HomeMy WebLinkAbout1806 CERTIFICATE OF DEATH ~3~~SS
I~rp~tlwvwl o~ ~ ~ta~l< ~wd ~~~+ii~Nrt Cerrltay fTATE FIL[ tt0.
~w.~~v~~~a~.n~ FLORIDA ~f _LiliU~
1rrF. O¦ rt~Ni IN ~"~"+~~°R•~0 REQIiT11A11•! HO a~
/tRMANINT INK ~A~p_M~ ~p~ us~ DAiE Oi DEAt11 ~ rowtr, ~~r, ~e~~~
SfE ~u?NDI00[ f01
~s?nc~ars ~ Rona 1 d (NN 1) SENNE , Ma 1 e ~ Decembe ~ 18, 1970 ;
lI1CE .~.n. w~ow. ~r~~c~~a ~wuw, AGE-wt w~a~ ~+t~~ we~~ ~~.t OATE Of ~1RM ~.~o?.rw. w~. COlR1ir Of DEA~l1
~~c. ~ve,Srl•lt6 Mt~?~na~~~ roi. ~.n Mows r~a. ~b 9' 1900 Brevard ~
, ~~r ~ ~ A g ~ ri
/ GTf. tOwN. Ot IOCATION Of AiN ..we c•n awm MOSMTAI OR O~1 NS - ~a ••a N. emw~, c~e arie~ uo wr.w~ ~ ~
/ ~~'6 '~`"'~lO~"° Brevard Hospital ~
n Melbourne Yes .
SiAiE Of M~1N ~ r wo~ w o~~., wuq Of W11A~ COIJMl1/ l1AR~lEO. llEwEt FNMrEO. SlllVNNG SlOl1SE ~ w wre. oeve .uet« a.w ~ e
' `N1DA'"~r~° Dorothy Su 11 t van Senne }
_ t~~., , Poh 1 ck, V t rg i n~a , U S N_ ~
~ex e~ce.uo ~tu SEN~1ill MI~fR USIIAL CCC111A~ION ~one a..~ w.wt wMt ~ww~o ~oa a KINO Of q15NE55 OR 1NDIKTRr
u.eo u o~aw~
„ 262 28 2527 .„~~e~~an"~" ~ Bu i id t ng Suppl i es ~
~T~ ~ V„Q.,. 4,.. ii
~lYDlrK! M~M! ~
,rr~sfa« RESqENCE-STATE COIlti11 Cf~Y. tOWN. Ot IOCATION w~sw! cn arws ST~EET ANO •
"~o' ~N S. D i x 1 e H i g hway
~.Florida Brevard ,.,~Grant
Fwt11ER-NAME •~at rw~t uA M0~11ER-M~DfN NM~E ~~es~ a.»eu us~
„ Henr SENNE Margaret HALL
11i~O~MANT-HAMf MAING ADORESS ~swn o~ ir.~. .a. cm w w•r.~. s~~n. tr~
Mrs. Doroth S. Senne Route /2 Box 235 Melbourne,Fla. 32901
?~[t i.
oEwnt wwi C~uSED ~r: ~EnrEe owir d+E uVSE rEt ~r+E r0~ Iel AL ~u~D kl) .mr.cN w~u...w w;n~
!l ' .
p~ G t, r t o C d r . T o ~~~a ~ S ~
co¦s~iw~s. ..n, !
.»~c~o~~en~ew PI ~(~C TO ~'Tfr~OSC~ a Ti " Co~ord~ ~1S('dS~ G/~~I7o•~~
~rrfO~at! t~Yil IM. ~ p, a~3 A COM1tWlMG O~•
~ f1~tIM0 ~M! YM~t~-
ltIMO C~YK l1lf 5
€
?~RT ¦ OTMfR SIG~NIFICANi CaNOt110N5: cd+anws eaww~m.a w ww w~ ~+ot ~eu~n m urse e~+eM n+ rur ~ w~ ~~v ~ YES .ren .~NO~..as co..- ~
~rt~pl»o~ s~sene ~r. a*eu~..~«~ c~use
ny W ot~rw
IA 11~
phbo61s1:A~`n~tt~~O A 1~OMM. M1. Tl~~ t HpW INl1{R~ OCCUt~EO wtw! p ~Mrifr ~w ~ O~ ?~n u, a[r ~
MOMIC~OE
~ ~ ~c - M tM ' t
IfiANY AT M~dl( ~IACE Of NJIlhI ro.e. snm. ~•n.xr, lOC~110N ~ amn a~.r.o. .w., cm o~ ~o~.n. sun ~ j
~ snan m o~ ..o r owK+ w~o.. e+c. ~ ~ncw. ~ t
1b 7M. „I
CERIHCAT~ON- nw~w w ~e.u ra+w~ e~~ nu ~rws w.~~ieRy~ w~i. ~~~ita
a•w~ ~ OEAM OCCYMfp .r *n n.c~. a. ~wt
IN~SKtAN' TO ~~o~e~ ooa qrn. ..e. w wn rsr
~ ~RlMOfO ~M! p MI l~llOGl. 011!
, 7t~ sea.s~o ~w.. ~ei t C j1 ~ t11~EC ~ 8~ ~ 9~~ 7k ( 7!~~ ) cl h(1 /)N M w n~[ uvuro suno
CERTIfKwT10N-MEWCAI ExAIM~IEt R w nn us~s w ne wow w~e.u~ TMe ercteeM +u r~oMOUrcw a~e
~f~rM~~ql~ O~ 1~ AI~Ia 11~ Mr~f~R'iAi~~. M r! O~M~~. W1 f~~~ MOJ~
N~n1 OCC11Vl0 W M N! MIO OYf p~Nt UYlt~fl S4t[O
G ~ u 3 : M
CE~itfiE -l/AMf ~mtp~ n eeeh~ a~ r~n~ ~tE SK',HE w~ o.. . u~
r~~ /~~ono?+n M. D- rs Ul1 ~ZM. D. tkQeG. 19~a
AOO~u-~~"~t 1351 South H i ckory~ Y~reet Mel bour~?'i~ ~"f 1 or i da 329~
MIRU?l. CREMAMXi. ~EMOvAI QEANIORV-wu~E 1OU110N un o..o~+.. s~.n
tsrECrr~
, Burial Met urne Cemetery ,~Melbourne, Brevard, Florida
~~e " 2~ ~ 1 i e
Fu e
a~
Hane ~~0~a ~a`~met~o' ~ve°.~ ~Me i bou r~e, F l a 32901 ~
v. S. i612 f ~[GI -siG++~tu~t w~ec[+v[o s. iouu ico~
R ~ v.1910 tN ~~G
I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRELT COPY OF THE RECORD ON F1LE
IH THE IAC~lL REGISTRAR'S OFFICE IN THE BREVARD COIINTY HEALTH DEPARTMENT.
(Not v81id ~,u:leas the seal of the Brevard County Health Department is affixed) j
...r-! ~ . ' ~ .
- , 1~ ~c~.,,~:.-~ ~
'~r" 2 ~ ~~~Q Deputy Registrar '
. ~ fILEO A~1~ aECOROfO
~ ST.tUCK ;,OUNTr f~A.
ROG=F. ~ ^ ~~~~S ~ c ;
~ Ct£K~ ;;~:,:;,U17 COURT '~1 •
' . P~GI~""• V~ : fIED~~~ ~
A~c 18 I t 22 AH '11
80JK~V~ FAGF~~j~ 2~~~5 `
~
,
s~~~~x ~~~..~:.~.r..., x - sxc~~~
b._.e.. ~ ~,~~,'~s'~^'~~'