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HomeMy WebLinkAbout0398 ~ 23'~S51 IN RE: Lot 17, Blocl~ 22, LAKEWOOD PARK, UNIT NO. 3 as per plat thereof on file in Plat Book 10, pages 63-64 of the public records, St. y Lucie County, Florida. ~ ,o ~.:~~v~vtl. l tt,U 1 s7 A l E~)EPAR7'h1EN'C OP NCAL"I~H .t c~ a> Public Health Stalisties Seclioa-Ilartfo~d. Connec~icut U.S.A. Q Z Certificate of Deatb , a ~ N II 1. Fut~ o? Dc~tH: (a) State of Coonatieut Us~~s~ Rcs~oexcc w Drxcwsio: fa) s~~ Coitnecticut ~ ' lDl Count~ (e) 7~ivep (D) Countr I(e) '[bw~ (d) It RcsiJence Inaide r'airi ield Green~~rich ~`a r • c~~, or no~o~KA Lim{u2 4. ~ -~~i~l~ Greeii~•rieh e c~ ldl \a~ne o[ liospital or lnstiWtion (e) Strert Number Yes ~ No ~ ~ or~lxatiow) oe institutan ~ire Strett Na llt rural, c~~~ locx~~o4) If Ye~, name Citr or N m~ ~ ~ BOroujA ,t,_ q~ p~ llU:i Gi•ec:ntivich Hos ital 2 ~33 shop llrive. ~outh ~ r ::~us o? (f'int) (~tiddkl (Last) I 4 S~ctA~ S[cuun Nun~ts V~ ~ (T;ae`o~.;.u KOSE u~tl~ OI,IV~:R MEDICAL CERTIFICATION tTrpe e• priat) ~ F'ERSONAL AN[1 STATISTICAL PAI~TICUI.ARS Z2. C~oss w D[ATii (Enter oay one eause per bo: (a)(b1 and(e)~ ~ S. SL1 RACS 'j. j(ARR![D~(Q N[YCt MAIIIEO 1NT[RYAL ~lir~ ? PART 1. D[ATH r?A! C~VliO BT: ~~w~N ~I lx~EOU?rs Ceuss f~/ ovs~r •xo sT I Female ~~hite w'~"~ p o -e~RDIA ~ RR Re s T''~ ~°`"tg ~ i. Ir YARRIQ WIOOM'CC O~ D~voRCS0. w~z DdAIO[N NwKS o? w~n os HCS~wNO ; w,~, John S. Oliver ~a r D~a w (AloaW) cDay1 <Ycar) Dus so !?1 ~+ORp/?~//~ I Dc~m 9 ~ 1969 irCoeditiob.b Ri ~.,eo'Sc%/tos~~ !e y~r. l0. DwTC w Bast~ Aec (in rean if undcr 1~~ear if under 1 da~ ~ ~'O a last birtDda~) abore eaose Months Ds~s Hours Atins. (a). statia~ t~e uade~b- Dus ro te) 4-15-1896 ~ la~sL u~ ~ Il. HtatHrues (Citr or Wwn) (State or toreisn countr~) j. Pwsr Il OTNCt SICNIiII'At~7 CONMTM~V6 Co~Tiusvr~r+c t3. W~s Greeriwich ~~~Pi~i~Z.~iuY ~~ATN 1Vt NOT }ZllAT[D TO 7Hi TttMINA1. TII~A A~OT~. f CoKarqn C~rsN ~r Pwus I f~). Pnroerpt 12. (s) UsuAt OCCUrwTtoN IGiec kind ot w:ork done durin= most o[ workia~ life ercn i! retind) Yd~~ ~ HOUS@W1.