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HomeMy WebLinkAbout3840 ' ' ` " 1 ' . ~ CERTlFtCATE OF DEATH 24416'7 ~ DepaN~ew1 ef fi~aG6 .~.d R~RaLdu~u~e Senlcea fTATE FILE NO. FLORIDA TrtE, pR ?tlNt IN ""'~r'~uR~*'"~0 • ' • REGISTRAR•5 NO. ~[RMANENi IN1[ pECEwS[O-H~f ~~ur ~ • .wa~ a•~~ Owif Of pEwTM ~~o..~~, o.•, ~~u~ SfF MiRD100t FOt wsrrunaa SAMUEL A. MERRITT mnale March 7 1972 RIICE ww~tt, wt6w, ~I~KAN IN04M~ AGE-a~s~ u.wn ~ c.• OAIE OF ~tR1M ~..p..rN, e~~, ~puNTlf Of pEwTN ~ nc. ~ srecM. ~ ~nn.a.. ne.~s~ +oi. w.~ ¦a,n •e•~ ~ . white 80 w .De 26 t• w ~lir, iOwN, OR IOGT~ON pi p(~~ wf~ei cm ~~.,~n npSrytwl OR pinfR wStiiutqN-NMnE .ar ~M e~~~e~. uve ~t~e~~ uo ~uwu e ' / / ~ n s?av us oe ..o ` H 11 ood es Memorial Hos ital STAtE Oi 4tTM ~ x ro~ w u.s..., ...rt CITIZEN Of W1t~i CpUNTt~ MAtMEO, NEvf! i.v.ft~EO, SIMVIVNG SI'OUSE ~w, am ~uot« wu+t ~ cowm i w~00wE0. W~ORCE~ ~ sncr~ ~ Y3V.<«s~~~ ~~w York + U.S.A. married Gla~s Mayer r,~eet cece.uo u.io ~r ~~tr SOCUI SECURITY M/+~+6ER USUA[ OCCUtAtlp~i ~uve cwro w~.o+¦ op+e owr~ aw~t w 1[Wp p/ WSYiESS Olt INDUSTRY ecc~ueo w ~+t+c+wc un, tre.. u.en~eo ~ ;~~`o<«:~~. -~t062-07-14 1 Ret. Salesman u. Real Estate +cy~s~~o.~. ~fS~OENCE-SUif COUNTIf CItY, iOWN. OR IOCwT10N M+swt cm ~r~n 5/tEET At~O NW~t{ER ~s~eta~ ~u o~ rw~ Florida Broward Holl ood es 1607 Arthur Street fAiMER-NAMf ~~q1 r~ppf lwfi MOiMER-MAtQfN HUMF ~~yt r~ppt ~wt~ ~s unobtainable - unobtainable INfORAUNi-N~E nulwG wDGRESS ~snee~ o~ ~.r.e. ..o., u~. W tOWM~ s:,~. =u~ G~ad s tderritt ~n 1607 Arthur Street Holl ood Florida ~~i OEwiM wwS GUSED !Y: ~ENiEf ONl1 pNE C/~USf ?ER LMIE fOR (oj. (b), Af~O ~c)~ ur.+etM OMS~~ ~M'.1 C!~'~ q r.ro~.n u~sa . (~1 ~Q k`1 , • ~ ONSt ! ! O - . coNOmo..s. u ..n. `-If-- rwlCw C~vt ¦~Se ro - ~~!•~S-i~ V Irr~0~~1t C~u1! ~o~, pyf t0. O~ ?3 ~ COnStOV(rK! W: ' 3~~11NG ~M! YMpl~- ~tING C~YS! ~~l~ - ?ART Y. OiMEt SIGNIfIC~riT (ONDIi1pNS= ca.ano..s co.aa~un..o p q.m ~~r.q~ ~eureo To uuse anw o. r~a~ ~ a~ ~~Y Ii tES `+e~e r~..o~~as cr Ittf W MOI l~01~lD OttR~r~w~wG U.St O/ O[~tM no R~ebMr) ~CC~DEHi, Su~C~DE Ot DA E W1UR~ ~ rp.~N, p,~r, n~~ ~ HOUR NOW INWR~ OCCURlEO ~~~a ~~un O~ ~„~u« ~M ?.n ~ oe r~n u, mr u~ 110?t1G0E; OR IN~DE1EwWE0 ~ Pc. M. !0/ IWUR~ wT WORK ?IACE Of wlUrtif .r ..o..t, r.