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HomeMy WebLinkAbout0715 r. vv.~~rv ' - ~ CERTIFICATE OF DEATH • DeP.n~eu~ o( Ik,l~6 •pd R~6~I.i~it~lhe . k~ea fTATt FILt NO. ,~,~~,~k?~,,~ 2 ~70 52 ' 1 r?E, OR •~~rit IN `R~+~*• ~ ~ F L O R I D A pEGItTqAR•1 NO. ~tlMANINT ~NK OECEASED-NnlwF ~~~st ..+owt SE1 DATE Of pfAM + rowi», o~~, r~.~ ~ SEE M?MOIOG~ f01 ~srwct+oa ~ FHILLIPS : male ~ Se t 4 1972 ~ ' v RrtCE .•m, ~icu,. •wncw ~wo,a.., •OE-us~ u«a~ ~.eu uwe~ ~ w~ OA1E 01 ~rRTk ~.~o~n.. a.., COU?~JY OF Of/?iN . ~ wh`ite ,;•,~i~5 p~s Aug 15 1907 Broward CITI, tOwN. Ot 10CAT1 OE~ «~sw trt+ iWns MOSML?1 O~l 01ME1 NST 10H-N ~ w wo~ w u*«a. a~ve srrtr aw «uwee i S?ft~ ref O~ w0 • „ Hollywood yes Memorial Hospital STA1E Oi t~fiN ..o. ~w ~.s M,..~ uni[i+ q w~ut toa+tar MAlt1ED, NEVER MARRIEO. SUtYNNG SlOUSE MnM, 6M W~0lN wM! ~ toiw~fe.~ ,No. CaroZina ~ USA „"OOm~~~~''"""' „ Ruby Holbrook, ~ +.ui oece•uo - ~~+to u o~~m SOCIAI SE~I?tIT! NUr+~6Et USUAI OCCWI.TIORI ~an cwe a.+o~c oo.+e ow„w ..os~ a 1(INp p/ wSINESS OR IHDUSTRII pCC~~~fD ~M rWtr4 l1ft. (Ytw N ~tAflp 1 ""'~"Y-°" ~t 42 07 2698A Welder " t=='~~ Steel o ,u.vstiww. RES~OEnCE-SUtE COUNTr Gi71P, 20tYit, C! lL~.tt!G»+ ~.rs/w un ~w~n SttEET w?r0 NUr~~E L"r ~w Florida ,pBroward ,,,Hollywood ~es 6353 Jefferson ~N. Y f41Nft-rfAw~f rea~ r~oae W~ MOMfR-MAIpEN N4ME ~wsr .uop~~ w* ~s Jake Guiten ~ Sally Phillips . [sic] tHrORMUNi-N~E ~u?lwG AOG1tE51 ~snea oe e. .a . cm o~ ~or..~. sr~n. tr~ Ruby Phillips ~ „~6353 Jefterson St Hollywood F1 33023 ' Iw~i 1. pEAM WAS GtUSEO ~Y (EMfR ONLY pNE UUSf KR ll1E fOR (01. (b?. ~O (cN :~.w ry 1~ r.reewt~ 4wst urr~4M Owf1~ ~~+o Ol~TM ~ ~ . ~~N a-- c~r%~ ~ • 1 ~ , w • w ' • coNmuoNS, ..n • wNiCM 6~v( t0 l ~8~ II~YlCI~i~ C~YS[ 10i, ~ 10. O~ AS ~(ONSEOyfNC! OI- ~ia/!u0 1M! yMO1b ?nwo c•vse us. , (~l . ?ARt 0 Oil1ER SIGNKKANT CONQITIONS: ca+anon cwnwun..p q p~~n~ wt MO~ aeuno w c~us~ eneN w. r~a~ ~ w~ A~~~ 1F YES re~e r~raNes cor- ~.es oe .q~ woiuo Wi~lYININO (~YS~ w ot~rw 1~~+leNrl wtt~ r+t, SU~U ~ Ib. n~ IN MOirKME: Ot lR+OEtElM~NfO ~~aa+rw, o~r, ~ea~ ~ fpW INIURY OCCURREO ~ e.m~ w.n~e w~wiun ~w ~~u ~ o~ ~.n m. ~ 1so.c:M 70a ~ ~ M ~ INJURt AT WORK VLwCE Of ltJUR1f »o+e. sr~et~. ~.c+w., IOC~l10N ~ ueta a~ r.o. .w., arr o~ rovu. ir~e ~ , ~ s~ec~a ns o~ .w r ar.ce ~no., ex. ~ snan ~ 7w 1M t1~. CERTIFKATIW-1-- ~Or~tw oae rtu rOnt~ O~~ ~!u uas r?St s~v Mw/~ uM oa ~ M~O~D MOt rw twt OEw1M OCN~~ED ~t n~f hKe. O.. w~! ~MTSKIaN: ~O ~~M Q?T 7l~f ~007 ~?R~ W~M. tnW1~1 O.Ut. ~nY, ~O tM! NS* ~ a~ItNOlD Mt . 