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HomeMy WebLinkAbout0861 CERTtFICATE OF DEATH • ~~2~~1 ~~ep~rim~nl oi ~~rai1R ~nJ Re6rl.l~flallv~ $rnlct~ BTATE FILE NO. 1)IYIVU\ I1F IIfAl.lll F L O R I D A t_ : t~'E, Of •R~?~1 i?a pEf+16TRAR•~ NO. • •l~MANlNT IN1f ' SE! r~r+~:p[ IOt aECEwSEO-n/wf ~~~a~ +we~~ ~•a~ ~Sf~ U~f! O~ OEwiN . ~o~•., o.., .~u ~ ;~:+~~a~c.s . RUSSELL FR~~.AN SJ~?TTIyG .'•:ALE A'.ARCH 21. 19l0 IACE ++~4. MI4~0. ~rl~ti~~. ~~.DUr. ' wGE-i.u ~u"~ol~ Vw~0l~. O~r~~ O~TE O~ !:A!N ~rC+•.n., 0~~, ~COI:NiY O~ DFATw • 11( ~ s~~C~~. ~ ~~~~MO~\ I~~~~Sli r0) W~f ' MOY~~ rM f~1~~ 1 ~ , . '~T:iIT~ Is. 72 I+? ~ ~s, ~ 13 A°P.I"~.. 1897,. BR:.ITARD //C, • Crt~. TO~+. O~ IOCw't0?~ Of DEwiN ~ sre c. ,u o~ wo {„OS%TAl OR OTNE~ NS711U11ON-NAM[ ~u ..o~ ~...e~_ o~.e v~~n ...e .....ur ~ , n ?'TiUSVILLE ;r, YT~~ rr~ J~S PARRISH ::~;ORIAL HOSPITAL l• SiwiE Oi !IltH ~.r .~o~ ~w v y.., r~r~ CIiItEN OF WNAT COUNIRY ~MARRi[p, NE~'ER MURbE~. ;SURYN~tG 3POl1iE .~•e. c~v~ .u.plr r~re ~ cou~.n., I 1 w~ppwE rvOKE ~ a.ecr. • , P~«'SYLVA!~IA U.S.A. r~A~RIEJ RUBY JOLLY --ea o~~uuo ~ o~~•., SOC~wI SECV*~TV n~MlfR USUAL pCCU?ATION ~u~~ awo w wu op~! ovnwG wst O~ KINp pi lUSWESS OR lNDUSTR1f oc:..••ea+~a~.e ~J y15~0~-3803 ~ly " SOLDI'~ enis ~ I Af ";~•.c, .,.o., r.~ti (RET. ) i,,, U.S. AR.~ED SERVICr."S. ''~'O~ RES~DE?~Cf-Stwff COUN711 ~IT~, TOWN, OR tOCAiION ~~M+wt tm ir.ns SiREET Ar~O NUMtEt L..~.~. j~a?lu•r •tf o~ .q~ rIARI~A ;,.,BREt/AL'D TITUSVILLE i~~, YES 1601 H~..''tITAGE DR. iAiMER-NA~rF I~yt rqp! uN MOiNER-MAWEN NAME rwff rrpx~ ul~ : 1 7 „ H..~'~1RY F. 67HTfI~TG GRACE BE.RLAND INfOUNAN~-NA1Mf ~upwG w00RE55 unen o~ ~.~.s. .ro., c~*~ a ro.~. a+.~~. trr 2'~RS. RIIB7C J. WHTTI:~G 1601 HIItTTAGE DR.. t^TTUSVILLE. FLORIDA, 3~780 ?ARi 1 pEATN WAS CAUSE~ ~ (ENiER ONi1' O!~ CAUSE /Ef ll~E fOR (oA (6), Mlp ~[)j ;~~:..,uw orsn •ro w•rw ~ 1~ r.uoust uua~ 1 . ~ ~ t•) (~~,~•~7iar ~,...hyt}'1.'~?la ~ ...~.,,.'._°S 6LTI •S • MSIOV~ • 1 COMDI~IONS. ~M7, ~ f ~.~c~ c.~e ~~u ro (bl .~~tt-,t~ myOC?? C?1~t~ 2:7r8'-'Ct'! 02: ~ G3 ~'l~ f0~~~1 C~YS~ 101. ~ sr.~~..o ~.e u~oer. ~t ro. w.s ~ co..xout..u a. i ; ~e:.-n , y ~n„ ~~iP.~~ V1 C :~~q~t f~? sease ' 'e<~~~.' ?wRT u OTHER SK,NIIKANt ~O?~p1T1pNS: tw.anp.f cwnn~~rt~.W W q.w. ~v~ wor ~~ureo ~O C~~s~ amr n. •u~ ~ w~ wUiO?Sr rES +e~~ .~.o~wcs co»- ~~"RC ~'_2','~ Of ,.I,Pi y' 1+~ ~.~s o~ .ae ! s+ee.w ern...,.~..a uvst ; V !l.^.`~•; V~? •_n~ "•L ~ •311 UT'° ~ac ~eria' Pneur.ionia ~h~0 O~ OlwrM ~h !?.