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Home My WebLink About2877 ~348'75 y ' C~:2TirICr11 c OF DEATH [~ep~rt~ew! ~ ~(ew~1~ awd R~{ul.i~~bli~e $enices r L O R I D A PTATi FILC NO. ~i~.~i!~.ir w•~~mo ~ REGICTRAR•f NO. 2~~ TY?E, O! fRINT IN ~[tMAtiiAT INK ~E~p_N~ ~wsi ..,~,e wi SfX DATE OF OEwM ~•owiw, Mr. +e~~~ SEE r~MDI00t ?01 ~ YISTIY(i~OK Nj- t' 11~• i t^ I. ~ 1 RACE ~rw~q. wlOq. uentu+ wM~~, AGE-.~f~ ~•x~ ~ n.¦ ; u~u+ ~ o.~ ? GATE OI ~IRM I~TM. Mt. `COIJNiY Oi OEATH ex. ~ wcrr ~ a~nw~ ~ uus~ .as. ~ w.s ~~.was ~ r... • 1 66J2 ' Ne rn s. 70 ~u k ~ • A~i•,: } S. i` L C(I11. TOwN. OR IOCAT OF OEAM ~«sw~ cu+ .w.» ~ eN~5t~7w1 OR Oi1~Et InS UiIOH-NAMf ~w ..o~ w e~an~, cwe ur~~ w..wa~ ~ sncw• .es w ..o n FJ"i: P~erce v°s !l• 7J: S` SfATE Of W1M ~M N0/ w ~.s.~., anx~n of w.u~T c itY Iw~Ati~fD, NEVEQ wuR~+fO, SIMr1r~IG S~OVSE ~r rw, oen .u~ou~ wire ~ - coww W~DOwfO. GIVO~GfO ~ sratrr ~ } ~.~.,.n,w..a ~ SOU~h c,~ -oiina • U:ia \I[:t_^: ie3 fr.• ; ',Vj~~'A~~a~~v ; ~.ta oeu.s~o _SOCUU SECU~fiv N~w~E~ uSUwl OCCWw:..'7H .art a~..o o. .ro~a oo..~ ow~.w .oa~ a [wD Of :uSINESi OR wOUSTRtf uvto- Ol.s OCCVt~tO W ~+O~lwO W~. lrt~+ J 411~101 „ ~55-~4-~63~i ~f H•~:is~w:Ce ~;or.e ~erw«ce uror •wss~ow_ ~ESiOENCE-SGIE C011~ dTY, iOWt+. O+~ 10:wTlOt+ ws+~ STtEEi wND ~+Ur~E~ . ~sncu~ ~ts w no~ . ~v s l0~':3ii i~f Sa.n~. Li,;-iC :a: ~~J'ti ~ P;f_:'~~ ~N ~~~'1,•,' ~92• fAINEt-NAMF r.nt rm.c us¦ rWie~El-1NMDfN HAME ~:~s~ ~bR~ ~ Z_~ 5~3~1i1 ~_P' )r~i t u James =1a_n!~ - ; I WORMANT-lIAMf iw~1WG ADGRESS ~uu~~ O~ ~.r.o. Mo.. tm o~ W~... N•~e. tr~ 1 J rr. GQ•~:tl LFO iit~ 7.)c'. ~~77~~'i i Lh J~TCC: F~?•`. p' F±c)2•!`i~'- ~ ?ART 1. i .rr~ou.~-e ~..:a~r.. orwn+ wws :~ws~o sr: ,F+vTf4 W:tY Or~tF UUSf Ift lwf f0R (eL Nl •wD (c1) uri~~.. o«ur ..~a ae.s. 1~ r.rtwra uu ~ / ~ /:J~"'Ga; '(."~.L~.~ ~ ~ ~•Y^ f J ^ , N~ L~. f Jy C H ' Ke p: GOw0~110~+1. ~M. ! / , t r,L( i ' ~~4,.".~ . - ~YMICM f.1~t~ •IS! lO ( ~l~ ~ v v~-~ • ' Ir~lW~i! C~Yl~ 101. ~ w. q~! ~ COwYOV(~+C! p: {~~IING 1M~ YM~l~- ~~~MG C~vft u3i L . 1 = ~t~ IwiT N OT?1E! SK,IVYICANT CONWi10N1~ to.ano~a co.awu*.«c io ou~w w~ ..oi ~wrts w uus~ cntw w r.