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HomeMy WebLinkAbout0361 - ~ ~Y-~ 241`7,7,2 CERT1FiCATE OF DEATH Deyr~+~ew~ ot Ik~h6 ~wd Re6ab~l+~a~i~e Srrrkes fiA7c FI~.[ NO. FLORIDA tr?f, O~ ?nNi IH ~""~'"'~'~~""'O REGILTRAR•S NO. l~}S ~[~MAN[NT INK OftfwSEO-HAME rwst rbae ~~ft SEIf DA~f W OEAiX ~~o..tw, N?, ~t~~~ fEE N~Ik1100[ F0~ ¦S~~ ~ PAULInE REAVES SHEARER ~emale ~ March 9 1972 ~ACE ~r~wn. weOq. uMnt~u uwuw. AGf-usr u.~ote ~~e~e wu~~ ~ wr OwTE Of NRTN ~ro.+M. e~r. tOUMTI Of OEA1M !K. 1 W CMt 1 4~uM.\~ 1 fl~~11 r0f. O~f1 h01M! Y~l T4! 1 6602 ~ ~~?hite ,.81 Jul 3 1890 Saint Lucie Cml, iOwn. Ot IOCAiWN OF OEwTN r.s+a cm u.m MOSI?TAl OR OT11E~ tISi1TUT10N- ~r ~.a w~e~y~, cn~ ar~t~ uo wure~ ~ vtun sea o~ w n Fort Pierce Yes Fort Pierce Dtemorial Hos ital " StAiE Of MRiN ~ w Mo~ « ~.s.~., M.r~ C~TZEN Of Mnu?i COUnTtY MwttiED.1~YER MARIIIEO. SIRVNNG SIOVSf tr ~rw. pnt r?~eeM ww r eoww~ ~ w100WE0. ONORCfC ~ vetr~ i ~s~....s~..~~ , Geor ia USA n Widowed .r.ra xcates un0. Ot~~M SOC~AL SECW~Tr M/Mif~ USUAI OCCINATlON ~GM aw~ q.o~i OW/ Mw6 r01~ W KMq Of M1SMlESS OR N~USTl~ ~ occu~ns w rO~rO ~M. Mw Y@n~lO 1 RR# k~0 352-722 Housesvife lESIDENCE--SfAiE COlNift GiY, iOWN. O! tOCAiION wsM c~ irqt SitEEi JWO HUM~E! ~ _ ~ vecr~ tH w wo ~wFlorida ~a St. Lucie ~..Fort Pierce Yes ~w1713 Ba shore Drive fATME~-NAMf ~~y~ .u0pu ult MOTNF~-JIMIDEN N.~ME Irft r1Mt! Wt ,s Car~o G R av s ' ~NfO4~wt~-Ww~E Nu~wG wDOlESS ~nun w a.r.~. ..o., an a w..., s~.w. [r~ Frances Cannon ~n1713 Ba shore Dr. Ft. Pierce F1a.33450 ?ARi 1. p~M WAS CAUSED i1/: ENiER ONtY O?dE GUSE IfR ll1E ?O~ ~o~ M1~, AND (c •nwaw. w ~w.a 1 N nrr~w oMSe.... a.,~ U rrew~e taru~ ` /11/~ OCQl~~t~Yl //t ~Ctf C~~OJ'~ a~ l~tY!? S , . co»smo..s, v ..e. ~MICM G~t~ •1~/ b ~d~ ~rrtW~q C~VSI ror, OV! q. p tl ~ CW~ffqYt~Kt W: ~ - ~1~~IMO 1M! •M~l~- . ~~~MO C~YN l~ft (t~ ?ART Ot t S~G?+riCw?+~ COnaT~OnS: ~~+~w~ ~uA~run~e w«.m wT .a. uuno ro u~se oae¦ .~+.u~ ~ a~ ~~Y i YES ~~n ~~MS~wos eo.~- ~ ~1 ~n a w~ w~e~~s u+ arur,..xw uus~ ~ f c~.~nd? ~ i~e ~L Wl c,~L <<C.- n. 1w ...~r ir..poW~~ wCGDEM. SUCWE d ~ ~~a.~w, wr, ~t.