HomeMy WebLinkAbout0787 23'7828
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`~TA?s D~- j ~ATE BOARD OF Mew~.~x J ~ CERTIFICA'rt OF DEA7H
i~aa; auacwu oR v~Tw~. orrwroncs FL08IDA ~wTC F~~c wa ~
ord ¦A~n .BIRTH NO. REGIBTRAR'8 NO.
y~op~rl~
•:eeut•e 1. PLACE OF DEATH Cooc rio. 2. USUAI. RESIDENCE i~r.a~wau.~? tr~..u~ar.:r.+
an~ •111 GOUNTY SfATE 0. COUNTY
s. ~i.e.a -
in p~r- b. CITY Ut ~ouw~ as~e•u u.tu. ..tu aua~t.1 c. lEN6TH OF e. CITY tII ~tvM anwM u~~u. .rw tuluW
¦~o~~t O~ STAY/b~usN~u) OR
r~i.. TowN F p - Town
~ d. FUII HAME OF Ilt ~M ~w~u1 ~r IrutwM~. ttn ~tnet MdtMS ~t MatNU IU nnl. NM -
HOS/ITAL OR
INSTITUTiON
NAME OF a(F[eat) D. (YWdL) a(I~t) DwTi (1to~tti) (D~,T) (Yaar1
DECEASED Francis Harmon Conrad Sr ~?n+Se tember 6:h 195
(T~yr er Pri~e
s, Sp( COIOR OR MCE L I.IAlR1ED, NEYER WIRRIED, L DATE OF tIRTH A6i ~L v~a~a~ ~~w v wu a~ r
vn weo rro c.~n cs..~,o,~ T r.. Da. s..n ~a.
- Male White g°ar~~ec~ r~ovember 13 18 1~'
IOa. VSUAI OCCU?A110N~p;w u.e .r .rt ~Ob. K~ND OP tUSINESS Ot IN. u. ~ian~nwca ~.w,. «w.,~ IL CITiZEN JF WHAT ;
eA p• r- rr d.eNS•w H..eti~s wti wr rt nurM) DuSTtY COUNTIri
~IA~YL / 3
ei.`t I~. FATHER'S ltAIAE IL MOTNEI'S MAID ~uwE
Lloyd Conrad - Sar"ah .Cha an '
IS. WAS DECEASEC ER IN U. S.AUAED iORCEiT Ik SOCIAL SECURITY 17. INFORMANi'f SIGNATIII! J~ i~ • 8 A 3
, 1Te~~ ~r ~.trwl lU s+. dh w ~r ~ar. d w.feU NO. ADOlESS ~ O 1~ 6I' C 9
Fun~r~l 1~. CAUSE OF DEATH MEDtCAL CERTIFICATION ~aTM~+ 5
eir~etor Euter oab os~ uak DISEASE OR CONDITION ~o ~Tw i
¦u~s fll• Da liN !et (~1• 111• DI~ECTLY LEADIN6 TO DEAM'(~ Cerebrovascular Accident • ,
t~• e~r- ~ ~
~lr~~.~. ""*~DENTG10~ Arteriosclerosis Year :
.fce se• •rA+.i.s.*Kw~a~ DUETO ;
1 o e w l tl~ wwi~ d jln+~Y. YMO~ QIf1~EltiI~ U pY. D~rsD .
rtt~ u AnK Jsilars. riw q W a?o~s euu~ (s) atsh f
r• lat~ar u~~ sta !t wta*~ ~~D a"w Wt' ~
s DUE TO c
.fce~s vs ~A. d;s..+.. i~i~+ri ~
Aours •f- oo~sGatio* rAi~~ II.OTMERSI6NIFICANTCONDITIONS ~ ~~~}s r$• i
c.r a..ee a"~ c..i:b.w. es.c..'~ti.o a U.+esU? ~*~~b6t (lusarthritis 30 Yrs. ~
or e~for• nlsed t~ W~iaca~e or eowditiow oaran asstk ~
uca e
~~t1~~ •e7 N~. DATE Of O?ERA- 110. MAJOR FINDtN6S OF O?EtAiION 10. AUTOKTt
TION i
~ d~sposl- •
-•+e of ru? No~
; ~pny~W1 llMdb) 21b. ?LACE OF INJURY t~ ~r ssoa~ 21e. IGIiY OR TOVIN (COUNiY) (S1ATE)
; ZI~- ACCIDEMT ~~L t~~L I~et~r/. WM. ~d ~1aL. ~I I[ Rd, qai~ YYII~L1
E su~e~oe
~ Ild. iIME l~~l tDVI Iiaq tHwrl 21~. INJURY OOCU~RED tt . HOW DI INJU~T UR
OF f111L[AT ~OTrMllt
~ INJUtY ~ ¦oac ? ~i~o~c ?
n. I lureby certiJy thut tC
n~t'eended tlu deeeased Jrom~ 19~, to S9Bt
6_ 19~., that 1 Ios~ saw lAe dcceeaed
?ii is•.• oj;~ $6pt6 191w
- end ihat eitatA occurrcd a! 6: 35Am rom tAt tavses ond on tke da~e s~afed rt6ort.
•r• to D• SIGNATURE (Desr~e or title) yb. AD~RESS 23~ DATE516NE0
eo~pl~t• ~
Richard F. Sinnott 14.D. 08 S. 6th
2~/~. t U R 1 A l, GtEMA- 2~b. DATE ltc. tt/WE OF CEMETEtY OR CREMATOtY 24d. LOCATIOH (CiV. to~~, x~unes) ( 4te
~TION, REMOYAL ~s~.dt»
~IYii e Cit Ce e Whi~e la
' DATE REC'D ~Y LOCAI RE6ISTRAR'S S16t1/1TYRE 7S. fYNERAL DIIECTOR'S S16HATURE ADDRESS
f~oo 9-8-
~
~ 237828 ; ~
FtLEO ~ND RECOROEO ' -
ST. LU~~E C~UNTY FU. ~
RO~E~ ?O~TaAS L :
~ CLERK C~F.~UtT COURT ~ £
RECO?C 1~~IFiE~J_.~~. ' ~ `
~ t?ereby oertify thi~ w b. a trw •nd correc+ oopy af the t+ocel
~ Re~ipir~ra reoord on f(k in th~ SL Luct~ County Heahfi Depa~ ~ ~ 1 f
~ m~nt .t Fon Ptero.. Flor~d.. SEP I1 ~ I 13 aM 7T ,
~
(YV~minp: Not valid unl~s raised seal of the St. t,ud~ . ~
County Flealth D~pa~tment is affix~cl.) ~
1
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N. D. MILLER, M. D. ~
ty Hsaltfi Offiar 3 1 R~glstrar
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D~tr De~xAy Lacal Rs4istra? ~ f i
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