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HomeMy WebLinkAbout1088 ~ : Yi - - 1~ - - - ~ - 235`73'7 : - ; CERTIFICATE OF DEATH Qep~lwewl ~I Ile~{I~ ~ad Re~6ili~ativt $etritet lTAT~ FIL[ HO. ~K~~'~~~~n~ FLORIDA Tt~E, Ot ~RINT IN ~~~R'~° REGIBTRAR•f Ho. 396 ~ ~tlMAN[NT INK ~~p_N~ ~NS~ +wp~ w~ SEX OA1E Oi OEAiN ~ rpwrw, Nr, ~~u ~ . SEI YII~100~ f~1 ¦stwcrarc , ~ DOI;t )T; i Y L~` I S ~ ?A.. ~ ~ ~ ^ • , fACE ~wn. Ne6w. urMtu~ w.~w, AGE-usr wx~ ~~w ~a~ i wr ow~ or wen+ ~.o~... cou+tr a oFwn+ • tx. ~ vetrr ~ w~aw. ~?ws~ .oi. o?n Mow~ nu ~ 6602 . [Vhite 53 A k •.~:ar. '_8 1.~.?'~ 5t. Lucie CTf, iOwN. OR lOGiION Of OEwiM ..sre un ~rns NOSMGt OR Otf4H NSTrtU1~ON-wurE ~ r.o~ w awr~, owe srrn u~ ..wt~ ~ ~ w rort Pierce ~1~« ~ r.. iX~A-I~ t. Pierce ~~:ecaoria.l I tosnital STATE Of MqN ~ r.ro~ r~ ~.s ....u Gt~29+ Of ww?T t ~Wl~EO, ~+EV~t ~utMED, 51RVn~+C, S~OUSE ~ r..re, oen .u~+e.~ ww ~ caw.w~ ~ WDOMiEG. OIVORGEO ~ wcn ~ ~ ~~?4~ ~South Carolina • ?3SA w.:iarried t'eter i?art .r.[a na.u~ SOCW 3EM111I NIMVER USU~I OCQM~TqN ~a.e aws a w~ ww wwrw .wf~ a RwD Oi MlS~ESS OR w01lSTt1r ~m~. ~ Knw rW{~O W~~ MM N tlYM 1 OC(71W~ M ;;,N,' ~:127-09-696G u. '.:ousev~i~e = l:ome:r.afcer •w~- ~swcrx~-sur~ cowar cm. To . oR iocwna+ ~~••~•s sT.~n •r,o r+wuce ~ ~ snca. ns o~ w , ~ torida ~wSt. 1-u~cie ~a ~ort Pierce ?:o• ~w 114 Soneto PSL fAT1~.~-NAME ~NA r00N Yi1 MOTMEt-MADEN HAMf ~I~f~ r~M~ 4Y If I/i:f~l A ? 1~ ir:A\7~1 r, InfOWMR-N~wE ~uawG wOGRESS ~smn w~...e. ro . cw. w w.... s~.w. ir~ Peter ::art 114 Soneto, :'t. Pierce Fla. 33450 rwn oFwn~ w~s CwuSEO ~r: (EnrEt owr a+E uusE r[~ u+c roe NL NL ~rn ~cM ur.en. o«u...~ .e•u~ q_ .reww _ u ~f i ' t,~l~r~.,,Y i~/I~u~n4f:Z :.~cr~ .fl: sc~c•s~~ o~J^~ i',1, ~ I . . . . . ' i I coMSn.o~s, •.n, ' 11/M1(M a•.e nse ~0 1?1 , I~W M~tt C~tllt 101. a.s . ea+aeam+ee a: ' . ~t~tIMO t~l~ YM~(~- • ?TM~O C~Yf~ u1~1 i ~ ~w[T OTnEt SIG+~~iKwHT CONDrTq~S: ea.ana.s eaarv~wa ~o w.a~ wn .w? nune w uvw a~+e« rur ~~o~ ~OKY i ~ES ~~a ?