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HomeMy WebLinkAbout0967 . . ~ r?,~. e.- BYAT[ pOARD or Nirw~ni CERTIFICATE OF DEA7H co~es • pURUU OF VITAL ~'YAYI~TIC~ ~TAT[ FILi. NO. i,~.~ r~~- FLORIDA ord r1~en OIRTH NO. REGI6TRAR•8 NO. r o • ~ l 2_ YfYAI R<{ID[MC~ R~w~ J.s~d h.d Jl:~.w.~.wr Rr:IwM Wti ~wi.~) ` p r r ~IAC( OI OCATN COOC NO. ' e?~ t u t~ d ~NTT STATE COUFTI/ ~ •nd •i~~ BroWard ( 6" Massachusetts Bristol ' D• p1~t~A t. K IIES~OCNCE 1 n p~r- A. CiTY. TOwN.011 LOCAiqN t. K M,ACC Oi DC~TM t. dTr. TOMN.OiI IOCATION ~ IItS10E tITY IIMIT51 INSIOE CITY lI4tT51 Ft. Lauderdale ~Sp~ ~p Fall River res~ uo0 r,i.. NAME Oi (//Mt h? ~Nyitd. ~bt idtd ~Ilrut) IEMGTN Of I. STIICET ADORESS ON A iAIIMt ~,osr~T.~ oa STAT IN N 364. Eldridge St. resp Mo0 INSTITUiqN groward General Hospital 4 Mons 3. NwMC or f'f..t I~t~ts L..t a?r[ Moa~u +.~r Y•a ' occcwcco NERMAN ~S~N o~u`TM March 26 1963 (7tive « v.r~r) S_ SCX i. CO1011 OII 11ACE 7• MAIIRKD ~ NEYER MARRIED? DATE OF ~IIIiN AGE (l~ Ktl~ ~i lM.'~(~ 1 tUUt s tN.Ot~ t~ MS. 1Nt OGWq) M..~M D~w ewn Xi.. . c• rfale White ~~op avo~cco Nov. 9 ~893 69 p I~ 1 n 1~ 10~. USU4l Ottu?~Tqr (Qkt Ha1 ~/m~rk I~~e IO~. K1MD OF ~USIIQSSOQ IMDUSTIIY t i. ~T«ruec <sr.a r h•~M~ ~~?r) 1. tA~tiu o~ RMni OO~Mtwr1 • f t n p~r- ~rri~o ~at o/r~.lt~/ h/r, i/?dbd) ..~.~e President Furniture Co. Russia United States D i~ e It 111k ~j. fA1N[R~S MAME II- NOTNER'S NAIDEN NAN( ~ idoses Goldi . ~ c~p..ric•r } IS- MtAS OECE?SED EYE11 ~N U. S. ARtiE~ i011CCST 16. SOCI~L S[CUIIITr MO. 17. IN~ORMANT • NaMATYIIt ~ f~ IYr. r~.lrwl /!l K~. wM w~r ~Y~ wnisl ~ 1 ro nobtainabl e ~~u~~• I ~ C~-wa- ~ y~ Fu n~ r al ~ANfit 0? p[ATH ~E~~t? ~nf/ 1~s c~wt pt~ li~e /~r (b). t~1 (t). IkT(RYAI lET1AtEEN E i t t O r ~ApT l 0[ATN WAS CAUSED fY~ , 7 ONSET AMO D TN IYYEWATE CAUSE ~ :ss= ~.Z~ ~ . . ti~• e~~- e~ r ~ e. e• Ce~taio~,. i/ a.r. ouE To (e) ~ } r 1 t R t A! ~eMd /ws /11/ ~ t 1 o e• 1 ~Dcer taru ~ t r~~ ~trlt~/ l4t r~1[r- n~~r Tn ! - ' ~ i~~a~ na~[ i.s:. i - - -t) ' s 1 t A 1 n T~ ~ ~A~T 11. OiNU S~GMIi1GNf CONWTqNS COKIRMUfW6 