HomeMy WebLinkAbout1097 ~,~~~ZU~
RE: LaFAYETTE WILFRED RE~iILLARD, Deceased ,
Lot lI, Block 27, PARADISE PARK SUBDIVISION, as per plat thereof re-
corded in Plat Book 8, at page 17, of the public records of St, '
Lucie County, Florida.
;t~~ar~ent r:~~ :
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/ LEO ANg R~~~r~~~,. a. Grittin,lZ.; A;1~. ind St.
s#• ~t'fk` o~~~?s ~ort Pierce, Fla.
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~ STATE ~ IOGY. REWSTRAiION ~ C"
f ~E CERTIFICATE OF DEATH , o~ct~o ~~~1'' •~~1
~ N rf STATE OF CAUFORNIA-~EPARTMENT OF PUBUC HEA~TH Eat E
~ 14 NAME OF DECEASEa--f~RSt ?u~YE ~1~ iuDOLE ru~rE ~ k u5T ~urE 2~ DATE OF OEATN--ro~tM- w~ ~cu ~ 2~ ~WUR
Lafa tte ; i~T~l f ied ~ R~NIII.Z.ARD Mar h 13 1 64 ` 12; 30 A
3. SEX ~ COIOR OR RACE 5 BIRTHPLACE ~`o;w,;,°.', ~O1"O' 6 OATE OF BIRTH 7 AGE ~"N•' urot~ ~ tuu v u~x~ ta wuies
Male Caucasian Rhode Island Auguet 8~ 1908 55 Y
~ e NA11E ANp 81RTF~LACE Of FATHER 4 MAIOEN NAME AND &RTHPLACE OF MOTHER f0. Cm2EM Oi ww~i Co~M~~r 11 sotu~ SEtu~arr tawErt
Medrick Bemillard - Unk. Grace Fontaine - Onk. U. S. A. Q39 ?6 2044
v o.e ~t. usr oteuP~non ~3 uM.
n. ?ure ov ust cw~orwe cowun oR ~ar 15 KIND OR INOUSTRr di BUSINE55
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a~o~o~w r~ww~ IS~ NAMf OF PRESENT SPOUSE 18~ PRESENT OR LAST OCCilPAT10N OF SPWSE
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A u 19 7-19 7 Married Clara D. Yemillard Homemaker
C G~ 19a PIACE OF DEATH-N~r[ 0~ MOSMTk 19~ STREET AOORE55~-~ene sr~ccr w w~e~u aooRrss ae wut+ow uo w? usc r o. w~ Mw~cws~
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O ~Q p" 19c CfiY OR TOWN t9o COUN7Y 19[ ~EnGrn OF sr~~ w 19s ~owrn os st~r w
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S o San Die o San Die o . •
~ 20? lAST USqAI RESIAENCE-SiREEt ~DOnESS.~,.~ ~.re 20~ ~s wyoc an ~r outs~u em twroR~tc urrts 21~ NAME OF INFORMANT ~s otNt~ nuM srouse~
C ~ a s~a~ nara o~ouro. eo .o. uY . o w. w.wn ~ cO~ro~~r[ ~wms cru or ~
o~c o ~ 4939 Del Mar Avenue ~~~~•~p ? a••W p,«~••w Wife
a' 20c CITY OR TOWN 20o CWNTY 20c STATE 21a AO~RE55 Of INFORMANT
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A° ~ San Diego San Diego California Sa~e
a' . 22~ PHYSICIAN ~~tw[~. uwn.. ..u, w•n. occww~o w• ...a ..ww u.~a um n.c~ ~i~~r`ao' 22t PNYSICIAN OR C01iON~ TURE DEi~[[ oil ttR~ '
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o eo CORONER :,,...~,,...„~~,w.......o....,~,,.p,,,..,,,...,~., ~l~qE~. Paltmbo, LT MC U3N 10-13-64
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Q 23 "'O""" 2~ DATE 25 NAME OF CEMETERr OR CREYATORY BALY E~~s wo [o~ EN?w~d
8~~riat 3-17-64 Pt Ros ~~rans National ~
-V U N 2T NAME OF FUNERAL 01RECTOR 26 r~ ~K ~'a^µ Ri~~
T"~ 29 LOCI?L RF~'i15T~ SK~MATUrtE "
! ~ rds e Fu ~ral Nom ~ 1q64 ~ ~ . -
I"~ 30. CAUSE Oi DEATH lMi[~ OM~ OI~[ CIWSE KM c ra uo~c~ -
' -r OU rART 1 OEATM 1MAS CIIUSED ' ~
i u Cerebral Vaecular Accident ~O1pMA~
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~ ~"'a - J• V JOQEFt~TION-.-CMECR ONE 32 DATE OF OPERATION 33 AUTOPS~-CHECK ONE.
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3[ NEfLL C3RtFitN JEFFRtE3 S LLOYD
F ~MARTEREO
P O BOIC 1270. iORT PIERCE, FLpqIDA 33450 - TELEPHONE ~.3051 464-9200
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