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HomeMy WebLinkAbout0504 ! 1~ 1 L/ i~ , j ~ z . / /1 L~ AN{? h1C N L ^"~~~)l~~j~ 1T. L~GcGhcao Mar~= l~. 11 CtERK c. cu~r Co;l~t x~vari ro: R~cn~r Y~~;:,r:re '.`.~.YER, I.EBEN, F1XEL and CGAINES 4~~5AAbmolltwood Doul~~ard ~ I • f? 0~ ~ ~ ~ Hollywdod, Ylodda 33020 l ~,t~ - - ~ ~s CERTIFICATE OF DEATH ~ ~tp~etwtwt o1 1 kallb ~nd Rr~alNli i S'TATS FIl6 NO. UI\'tFNA\/1FIIf.\I111~~~ 77~3 FLORIDA - ly?E. Ot ?RINT IN ~tiYV'^u"•^"° ~ L R[GISTRAq•S NO ?ERMAMINi INK 0[CEASEO-?+~wE ~~a~ ~«i SEX pAiE Of DEAi?t ~+o~tw, e.r, nu ~ SEE WO{00[ i0t ¦srainars I,p~~R~ E. MYER ~ Ma1e March 3 1972 ? RACE ~~ute, «~p~o, ~r1~~c~r weuw, AGE-~~st ~~t.~ ~u~.o~t ~ o~• 0~?TE Of ~IRM ~~a+~w, o~~, ~puNT~ Of pE/~1H ltC. 1 i?lCr~ ~ ~ unro~~ ~~euf ~ ..ot. wq MOU~t rM. tl~~ 1 . White 37 k ~ Aug 31 1934 Broward / Clir, iOwN. OR lOCwi10N OF pEA~M .+f.e~ cair .w~» MpShf~l OR 01HER NSTIiU~~-N~E 11~ MQt IM ~t~Mf~~ (~IY~ ~t~~1 ~MO Myr~~~ ~ sno.. ns o~ Mo Fort Lauderdale No ,~Stirling Rd. 90' west of Ravenswood Road ' STAfE Of ~1RiM ~ u rpt w u.s w~.i CITIIEN Of WMAT ~p~~NTR11 MARRIEO. NEVEt MARRIEO. SUtVIVN('~ S~OUSE ~d re~t, pne rwqe~a wurt ~ ~~n~ ~ wworvE~, pIVORCEO ~ sncr? ~ ~ Pennsylvania , USA Married Anna Ruth Mowrer ...e~e ae~•seo ~~.~o. u q~tr SOCULL SE~Ut1iY NU+MDER USUAI OCN~ATlON ~a.e a..o o~ .wa eo..e ow~•w ..osr or KWp pf wSMiESS O! W'JUSiR1f ~ occuuio w W~~WG 4K. hl~+ ~lntlp 1 170-28-5140 Mana er ~ •~tio~•.c..~a.~ q „ Service Station .o.=ssw.+. ~ES~oENCE-sr,.rE tOUNrr c~tr, Tow», O~ tOUT~ON rv wsae tm ~rn~ STREET AND NU~ER ,NFlorida Broward Hollywood ,,,4Yes~~~,~ 6701 Pers~ing~t, /~inER-w~uuE ~~q~ r~oea~ us~ MOTM[R-wuuOEw n~,~tE n+sr .uoae ~wv „ Vernon Myer Helen Stover~, ~~~N1-~E ~twlu+G wOGRESS ~sw~e~ oe ~ r.o. ..o., un w w~.., sun, :~i - Anna Ruth Myer „~6701 Pershing St., Hollywood, ~1or' ~ART 1. .n~ou t~.•. DEwM ww5 CwuSED ~r: ~ENTEt Ornr ONE C~usE ?ER lwE fOR /a~, ~D~. ww~ ~~p rr~ew o«s~+ ...o ee I~. wu[D~R 4Y1! ~ , ~ v f ~ Multi le trauroatic in 'uries - • , .s • eo..ua,e»u o~. ~ co«omo~s, ~r ~ra. ar~cw c~.t usf w Ib! IrrlOe~tk C:.YSt b~, py! t0. O~ ~S ~ COuD[OUlK! O~. si~~~Ma ~¦e v..ot~- ~~~NG C~Y3f l~lt ~t~ ?ARi OiHER S1GNtfKwNT CO?~DIiIONS: eoaai~a..s eo.an~,rn..o q q„u~ nn ,.o~ nuno fo uuse emM w r.~r ~~o~ AUT015Y IF YES ~+~ee ~~..~~..