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HomeMy WebLinkAbout1077 z33ss~ : s Dc- ~TAT[ eo~?wo o~ Hirw~r+ CERTIFICATE OF DEATH co.es • PURGU OF VITAL iTAT1YTIC~ YTAT[ Fltt NQ irqal FL08IDA orA •Aen e1RTH NO. RE616TRAR•!1 NO. ~ properl~ . e:ecut~d 1. rU1C[ Oi Yt/1TM GODi NQ 2. YWAt R[NKNC~I/aw~rw.dliwr fl:w~Arw: R~.MrW.n~reu.) s~° .il O00N~'St. Lucie bb-025 ` ST~T`Florida C01f"TMSt. Lucie De pl~e~d ! rt p~r- A. C~T/. TOwM. Wl ?OC~TqM t. 4?I~CE O~ OE~TN t. C~TY. TOMN.OR IOtATqw t. K IIES~OENtE • i n~ o t tN510C CITY LIM7751 IMS~DE CITY UMIiSt , r,,.. Ft. Pierce YES[~ ~O Ft. Pierce ,~,o I. NAME OF . (lI N! iw ~N~itd. Iirt ~hod Wrt~) STRfET AOW~ESS ' . MpSMT~I 011 NKT~TUT1pN gt~ pierce rtem. Hos t. 915 Ave. . w?Mi o~ f1.r al:srtr Lur wTC LI«W? n.r Y•u ~`,~M~.~w, iJillie rlae t,ioolley ~TN Feb. 17 1969 S. SE% 6 CO1011 011 11ACE 7. MARt~EO ~ NEYEII MMN~[D Q~. DATE OF ~111TN ! AGE U~ K~?1 i IMQ 1 ~W N~DlA H MS. ~u~y . 4 1915 a.. p..~. w.,. w r 1 t. f emal e ~u • 1hpp~fEO ~ .71VORCED p:? t n 1~ IO~- USUAI OCCti~ATqM (Gi~t ti~~ ~/tM! Nu fOD. K~NpOi WS~NESSO~ WOUSTIIr Il. NNTWiACE (57~ft M J~?ryw d~~fr~) f2 pTR[w Cs RwtT WAri~~~ ricA per- ria~ yr~? 1 hk.en~ifrdvd) . ~ac~er-~~trus Pievins ideal Glenville. Ga. U.S.d. DI~ck iek ! I3. IATMEA~S 14YE l1. MOTM(A'S YA1pEM NAME { i o r 1V&Y1C3/ +~'1"L1TII ~TP~~~It~~ Unobt. ~ ~ K. SOCUI SECURITY NO. 17. IN~OA L SIaNATYR[ A//rtq qi5 Ave. i'1• 62-24-8609 F.arold ~ioolley Ft. Pierce Fla./ ' F' u n~ t~ 1 1~. CAYfI Of ~[ATN [6wh? ~wl~ Mt cNiu ~tr ti~t /r (01. (t).) INTERY~IL aET1IIIEEN ~ d i r a t t e? ?411T l OEATN 1~AS U{16ED ~r ~~~y~.~ r/t~ ~ t f~ l• . IMMCOIATE WISE (f) A(:N/f.(~~0~.7~J/Y[O~aS~ W^.G ~ cne e~r- ~it~o.c• C..tir~«u.:/•.r. ouc ro ~e) Coaancuy Idea.t~t D+aeaae 2 t!?.Q/C6 ¦ 1 t If tA~ r~i[? /~rr r4~ f~ ~ - . I o c • ~ ~Dret ttut (i). - r e~ 1 s t u ~ K~fi~/ l4 MRIt?. D1iE TO t) ~ ~ 1/i~~ qut lut. ~ ~ o u r s n f? ~ fMT 11 OT~ SIGI~i1C~MT COwO~TIdR COMTMRIfwG 10 OL~TN MR NOT RGA7[O 70 TME 1ER1~1M~1 OtfEASE COIiO1TIQM CNfA MI ?AR1 f(~1 TOKY . crr de~tp ~ YfSQ MO~ o r D e fo t• 1~~ l ~uA~ ~U~lf pCCURRED. (E~lO adW~ • t i~ Pwf 1 M PM! f/ ifts N.) . n ~ f n6 •w7 ~ ~c.aocNr w~c~a NoirK~ac / vr?r N d1a~o~t- ri a ? Q ~ . tion O~ V 20c T~wE os 1INr M~wq. Mt. Yer ~ bod V ~WY . G D- r- W ~ ~ 2W. YUYIIY OCCU1111E0 mr. ?LAtE OF uUU~~ (t. I~. ~s M~A~rf w~t. 7D/. pT~. TOrN. q! IOCJtTIW~ COUMTY STATE WNKE AT ~ n0T wN~E ~ /V~. htW/. rtrrN. aq., tft.) ~ NORK AT 111011K I~ ~ I ~ff~ ~d tM dKNS~d /rom „ fo ~e,apJJ~ ~"SJYe •nd I~st a~~~~Ii~~ on ~ ~ D~~? nr~~d ~t ~2 m on ths d~t1 st~tM ~bo?~; ~nd ro tM b~st o! m7 kno~Nd/~. /rom tA~ uusea ~t~t~d. A;: tt~~• jj~ tl • r e t o E• ~«/~K M fY~ I2G AOp11ESS ~t, D4TE 51f.Nf0 ~o.,,.~. a P.CI, ftwC 3657, 9t. Pi.Pitce,~la. 2/20/69 • c c u t a t t. ~~u. ~~~i~. ~ pATE 27t ML OP CEM[tEAY pll CR[MATOAY 23/. LOCAT101r (LS!/. [Mrf~. r~~J (ST~ft/ ~ b~ur~~'t"~~'~ 19-1969 . Pierce Cemetery Ft. Pierce Florida 'i . t612 2~ F WRfCT 5 IfMATURE • • Jf 2S. DATE RCCO. ~r WG1L11EG- REG1ST11A~1'SSKMATYRE . nev. Ip69 Ft. Pierce Fla. February 20, 69 o-^ • ' fILEO AkD RECORpE8 ~ :T. LUCIE COUNIY FLA. ' ' ROCER P.OITR'A5 _ - CLERK CfRCtIiT COURT 11ECORD VERIFIED.,~~~ • ~ hemby oertlfy this fo be s true .nd corroc? ooP9? af th. t~oc.~ 19 i 3~ PM'?~ Registrars reoord on file in ths St. Lucis Counry H~alth Depart• . ~t .t ~ P~~. F~,~.. 23356'~ ~t- ~ . (Waming: Not valid unFeu raised seat of the St, tucie • G~~ ' . ) _ i ~ , Counry Neelth Dtpertment is aftixed.) ~1 - ; =7. . r~i = • ~ - ~sY ; v. t ~(l • 'S~Iy~ , N. D. M1llER, M. D. ~ " ' ' ~ CouMy Fi~alth Officer d. locai Registrar • ~~s. ~ ~ , = -~.:i~,, ~ t a:;.y ; ~ ; c~ - ~ a C, ~1 J'.~t~ ~~i,m,?~.. cwa ~ _ ~ r' ~ - ',t . ~ c~,~. oe~,y ~i r~~:~~ ~ j a~'~ r~~~ . • ~ f ~ ~204 ~l0??~ ~ ~ ~ _ _ _ - - _ ~ ~ = , f s;,~. ~~.~v~~,ua