Loading...
HomeMy WebLinkAbout1296 T.: s~ - CERTlF=~ICA'f ~ OF DEA~'N c~~ ~k s• ~~r~wdmen! o~ ~~aa~t~ and ~c~~.+~~i~it~tl~e Ccnkes ffA7E FILE ti0. :i av~n~~ o? ~u.v.in F J. G R I D A . «,.,~«.,~..,~.~„~x, cra +hen REGISTRAR-S 110. ~1 sr.lperlJr 33~13 ~~OUE 110. Z. YSVAI RtS10L~lL[(IPaw~lawdtu~J lf~vl.l~ha~: ~rwtAaMJw~M.~.u.s~) 1~ •b.tcuted ~-~~AC[.Of btATN =TAi COtlAi~ en1 ~111 CO~hT~ /~'~V(F`f F; or~dQ ~r0`r7AY'Cl~ De pl~ced ~r~:•~-~x 1n D~~. C1Ty,TO~~.ORIOC+IlYJn t. 15 ~l~lC( O~ DEA7N t. C~iT,TONN,ON IOC~T~ON t. K RES~Ot!~CE ~ INS~OE Cli~ L1MiT51 IMSIDE CITY LIlIITS1 i;,~°` Ft~ Laudarda rESl9, ~00 Pompano Beach ~s~g ~~7 t. IUNt OF w~t in ~ayital, t~st ~lrtN sl~rtu) t. STREET AODNESS f Nos?~r.~ oe ~ ~s~~T~Tb"~3rok~rd Gener~l 2ted C~~ ?!~8 S. E. th Avenue ' ~ NA~IE OF Fi?It N~t~ft ! lsi! OATE MOw[~ D~/ Yts? ~ ~Tti,~N ~.~a~~ WILLI Ati LlINGFJRD RTCE °EAT" an ~ar_y_31 S. SEK ~ C0:011 011 RIlCE ~ M~RR~EO ~ NEYER MAAN~EO? ~ DATE Oi tIRTN AGE (fw ~tv~ M C~~:R ~ tiW Wt/Eal~ ~'S. L tue 0'ut~[~l1 a~.+t~. D.s. R.w. X:+. • r 1 t. riaie ~ ~mits w~ooNCO~7 DIVONCEO T~iapJ ~Q ~,p p 1 a 1 n 1 y ~U4~ OCCUi~Tqn (Cu~ tinQ f/~i0?: ~oqt 1W. KIAD Of CUSIAESSOR IhOUSTRY 11. {IqTMKACE (.S~'Jl N/~~t~)A COltwf?~) 12 qTt2fN 0~ wxRT OOU.ri~t~ • f t A p~ r- Iaie~ ins~t ~/~r~rli~~ h/r. tcew jJ ntutd) ~ ~ ¦~nent Farmer A~riculturo Florida II S A. ~ , ?1 ack 1nt ~j_ ~AiMER'S N~ME 1~. MOTMER'S MAIpEN NANE ~,F~.~s«r Richard H. Rice Nao:ni ri. Unotitainable ) K. SOCUII SECUR~Ty IMJ. 17. INfORMANT Afbui 2 S~ E. th Av enue ( b2~60--8780 Mrs. Celia Rice Pom ano Beach Florida ° Fu n~ r~ 1 ~E. CAUft Of G~ATN (Etitt~ ~nl/ o~t toult yt? (int /hr (a). (AI. ~n1 (t).~ Ih7E~VA~ ~ETNEEh ?ApT ~ OEATM NAS CAUSED ~r- 1~ ~ OMSE? 41Ap OfA C y t/IiLt/isL«LCtcY L~C1~Lt~s. LtisLit~t ' 9 t r c c t o r 1NNFOU1iL tAUSE ~u•t Lllt - /-~-I tn. e.r- ~i(i(iLt+~ific~.t ~-~.~t~ 'f~~N-iiL~ , f t3Cicat• ~~~yjoR~.~~en~. p~ TO (a) • 1 t A t A~ r~icA /sn rps b . ~ 1 e c• 1 ~Dast nru (a)• r e_ i s t r a r ~~~+~f f~t rwQu. . i c n~ n 7 Z hia~ nair lait. ~:f To (e) O ?~RT IL OinER S~G~:iK~Nt COh~tTqaS CO~TRtDtJtt'~t. TO pUliH l~Ji Iqi REUt[O 10 7ME TERYtlWLL pSEASE CWwfITqK G111[h Y1 Nu1T 1(~) . 