9~4~72 ^f Or r~ twp~.itOGt. Oc! !la oeq.seo no.. / ~ !tl? !1. Z!1~ !Y. : 30P ~A. ro n~t uwse~u ft.v~ CEiTIf~G?T~OI+-MfDK~I Ex/wINER OR CORO?rER: a+ me uHS w ne ~ow d oa•n~ rwt aectoe.a wl.s tio~+ou.+cto oe.o luriw~n0~+ W MF WO~ ~NOlO~ n~! wvlSriwT~Ow. ~r~ r~ dwWw. rpa~M 0~7 q~ty MOYt'~] Ot~m OCCUaRlO Or~ M[ 0~~! ~wo Out q iM! C~uSE~S1 Sr~elO. U M. }2~ ~~1 ~ • ~ I 7 Z,~ 7T~1 CERTIf1,~R-NAME ~nn o~ n~ n~-• S~A E ~ « ^ pA~ M t~ -r, s~'t'~ ~ v ~Nc~ ~ . ~ ~ ~ ~ or.~,.~,. o,...w. ~ ~ ~49~eG,~~ESS-CfRi1f~FR ,1 ~ i" 1'. ) , `~re w a.r.o. ..o ~ m a w.~ - • r- 1- _ -3 ~ ~ L4 wu.~lj-~ 's=4C.~~ > ~ U RIAI. CREAIAiION. RFMpVAI tFMEiERY OR CAEMRi01rr-N.~,ME IOUTION an oe row,. s~.n ~ f?KMr ~ burial N~ Westlawn Mem Gardens ~ Ft Lauderdale -Florida ~ OATF r.~oarn. o.~, ~eu ~ NHE~AI NOME-NAMf ~Np AD6RfSS ~ sreen o~ o.w i o ro~.., ~r tu ~ ,N Se~t ? 72 „~'RED HUNTER FUNERAL HOME 6~0~ Ta~~ St Hollywood Fla s. ~b 12 iu+E~~y ~RKT G~uT RE R ISTRAR-SIGNAiUf OwTE CE~v(D t lp~j~ RtG~itt~t P.ev.29T0 ~ /f~ ~ iN ' ~ - . . - . . • ' - • CERTIFIED COPY • ~ ~ I hereby certify the above to be a true and correct copy of the I.ocal • Registrar's record on file in the Broward County.}iealth Depart~eat at Fort I,auderdale, Florida. . ~ . . - ' . , • . ~Y~~g~:`:~~4~ valid unless raised seal of the Brovard County Health . ~ ` . .%~~;~~oent is afflXed.) • - ro _ , ~ f ~ ,•f ! , - , ~ ' ' _ . r,~ a~ 4 ' . . . . , , . ~i1~~"~i~~~/~~~~,~~,i~_°~ ~1/ ? . . . ~ • County Health Gf;icer and L . . ~ , ocal ~egistrar _ •.r=.,... .'~,,1_ - w=~ ~ y r: • ~ • ~ ~ ~o~ ~ ~o'~°'s . ~nGlY . 9-~7?2'.~.~_•• ` .1 ' ' ~ ~ t AcY w~a~L~X - ° . ~ ~ ~ ~pus~ , , Deputy Local kegisLrar - . ~ - . - _ s _ RECORD & RETURN TO: BRUCE A. HOOD Attorney at Law ~ « ~?MO ECOR ~ s~. ~3~~E ~SUMtY g~ 1943 Tyler Street AOCfF rOtTA~z Hollywood, Florida 33020 RECCR~ Y q;~j fp ~~UpT ~ II i~i ~!'7,~ ~oox w?c~ 2 39828