~~ 21. Svscui R6LLVANT 1'O CONDlIIOXi Rsroam ~w Its~t 22. /l) IRwsraY os BusiYw (a) N~me of operatioa I(b) Date performel ~~i D~C[AS~D A VEiEL?N! Yp or No ~ Ip) T~HS o~ Iwicar lb) T! ~s, sir~ war 2S. (a) AmosxT Sviaoe Hon~ans I H~s. lfewtA. D~1r. Yes? Unit ~ Ship O ~ m, ~ HAMC Pasqual t+a?gCa jNJUtT ~CCVRIICD Idl PWC~ Of ~NJUtT fap.. iw e. ~b~rt Ae.w. ~ (Citr or tora) lState or tbrei~e countr~l While at Not WAik l~^'~ Jutery. ~t.s~t. o~Ccs MII., ~te.) ~ Castle Grand, Italy ~*~~k p at Work p i 1s. E~aruw.us I_ x"'°"6?axiantoni.a ~aspp~rino <<, c~. Tow~. a c.«.~,. c~~~n ST~Tt ~ I ti. NwM~ 1= (Citr or to.rn) (S~att or torei~n eouatq) 0 T (I) DESCRI~C HOW INJU~Y OCCUR1tO. ~ 17. BIiTUM.aCT Castlej~rand~ 1t~y 16wft~ w~lrrt el iwjrry is Part / ~ lE. 1HroaxwxYs N~us . o. Pare !I eJ itcw si.) i I 26• I HEREBY CERTIFY. t6at 1~~t eeeued ~ John S. 03.tiver " t~uedical Lx~aine~ for Corone~r,~ i / ; 19. eowt~/~l~~f+f1~ naee_ q,=~.~- A Q € Cemetery ~r~~e~~ ?5t • L'ld1'y . lLat l#~e? saw the daeaed a~~ o~na 7~~ . ~ Fl~ce GrcemNic QT121@CtilCLlti and ehat deatA ira+:i.~.~r+e oecurred on ?i -69 +i 20. NAM[ 01 Ex~w~M[s t? Boot M'AS 1':V6AL7ilED ~ Licena~ numbK ~t Am, I it iharles ~anks 159~s II s~y~ i° a pH*~~?„ , , - - _ ~ , . ~ ,;R~._ ~9"`r e'1~~~`°~~~'~'Q~~f~~` . . v ~i _ IAR~~~-B~i~s- J. CU01.11a11 j~elly, i;.D., Lied. Ex. A.2dress G c; en.~C~ ~~LP._~'~ ~ Addr f 1i1.ve1 ..S ~ ~ ~Qnn D!~ ~ ~a~ ftt ' Cl:K7IFtCATE RECt:IYE FOR Y.ECORD ON :.~K R ~ II ~ ~ i Y~ ~ ~ar,a I ^ , ~ ~,c ~ • y'~i.2l~ :il L '~IiSPCIICtiI, t . ~s. ~atrii of Q~rrc?itvtcij ~ :.t,:°t~ ~ ¢.~i: f;el~. ~ ~ ~il\i~i V• ?7V~iV.ilY ~.S~JZ$tc~nl~ hr~!•I?Js . , . ~r-. .:f1:: ~)fJt~~S ~j ~Jiaf ~Otlri r~~ ~~~i'e~qi~ti{~. ~Ff~'e'r ri~ 1~~~• ~:~i :j?fre!lI J?7.~ ll} ~ . . . . . _'r~ lEje ;~me in ~ut{~ent:...:r: n ;,t ;i~e Kr:•:r.~ r i lii-ti , ~~.:+ri.~~ , ~ ~ ~ n: !~lti :J~F Jslli iU~ti~:i1. J:r,.: Si~cs~trJ f~•c sei'.~~.' L:jtilll , ~j [ . . . . ~ . , ~ s~ .t:~rtc ~Fd i~ts~t~i :t ,y ~ r ~ : ~ ~ ~ ~ , - ~ . ~O N ~~~L~ !-..11~ ~~f1fU~~ ~~L~~~1~, jf~Jl l~~ Jl/r:c':<.1 .~~It1~;.~1:e~ f~ ;rl.i J~:c: C%1?re'Cl C.-h~ - ;r:. . .rf:• Di~imH jc Jr., .:~s rn ti~. '!i; 11~~rt.:~~c srl.: • t_ • . - iW . ' 1 , l~rre?17.i:f~. _ . « ' L 0 ~ ~ ~ ~ ~ x^ ~;~t : ~ • ~ , J ~ _ 31tt ~~tittte~~ ~~~hectot. t _ ,,f ~ E~`+J ._i ~~'I:IJ: ll.l:.. ~ . : . . : r, ~;-1. 1:.: ; ..t: ~ . . ~s ` ' 29TH . SEF'I'EMBE~t,~„ 69 td : , . . • I~ ~ •r c„u r, i~ l;~, . y' : ~ 1 ~ * gt- ~ ' f ~ F' ~ ,~F s}~, ; a ~ ~ ~ ` `r' s ~ i ~ ,.~'g 3 i ~ _ t'- : ti5 ii~: `1~~~~ ~ `-'_C' . 1~ ~ f t~$Sti • ~ h, , t . ~ ~ . ~y~J».! 1'..:~~~ ~ BOOK U PACE - _ ~