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HomeMy WebLinkAbout2945 _ _ - 243~82 F~~EO :.r~: u~c~noEO ST. LUCIE CJL'NTY FIA. R'vi.~r. ?JiTeiAS ~ ' y~ 243582 REf.4 ERK C^.~~~`~ COOR1 ~ ~ 3 10 is AH ~7t - Tn~s e~- erwTC eowao or H~?~~x CERTIFICATE OF DEATH ~O~~s • BUAGU OF VITAL iTATiGT1CY STATE FiLC NO. tz~~~ r~~- FLORIDA ord •~~n BIRTH NO. REGISTRAR'S t~0. properlr ec~euNd ~ut[ O! OGTM GODH NO. 2• YSYAt R[t10ENC[t~'~.~~s.~..tlw/ Uwn+.h..• It...sw.a~.n.iwi~.) •nd •111 ~V~TM St. Lucie bL~VV SiATE Hzloricia COUNTYCt. Lucfe e. ylse.a ~ nn ~ lw 4,, ~~Trt T`~~ wK ~ T~} t. ~5 Y~4CE O~ DEATH t. CITY. TOWN.OR LOCATpN K RfSaOE?:E ¦~0~0~ ~ ir:l.l ~9r}i of r't ~ ~}lQi~ CITY LiMIT / :MS~DE CI' ~ UMITSI rsi.. on J.~. irl n~a•a resp wC~ ct.F.ll. Ft. t'ierce res~ No~7 J. N~~eE Of q~pif~1, /irt Hrrtf altrtMl IfNGTM Oi I. STpEET ADDIIE55 OM A FARMI MPS?~TAL 011 sr~ ~r ~ ~ r. f3 . f~ t P i e rc e F'18 ~ tN$TITUTIpN ~ L~ ti t. P i e rc e Fs • O rs • ~ Yf5 ? NO 7. MAM[ OF Fi?a! Vwidlt La~t 1. O~TE Matt1 D~/ ~tp i~~«~.r.~~ Carl Alfred Jonnson ~TM 1- - 19 ~b s. SEX ~ CO1011 OII RACE 7. MARRlEO ~ ME~CR MAI1R~[O C~. ~TE OF t111TN 9 AGE YtN1 1 tW LL~0(~ i~ MS Jul 7 1g90 ~~6~ `~"'r~ x.,w n... x.... w;,. t. N.ale wni te yPtDONED J uti~o~~E~ ~~lei ~ IQ~. 45U41 OCCWATqN (ri(t ti~l ~Jrwk 6aRt 106 K~ND~F i1.51nE550R uiJ.+STRY 11_ itNTMi~ACE (S7~lt M/~?tyw t~t~fri) IZ- GTtIEN OF tM~T CpMTpil • i tA y~ r- fviy ~w[ e rati~y dJa, ~siw ~J rrtvrl) ~~p~p~ ~ontractor ~or,struction 1~orua USA i~atl. Dl~ct lak ~j, FATMER'S ?tAwE 1~. MOTMEII'S MAIDEM NAME - er ~,...~1~.~ Johan Ludvi ~ndreassen Karen ~sst ~~ame unknown IS. WAS OfCfA5F0 EYE11 IN U. S ARYEO fORCE51 16. SOCIAL SECuRtTr NO. 17. IN/OR t QCNATYR[Larl ohnson . lr...........,...1 u/....n.....~«b..r...~ed No 266-O~i-7I~? nA«~•• :t.F.D, rt, erce s. lun~r~l 1~. G1VK Oi pt/1TN (F:nt~r ~~lt ps taWC p[+ /i~r /w (A). tR/ (C1.~ (hTERYAL ~ETME[N air•ecer ~ARTlOEATMWASGUSEO~r~ Krt~SCIP+T~Ot1C Heart J~g• ~~~"~~TM . ¦Y~t fll• IMMED111TE CAUSE ~ tA• e~r- i titie~t• C~R~vy~~~~M~, pyE TO (b) =~v pertrop~~' Wltfi n~ t~ertens ion ~~2~3 ( ¦1te tA• r~iJ ~an ru~ q 1 ! 