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HomeMy WebLinkAbout0429 i - - , ' - - ~ / , ~ _~,,,r' ~ ~ 23'75'77 = . ~ . , . ~ ~ ~ : tA/s O~- ~TATE BOARD OT NtALTH CERTtFICATE OF DEATH ee~es BURGU OF Y1TA1 RATifl1C~ STAT6 FIL6 NO. ~~a•~ FLOHIDA . ~ •rd ¦Aen RIftTH NO. REGI6TRAR~B NO. ~ or~p~r1~ _ . . ~ ei~eutlA 1. ?U1C! OI ~[ATM CODE NO.. 2. YfYAI 11tf10~MC[(A~...~.a~...MewN J/...~ra~: t~d..rN/..w.w:.~) ~A~ •111 ~MTY a STATE b. COIINTY 1~ ~l~CN .Sti• Ll]Cl@ - FIOTi ciA L:C: `3 iw y~t- pTY. TO~. dl IOC~tqM c. K?L4CE Os OE~tTM r. dTY. TDr7r.01t LOt~T~ e. K RES~DE~ tE ' •~A~~t IMSIDE CITr LIMITST IMS10E CI: ~ UYITSt ~ r.i.. Ft. Pierce res~ No? Ft. Yie:~ce resp Mo(~ ~urE d' (/f Nt b ~NJNf~f. /+r Mtd Wrta) lFM6T1 OF f. STREE7 AODRESS IqSNTAI OA AY W IA Shannon Dr. OM A iAA / - "'~T""r10M Ft. Pierce t4em Hos . ~ Wk Lakexood Park ~QI . nwni ~r ts.M ~uurr. LW ' 1. DATE l~.r? pr v.a ~ien 6arlos Onle Sr. ~TM A ril fi 1~b0 " S. SEX COlW1 Ow wACE 7. MARIIIEO ~ 1EV[A MAR~1E0 G~. MiE Of NR7M A6E !'~1 ¦ 11M0[~ t tW YNp •~i^My, + INt Oinltql ~r..r. nq. r..n Y+.. r f[• j~(. w. ~rtoowEDO qvWetEO :iarch 2~ 18 8 ~ 1•~~ 1~ lOr. usuu octw~non (oi.r r~.r yw.t A.e 100. Kwo oF wswESS ae wousT~r 11. k~rNrucc (srrr r/ary. nr~tr~1 1. aom~ ar .w~r aou+mn . f s e r- twiy ~wt N rwtiv dp. err~ y re'rN? ••¦•~s Co t tor Fsuildi Girdletree ?~,d. U.S.A. il~ek 111k ~l iATM[A"S IIAME I{. MOTNER'S YAIDEN NAY[ . Ot t~~~~~1~~! ordelia Price IS. rAS OECEASEO CY[w IM U. i AAMEO fORCES~ 1~. SOC41 S(CURITY Ip I). IIf S NOMATY~[ ~ey . ~r»............, w...«.......r...,?...:.d 'r.lizabeth H. • Alire~a ?~w~r~l 1R cwus[ N wTN (Swtn wlr ~u nur ya l:~r/v (U. (A1. ~at (c)-1 IKiE11vi?t tETMEEN ~ 1 t t0 ~ ~ART L OEA?N MAS CA115[O ~Y: ^ OIISET AMD DGTN } ¦u~t il1• IMY[OUTE CAUSE ~ ~ t\• C~~- 1 tf[le~t• q~~ry~. j/p/. p~ To (N E ~ •1t~ t~e r~~ ~ rut y 1 • e • 1 ~r esue (~1. ~ r~alate~r ~ t~r. p;E TO (r) ~ ~ •1t010 77 2 ~IW t~~K /Yf. \o~f t• C- O ?~T R Of~ SR~i1Wf CONOITDNf Cprty~UfNG i0 0[~'M M!f IIOT RELiEO i0 M lUYwlll 06GSE CpO~iqM CMU M?Mi t(~1 . MAS AUTOISY ~ t fE11i011MEDl c.r a..s~ rESO ~O € er s~ [~r• _ ~~~~r «tu~~t[o_ (l~a wrwe q- M/'M( I M PPt I~ ir.. t t ¦•~l.s aaj ~CC~oE~s 3utCSG: MorKtaC N ltn tu ~ . ~ Y O ? ? •w •f ~ r~/~. ~ 2Q[. T~ME Oi /Iwts ~lMN. QrI. Yta~ fNJY~Y A. ~ W ~ IO/. IMIYIIY OOCYMEO mt- KACE Oi IIUUII~ It. nq ~r ~Mrf Mwt. mI. CITY. TONN. OII LOUTION OOUIfTY STATE _ MNIE AT ~ NOT MM1lE ~ haK/. rfr[d. ~~tt GI~I.. Nt.) - M10RK AT MpI1K - i 21. 1~ff~ndod tM d~wNd Irom ~~~1 1959 . to ~ • 1 •nd l~st w~ h,~ ~/i?~ on ' OwfA oceurhd ~f - 1:1~ p- m on th~ d~t~ ~t~qaf ~Do~~; ~nd to fM bNf oJ m~ R+w.?/~dN. l~om tM uuw~ ~t~t~d. ~ ~11 lt~~• ~TYlIt •t• t• 1• . ~~'Nn ~r W1~) ~I AOORESS ~t. DATE SIfiNEO =••r~•e• . :~ielvin 'nTolkoxsky 808 Orange Ave. -7-60 , •ee~rae~. tl. owwr?. e~r.rio¦. Zl~ wrc 2~t. tWME OF CEMfTEIIti OR CRErATOR11 731. we~T~ow (CYr. [«n. naarp (&.u) ~ . acrorK ~ . Remova~ A r. 7-60 Spring Hill Cemetery C:ir32etree(ti:orcester) ~~td. Y. 5.+619 j1. N~QIIAL OMECTOII'S SIGNAiYRE AOORES 1' • • MT[ 1tEt0_ ~Y WCA~ REG. ltE'6KTIIAl1'S SKKATl/IIE ~ R... iobs Milton V1. baird , Ft. Pierce, Fla . 4-25-b0 Anna Lee iienisoa, d. r. < ~ ~ . ~~y ry?y - ~ s ~ 1 F?snby csrfify lAis to bs • tru~ and oon+sct oopy af fhe iocsl 2V ~ 5/` " ~ ~ Re~lstirers r+soord on f!k in th~ St. tud~ CouMy Fie~hfi Dep~i~ ~ ~ m~nt ~t ~oA Pieto~, F{or{d~. FILED AND RECOaOEQ ~ ST.lUC1E COUNTY f~A. , (W~tning: Not valid unlsss nlsed se~l of tfis St. Luc1s aOCE~ r0!TRAS ~ CouMy Heatth OepaAmsnt is a~xed.) CLERR Ci=~U1T COURT ~ + ~ - . . ~ : RECdRO Vi~'r~EO ~ } t ~ N. D. MILLER, M. D. ~ ! S 49 ~H ~~Z . t ' , ~ ~ , ' ' ~ County Hesltfi OffioK b Loat Rogistr~r - ~ ± ~ '7~ c~ y ~ ~~l?' - A~ lI ' • , i ~ D~l~ O~piAy l~OC~I . ist?aI ~ ~ ~ ~ ~ - . . ' ~ ' . ~ i ~ ~ ~ ~ BOOK ~rVV PACf , ' . . - - - - - - _ - - ~ ~:~r.~--