~.., sr~~r, s.~ron, ~puryp~ ~ snar o~ e.r.o. «o., an pe tor.., srwn i ~snan ns o~ ~.o~ orr~ rnc..~~c. isnan~ 10~. 7q !9~ ~ERTtfICATIpN- ..o.oN p~~ ~f~t + rpqiN pt7 rt~t u~f y~w wwiw~~ ~I~+t Or~ ~ pWioro ~.U~ ~.a~ .w~ Dt~~r~ V~~u..cv w. ~we ~.Kl, :r. ~t •M~SKura: TO ra.:w o.~ n.~ ~OOr ~~iE~ Ol~M. ~ antHOec n~e / '~ou" 7~ a.n• •.n• ro ~.e r=" !1~ O!Cl.Sto wOr / t.. ~ l~ Z ~1j ~ r O~ r~ iw^+:ext. c-! G T 21~ 2Ic Zj ? ~1~ M t0 df f~~i[ S: S'.':; CERAf1Ul~ON-,NEDKwt EYw~uivfp 4 tOoONER. o.. rr~ ~.y~~ p„q e¦..u+.nw. or n~ wo. .~oio. r~~ ~~.~s~w•.a.., o.w~o.., ••ov¦ or oe.rM r oeceoeNr ~.s .~o»w«ceo ouo ~TM O~~ rt~~ wpua Ot~*w OCCW~fO OM M~ D~fF Y/D OV! i0 iw( UVSF~lI S~ATtO. :r. rn C~R11fIER-NAME m?~ o~ n~«r~ S~NA~ M Dr. Dal~ T. Anstine ~J~_ /"i~~otanrqnru nATES~/Y~~7Z.~•~ i[ c..~O ~s1 MNILWG wDORESS-CfRl~ir(t uae~ o~ o. ~o c~n w ro.~~ ~..•t ,T-'t r. 1206 S. Federal Hi hwa Holl ood Florida ~URIAI, CREwtAtiON, REMpvA? CF~.~EtERY OR CcEMwTORr-Hww+( ILOCATION un ~ q,... s~wTt 1 !~[CM~ ~ ' I~• Bur~al ri~ Hollywood Memo~c~al Gdns . Hollywood Florida ~ y~=, DATf ~..p..r«, o.r, re.~> iUNEP~t ?+Oti+i-r~~~rf ~~:D ~DJ~SSS ~ ynier o~ ~ r~ .p , ai~ o~ ~o~-., s••+e, nr, :uMar h 10 1972 ~r,. JOHNSON FOSTER 1650 Harrison St. Holl wood Fla. 5.;61j fUNEP EC,~ GNAT•~' ~ pf(',~tS?RA,~R r:' J4E ~!J ~ ~ \ ~~`i ~fCE.•f0 ~G" tfC••5:~~2 ~ R e v. 19 T 0 7S~ ~ ~ rs~ i' LC.u~./ Cy=t.a.~.P/1.~ tt~ / ~ v - o r- -1 ~ . ~ _ . . . N•~ J p ~ r m~ ~ - - ~ ~ - CERTIFIED COPY ~ ~ ~ . ~c>mmZ ~ ' n ~ np ~o I hereby cA~~i~~i'~he above to be a true and correct co py of the Local ~ a~ pio Regis~rar!s • ne~nt•~i 'on file in the Broward County. Health Departa:eat at -,o o , Fort 3.aticicr,~~4i •,~'Z~rida. _ ~~r~ 3~r.., . - ' ~ . • - a ~ ~ CS:°;~,~ . ~ so 1~ ~Kar'nYn~• 1t'ot~ valid<<unless raised seal of the Brovard County Health ~ ' : `~'cpartc~ehft ~s affixed.~ ~ r~ ~,i~t;:E t~~?::: y . ' - ` _ - . .Tl3i !B~ ; _'c ~i ' ~ - ~ _ - ~ ' ' ~ . . . CiZ~~e%C.!/"~~"'^'~~~~~ ~ ~ ~ ' ~ County Health Offic~fi" And Local kegistrar ' . " . ~.~;~2^~'~ ~,Q - - ~ 12'14-~2 . Deputy Local kegistrar ~ k ~4Gf C)/JJ - - _ ~x~ . ` ~ J ~ ; ~ , ~ ~ } > , ~ ~ . _ ~ ~ - Y ~ . _ . ' ~.z:~:~ _