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HomeMy WebLinkAbout2378 \ 1)11I)I: COUNTY ~ 2~9~s , ~ ~ ` r'~ ' I)F~.l'~1~T:~IN;~'T OF I~UI3LIC I3FALTH f 1 1350 N. W. FOURTEENTH STREET M~LTON S. SASLAW, MD. MPM. l :I~i....~. - ~ ^ ~ + DIRECTOR ` • • ~ ~ITA~II~ b'LORIDA 331~5 i u~ ~ . . ` ~~1. `i _ • • CERTIFICATE OF DEATH ~~.,b.,m~„~ ~t tkai~b .~a tt~,~6ililatire s~.Y~~n F L O R I D A sTATE FILE Ko. IM\iSiON ~1F ItF ~t lfl ~'~a0~m~~~~~ REGISTRAR•S NO. ~ ~ : ~ ~f~SEU- NAMF ~i~sr rwo~t ~~5~ .Sft OATf OFDfAiM ~~~NiM, 0~1, ~l~~~ ROB:~tT t~1RABLE HADNO'i'T MALE MARCH 30, 1972 .+._f re. ~w~~, •re~,a.w ~w0:~~.. ~ AGE-t~l* o~ot~ ~.T•¦ ~o~ou r o.. ~ATE OF l1RiM +wO~rh, o~~. COUNTY Of OfAiH . ~.ec~~• j ~~~Two . ~ ~un, ,.os wrs t ~o~~s ..w ~t~~ ~ ~ . '~fHITE ~i0 ` ! ~ JUNE 15s 1911 DADE :'t ~OwN O~ FOCA7eON Of DfATH a.~r~~ cm iu.~is HpSMTAt O! OTHER N571TUi1pN-NM~E .v wi ~w t~*~[e, ~nt ~~4[~ •w aw+~e~ ~ ~ M i?eun .ts o~ Mo ~ ;:Iti2iI YES VETgtANS ADNQNISTR.ATION HOSPITAL_ _ `~~'~T E O' !'RTH .,o~ v.a •~~~e~UT~ZEN Oi WNAT COUNTRY MARRIED. t~tEYER MARRIE~, -TSURYIYNG SPOUSE w~~t, a~rt ..wwe.+ wu.e ~ GDUr~rfr: t WlpOW t S?iCn~. ~,';~~~TH CAROLINA U.S.A. I ~ SHIRLEY De G&OAT ,i~ 1!? - - - SECI:MTY µUi.~6FR ~ USUAI OCCUPATION ~c~+r awo o~ +ota ww[ ou~~»c yosr c~ KWp Af bUSWESS OR INOUSiR~ ~ , 575-~7-2955 _ fi ~f Y•~OCKSt,QTH GO~~ERAMENT =F">!JEN~E-S1ATF COUNiY ~C17Y, TOWN. OR LQCAffON ~wpDf UOi 1u~03 SiREEi AND NUM~ER . ~'iARIDA PAI.~1 BEACH i~TEST PALM Br.ACH 283') t~RBILL ROAD io w No u. -''+ER 'lAA~f i~R17 r~OW[ ~~ST MOiHER-M4fUfN NAME nNT ripp! uit JAI~ES HADYOTT „ BERTIE ONOBTAINABLE ~ ~.`ORM~NT-N~Mf en r0 fluJG AOGRfSS ISTt(FT Ot ~ I O r.o c~re or +o•+.., sr•n tn~ _~,DNa E. WILLIAt~bS VA Records V~Ei 1201 N.W. 16th S'~RE~'T, MIAMI, FIARIDA : ' •Irpitwt ! i ral " ' DEATH WAS CAUSED SY~ ifNTEp ONIY ONE CAUSE PER LINf ~CH! (o~, jbj. ANp (aj~ ~FLMifIN ONllT ~NO Of~TN ~ ~rr{D~~!E ~~u1! y ~ ~ _ __-`a) . . . ' ~ ' ' .~1 I _ / ~ ? i / ! ~ L / . f f- ) ` . I ?S r4 CO•~3lQ•JfN_f Cf ' ~ ~ ~+CI«O~ti. AM! i I / , , ~ ~ J, ~ F _ : ? - i~ ~ ..~v~ e st ro ~ lAl . 4-_ ~t_~-~-----~- ret..*::wuSM ~o., I q;t rc.O~~wS • C(:r+f[Ouf•ai[ O ••G. Mf Ol~~ ~ . . YS! .~ST . / ' . fC) _ - _ ! ~ OTM[R SIGNIfICANT ~QNO~ilONS co.+o~n. vs .«~~+n~„n.,~ •o cF.*~ w* .+o~ .u•~~o ro uo~e c~+t.+ r.~* ~ ~o~ -TAUTOISY If YES weee ~~MDINGS COW + ~~ns w s~o~~~o ~M oE~t~,.