~~~~MOi tow i ~ i i , ~ ~ttl O~~MOI LOlH~ M MituYMaW CwYi/ p ~e~rM i tA O M ~ t ~?w!~y A I+OMiw. Y~, n•~ ~ MOUR ifOW IN1U~1 OCCUttfO ~ ~r•n~ ...~wt a ~wwn r.t? ~ o~ ~~n N, ~tr ~ t M~OWyC~WE~ O[ 111~OtTEY11NEO ~ ~ IA ~ M. IM ~ ' 1?LUt~ AT WORK RACE Of NAlRY.~ wo.e. srrn. ~.c~wr. IOCATlON ~ su~n o~ ~-r.e. .w., an o~ ~owr.., sr.n ~ ~MlOI~ 1~f O~ MO~ Ow~Q MN...IK. ~S~KY~1 ~ Iw 7M. „1 ~ CElTIfIGiION- ~M O~~ hu .OMM Wr ~ty ~ui 4sr Lr rr/M~ yM Oti ~ M/aO .~W ~ M D(~M OCCYf~tO ~t M h~[f, O~+ M ' INTiK1AM: ~O~M W~ RY ~?R~ p~s _J_. ~~q~M~ M1l. uy. A M Mf1 ? ? ~~mwoeo na ~ 2 fj e~ TO ~.i~ ~ 7 Z ~ ~ f ji ~i c~ 1~ O I a.~ awoouou. we ~ : ~ T~. wcuses ~wr Tq. 7tc 71 )N • NL ~o w~ wrsto~ u.ne. , CE~TiKATqn-MEWCAI EiwMarfR OR CdW~ER: w n.e us.s w n* .ow a a.r nN we~a.n r.s nor.wnns oew : + i ~u.w•na. p re ~ow u.o/o~ e~a ~.tsnwno~+. r. w.+~w. ..w~¦ w• •tu ~oo~ • t ~t~~M OCCWMO O~+ M MR ~M 011! b tM! UVft~f1 S~~RO ~ ~ rn A ~ 5:30 P M. . . n, ~ CER11f1ER-NAME mn a?a..n 51GNwiUtE i oeuee os~~ru OAiE ~..w~w. w~. nu~ ~ Bernard D Ros s ~ ~f - J ~ ; ~uLLNG ~DO~ESS-CEtT/Ee s~aei a~.r.o. ..o. cm o~ q... 31~R tV ri . ~t!llAl. CREAMt~OM. ~EMOVA? E~ TOlY-NAMf lOUiION an w p~~ sun _ ~ srtt~ i • j emoval ,w FlUShin Gemeterv r'lus!:ir,c- 1..Z. P;ew York " CAiF ~ .W ~ fU+1ER/LL HOME-NAME ANQ ADORfSS + snu~ o~ ~.r.o o., cm w~o.,., s~•n. [w ~ ~ Auc~. ~,~~572 ,wYates Funeral i`:ome, PC uox 777, =t. Pierce F1a.33450 ~ V• S. ~612 iIIN ~ ' REG~ST SIGI~fAtWf OA/E ~E(EIrEO ~i} ~ i : ; R~r.1970 ~ iw tw ~~5~ ~ t ~ . ~ _ ~ ~ f1Of~b'~/ OOff1f~/ 1~ttS 10 ZiW G~Ofi'~C't OOP~/ C~ 1f1s ~D~70~ ? I ~ r~~.rs ~a s~. c~? ~.r~ u.~ ~ 35'73'7 m.M .t Fort Ptero.. Florida. i ~ ~ (Wamk~p: Not valid unisss nlsed saal of ths St. l~ud~ f1~E0 J~'10 RECORpEO ~ County Hsalth D~partms~t ia aff'~xed.) ST. LOCiC COUNTY f l~• , ~ ~ ROCEK POITRAS ~ CIERK C:~+CUIT COURT ~ ~ ~ ~ N. D. AAILLER~ M. D. RECORQ YEn~~{ED ~ Fkahh offic.r b t~oo.l w~tar.r ~ 11 41 Nc~'~Z ~ ' ~ ~ D~~r ~oc~l it~oistra? ' . i ~ ~ ao~K205 ~~E1088 - ~ - - r- r~n _ . . " '~y= ~'.-.z:~t?~"~-:~,-»'.^.;.,., ..w . _ . ~~'~'s~ _