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HomeMy WebLinkAbout0475 1~~ ' ! ~ - ~39695 - . ~ CERTIFICATE OF DEATH ~ ~eqA~ewl o~ Ik~llti ~wd Rt~{.a6ililalire $nvkes f'YAT[ FIL[ HO. i iM~~w~~ ~~rtwi~u FZ O R I D A ~ i~~E, O! ?tiNi IN ~~~~4R~~0 pEG16TRAR•f NO. 75 ~ OKEASED-N/WE ~~ts~ SEX OAIE Of OfAM ~ roM~w, e~~, ~tu ~ i[lMA1i[MT INK ~~oou ~ m~a.s ~ , tFemale ~Februar 9 1972 { t~CE .~w~r~. ..~aw. uu~K.w ww., ~GE-ui~ woe¦ ~.u. . w+o~~ ~ w. D~TE Of M[M ~no~+~r. w~. COIR~T1f OF OEwTn ex. ~wcr+~ a~w..~~ws~ ws. wn ¦ows nu~ r~ .S~'i• ZL1C1@ 6602 ~ Ne ro 72 ~ ~ ril • 1 18 Ctri, TOwM. OR l TWN Of DEATM wsee ca~ ~ru.s MOSMTnt Ot OMEt NSTItUf - ~ r•~o~ w unr~. one srru uo .ww~ ~ } s?ttur •u o~ Mo ~ ~ Fort Pierce Yes Fort Pierce Memorial Hos ital : STATE Of MR1M ~ r~o~ r. ~.s wu.t GTIZ@1 OF W/u1i COUrRRY MARtlED. NE~E! MARlIED. SYMrl1G SI~OUSE ~ r~nn. o~re r?oN+ wrt ~ • . • tow~n ~ WE~. O ~ wcn ~ ' ~,~u Florida ~ U. A. ~.~llarriec~ Horatio Grisb ; ~wu ace.us SOCw SECURIr MwVE! USW?l OCCU?wT~On ~a.e a..o a wu oo~+e eueo.o .os~ w KwD Of MKr+ESS Ot wDUSmI u.~e. N a~w~ .waw M.. u un~w ~ «c~ue Dome st ic „ Unattainable ~ouse Wife .es~«nce ~tror cm ~ws STeEET At+O ~NW~E u~isaw- tES~DENCE-STATF COUNi1f Gtt. TOwH. OR IOGTWN F 532 1?Yeans Court ~M Florida ~p St. Zucie ort Pierce es fATMER-HAME r~n~ ..aote ust MO~MER-MAIOfN NMIE ~rft rwa! uW . Alex Sills Delia - Mays „ INfO~MANT-NAME MAIWG AOGRESS ~s~nn a~ ~ r.e. r.o. cm o~ q.w, u•tr. Horatio Grisby 532 Means Court, Ft. Pierce, Fla. 33450 urWauu w I~vY ~~Ri 1. pfA7H WAS CAU LY. (frrtEf OrtlY ONf USE ~Ef lNf fOf (sJ, (4~, ANO k/1 ~~tite.. owsn .w N.~r 1~ wrl •uf~ N1 ~ ~ s. r co¦omo..s, ~.n. .w~c~ c.v~ ust +o lsl ~rrto~~tf C~YS~ b~, i f~~fIM6 1~1~ YNOI~- ~~O. S• / OYlK • ~ ! I lf~MO C~VH l~f~ ~C~ ~ ~ . ~IUT N. O~HE! i~Cw?+7 C no..a co.n~wun.w w a•n~ ~ui .w+ reo ro uv~e c~+e.. w rur ~ a~ wY10?S~ 'If trES weu nMS~..cs cw.• . ~ns q ei°tlw ~t~~WMIMO C~Y1l ~ ! t u~!!