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-`rei~ D~- tTATt eowao oR xsw~ni ~ CERTIF[CATE OF DE~-t tl t~ ;
l~~~l ~~e- ouRiAU OF ViTAL fTAT1Y7'IC~ _ iTATC FiLC NO. ~
a FLORTDR ,
o~d *A~p 9IRTH NO. REGI6TRAR•S NO.
•a~cut~d ~ 1. KAC~ O~ O~/?YN . COD6 NO. 2- Y~UAL ACNO[NCtI~?4.~+rr1:..i ff:+.h~u? R~it~.w~d~:.ri~ ~
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10 p~T- 0. CITY. TOWM.OR LOCATqN t. 15 K+~CE OF OEAT?1 t. G7?. TpWN, pll IACATpM - t. IS RESIDENCE i
•~N~t _ UrS10E C{TY LIMITSi tIWDE CIT1I UMIT51 ~
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N r~*~~ RAYMO~iD FARR C02~tAD °f"TM March 1 , ;
S. SEX CO1011 OR MCE 7' MAR~IEO ~ NEV[R MARNIEO D+ITF OF t111TM A6E U~ /[YI i 11MOE~ ~ tGt IMO[~ 1~ 1Rf. ~
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ir r i s• 11181e White rnoorraop wvoieao DeC. 28 1 16
yl al nl ~ la. «~ATipN (Oilt tid NrM! Ie~t {0?. KWDOF WStNES5011 WDYSTRY 11_ YMTM?LACE (9~fe ~r ~atyn p~~lr/) 1. C7~Rp OF ~MT COYMIRt~
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•~c~ y~_ t.n.~...,r./w.tM~hk...r.y.enrM ~
~~A~p~ ~oad De t. St. Lucie Count S. Carolina U.S.A ~
D1~Ct f~k 1~ fATNER'S MI1ME 1~. NOiNEIIY MAtOEMlY1Mt J !
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ssr•••~~•~ ~ancis Harmoa Conrad Dora F:lizabeth Thom son !
' IS. wA5 OECEASEO EV[R W U. S. ARMED FO1lCE51 16. SOCULL SEC111l~TY NO, IT. ~N/~O ~ NONATYRt _ D,,,,,~a `~nI,B~ i
~r.........~l...~1 wYi..«.......w»,I...~.1 cbau
no 500 Starr Ave. Ft.Pierce Fla. '
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u r. e cor r•~r ~ ourM w~s c~uaco ~r: s
~N«ca.~c c~ c.~ Pulmon Edema =
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ca. •.r_ i
:i a. 1 ~ to u~ Coronar Thrombosis ~ ~
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siseiw 79 z JI~M n~ue t+M. ~ i
~ ?A~T IL ORIE/ SKMfIW1? COIb1T10RS COMiW1RMG i0 OUTN ~Nf MOT RFtA7E0 TO TN[ 1FaYN~I 06fAS[ COIOIilOU Clr[L M fMT 1(~1 . MAS AYTO/Sr ~ i
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= 201. wJYlltl OCCYMED ~t. RACE OF IN1U11Y (r. 's v Nnl ~~e. 20% qTr. TOMI11_ 011 LOCATqN MYIITr STATE
MtMH.E AT ~ NOT 1NH~LE ~ fu~.l~~?/. ~t~td. ~~n 01~/., dt.) '
WORK AT MOIIK ~
2~- 1~tt~nd~d tM d~a~Nd /rom , to •nd I~at a~~ ti,~ ~/ir~ on
Dwth oce~~~~d ~t ~ 0: 55 P. m os~ th~ d~b ~e~t~d ~Do~~: ~nd to tA~ but o! m~ leno+l~dN. /rom tA~ uuws ~t~t~d.
111 it~~• ~ NQ~y~~
•r• so 1• (Drlra r w~1 ?1A. ~ooRtss t1s. wTE S~o
~.•vl•~• a John D. Brownfng,:~. D. ~ Ft. Pierce, Fla. 3 11 61~
•Oer~~t~. ~~r~ ~KE OF CErETE~Y Olt CaEwATOI1Y n/. WCwTpM (~yl./~w. r ew~at~) (~~1
~iir~~'' Mar. 12, 19 ~lhite City Ce~etery Ft. Picrce, Florida
8. / e 19 21, NNEIIAL 011'S SICNATURE a 9~ er ORIe 25• D11TE RECO. ~Y IOCAL REG. IIEGKTIUU'S SIGMATYIIE
t.•.~aas Joseph W. Yates, Ft.Fierce,Fla. 3-11-64 Anna Lee Denison, d.r. ~
• ~~82"J 1
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Ft~EO RyD RECORDLO - ~
ST. WC~C G~UtITY fU. ;
ROC?"t ~~0'TR~S , ;
C! E~~. ~ ~';.u~~ COURT ~ !
1 hereby aerlify fhis 1~ bs a tru~ and aorroct oopy of the Locs i R E C G~ ~ Y E=::! E 0~~ ' ~ ;
Repistr~rs reoord on file in tfis St. Luct~ Couny He~Ftfi Osperi~ ~u ~
msnt at Fort Plera. Flortda. ~ 1 ~ ~ j 2 N!1 ~ ~ Z s `
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(Wuning: Not valid untsu ratsed seal of the St, tucls ,
County tiealth Dspartment is affixed.) ~ ~ ~
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N. D. MILLER, AA. D. ~
County F!ealth OffioK d~ it~gistr~r ~
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