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HomeMy WebLinkAbout0522 ~ , s-~~~ , ~ . p„~,~~~.,: _ ~ 2~338 ..~.,o..~ . . _ ~ . . _ . ) oa3a oei . " ~ , i~~lU4~ ; F.,:TRAi • 4 _ ~ u '_L~ ~ _ ~ i 1 ~oct ~ ~`7126 . , , c~c~K c~ ~c~:r cou~T ~ _ . . '~:ti r r~. N. ~ECCN~ ve . ~~fo..~~ c~...?~~ ,</~~~a ~~y _ ~ i 4~9 Af~~~ °c~:~~.~1 ~ t~:~~.? -...:_,~,~~.~`T o r ~,1;,11 W;? I.1 ~ ~G~. ~ ~ ~os•r o_ _ -v~~ ::~o:. 11 D.~~~ Ci=':, 0:._~~_\ ''~2'st-~4~ ' . -tw 2~338 ~ ; ; - ~ ~ ~L~~,G ~ -r.i: Dr- BTATE eowreo oF t+swt.Tx CERTIFICA7E OF DEATH ' ;o~es • BUREAU OF VITAL fTAT1iT1G• STATE FILi NO. l~;al FLOP?IDA usd ~hen BIRTH ?:O. REGISTNAR•9 NO. fro,erlr L rLAC[ Oi p[ATN 'C03E NO_ 2 UfYAt R[SIO[MC[lR~...~s....t6..t U•w:e.~...: Rr~1..a~N.~..t~w..•) eieeuted ~OUwTY ~ { ~ o- STATE 0. CONNTti .nd •111 ~~$L.~ ~ -~.-C'_ ~lorida Pasco . ee ylaeee ! A_ GTY. TOYYN. OR lAU1T~OM t. t5 °L+CE Cr ; E ATa CiTY, TONN, O~ IACATIOM t. IS RE516E~CE !n per- ' twS.CE G~TY u4 ~51 ~MSt~E tITY UVIi5/ ¦aeeat ~q fll!- rt`'-~:iOTi S rin~S i YEiU ~~~..]i ~l`c~~Z:On Snr{n~s YES MO Q_ NAME OF (If w! iw ?ay~td. /s[ it~tt[ all+t.n: . ~ Q. STPEET ADDRE55 ~ 07 I. or_gwo od ~venue HDS°IT4! OII J .j.J~r j IIQO?; _ "'.t: IxST~TUi:ON T~it T 3. M~ML Oi 'uat " V~1~~a yy~ t. OATE 1NoRtA D~I Y[a+ D[C[ALLY - ~ tT~uo.y.~,~) r~t3^~CK ~ ou7M,~0YBT~er 1 8 1~06 ,T = _~i_ i:oaonu S SCX +6 COl01t OR MCE 7 S~TE OF 61RTN ?GE (Ia ~tua ~ T~ ~'*~a ~ MaRR~CD i~ hiyEA W~:P:£J ~1 IYf dq/1~q) !l..c4 Mw Hwv~ Y~w. • r 1 t• ~~a;e .~~lit. w:OGriEOL: ' D+.?..:e^~_~2b t88 p 2 a 1 n 1~ ~S~~l OCCli~ATfpN (C~tt 2~4/OJ~Wk lOAe lOG K'M~ OF s„5. ~'SS C~i ~~:.:STRY 1 i. i.RTNiLACE ($~tt ~?h?ty4 CNt4t//) I2. QTSEh 0~ ~M?T COIi.~~~7 .ftA p•r- e~.~,~4o.eo/rar~.~hlr.~s.*i~.at.ai ~rr •~~•~tv Galha Ireiand U.~ •~aent ~=_r3erer : etir d v~~::~__., bl~et lak ~3. FA7MER~5 M~ME ` l~. MOTNER'S l~A1DEM MAME 'i or tTp~~rlter `~.=0:=`iS J~?"C.-''~ ~ t%~-neri~@ Z.CUtzc~h i , i6 socu~ scL.RITr NQ 17. iM/OAMAMT •~IOMATUR[ AL4tN ~ 0? ,T.,pri~W00~ ::Vc: Li@ ~ ,i~''f`~ ~r,.•_~~1_:n;. ~ ~ ~ l ~ n jr r;r~ ~l ~;r~ a ~ 1 j0-12-~i 2 -T ~'j~z: - ~ . - , l0. C~UK OI OUTM (Eatn oall ostca.ae pr ~s.-'.~- , i;•. cc . C~ IMT[R~JLLlETW[[ti . Funcr~l / l ~ ~ ONSE7AtWOEA'tl E ?ART t. L+EATN MAS CAUSED ~Y~ 1~ / ~ l ~ 1lreetor /t.i%'':'~i.