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HomeMy WebLinkAbout2924 I ~ / ~ 239284 rn~s pe- BTAT[ BOARD oF Htw~r+ CERTIFICATE OF DEATH eo~es a BURCJ?U OF VITAL fTAT1oTiG• 1TAT[ F1L[ NO. lea~l FLORIDA pEG16TRAR'S NO. ~2S ord •Aen gIRTH NO properl~ L~U1Ct Oi O[ATM GODE NO. 2. YtWt R[SIO[MC~(1?4n4ra/Md l!w~.w~.w: R~dwuWn~+wiw) r t e c u l e d ~~hTM ~ STATE D. COUNT~ .~a T ' Florid~ St. Lucie De p1~e~A 1n ptr- O. CiTr. TOINN,011lOCATpN t. .S i~ACE OF GEATN C~TY, TOWM.OR IOCATION t. IS 11E516ENCE lAS~JE UTY 11Y1T51 IhSIDE C~ LIYITSi f 11 ~n` ~ E res G~S. ~r~o ? ~Ol't n1P.~'CC YES ~+0~_ 1. w~ME ~Oi 1If Mt iw ~pitd. Irt ~t~ttf ~:drrH) I. STREET AOW~CSS Np5hT11L OA INST~TUT10h pyerce ~-QT~.O:~=n1 j-~7c^ c`S~ tj22 Lt~l1 la$ C~urti 3 ItAM[ O/ Fvlf Vt.:ift Lart D~iE Al~wf~ I1~1 }'tP (DTyp~ M p?IAf) i !iW~il'i OEATN N.arch 2~, 1967 r"' 8 D11TE OF lIRTN ~ AGE (1~ ~tYJ ~ u"~~ ~ W~~:~ ' S SE% 6 CCIOR OR RAtE ` ~ M~RN~FD hE~ER M11RRtEU ~ /~1! ps~y x~yy pw N.w Ni+. << t• rerr,ale ::e ro vc:nowca;=; ulLOACE~J July 27~ 1912 >4 p1~1f117 10~. USIi~lOCC41ATqM(Cis[ti~/~/aOrt/~wt lOD KINDOiiLS~AESSOa~hOJSTNY It. YiNiNK~CE (SY~feM/Nty~tw~tr~) IZ pT1IEM0~RM~TQOU/(i111t .1 c A y~ r- ~rri~' ref y r~r~i~1 UJt. nr~ i/ rt~vr/1 ¦~n~nt Dor;.estic Pri~•ate :~°:e Su~:~ter, S. Carolina U.S. . Ol~tk lOk ~j_ F~TME11-5 NAME 11. vOTHER'S VAIGEN MAME ' er t~p~~r1Nr GeorFe ~uldrow ::n'-:no~n 16 SOtu?~ sc[u~iir ?.o IT IMfOAMA ~ i1CNA7YRE A14~~! 26~-60-9~?1 ~:alter 'ooLh ~22 DoL~Ias Ct.,Ft.Fierce,Florida F'un~ f~l 1~ C4Y« 0/ O[ATN (Eafa ~s!/ ~wt t~r~t pt~ 6wr Je+ 1~). ~~I. ce~ (H.~ IhTERYAI ~ETME[M ~~11T 1. O[11TN M~S CAYS(D ~Y~ OMSEi MO DEATN d t l0!' IYME014TE CAUSE CarC1~~::~a~~$1$ ~ .usl fll• cAe e~r- t1flc~t• Co~/uiows,i/~~I. pyE TO (61 _ CaT~C1:~:C: c ilT~6oSt _ • 1 t~ th• ~r~rd /~rt nu f~ 1 o e w 1 ~Dorr t~~u S re Istr~r 4t uftr- R //u/ nrx I~N. DbC TO (N-----~--- - • 1 t~ 1 n '71 ~ ?A~T OTw[~ SK/+/~GwT COnD~iw7wS Co~t~:~Ui.vG r0 D[~iH &tT *Gr a[.ntiD i0 i~tE 7[~r~wl dSGR CONO~TOw 6~ W~Mi 1(~) . W~S AUTOrSY hou~s •f- ?EIIi011MED1 ter destA v YES~ MO? or Etfer• ~ ~ ~ - - ~ ~ n ~ 2~D DESCN;6E ..i.a :nl~AY JCCW ~ED i Eafer wdrr[ • n r i~ P~rf ! M Pof 1/ • Yrw f1.1 ¦~k1oa •n~ ~ ACC1D(NT SU~C+DE NOMKIDE •posi- u ? rJ ~ ? ~n of TirE OF H~rr M~wt~, Mt. )?~r bod~. V UUU~1r 1..~. 0 0. W ~ 20d ~NlU11r OCCL'11I1E0 2(lt ~.~CE O< <N.Ua~ ~t. y+ . ~n w~'N~: R6v.[. 2AJ GTY, TOWN. OR tOCAiION COIIhTY STATE WM~IE A7 ~ NOT WN~IE ~ faclcrY.+~a:. c',jict ui/~.. tl:-) ~ WONK AT MOIIK 21 ! ~tt~nd~d fM dee~~pd /iom _ ~'ar• `7 ~o :'a~• - •ndlut a~~ AIm ~Ii~~ on ?~r• ~ ; D~~tA occurr~d ~f g~ A• _ m on ths d~t~ st~t~d ~Aor~; ~nd to th~ 6~0/ my Ano~l~dp. /rom th~ uuqs ~t~ud. ~ ~11 fte~• jj~ s14NATYA[ (INprtWliSrr 22L •ODRE55 T2t. DATESK.NEO ! •re to b• i ~o.p~.~. . N.artin G. GoLld, 1~;.; . i Fort c'ierce, Fla. 29 Z~.ar. 67 , ~ •ceur~c~. ~~M~I.CAEM~i1pN. Z]D p~Tf 2k ti~w~O~ccwi:[praaCREMATORY 23/.IpCJ~Tq~IGY~.br~.re~~t~) (~~r~ MFrOVLL 11ytt~J/~ . ~ 1 - - ~e Gr ve ~'GI'2+e Q ~ r I ~ j V,l,~EI$ j~ iUbERAI DIRECTOR 551GNATYl1E AOOA[SS 25 DA7i AECO. ~YIOC~tlRE6- ZS. REGI5T4A~'S516M11TU E } "".'065 per:~~rd R. Gibson Ft. P? erce '~-?~--5~ A. na Lee Deniso ~ ~ i hereby oeriify thia to be a frw end corraCt copy CS` t:~3 Locat a Rogistrars neaord on file in the St. t~ucio Counry F;;ai~ Cx.~rt ~ mo~t et FoA Pieroa. Flor[da. . ~ (Waming• Not va~id unless ralsed seal of the St. luds . j` ~ . ` ~ ~ ~ ~ County Health DepsAment is affixod.) ~~~:fi ~1~'• : r , . f- ~ ~ N. D. MILLER, - - - ~ - - _---+-~r--> ~ Co~x~ry Healtfi Off~c~r d~ Loal isir•r i} f'~ F ~R, • ~j~ i - ~ • ` ~`'+~i~i. " ,I 1~=. ~ ¢ , ` ~j`I_~Y+~~jJ 1 ~ • ~ Qi~O ~OF11A~/ ~+OCO) ROQlsttbl ~ ` s ~ ' ~ tLEO AM0 REG ROEp ~ t~~~~-...."''`~~,~_ ~T.lUC1E COUN~ flA. - ~ ~.f I ;1 E~ ` ~ . . , ~ ROCER POItRAS ~ , , , ~ CIERK CIRCUIT COURT~ ~ RECORO VERtf1EDr.~~ " , ; ~ 239284 Oct 5 2 4o Pt!'1Z ~ aoax~ PACf~~ _ . , . .a.~Y § _v„~- . ~~"c~~