1MA5IUTOKY . houts af- ?(Ryf~pqMEO~ ~ : c.r ee.~A s ~I1M~i1-s.~ /~t+~+'Z~tsi /.t~~t ~it~.ttu~tdt-ttae~ +l (J =ttas. trcs[9 tu? ; or Defore ~ 20~ ( ~~VI 20D. OESCRt~E NOW INJ~RY OCCUAREO (Ealer ~drre yiyer f in P~rt I a Pat 1/ ~/iftn j ~aklna ~ scuarcr wK~ac NoMK~oE dt~post- tw1 ? ? ? t i o n O f J~ TtM[ Oi tlOr? ,II~nA, D~~. } l~r ~ p o d s UUURr a~. . ~ o I- w. w ~ 20~ 1NJUR~ OCCYRRED Nr. tI~CE OF ~H1UI1Y in a~!reat A~.Re~_ 20J .ClTy_70MYK.DR IOCAT~6N OOUNTY ST4TE • NM~tE AT Iqi rCMtLE Q I~°~. ~O/I. N'~tf. eQ[u ~l~.. d:.) KOIIK AT M9AK - • , 21. / ~ftended th~ dsc~~sed /~on~ + V h , to 7y~~o •nd /~af s~r Aim ~/ir~ oe~ ~ 3 ' 7? D~~th oceurr~d ~t J~ ' m on th~ d~tt at~t~d ~Dore; ~nd to tAe Oeat ol mr ~now/~dje. 1ro~n tA~ e~ussa st~ttd. _ • (Url,u wWtd 2Ie ~ooacss 22e. a?TC s~e?e¢o eti tc~.s t2s. s~cru~TO~c •.~iLlYll' S@ BVC~ eci~let~ek •~'~u~~ M.D. Ft. Lauderdale Florida %Z'~-~~ a: c u r a t e. 2~ ~r~lTqrc 21~ OATE 2Jt. MJIYE Oi CEMETERY OR CREMATORY 23d. IOtATqN (GYI. lorw. N duuffl ~Sttlt1 R[r u lS~c~ 1 ~5 ~uria~ 2- - 0 •loodla:•rn Ce?neter _ l~iiami Dade ~ Florida 612 j~_"~U~°~l Ot C7pq S S~.:NxTURE AODNESS 2S AT •IIEC0. LOCAL REG. 26.~ GIST AR'S NAT RE KY'A96r ~ a'?.l963 j~G.~~~=~~7:s= , ~ora ano Beach ~i~ / `'IG ~~c-6~i - ~v. ~f'''" f' , . - 3. - - ; - ; ; - - _ - - _ _ ; CERTIFIED COPY_- : i • ' ' _ . , E . . . { I hereby certify the_above to be a true and correct copy of the Local ~ Registrar's record on file in the Brocrard Cour.ty He~.lth Deuar~ment at . Fort I,auderdale, Florida. - fi,l-~~?~~~«; Not valid unles f r~ised seal of the Bro••rard County Hezlth ~ ; • 'De ar~c~ent is a_fixed.} . J;, ~~y ; P . - - ~ . : . ; ~ ~$.t~~~;.,•;,;, . . . ~ :.'~~j~~Tl~~~~ • . - ; . - , • . i:r ~,w , . ~;~F[:~•~~a~~~DZ~L~ County Aealth ificer and LocPl Re;;istrar - , - ~a i~ 7 ~ L,~ , . ~ ~~~~~~~~i.~~~},~' ' , : t ; ~ t ~ ~ . - , , : ` • - . " _ ' ~ - - ' ! ~ ~ # . ' ' ~ n~~utv Loc~l ~e~is ~rar ~ ~ ~ ~ ~ ~ o~ ~ ~ ` u A ~sr~ <~eF,~~ . .A~ ~o ' ~1C c~~~ a~ a ~ ~ ~i ~ ~C ~ ~q ~ ~ ~ ~ r - N ~ ~ ~F ,~„y_ j ~,~x- ~ ~ , _ ` - ~ t~..~ Y~~_~~~~~ ~ ~ _ . _ ~