10 OFAM ~Iff IqT R[UUFO 10 T11[ 1F1lYMMl DtS[AS[ CW~01110M 6MN M/MT 1(~) . WAS AUTOTSY . I hours •C- . KRFORNE~DT/ } I t~r d~wtb ~ . YES? MO~J ? ; or De~o~• ~ lW ~ ~ID. DESC.PIOE MOM IMJUIIY OCCUII~EO. (CsRfO ~I~f4tt ~/h1/IU/ IA PNI / N Pt/! I/ ~J~ftw II-) E ~a'rina •p~ ~ ACGDfNT 51JiCIDE HOMICIOE ; el.po.f- p O O tton •t ~ . 20c. i~uc OF llorr MsntA. Dq. 1i~r E Dod7. ~ 1?UU11Y w. ~ o p. w. ~ ~ ~ 20d. ~NIURV OCCUa~EO ~t. K1~CE Oi tNJUN1l (t. ia a~! leat~. 2% CI?1/. TOWN. OII LOCATqN ODUNT~ S.TATE ~ WM~IC AT O MOT WN~LE ~ M~w.NaN~. ~trt(t, ~p[t d~~.. pl.l ~ . WOIIK AT WORK ' ~ ~ _ _ ~ ~ _ 6 . fo 3 ` •nd h~t Nw h~i/i?~ on ~ 21 • J ~tt~ndsd fh~ dsu~i~d /rorr~ ~ r D.~th oceurred ~t 0 ' ' en on tM d~h ••f~d • ~nd to fh~ b~~t o! m~ kno~bd/~- bo tM uw~~ ~t~t~d. '.1 l] f t~r• 2z~. ~IG 4 Y~t (Dqrtt N tflk) 2tb. AD RE55 ~ 21c. OATE S~GNEO _J'',ro~pl~t~•~ i ` fit~~/~i~.Q.~ 'V d[r:__ L •L-(~~y~LCi~ (~4f/ ~~~.'7 G~ !~tcu~ ' j ~ 23a. 6um~tlUtE~~tiuw. 23D- OATE 2k. NAME OF CEMETEIIY OR CREM~TORY 23d. tOCATqN (Cd~, l6ft~. N tor~fl) ` Rec?ova~~~~~~~~ March 27,196 F~11 Ri.ver I~Sassachusetts , S, 19 j{. fUhERAI G~RECTOtI S SfGNA7Ui1E R1V6i 5 L~C MeIIlOr lAl •~TE RECO. ~V IOGAL NEG. REGISTRAR'S SWh~ URE ~Q ~ Re~.1~60 ~~'y.~). le~iLyr..~r Chapel,M.R• 7 ~j'j ~ CLs'1 • ? ~ • . f. ' , , ~ ~ • . . , ~ C}:RTIFIED COPY - ~ ' - g I liereby certify the above to be A true and correct copy of t}~e Local ~gZ~r _ RegiBtrar'c record on file i.n the BroWard County Health Department at Fort Luuderdalc, Floridtt. , ' - ~ (W~rnf~~;,ltot valid unless raised seal of the Broward County Health ~ ~4 « f;; ':D,cpartment ic affixed.) ~ ~s„ ~ O~•~~~~a~~~~ A~ ,-~'~AC1~ ` • • ' N T~~~2 - C i UI Y••'a, . ~ /~i/ ~t- , ~ Q/'.~~~ ~i ~`z'" ~ " N ri ~A~ ~.:2 'i y N 'wCOC7~ . ~ ; ~ ~ ~ .n . ~ o- ~=p. ~ : ~ ~ ` _ County He~lth Offic An:i Local riegistrar ;'-.o . ~ : - : C~ _ ~#'~A , . c ~v ~ ;r~..~~ ~oL-o~~e: . ~ :o , ~ ~ ~9 ~ ~ ~ F : ~'c )~D ~ w " ~ . , ~~A . Deputy Local keF;istrar r.. ~ _ . _ _ _ _ _ - - - - - . _ , < . ~ _ _ . . . ~ _ ~ _ _ _ _ 3 ~ ~ a----~-~-~` ~