~:L~:(i`. iL~"J~ iu~•(4. IMNEOUTE C~USE _ _L_~- - . ' •uat C11• ~ • ene e•r- ~ • . ~i~~% ~-f,~<< 1~.y- tlfie~te Conliio+u.i/~w1. py( TO (A) - • .ita tD• r~u~ Part ?u~ f~ ' 1. e Q~ 1 s:ar cas~t {i)• reSlstrar rtYis/ dr a~![r- ~E TO (rJ-__----- - ~ _ lrinp urs[ laat. - - ~ 1 C D1 n T2 O ?1111T 11 O~E II y1LlC4CT COND~TIOMS CCl~'T~'s`J'~W ]O C(ATM B; .C' 'E ~'O THE Nr~`JIL WSUSE COMCAtqN GMM iw ?YT t(~I . M~5 ALTJPSY Aoufs •f- r / y ? S ?FRfOMM[i:T / ~Ay~ f' / . r_ ist. d~~tA u '//~!%Jis~~~(11' C.~/.`•:~ii~C-!/i:/ ~__~C_~ ' ~ES? ~O cr Defor• ~ 2b i0 ) ~ F a~6f .~~A :ti:_•Y ;,~",R..FD .~t1.[t t10tY~t oJn~JY~/ ~A POt I M P~t IIOJ i•tL !I) ¦akiaa •n7 ~ ~ChLE~T SUtUDE M iC~Ot dl~post- v ~ ? ? - tlon ot ~?r~ TwE pF llorr Mu~U. p/. Ysor Dodl. ~ ~wJ:.ar a. . ~ y. W ~ Pi1 t~J.RY CCCURA[D 20[ ?i~CE C~ .~J;Rr ~ r ca o- :..t t:vi~. dTY. TOMN. OR IOUTqN COLhTY S~ Wn.IE AT ~ AOTYCHiIE D ia•rn. !u:,i.•Y. at•re:. ~'F:r C.a:.. rt:. ~ wpnK AT M6RK Zt 1 ~et~nded th~ dec~~s~d /rom _ _t=- . _'j ~~.L?. - ~ - ~ •~O /ur sa~ h~ •1..~ on ~ ~ ~ -.1` ~ ^ •t.e da re e: ~rad aborv. ~nd to tM b.st o/ m~ knorl.djs. lrom the ca:,~ss su~ed. De~rA occurr~d ~t ~7 ~ - m ?11 lt~~• ' -r 22c. D~Tf SG~EO 22a LIGM T RE ~ ( Lr;nt c~ .••/~a ~ 2:1 l~; yRi55 r ~ •re to De 1 ~ ` .7/L~`~~~ /l~~ J ~~a:/~h j~ ~ /J" (Cfl' co~plete t ~ . .~r,~c'~L~f"?- aeeur~te. v.z~ 2; .>,.::r~_•.. ,v~ ~c 2 LOCA7~Q Y/.focw.M~au~fy; ~~a:•~ s.a.: ~ YK~. z» o~TC ~ R s :It - ~.i --~"-Gv~1•' 1 ~ ~-~`7'••~`fOCi i~' _~~.i - ~~Ler~ Jt'~'.~~::raz~z:t.OT1~L.l. l:ew Y rk 9.. A12 2a F vi =a_-~:~CCTOR 5 S~GS~TUAE ~ ~x. ~ac:: - acC~ ar ?oC~~ aE~ 26. nEG/sTN~R S S~G1~T:.QE ) ~ ~ . ~i "7 '~~„t ~ - ~ - • l~/~ / ~ i r " ;~~J r,~~,°' Re~.Id6D Y ~fy.~ d - " - - ~ , ~os i C_ p~~ i..~ 1+ ~1 .i a . . ~ - - ~ ~u ~ f. l . - t.~-;.. C 1..` . I i:3REBY CET_Z?Ic ~ i::~ T:L`E A\D CO$RECT COPl OF Tr.E - LOC_1L REGIST.'~R'S t~~C:!'.J ~1:: I`~ Ti?c P?~SCO COtiI~1Y H~T:i - DEPART::E\i ~1T D.~~~ C~:`i, (I•:~rning: Not valid unless ~ . , raised seal of the i~asce Co.:~~:: ~'.~~lth Department is affixed.) ~ : i~ /J ~ z t' / , , - • = : . ~ ~ ' f{ ~ ~'v~ ~rl~ ~ U Q ~o~~: ~alth Offic r and Local Registrar ~ ~BOOK~ClS ~ ~ - ~ ~ i ~ ~ ~~tE: - L cal "r.egis ar _ _ ~ - ~ .,..y.... , . r . . , _ ~ _ . ~ t :xr~,S-~~e~