~ ~o { Ires~, 1 KC~OENf SUKWF OR DATE WN/tt ~+onrw. w~, nu ~ NOUR MOW INIURY OCNRREO w~ p~wwt• u. ?ut . w ru~ u, ner ~ . p Moi.' iuoE, u ura[i[wureo a ~a "M iw ~o. M ~a ~N1WY wT wOV( ?uCE Of wKMt~., w..e. i.rn, r.cw.., lOCwnOn ~ s,~u~ w~.r.~. .w., cm o~ ~o.n., si.a ~ ~~~ean ~es w r.o~ Iow~a wea..nc. ~sretr.~ 7M IM ~t r CERT~iKwT~O~+- •~o..rM we ~w ~ ..c«m o.~ ~e.~ i ~w us~ s.w r?~e~ une o.~ ~ eaiaa.w vK.. m otwrN Ottunt ~i na ?uce. a. n.i rNrs~u....: ..o..m w, nu ww .m. a.w~. ~~ww~ D~R, u~0. 10 M Mit ~ 1 nRlMDtO tw! T~ / ~ ^ ~ p rt [w0`ruDGt. Ow ~l~ OlCl~SlD /fOr ~ II~ 2~. sG --7 Z,.. ; 3 M. ,o w~.,,,as~ s,.,.~. . CE~TYKwiqr~-MED~Cwt Et~wwEe Olt COR ER>a. *~e ~•s~s w~w M~y1 M Of~M we xc~ wi w•s ..ceo w.e ~ ft~rr~rO+d Iwt WOr u~D/O~ lM ~r~v~SnC.~~Ww, w r~ d~.0... qnw O~t wOV~ ~ Ol~~M O I~~tO OM Mt MA O OY! q M YS~If~ Sf~TfO 7~'3D p M t J7~ _ M I2~ Ci' . CEllil E n a 1 S~Gt+ ' m~ ~TE SK,r+EO ~+a+~w. w~, •iu i il. ~ ~ ' O_ - , - MAING -CER sutn w ar.o. . ~{m s fy • • Ov i µ~py. ~µ~Tp~,~. ~Mpy~ tERY OR C1tEMATO~~-~+~+E ?OCwf10N on w q.r. s~•n ~ ~ vec~r ~ ~ Burial :.~Pine Grove Cemeter Fort Pierce Florida ~ DATE ~rO~+~r, Y~. ~tY~ FUHERAI NOME-N.tMf ANO ADDif Stu~t O~ O. r~0. Cm ~OwM, • ty ~ 33450 t ,w Feb. 13 197 Stone Bros. 3~7 N. 7th S~. ~t. ~~.~erce, Fla. . V. 5. ~612 fU~+E O~RECTOe- ~ ' -SrGrutu o~ ~eccrveo ~r ~ocu e[aisrw ~ R~v.1970 i _-Gf ~ T ~ r ~ 1 11efOb~/ OOrtl~/ 1f11! 1~ b! • 1T{!~ OOR~.'t OOP~I O~ 1f10 ~iOl'A~ - ~ +.-i~;;::. - Re~istrars r~ecord on flle in th~ St. Luci~ County He~hh Dspe~i~. . : ment ~t FoA P1ero~. Flortda. f LED 1?W~ RECOROED : ~.LUCIE COUMTY fLA. ' f.-,,:;~~ ~1, r (VYuning: Not valid unl~u relsed sea) of ths Si. Lucls ROGER POtTAAS t..•. €:.~;.7; l=:,, ~ CLERK Ct3CUiT COURT ti • ~ ~ : = • Counfy Fiealih Deputms~t is affixed.) RECORO ~~FlFIEO._.~.~.. ~ t~• . • ~ : ~ p ' j ir - ° • e,+%"; . ~ N. D. MILIER, M. D. ~T I' I 16 1 M ~Z~ ; ~ , ,Y. . alth offic.r b ~ ttpistnr s.`,~ _±~'''~~'~c'~ ~ 7 , j~ _ , . Y. : < ~ . , S.. v 23969 ~ - ~ ~t- ~ ~ ~ .;~~,x,,•~ ~ Dd~ Dqwty loui it~pt.+.a? 5 . _ . . . • ~ ~*~_t~R'~' ; ~ ~1~~. ~ , . . ,,,t~, ~ 600K ~Q~ PAGE 4 `75 ~ ~ ~ -