~s to ~ru a..o~ S~Dl~fO Ir~ DIU~r~rwG C~N ' or oe.tw lfi ND Iq psbebl~) ACCIDENI. SUtC~DE OR OA1 IN/URY ~.p~rw, w~, n•~ ~ MOUR MOW J R1 OCC y',~RED ~ e..tt~ w•ru~e O~ ~w~u~• ~w r.r~ ~ Oe r•n o, rtt~. i IIOMK~OE: oR uwc~cw~r+fo IY~~er OI motorcylce struck by , Accident ,w March 1 2 ~:4 M~ motor vehicle INIURY AT WOIIIC ?IACE OF W)URY ~p+c, r.~... ~rner, ~.no~~, ~p~ATlpl1 ~ sntt~ o~ ~.r.o. wo., t~n o~ ~O~n, 1*~*t ~ Stirling Road ~aqan ~u o~ ~o~ W~Kt RDG.,tiC ~vic~r.~ ~ ~~~•re's ~7v w.~i r~venswoou icd. ii. I,auderdaie rla. ~ CE[fIFlCwiION- ..o..rh wr ~i.~ ..o..n. pn• ~~+o us. s.• ~w; ~i~ .~,.e o~ ~ D~D/D~O ~+Ot rr[+~ M[ o[~~M ottun[~ .r r.~e r..ce. o.~ nr: fNrSK~wra: ro..m w~ ~w ~OO¦ .~rp oe.n. i Tp ~»an ~ o.n. •..o. +c +.e u s ~ ~rtt~oto rw[ s p1 rr ~.~??te.Y.t. D± !1~ oect•seo no. ~)11 tle 71/ 14 M. ~o n~e e.ose~sr s-~*t= : CERitf1Ul10N-MfOKwI Exn,Mt?~ER CR COROvER o~ r.e ~.s~s or ~.~e „a,~ o, ~.r„ +~e o~eeu..~ r.s r.p.o,,..~EO oe.o ! e....»..r~o.+ or me wo. ...oio~ r~E ~~.es,K..rro~_ o.n.~o... ..oa~w o.• nu ~.ou~ ; o~.r~ p~CY~~FD OH Mt O~T( ..,o o~e ro..e u~ie~s~ a..no. ApprOXl• 924~`j P• rn FIAI'C}1 3 1972 1~'0`J p• , ~ 7A . ; CERTIHER-N4ME mn o~ •n~.n SIGNAT11kE - - 9 Paul W~ H11 ~jQ$ Foete p r .DAiE SIG?1ED :r.^~« ~tau ~ - ~ ~ ' ~ t~~~li '~k t•~arch 1 2 MARW wD ESS-CE4ti~ ED s~~et* o~ e r o c an c~ rowH .n ~ Box 1021 242Z S. W. 6'^ Avenue Fort ~derdale ~ r' dP ~ tU1tU1. CRE~nAT~Or~, ffMUvwi CEw+ESERY OR CoEMwTORr-r~w,~ +~Q~AiIJN un o~ q~.. s*~~t }•-t"~"~ _v, t,.~~~~~ Burial Hollywood Meml Gdns Hollywood, Florida i-~ . 7' . OAiE ~ w c e~ FUNERat NOvE--~+.t:iF •!+1p ~O~i~ESS n t* O~ o ~ c~~. O~ ~o~-., s*•rt i~r • Mar l~"~~ FRE HL'NTER FH 6~3~1 Taft~ St. , Ho11~~rood, Fla 33024 Y• $yl~12 fiJ?+ERAI D~4EC?OR-S~G~t~iU4E 'EG:S7s~~-S'r._~;:i ~,j,,, ~u.:e a«t .to ~r iGC ~¦te~s~e.+ ~ .~~re 1970 ?s~ •.u-4/ tsa `~1 ~ t/ 5 C .-~n -i a ~ ~ V~~ CERTIFIED COPY ; ~ ~ ~ I hereby certify the above to be a true and correct copy of the Local ~ ~ Registrar's record on file in the BrowBrd County Health Departrr,ent at ~ ~ Fort Lauderdale~ Florida. ~ _ ~ - - . C'~ ~~~j ' ' ~ , i, ~ ~ (warn~r~rt~ '~~tG~,yelid unless raised seal of the Broward County Health - ~ ~•''~~~~~pai~~ent is affixed.) - 'iti~+~ ~l ` ~ . ~ I. 4 3 t i \ lV~ • 1 ' ~i~~PA~i~~~~V~~~'1/~~~~~7~~~~ - ~ - . ' y, ti~,p ; - ~ ~ •~i./ ` y.,i~~;~t3~1:[: County Health Offic and Local Registrar st~~o~,~~,t~~~a,.,,:~,a, - _ , i ~ fl ; ; : Of BROMARLI COL'~ TY. . ~ _ : . ~ - p~~~^~ ~El aACx wH~Et~t ~ h~+.Q a~~ af awa+~r a~t _ . _ _ , 12-21-72 . Deputy_ Local Registrar ' . . . f~ . S ^ R~ ~ ~O ~ ~ f , _ ~ : - ..s~ 'a ` r~..~-~ ~ _ _