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Ee- ~TATt BOARD OF HEAL7H CERTIFlCATE OF DEATH
c~•~: • •uauv OI VITAL aTATIlT1G~ srwzc F~~c Ho.
~ea.~ FLORIDA
ord •Aen BIRTH NO- REGiRRAR'8 ~o. 3S
p r o pe r 1 r L YfYw~ w[NO[NCt l ~?M~ Iwrd ~i.r I!.+.~J.4M: tr.s.,r ~el~. ~i.w:..)
c i e e u t ed' ~~~uCt Oi KATM CODi NO. ~ STATE 0. tOUMTr ~
and •!11 ~~TM 66-02~j ,
b~ ~lacel S~nt LuCle ~ • ~
Ip p~~- A. C~TI. TOM».011 lOGiqw l. ~5 ?IACE OF OEATM c_ C~T/. TOMN,OR IOCATqM t. ~S RES~OENCE ;
aisf~t IMSIOf ITr LIYITS7 IMSIOE CITY lfY1TS1 ~
r,,.. Fort Pierce .E~ ~p Fort Pierce No
f. H~MF OF (!f ~M is ~Myihl. Iit dttd ~IOal) I. STREET A0011ES5 ~
11pSftTAL 011 .
~wST~TYTqM Ft. Pierce Memorial Hosnita 120 ~venue G
j MwMt OI ~ ~?at Nid[t Lqt OATE XMli paf } iV
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M:.~.~~ LUCY LAMB ~TH Jan. 19 1970
S SE7C ~ ~ MIOw Ow ~ACE 7 MAIIR~EO ? MEYEN MARRfEO? , OA1E OF M~TN ! A6E (l~ I~v~ li U~OE~ 1~W ~p~y(.it~ 1lS.
fvlOvfNq) Xwu. aw Nwn M:..
r r s s. r^emale Ne~ro lI1DOME0~ avoncca JL2~ ~ ~ 6
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~1tA p~r- ~~ri ~t~f~rr L trr~ rNir
¦~1~~4~ ~ousevri~e' n iio:~e Geor ia i1.S.~.
li~et lat ~ATMtR'S M4Y 1~. MOTNER'S M~IOEN MAYE
or
Caeser Cald~aell Un known
16 SOCtAI SECYRITr MO. D. ~MfOw L i1GNATYRt AW?sN
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Fun~r~1 1a CAYit 0/ KATM (EAItI Ml1 ~At dr1[~ (9~ (S). ~~I (ti.) n w NTENYAL /ETWC[M •
d i t ee t o f ?~I1T 1. OEATM 11~5 CAYSCO ~Y: A OMSET AW DEATM .
• u~ t f 11 • wYLOU~TE fMrSE I~) v~t.l: ~L c-N?~c~-i~ ~Q1 s+a.~~ ` _
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~ i t A t A• r~it~ ~sra ?+y f~ ~ L--~'~-__ .
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reRislr~r K~~ t~ p~,~ TO (l1----. -
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• f t A 1 n 71 Q ?MT 1~ OiM01 S~f.~lil[Y~T COwpiq~5 Cq~fl1~MRU~G , pUiN Rfi NOT It[l~i[D t0 T11[ i[AMIM~I pISEAS( CpNDIJpp~MU W?MT 1(~) . WAS AUTOKY
hours •f- ?
a~r d~~tA v t °f'~ rERfWtMEO/
o r e. ro r. 'LQ,. u.tis.t~~'t'Ga~ YES r~
20~ alA oESt~~~E Mor r oCCUa~[o (E~ttr w~rrre n' ir P~rt I n
•~k1sa •w,~ ~ ,KC~OEMt SUIC~D[ NOYfCtOE JwI P~?11/1/il[~11.1
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~ 20I WIi11Y OCCUIUEO 711t. K/1CE OC uUU1111 It. I-. y K~~ ~~t. ZOf CITY. TOtfM. OA lOGiqN COttMTY STATE
WM~IC AT ~ MpT MMKE ~ N~A. ~K(NI. N~tet. ~~tt GII~.. NtJ ~ _
MOIIK AT MOIIK
21 J~tr~nd~d ~M d~c~~s~d Irom . . . ro •nd bst s~~ ~~~~/i~~ on
D~~th oceun~d~t ~ 2:~~ m on tA d•~u~~d ~awr~: ~nd ro tA~ 6~it of en~ im~I~J/~. lrom eM uus~s ~had.
All lll~•
are to 1• ~ f10MATYAt ~~K ~r [ii4) jjb ADDIIESS ?2~. MTE SIC.MED
cowyl~te t ~ • ~ t ~ ~
attu~~te. 23f 8U71u~ UEr~Tqw. ^ E j~[ h~YEOiCEMETERYONCREM~TQqY
lOC (CIl/. tMCA: M CMllf/1 ($f~ft1
BuriLL`1°"'n 1/2 /70 / Pina Grove Ceme'tery Fort Pierce, rlorica
9• f A 12 j~ iU ~ l pRECT011 S 51Gq~TYR[ ESS " 25 pl1TE afCO. ~Y IOCAL W[G Z6. GKTMII'S S~GNAT~IIE
~ rt. ~erc
a~•. ~~6~ ~ i~ . , c Januar.v 22,19~0 • ~
I hereby oertify thls to be s true and correct copy of the Locai
Registrars record on file in the St. Lucie County H~aith Depa~t- .
ment at l~rt Pierce. Florid~. ~ ~ _
.
t(Wun+ng: Not valid ~nless raised sea! of the St. tucis ,
• Counry Heshh Departmsnt is affixed.) ~
. N. D. MtIIER, M. 0. • `
, County Health Officer •b tocal Registrar 233185 , ?
~ ~~tU~GIE COUIITYRF~A.- ~ ' \ . ~ .
Da Depury Local Regimar ~
. ROC~R P4tTRAS .
CtERK Ct3CbIT CQtlRT ~
RECORO YER+i~EO.~.,~.....
eoac2~'~ r~c~ ~Qy J~. iZ I i~ PM'7Z,~/~
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