~..i~c c~~tt 1 O~ D[liN ! - - N~ _ j ~w , " ~ rCCiDF~:T, St1tCtDF Ok rDATE Of~INJUNY ...oti,~., o•., M UA MOW INIURY OCCURRED ° WT[~ •••~w[ O~ ~Nfvn IN ~4~T ~ pr r~~~ :r ~r[r r~ ~ Ci Wi^•EfERMINEO ~ I . ' i ` ~ ~ 1 .~.a ~}p~ i 7y W: SQd I „RV ~i WORK PL/1CE Of IN1UR~ •t r.o~i, r•w. s'a[r, saUOn, ~p~wT10N i sn[t~ o~ r r.o w~., un o+ ro+N, sr•zr ~ •S~t. '•fi O\ ~+p r p{II(f {lDi. , Ff~ ~ S~KIi~ 1 ~ ~ ~9 _(~~~~ir~.Tl(~-- r6NIM D~• ~t~r , ro~.rM O~? Anp IwiT S~w n~~. w~~ A11~E ON ~ pID/D!D *NT~ Ytfw ~n! DEATN OCCUtlfD ~t Mt ~tACt, Oa M! : ~ c„~~N TO ' r T ~ ~~OD~ ~1tt~ DF~tH twOU~: D~tl, ~ND, f0 MF {f5~ I ~:1-...t 5~~~ 3-30-72 3-3a-?2 , ~0- ~,2:lOpM O~ r~ [..ow~[OGe, ow _~e;.:. eo r~o.•. ~14 i14 tl~ tt ro n.t c•uuis~ s*.rro E~ti:KaTt~M(-At(DICJ1l EXAM~ftER OR CCNtONEA~ on r~t ~.s~S o• r..e or oe•~~ i rne~oecEOr.. w~5 ~~O~+OVr+CED Of~D. J^~ Of fM~ pD~ ~NC• G~ ~M! ~NY~S~'~•~1~~OM, ~N Y~ (~~~NrC'., YAMfM Oa~ I(~f yQV! ~ y•.~' Cu~~FD OM M! D~T! ~NO DV! ~O rME C~vSt~S~ ST~'f~ ~ l ~ ' I ~ ' M lAi~ , M ~ . ~iF0. NAME ,mt Cr ru..•.. ~ - - ~ - - ! SIGNAtURE ~ ^ j ; r~ M ~et o~ nnf DwTE SIGNED .~TM o••, •e.e~ J. Bs~'tk3n M.D. t i , - ~ - - , ~ . T _ rk 3-3o-7z : :.-.~r~:, wD01tE55-CFR?tf~ER ~rnt~ o~'r C.Y4_ • • '~!t O~ .o...~ AH 1201 N.I~T. 16th STitEET : MIAMI FLO~~DA 33~~5 CNEMATpN. REMOV/~l ~CEMEiERY OR CREMATORY-Na.vf IOCAtlON [~r. O? t0».+ Si.tt Removal tiillcrest rfefi.-'Park 1~~ i.'est Palm Beach, Florida - 4'f , rCw•w, o~~, +t.a • fUNERM H 1ME- NAAAf AND ADDItESS ~ rttn O~ ~ ~ D- r.0 , C~~~ O~ TOMN, ST~~F, II/' ~ „ ~1ar 30, 1972 ,~MIZF.~L-FA~TILLI:-?ERN ~101 Parker Ave. W. Palm Fe~ch, F'la. G}~~~~ RECTO - SIGh~TURE E~ B~- A ~ REGt S1 1 E DA~F lECt/YE0 tT l![GISIlAR ~ ;/L f T~ 7{? ~ ? ' i 1 ~ . - . (?~0` t . f? ~'j: I iiEREBY .CE~~Y•~'~.~~ ~~'~p BE A TRiJ~ COPY OF TFIE LOCAL REGISTRAR'S P.ECORD OF ~j~EA ~ ' • ~ ~•r`*~ ~ t ~ T O ".'•.t.`t ~I : • • ° ~ A!1'~ 4iECCil0E0 • ~ ' Y;.~v.~ . , fitEO ..~~~?Y ft~- . •J ~ . , ' ~ '•p.~. . ~ S?-RGG~r~~J FR 5 ~~ARt~~~1G r ~ m I,:~~:; ~/J ! + AS ~ - ~ V, .G~- • ~r • ~ 7t~'s~J~~:~~~Yl~~,f1~.,~ K C ~.;J~i COU~T ~ (t~otsV c~ ~ CIEk. . i x t- ~ - r : ~ ~ .~..r•--~'.' ' sed LEPUTY REGISTRAR p fr~P•, y. `~L :5~~~~~ ~pt~~ ~~o ital VITAL RECORDS UNIT `u +;I ~ DADE COUNTY 1iEALTH DEPARTMENT ~,i L I~ ~ N~~ ~ 'r~'~~'•'•~ ~ MTAMI, FLORIDA ~r s T ~ c`,~.~._ 906 a , 238 ~ ~ PACf s ~ ~ : M1 - - ~ _ ..Y r'1~~. ~ . . °`n"'?~B~a~~