, srarc ~ ~ s?K~n rts o~ ..o~ OpK! ND:.., Et: ~ srec+n ~ IM !M 7y CERi1FKAT10N- ..w~M o•• n.~ ro.ax. pa• .»o usr uw MW ~N/~ A{fv[ d1 t OW/pq spt rnwr Mf DfAlM OCCUIRfD r~t ?ucr, a. u.e ~NtSK~~~a: T~ ra+n~ w. rtu ~oo. u(n~~ w.u~. ~wou~i a~n, u.o. ro mt as- 1 ~t7FMDf0 fN( t ~ ~I~N~ay 177G Zlt ` 1 % • s ~ }l~ OICf~SlD ~fOr ~ v , O~ r~ [~tlDGl, 07t ~ 711 ~ 71e M*o M~ c.ux:s~ u.~ec. CERTl~IGI~ION-titEOiCwI Elt ~ fR R~pYpNEA o.. rMt s.s~i o? r+.t ,w~a os ~.r,. ~~e c~ceoeN~ ...s ?eo..ou.,po oc•o eaw,.w.~~w. a nr wo. .,.o: o~ ~...esne.~.o... o~ww.+. ro~rM ou .t.• ~.ou• oe•n+ occw~eo a+ w o•n u.o ow ~o ~•r c.use~s~ sr.reo. r n' - - rn ~ -.1=1.?~~ f • ~•t~ CERbFtER-NAME ~mE o~ re«r~ SIGIdATURE - M t~, ~T~ Frank G• Baratta - i ~ "~t 'DATE 51GNED ~..o~.m. o... M/?lNG wDORESS-CERiYIE[ snerr o+ r r o. ..o c. ro.... . t~ ~ ~ 2480 E. Comroercial Blvd. t. lauderdale ~'~orida ~tlR1~l, tRfMwiqN, REMpvwt CEMETERr OR CYE~.t~TOQY-r~w~+E IOC~i~ON c~n w p.~.a sr.r~ ~ srecur ~ ' Removal Naverhills Alass. OAfE ~.w+~N, w~, q•~ r ?UNERAL NOMf-NAM.F AND ADpRE55 f4tli O~ t.~ {rtt O~ 10~~, St~tt, L~ ~ ,u may 11,19?2 „~Calis Funeral Home 2505 N.Uixie Nu~ .Ft.Lauderdale Fla. ~612 flR/ERAI OIRECfOR-SI(;N~iURE tEGISiRAR- NAj QE D~tE RECEwEO N IOC~~ [[41Siba Rer. 2970 ~ ~ ~ - tw . ~ I ~ 7W , f Q~~7 ~ - r . . _ - . . i ' - - - CEATIFIED COPY ~ ~ - ~ ` I hereby c~rtify the above to be a true and correct copy of the Loeal ~e8~ -_.qrd on file in the Bro~~ard County.Health Depart~ent ~t k`~orida. . ~ - ~ ;~~'j. ~~.T , _ 'z. ~ • ' ' • ~ _ ~ ~cs u?a - ~ z r~+~ 1~ , _~~a~sg=°~•~io~ ~,:~ral~d unless raised seal of the Broward County Health ~~~~o . " r` - { ~~pkir~ment is ~ffixed. ) • : 1; ~ ~ ?'.l . . , ~ c~ r+~;,,': . ~ • , ~ - %t% , ry13S~ • T.c~ ~~v ` ; " " . ' .`nco~A ~ . , . r.+ - ' ~ v~A~n . _ ~ ' . Li:~G~e%~~~/~~L^'~~.1 ~ , ~ o~'~~ L~'~~~'~°~~~''~~ ~ County Health Gf.icer and Local ~egistrar ~ 7° w ~ ;~1~,11 - ~ ~ ~ ~ ' "1?,F7A'." I . ~ • - • ~ ~ ` ~ . A ~ 't~7i1.i. . . ~ l%~iI'V{V N.~ s~ ~ 5-15-72 ' ~ BQOK~V~ PAGE~~ Deputy Local keEictrar - - - - _ - w