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HomeMy WebLinkAbout0618 _ 246161 - CERTIFICATE OF DEATH - ' I~rp~rt~ert ~1 Ik~I~L ~~d Re~a6ili~Nl~e $ervkea ~ . tTAT[ FIL[ NO. FLORIDA 71f?E,'Ot ~RINi IN pEG1iTRAR•S NO. 204 ?ttMAN[M INK ~ p~p_?~~ nas~ ••s~ ~(i owTC or o[wn~ ~ rOwtw. ~~1. t!u 1 ~T~~ CHARLES WILLtAM CLAGETT :Male ~ A ril 11 1972 RACE vrrn. ~oao. urut~w wu... AGE-wr w~o~¦ ~*t.e ~ w~~ ~ w• OwTE Of LViN ~.o.nw. e~~. COIINiY Of OfATH 6602 !K. 1 WCrt 1 wAO~~ 1~lYl~ wOf. O?~~ MOu~i rs~. , White 70 ~Nov.4 1901 St. Lucie Crt1f, TO~M. O~.l iION Of DEI?iN • +•s+a c~n u..n MOSMTwI Ot OiMEe NSi~M~O?~-?~AME ~r w~ w ur.u, aM anen .w wui~ ~ s.ec:.. •u o~ ..o E r Ft. Pierce Yes Ft. Pierce Memorial Hos ital SiwTE Of MtM ~r rw~ w~ ~.w~., .ur~ GTIIEN p MnuT CqlNilY w~RRiEO, r~EVER ~uRltlEO, SIRr1vNG S~OtlSE ~r w~, ow~ r.et. wa.e ~ • coww~ ~ I w~DOwED. D1v0lCEO ~ vecn ~ ~ Washington DC USA Married Re ina Ba le ..ir N:e.s~o SOCuLL SKWrt1f NMYEt USUwI OCCU?wT~On ~an ~..e w rwc oo~.e ouawo .os~ w KM~D b/ WS~+ESS Ot wDUSiRY u.es. r ww occw~es r ro~w w. ~.t.. n~ea ~ ~ „263-82-2535 Supplier & Accountant „ U.S. Na De artment ..WS.b.~ eES~o~+cE-sr.~c cowm cm. Tow~+. oR ~oc~TwN w,« sr`~a~pe"~ `d Park ~ v~c+, .e~ a ao ~ Florida ,N St.Lucie Ft.Pierce No ~w 5274 Hibiscus Road ~ fATMEf-NAME r~pt r~Oae us~ MOTMEt-MMDEN N4ME ~Wr ~qott ul* „ George M. Cla ett Unavailable O ~MfORMI1M-NAME w?an+(; ADO~FSS ~uun a~.r.~. w., cm a w.+u. s~.n. ar~ Re ina B. Cla ett ~n Rt. 2 Box 52 Ft.Pierce F1a,33450 ~ ~ ?/1~T I. OfAIN WAS GUSfO i1f: (fNtEt OrH1 OrdF USE IEf lNE i0A j~L (~l. wND (c .?sWu...n u. u u N Nhrl~M ONS(1 ~~+0 Ot 1w 3 u. rrwe wr ~ • ~ •`t ! 1 ~ • . ..c~ o.: , ' .-i coM~~noMs. ~r .a.. ~ ww~tw O~ot ~~f! p ~ n~ ~ ~rr~M~t! C~VS! 1~1. ~ q. p ~ ~ ~~u~~~ p: : 4 11~IIM0 ~A~ YM~!\- } \hM0 ~~Y1! U~t j - ; 7-I wUTO?SV ~f ~ES .+i~~ ~.o~wcs ca.- ~Ati II. T SIGtaIiKMIT f : c wa.s co.a io o u~ ~ r ~o ~V1F GI~RM •.n ~ ~o~ Q ~ ~.e? o. ~ ~se~eo ~..~w..uw ~x y A p ei~rwL/ € / i~ ! ,v ~ ~WJ• l{ ~ lfi IK ~ 4 ~w!eW~ : MQMKIDf~ IAOEiEYtMED ~+~OM~w, O~t, u~ H IN r OCNttE ~lwR~ wrwe M .on •.u ~ u ~ w, au w ~ ~ 7w 20c .N. 7Y ~ n+~?er wt watc KACf Of NJU~Y wort. ~~w. s~rn, r.nws, lOCwiION ~ inee~ w ~r.