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HomeMy WebLinkAbout0086 _ . .~•~Y , ~ ~Z.~;~TGE COUNTY HEALTH DEPARTMENT Central Blvd. ~ Postoffice Box 3187 • Tel: 849-3335 • Orlando, Florida 32802 ~ j . _ ~ - - - . . : , _ - - - 23941~4-~ tOAND o~ Hr~?~r,~ . CERTIFICATE Ot= DE~TH l~ ~ u os v~Y~?L l7ATIbTiG F L O A I D A~ ~ lTAfE F~~c No. - • • _ ~ REG~6TRAR'S NO, ~ ~ ' ,t ~i~~i~ o~ O~~fM CODE NO. Z. YSUAL 11[!IO[MCC(Ir~~.~fKwdlwd !.'i+.~d.~w~ Rr./ne~MA.~~t~v.:~~) . STATE (pUNT11 • •'v:ange County~ q Florida St. ~I_ucie _ ~ ~ r:~• O~ IOC~iqll t- ~5 ~IACE Of DEATM Q CITY. TOWM.OII IOCA qN t. K 11ESIp(RCE •~~r ~~~ndo C, ~Trr UMITSI FQr~ Pl~rce INS~O~YE ~CI~ UMI~Si r4S L7 No ? ~ rEs~ rq~_ i ~fJ wM t~ ~~~ykd. /a~ Krut ~/I~ea~1 f. iT~EET AODIIESS i nrange hiemorial Hospi`tal 903 Deldy+?are Ave., _t:,, ~ o~ ' FhN MI~Qr tvt ~ ~ O~TE M~t~ D~f Ye~. ,~taude Ruth Bro~vn uTM 11 20 67 ~ , ~ ~ CO:O~ 0~ II~CE ~ MA11111E0 ~ NEYEA Ma11A1EC ?~~TE Oi ~tI1TN ~~GC ( I~ ~tM1 r U~OC~ 1~ W f N~O(a 1~ MS ~ Tc tdhite May 21.190~ ~65 ~r? w.. N.... ~ w~oowto Q avoRCto ;;r.~~t p~ 1f.ic~ tiw~e/a~r! tewt IOD K~hDOF WSINESSOR INOYST~Y IL ~IIITM~ACE (Sftlt whrty~ CNntr~1 li. anra or ww~r cocx~rnn i~~.• ~a? ¦a+~RI t,p. ~re~ yrrfi?t11 Geor 1.3 ~ ~ ::~~u~c:~~ife Nome 9 ~ United States • r~'.n 1~~~( 11. MOTNER"5 MAiDEN NAME j~ -~,?orr, F. cdhittle Parthena O. Shaw a.a yC._~~Tr Iq 11 IM/ORMAMT {~101'tA1YAt A~bp1 ' Robert L. .Brown 903 Delacvare Ave., Ft. Pierce,Fla. ~ ~ 1 t~vs( •t KiiN tER:rr onl~ eet tn~t ptr h~u J~r (~1. (~l. ~s~ ) IME~v~I ~ETwtEM ( ~ut ~ G(~iw w~SC~UN0~11 ' CA 1 L 'i ~,~f D~w~ ~/j OMi[T +ry/bFATH ~ ~Yr[O~~Tt C4USE C!(• ~ll JLLLYV~' LLl L~L. `-C~/C _ ~ . ~f ~ ~ c.. r. sei-TO te~ /6 G ~Q7, l~Ly~~~ 1 L ~0 ~ ~.,r ,u r, _ 14+~ t~vw l~l. . ~r~~~~ r~~ re~~n 04( TO (H f r.,~ - . ~ T~~ O~~tA SK~KKA~I (pNpTqpS COMtA1~IJIWG ?O OEATN ~Uf NpT R[UiED ip fM( ?(RMt1U( OfSEAS( CQ11pTIp1( G1YEA M?yti 1(,~j . MAS AUTO?SY + ~ ?t~i011M[01 s ~ES Q h0 ~ ~ I+:i~sL~ 2D6 ocSt~~tE ?rpw +K~u~r oCtv+~~co [E~/a ~rrre yi~jr.~ 1,~ Pat ! n Pnt Il y kriw I~J acc~u,• w~uoc NoMK~oc _G O O ~ ~ ~ r. ~.~t or lr.r, Afe+,?, u•r. Yr•. +i~~• ~ ~ ~•`r OCCW~tO 20t ?L~C[ O~ ~NIUIIY (e. i~ or ~fy~f Aoint, 20/ CITII. TOWN. OII tOCATqN COUhTr STAT[ ~ •i ^ ~O~ wM~IE ~ /uw. l~ct~r1. Mrrrf. o/fu AI~., Hc.) ~ aa v ~T w0~~ • / ~iunA?d iA~ d~c~~a~d /rom _ I ~ _ ~ . to •nd /ut a~~ ~/i~~ on / ~C ~ ~ D Yf/• I ~ , ~ / m on th~ d~t~ st~t~d ~bo.~, ~nd to th~ b~st of s~) ino+l~d/~, /~orn th~ c~us~s ~t~t~d ~ I?t. 0 C S~G D ~1 M~TY ( /IH l7 ` - I ub ~ /a ~ CY ' , f ' U~,~,. ~c ~ C~/r~e.ry~ I]A O~T[ 2J[ NIIME Oi CEMEtE11V OII CIICMRTOIIt~ 23/ IOCATqM I I.INI~I. MCIYSf/I ~S/NIl _ +'Y~};""'' y/22/196~ Ft. Pierce Cemetery Rt. Pierce Fla. ~ '~t'~: v•tCtO1i 3 SK.N~ib AD ESS 2S pAt~•~ D Rl11EG Z~ GKTM~"3 ATU~ - , 1.,y/,J~~. /~~~/~ates `~`uneral Home ,.U1 ~~°~b°t . < ~ ~.Ft . Pierce Fla. • ~ ~/,r~ ' /~A ;j . ~ cV t~ p~a n< . _ - - - - - , w ~ oc = ~ o~N~ =Y ~ K ° ~ CERTIFIID OOPY _ ~ z n s'?~~ O ~~ereby certify the above to be a true and correct copy ~;CFi@'~,~c~l Registrar~ s record on file in the Orange County Health Department, Or~p;..,'~r~~e. =~~u" - a,p ~:•t:~ - ' JJ¢W~.~.' I , , ~N V~' ~ . `l ?w fLj r1i ~ ~ - • ~ ~ ~ ` , lt ~ 'Y ; ^ / V'. ~ ~ i t.J eY~~ ar 4~ ?Ih County Health Officer and Local RegistrAF , ~ ~ OCT 6 ~n ~ ~~y.~'.~',~.e~,%!. 7~~ : w i Date Iasued ~ ~put Registrar ~ NARtdINGt Not valid unlesa raised aeal of the Orange ~ ~ Cot~nt Heelth De rtment is affixed. Q~~~~ ~ ~ Y Pe L~OK ' ~ 'r,1%t - - _ =_V~ - _ _