~r ~ w~ ~wUTpST 1F• YES ~~~c r~~n~wcs coa- . ~ ~ •e~ u ..o~ s.oeuo wr~u.w...e w:u q OI~iM 'i E~w iF0 ! ~w I 1p DE~: IM4EiEY~WEOOI A W/WY ~~wrw, w~, ~t.~ ~ jhOlfB I HpW INIUIt OCCURlEO ~ e.ni~ w~we M uuun ~w r•~i : o~ r.~~ mr ~ i ` 7D~ IM t Y.c. M' 20l ~ ~ INJWY AT wOR1C flwCF Oi WNM~ ••or. sru~r. r.a1r., ~ lOCwi:ON ~ anen w~.~.o. .o.. tm o~ w~.., sT.n ~ ~ ~ ~ sna~r ns w..o~ oa~ee ~ x.. nc ~ srecr. ~ € ~ ~ ~ g CERTY~CwTq~- .~o..r.. w• ~eu , .o..a. w• •EU .,.o wr s.r r..+w~ u~~ o.+ Mlao Wt vrir u~l DEwTN OCCUUED .r n.e w~n. o+ w ~ ~wisK~wH: .a.n. o.~ ~w ~oo~ ~m~ oe•a ~wou~ ~ ^ o~n. w, ro s.e ttsr /j~ / ~ r ~ ~.newwo t~~ g TO , / /y J' w r• a.~wuoGt. wt ~ tl. wce.uo r.w ~ / V 'tn e0 7 /U ~71c , 1 71~ 2t.:J ~L M ro w w.uni sr.rtc 3 CftTYKJ~t~ON-MEO~C/LL EIIwMIr:E~ OR COROr.Ei. o~ r~~ ..i•s .r r..e ~.o-~< o. x.~. ~~f oaeeo~..r ~.a . ~ e....r..na+ o. na ww .w/w n.e rwes~~e.~u.~. o.ww-.. , l .o»n~ e ¦ w„¦ w.n. otewno w~w wa ..w we w'wt u~~s~ f~.reo. ~ ~T '^~L` I ~~L• M ; a. v ' .,M= rn # CEtT i ~ S:GriA7itR ! i,~ a ~ DATE S~GNE ~..a+rr, o.~, .w i ~ i ~ -.t//~~l( ! ~zr. ~ 1~ ~t~~-~~ ~ ~ 7 7L ~ sru~r o~ o wo. r/ t~ w qr - s•.q[ i~• ~ ~ ~chf ir ~ ~7- 1 * • C ~ ll ~ Wtt1A1• CREMATIOI~1, REMOVAL ~CFME1EpY Oi CRFMATORr-NwMf IOCATION an p to.~+ fr~n ~ SMCwf. :a Bu.:at jx. P;n~ :sro~•~ :.~:~r.~:a-y rort Pie~~•., Fio; i~a _ D~TE ~.oaaM. e~~. nu~ FU~+Ei~i HOw~E-~wMF wn~ ~DD~FSS I: sruir u a.~.~. ~.o., t~Tr M qww, ~t~fl.,iV ~ "s . ~ ~ :s. , :~~T~. 728 ~1.~en;:~ ~,D" Fo:-~ P.~ ~-p F~~-i-,~,~~ ~ v. S. a61Y fwEitwt ..aECtW- c.~u ~ / s~ ~ ~~:~G~s~~..'-S~v7vA~~.iF A G~Tt IECEn/EO ~OCA? ~EGttiW Fi~v. 147G ~ ; 1 • ~ ~ ) ~....x.cJ/~iC.! tw .Ti.-+o 1 Q a7~ ~ ~ ~ h.roby o~tify thk to b~ e true os'.d ~:';,ct co~y t,: ~ l.c;.:l Regi~trat's record on file in tfia St. Lucb Cov~:.y 'r:,,.:..:a ~ ~ me~nt at Fort Pierte. Flor(da. ~ , . ~ (Warniny: Not vaNd untess raised scal of t'r.~ Sr. Lui.; • , County Health Qepartment is affixed.) ~ ~ • ' . ~ . N. D. MItIER, M. D. - . ~ Colxlfy Flealth OfritOr dc lACS! F.c9issru , - ~ 2348'75 . O ~ I ,`J ~ Dato • Ooputy tocal ~gistrar S~ Lt~W E GO MTY iCA. • ~ ~ ROCEA PBtTRA= ' ' ; CLERK C~ ~CUIT COU~T ; ~[CORO vER~i1ED~..~..,~ ~ o R , Ai~ ~ IO 44 AH'~Z ~ 800K P.!6t ~ } ~ .r~~ t - , , ~S- , a : . . ~ . . _ . _ _ .