~. no., cin w ~o.n., vn ~ -y ~ snc.n ns M wo ~ owK~ ~ua.. ~~t. ~ snCrr ~ ~ 1h 1M ~f ~ CffIMICATION- rw/w o.r nu rw+w~ we u~o us~ Yr wr/~.e~ iu~vt ow ~ ao/ao ~+0~ u~r n~a OE~~N OCCUUEO wt n.i nK~. a. w.~ 1NrSKUM: T~ / ' I! ra.r~ w~ nu ww un~ ~.ow~ ~.a, u.o. ~o w usr ~ •n~.roee n.e s /3 ~OO . ! I ~ ~V ~ w a.wuow, ow ~ t4 wa•s~s rwr ~tU ~m. ~j~ 7u 74 M. ~o m c.Yx~s~ ~i.rio. ' CERi1fKwTlOn-r~EDK~I E7cwriwER OR CO~O~+E~: o.. nu ~.s.a a i.r w w.u. i eeua.n ...s ~w~w s ew+..•na. w ew we~ ..oiw ~we ..v~s~.c.~~o... dr..o«. ~ ra+rw w• .eu wou • Ol~tw OCCWtlO d~ M MR w0 NR p M 4VS111~ St~qO. ' jj~ • hl M CERTiFlEt-NAMf mre w nr.n ; S tE o~cn~ a rrne O~iE o..,.eu~ ~ ~ Melvin Wolkowsk MD ~rn ` F~. ~ n ~ ? MAKING ADOtfSS-CERff1E1 srut~ o~ c~n c~ ~o.w sT.n tJ? ; ~ t~. Ft . Pierc ; ± ~ {URIAL. (jEµAilpN. ~MpVAt NY Olt CAEMAIOiY-tvwMf IOC~T1pN ~ un w q.rw yT•tt i Delra Crematorium Delray Beach Florida Removal-Cremtn . r. y ' ~ OATE ~raww, r~, ~au~ fUnfRM NOw~E-N~wf ~l~D ~DOItfiS ~ anen o~ ~~.o. ..o., an o~ ro... s~.n, ~ ~ N. .13 1972 : Baird Funera m 901 N. 7th St.,Ft.Pierce F1a.33450 ' n' y. f612 F1~ERA~ EL70~ SK~r?IA REGIS SlGnuTUiE DwR aECE~vEO ~r .OC~~ ~EG~Sta~~ ~ R~v.19T0 ty~ 7M ~ rw A ril 14 19~2 ~ ~ ~ ~ 1 heflby oerfify fAis to b~ • fru~ and oorrott Copy' Of flle IDCeI - Regimers rooord on flk in th~ SL t~uci~ County Ho~hfi . `Y, ~t at FoA Pierat. Flortda. ~ : ~ . . ~ (Wamin~: Not valid unl~ss ntssd seal of tfis St. Lude Counly Hsalth DeparTrr~snt Is ~ffixed) FIlEO ANO RECOROEO r~'='~'• ST.l1lC{E CQUMTY FLA. t~: ; oy~" ~ _ ~~y - ti; i."l t~ p , ~ - aacf~ tOtTRAS ' ~ ~ - r',; :r~ ~ N. D. NuLLE~, M. D. ctFRR c ncv~T coux~ ~v Coun t y H~alth OffioK d~ RECOQ!s vE ;~F~EO ~ ~ H\ a Loal Rsgfstrar ~ , . . ~ / 1 . , 4 _ a. ~ - ~ ~ i. ' • ~ . vs ~ ~z s 5s aN~'~~ ~ ~ ' ~ ~~~y _ . ~ . w _ t' . ~ i x~ i~qrry t~oc~l R~olst*~? ~ y'•. -;y) i~ : ~ ~ . ~ 246161 ''~?i;} 4 rt, . , ° R 210 P~~~ 618 ~ . ~ ~ , 3 ~ p~ - 4 '43~~~'~ . ._e , _ _ , . . ~`y~~`r.'4.2~;