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HomeMy WebLinkAbout0625 - ,S ~y6.3- t~,~ Dt- ~TATE ao~ao OF NEJILTli CERTIFICAYE OF DEATH ~ co~es ~ BUREAU OF VITAL iTATIBTiCt fTATE fIL6 NO. l~a.l FLORIDA REGISTRAR'S No. ord ¦hen BIRTH NO propetlr ~~~ACE Of O[ATM GODE NO. 2• YSUAI R[SIDENCE(1i'?wel.~w..I1.a1 1!~+~1.t.tw' R~./wMW~.~~Mww) e:~euted ~ ~hTY STATE D. tOYNTt .~d .~1~ Bro:rard Florida Brorrard 0• pl~e~d t. K RES1pfNCE in pe~- A. CITII,TOWM_Op LOtATqN 1~,~~~~~~~1M1T51 CiTr, TOWN,OR LOC~TqN ~NSIOE CITY LlrlfS* Holl rood •~S~ ~O kallandale ~s~ rii~. I. NAwE OF w~f iw AaPitd. /ire ~trut ~dd~~i~l STIIEET ADOIIESS ~ ~T~` ~ biemorial Ho s~ ital ' 1004 S. ~7. 3rd Avenue a~sTiTUTa~+ 3. NAM[ Oi Fi?~t Al~fllt l.uf 1. pATE MewtR De~ Yt~? _ Paul Didier, Jr• OEATN April 27, 1968 S. S(1[ 6 CQ:011 OR RACE ~ MARNIEO MEYE11 MARRIEO Q~. ~TE Oi lIATM ` 9- ~6E 1/~ ~tv~ a~`~~ ~ Z~ ~ Q ls7t A'vWtYI 1M~+u~ n.r~ X..r~ .v~.. ~ ~ t c• ~181@ ~Yhite rriooweo~ ava?ceo Feb. ~3 18 ~5 p L ~ f n 1~ jQa_ USWI OCCU?ATqN (Gitt [i~I o/ rWt [oit 10D KINOOi ~U5INESSOR INOUSTNY 11. NNTM/LACE (S7Nt 0? JO?tWw cOrRt~~) ~j_ ai12E~ 0~' ~T 0~1~~~f •ItA p~r- frri~owo~to/ra4i~~l~/r.r~rwr/?d~rdl - Endineer U.S. Govt. Pennsylvania II.S.A. Dlacic lnk ~j, FATNERS ?u~ME 1~- MOTNEII'S MAIDEN NANE ~,P.-rs~•~ Paul Didier ~arie (IZot Available) 16. SOCU?l SECYR~T1f MO 17 INIORMANT t sIGXATYIIE A~~~~~ 004 S~'/ . 3rd Avenue - - 8') n rnthy Di d~er Hall.attdale . Flo ida. _ . ~ w~ ..s~~u f t'.~.. w../. w.• r~ru ivr hv Nv fal. ID)_ o~ lt)_I IhTERV~I SETWEEh ~unf~~l . ~w`v~ • ' _ - _ • . : ' V~]Ct /ufY Vaw~ei `~~~~o~ MRT 1- OEATM WASUUS[O!r• ~ • us t f 11! tMMEWATE G1USE ~ se. e•r- Q~( /?O ~L7/`1 d~ l~liC `~/~lJ~~/"~~ ' ! i f f e~ t e Ce~/iti~w~. i/ ~ui. D~E TO (a1 _yril • 1 tA tA~ rAi~~ ~ue ris~ t~ 1 o e a 1 aDosr nux (i). . r~atatr~r KotiAl f~s rwfrr. ~E TO (t) l~iw~ c~ux lut. s 1 t h 1 n TZ O ~ApT 11. OTME11 51Gw'K1UIT Cdru~iqlt5 CO?RIUMlfw6 f0 OE~TM M 110T REIAiED TO TME TE1tMUULL pSEASE COhW nOK 6tYtN U~AI~T 1(~) . WAS AI;TOKY . 6our• •f- fE~ONNED~ li c~r deatA V ~ YES~ NO? ? i O~ EeCo~! ~ IR~D~D ) • mD. OESCNIlE MOW IMJURT OCCU~REO. (Eaft? wdrrt ~J~~jar~ i~ PVt I er Pp/ 11 ~J4[w f/.) s~ k 1 na •n~ ~ ACC~DEMT SU~C~DE 1qt~K~OE ~ d1~Des1- m ~ ? ? tlon o[ V 20t TIME Oi Ho~~ Aled~, M~, Yt~r lod~. V INJUR~ fe~. \ • ~ f~. W ~:.~5. :%::unS VCLVAntV wt- i~ACi yF inJvR'r 1t. ~n w aasl lo~t. ou%. C17Y. TVww. Vi~ ~in:wiNA unlhi'r S7J~i2 . MNIIE AT ~ N07 WMIIE ~ k~w. /Kla~. u?ttl. Oatt O/I/.. N:.) ~ WORK AT 1MORK t~- 1 ~ft~nded th~ d~cs~asd/iom ~ ~ ~ ~ , to ~~~~'68 •ndl~st sar ~lir~ on ~ ~ p~~th~bccu~i ?t 2~ 1~:~ m on th~ d~t~ st~t~d ~bo~e: ~nd ro th~ e~at o/ mr inoW/ed/s, frorn tM c~uaea st~ted. ~11 1tt~s j~~ sfC~ ~T~''R /Urpre?t4ld 2IA AOOIIESS 22[.OATES~GKEO ~.~f 'e ~i" 1'~~.~----, ~'l^-C~ Hollyti~ood, Florida Jf-2y-C _r? ~ o. ~ c~ a (it~'~- ur te. ~ 2Ja~ S~~t. C~E ~iqti. 23D D E ~ ,2}c qAxE O~ CEMfT# R~ CREy?TORY 23d. LOUTqN (Ct/. [orn. N nsAt/1 ( at~~ RErOV~~ ~_Yjx~.~r~ l1011~YOOQ ~L1eIIIOT'1c11 ~ Entom~ent 4 0-68 ~ ard~ ' , g, ~'r j~ KEi1Ai D~REC70R S~GNATURp ADCRESS~] 25 O~TE RE O. LOC~I IIEG 26- aE~u:RJ1N"5 S~G ATGRE ^v1 `~'t/Ltt"~~ ~ i ~L4'~t~ lS2O~~y~ 1~0~ • ~ /J 7 ~ / ~ l~l~~ Per.106S ;ladlin ton Fu .eral H~ne, Fla. ~2~~? y~~`i' ~ ~'Li ~ T . z3s~s9 --1 ` CERTIFIED COPY - ~ ~ ~ I hereby certify the above to be a true and correct copy of the Local ~r Registra:'s record on file i.n the Broward County Health Department at i~a ~~o Fort Lauderdale, Florida. . , ~ An~'^o . "~t,~+ooA e'neo~r„ (Wnrnin~: 1~fot valid unless raised seal of the Brorrard County Health ~o - Q~partment ic affixed. ) "'o ~a :v 1(t~' r ' - - - _ - - ' a,-~•+~++ ~i%'~~~~~iW' ~ - ~ ) ~ 3'•` ~ t x •o . CZ.+uGI~"'~ ' R B~~` County Health Offic anci Local r~egi6trar : ~ ~ . . - , - ~,iT. ~~tl:~ h~A\t; . ~~i - ' Tlttil~l c $flDK~! P~6f ~ •''..s;,; :••'•ce' . ~~?^t?•-ti~ Si'• DeputY Local Regi6trar 10-9-~2