~boE~~1 ~CCipFaT, yJK~DE O~ DA E WJURY ~ rOntw, p~t, ~!u ~ I M061R i HpMtC~Of: OR UNOf1EW~rttO NOW INhJ~~ OCCWREO ~tMK~ rutv~! Or u.i~~~ n~ ~~rt ~ O~ r?~. n. nt~ E ~~•hl • x'° ~?N TJ~ N~. }p1 ~ i 1 IN/UA1 AT WO~K #?UCE Of IN1URr ~t worf. i~~r, intn, ~K~q*. IOCA~ION ~ f~~It~ W e.~.o. r0., C~n O~ r0`ru, st~~! ~ ! ~s.u~n •uo..+o~ ~o~~Ke woe,ea. ~inum ~ 70. ~ 7N CEtTIfKATIQN- rO.~~w O~~ rp+m O~~ rl~~ f~~ YSI ~W MW/M~~ ~lry[ ~ pq/Op ~ap~ v~l~r ~w~ OEwiN p(CY~~FD •t r..! ~uK~. Or~ wM INtSIC1~N~ tO ~ ~M+A O~t t~i~ ~pp~ ~Itt1 p~~M ' ~~~lMOtD IM~ ~^~~~1 O~T~. ~wD. TO Mf N]~ o,«..~o..o_ ?_/?2;7p ;i~.N~AR. 21, 1970(:~~'KAR 21. 1970 DID ?n.4:00 o~<i':,'~<<~°~,:~o CERiif~CwTiOr~-MfOoC~l E7c~trrER OR CORONER p. rwe ~.s~s o~ nn ~.ov~ or a.n. ~w~ oec~oe•s. .+.s ?~o.q~..uo oi•o l~.r~n.~~pa Os n./ WO~ ~wa/O~ 1we ~wvtS~K.~rWrr, ~w rr Ww.p.~. rQw~w Ow~ •e~~ ~.p~• ~ y ~ Ol~M p(CY~~~O W M! C~If ~wD OY! t0 fw~ G~VSlISI ar.r~o. ~n ~1= I }~A~^U~~~O ~io4 p- th - - M. lA 1'1(1i~1 M CERI~FlER-r~~ME ~~+n o~ n~..n ' SK,NwiUgE ? oew~e a nn~ ~ O~TE S+~ o.., .e~u ~ E D : ~cv+ 7]~ ~i v~ i • • : .C i~? ~ ~n ~ l'. ~ J • ! J7? L. ` ~lT/ /-(,R/ .'~~1 ' ~ ~ ~~G4', ~ - ~ ~ 7k ~ 1 . MAIUNG ADDRESS-CfR?1it[R ~ sneer o...• O. w0. rC~^/ O~ :~+~v s~.re ~ ~ r.. iH 0 h. 'nTAS:iI1Gf0~t AVE. TTTUSVILLE F'L4RIDA - 2 80 6tiA1Al, CRfMA1pN, RfMOVAI tCfM.E1ERY OR CR:MATOR~-NAMF ~LOCAiIOM C~n O~ rO+w ~rar~ ~ SrtVq ~ - RF!OVAL-3URIAL f:..BARRANCAS \'AT. C~~lETF~RY PF:~SACOLA. ESCA,~'iBIA CO.. FLCRID~ ' , ~ .'i . OATE ro..•., al.~, !•u ~fUNERAI MOME-IYAMf AND ADORESS t f+nl~ O~ ~!.O. ..0., Ut• p~ rOWN, St~+[, L?~ :'SA~CA 23. 197~ !:s. S:':I'"~i F(T,v~AL HO::~ P.O. BOX 1~: TTl`USVZLLF i.C!F,,T~„~~ _~..._:?_7~~ S. ~p 19 ?UtrEowi OiRERORy-S!Gv~TV%.` ' . REG~STpAR-$iGNAf~JRF ~ a~~c eett~~e. .oc.~ ?[as~«~ rtev.:Y70 ~ti~ ~ . i~ ~ ~J.- .,i. ~ '1~~ - ~i%f ~ • _ - - . ~ I HEREBY CERTIFY THE ABOVE TO BE A TRUE AND CORRECT COPY OF TiiE RECORD ON FILE IN THE LOCAL REGISTRAR'S OFFICE IN THE BR~VARD COUNTY HEALTH DEPARTMENT. ~ " ( Not valid: ttnless ~ttie. seal of the Brevard County Health Department is affixed) ~ ~ . 4~, - • ~i - ~ .l~.4V 7 19T~ , - . f ~5 Date" f>.~Seal - ~ , ' ~ - - Deputy Registrar ~u , , . . • - - pH~ ?EC~P.OED ~ ,~,.',.~.y:,- ~ • _ FIIEC T1 FIA. ~ ` - ST.WC1Ep~0~NZA5 ~t - RCC= ~ ~ ~ ` ~ CIEF~ C • CU~7 C~JURT ~ - . RECQR" '~E- FiC~ ~ 15 4 Zo PN'~Z ~ ;~42141 ~ O k ~t~ O ~ b00x VO ~#GE O ~ _ ~f - = = F ~ y ~~,~~=a ~~_~m < .~r ~ _ . ~ r„~