~ ~ ~~OUI MOW INWIY OCCUttEO ~[rn~ w~wa ~wvn ~M ?ui . q .n n, ~nr ~ NOM~CIOE: OR IIWETERYMttD ~ ~ M 7M 7F M. IM ~ ~N1U~r At wORlt fIACE Of MIARY wo.~e. •.w, s~rn, i.aon. IOUDOH ~ smn w~.r_~. Mo.. e.n o~ r~r», a~n ~ E ~ urean ns w.w ~ ow.a ~oe , tu. ~ arec,n i ~ 7M 7M ~1 t ; CERt~f1C~T~ON- .~o.nM w~ ~e~u ..o..a w• re,~ uo us~ far wriwt~ une o.~ ~ w/WO rOt m[~ Me O[wfN OCCYetEO .r wt ?uce. w~ ~N~s+u~H: tp ra+m w~ nu wo~ .?n~ a~M. irow~ d tin. wO, q Mt Yir ~~nIMOlC M! 7 i q r~ aMOwVOGl. ON ~ n~ wce.xo no. a 7 ! v ts? ~ ~ ~ 7i~ 3 9 7Z ti1 ~~i O tw. w?_ ro wK e~n~ sr•rcs ~ CERTYICwtiON-MEOKwI Eiwwu?~EII OR CO~Ot+ER: a. r.~f ~.s+s a rwe wow o~ ne.w tw~ eteeeE.n r~s r+oMOiw~ew aw ~ ' ~w.~..nw a n~e wo. uaio~ nr .~.tsne.~~o... w r. o~..~o... rwm w nu .aue ~ o~~n. occwaa w M wa u.o eut q nie uus~n~ s~.no ~l 2» ~9~ 2 i 1 ~ ~71 ~ . CfRT1f1Ef-NAMF ~mt w?nr~n 51GNA U ~ o~ ntu ~ A SIGNEO ~+w~*«, w~. iw~ ¢ Dr. Bernard D. Ross ~~~C Ir~. ZO/?2 ~ ~.u~, o. o .a « , ~.R tp ~ ~~or~~t:~~ucie S o i ~ tUtlAl. CtEMAT1pN. ~EMOVAI f/MEifRY OR CREMAiO~Y-NAMf IOCA t~n q q.n. Sute . ~ ~ sntm ~ ,MRemoval-Burial „.Forest Park Ceme~ter Shreve ort Louisiana ' . OI1TE ~ w~, WN RAl HO.titE-NAME A1aD ADORESS ~ in~n o~ ~~.o. wo., t.rr w~o•.., sur~, iw r ~ ` ~a March~0, ~~72 ~~ates Funeral Home, Box 777 Ft. Pierce Fla. 33450 ~ y. 5. ~bI2 f~JHf f - REG1S R-SfGH~tWf OI.IE tECErvlD lOCwl tEG111tw~ ; R~~. ~9TO ,S. G ,w . ro. ~ch ~ 2972 i ~ ° ; - • . • I hereby aerfify this to b~ a frw snd aomect oopy aE the t+ocsl fILEO a~+~ °~CORD£0 • Reglstrars r~eaord on tik in tho SL Luci~ County Heahh ps~. ST.IUCjt ~~UMTY flA. - ment ~t fOA PbtO~. FIOr(da. ROCEK ~'O~jRAS ` . ; CLEaK C~~CtflT COURT . , ~ (W~rning: Not vaJid unlsss ralsed seal of the St. t~ud~ 4ECQR!~ VEFI~~ED~ ~ r County Healtfi DepaAme~t b a~x~d.) ;i, z lW~ ~ .....-,;~..,r • . ~ ~0 I 43 PN •'.~Z,.~:, :~°f 7~~.~i ~ N. D. MIILER. M. D. . ~ ~~Y ' ' _ i ~ - § COY~11y Hei{1f1 ~ff10~f ~t ~Q~itfK • ~ ~ ~`a ~ X ; .Y z4i : t~ ~ ~ ~ ~ 1.'~1,4.~?~. /y7a _ ; ~ . ~ i , ~ Drtr D~p{Ity ~OC~! R~Qtl~1'~I ' ~y , • j,,:_~n,~,' * 3 , •~f?~~. ~Z ~ • _ ' j._~F y~~•'~`' ~ , ~ ~ f+, ~ . t "%.i.:.. ..1 y • = aooK208 ~~E 361. - . s~ - _ . g _ _ . - - - - `S`. "fi~, ~ b_:; - F~ ~ , . . c _w. ~ . .s~....~~~~~~