1 e e-w 1 ~Dwr tarK til. } E st~tia/ Ae rRJtr- {~E TO (cl r~sistr~r ^ E 1f~~I nwr tuf. ) .-~Oii.'L10 8~~i- • 1 tAi s 7Z ~ ?ART 11. OT+EA SK~f1GMi COMpilOwf CpNR1~JiWG Tp pGTM ~yf pT REl?liD i07M[ 7[Ar11Vl W54SE CA1i01i~01~ WY[M W/Mi 1~) . WAS AUTO?SY ~ AOUrs •f- ~ ~E ~ ?EIIfO11MED7 e~r d~~ts s ~ YES? ?.O? or D~ter• ~ ~ ~~k~aa ap~ ~ ACGOENT SUfCIDE MpY1CIDE ~~pIBE MOW IN11;RY OCGilRtiEO. jERttl f~sf4~s ~/~AJrry ~A Ptlt I M Ptlf 1/ ~/1ftf~ !IJ •~sye~i- u ? ? ? a •t J TIME Oi fl~rr Xat~. pf. Ysr ~7• ~ uuunr a..~- ~ p y. s. ' ~?Od. 11UU~Y OCCURNEO IOs. ~L~CE O~ IniURV 9., q M a'+ou110~u, ?D/. C177. TOMfN, OR lOGi10M COUNTY STATE ~ 1MNILE AT ~ /iipT WNILE ~ W A. ttI[d.OffS[t d[/_, [!f.) MiORK AT WORK 21. I~tt~nd~d tA~ d~q~~~d /~om ~1 y 1~t ~ C' . to ~ ar. • l~ 197 d!ut wr ti,m ~lir~ on L ~ DwtA oeourrd ~t m on fh~ d~t~ ~f~~~d ~6or~; ~nd fo tM W~t o1 m~ lno~l~de~. Irom tR~ uu~u ~t~t~d. •I1 lt~~• jj~- i1CItATYR[ - •r• to D• ~~'r« M~~k~ •~~u Ilt. WTE SK?~O ~••rl•t• • r.b.voodwir. Jr. i:.L. rt. Yierce F'ls. - •ee~r~t~. o~~. ~E~urq~. ~ p~TE 13t. MArE OF CEMETCNY Oq CNE~ATORY 23~. LOGTqw (GY/. [wrw. r~w~fp (St~fe) ~u`r`~a~°"'h~ 1-6-56 :illcrest e:n. v d~ s rt. Pierce F Y.9. ~611 j~. iUIhERAI D1RE OII'S SIGqATURE AODAESS 1S. DATE RECO. Yr ~AC~L REG. Z6- REGISTRAII"S SWKATYRE a...io66 Joseph ri. Yates 1-b-76 Arra yee Ler.i ~ d ~ 1 herQ'by oertify this ta bs e true and correct oopy vf tho Locel - Registrsfs reoord o~ file in tfie St. Luci~ County HoaF;h pepa~i- t - ' ; a:.., " , ~ ment at Forf Pierce. Flortda. . i•='' _ (Wuning: Plot valid u~less raisod seal of the St. Luc1~ ~ County Fiealth Depa~tment is effixedJ . • ' - . ; . ~K ~ : . r : i -t' • ~ N. MIILER, M. D. w ' f~ , ~ ~ Cotx?ty iieatth Offic~ E~ Loal Rqgistr~r • ; " , ~t • ~ i-~~ • . ~ ~G',°.~ , ~~~Li.~.. ~o . /l ~~C.~ :1 ~-L c~ . ~ - ' / ' ~ ; , . ~ Dea Detxrty Loca1 Reotstrar n'•7; J 1~~~ ' j~ . . ~ ' ~ t~~? i~~ v ~ ~ - ~ RK208 ~?~29~4 - ~ goo , ~ . _ . = _ rt} ~ - ~ ~ ~ r.M ~n. _ . ,:s~~~r _ z:~~~. S : ~e~'~"~'~,~.