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HomeMy WebLinkAbout1413 ~~ssss 860 Pa 85 ~ ~ / ~ ~ J~~~~~~f ~ : -.~L t~lllt~l ~/_l'1~41l1 ~c ~arf~::eftt ~"r4 Y.)'TR~; . (I ~ CIC~:~ '~;;;T COURt ?sC~F~t~ ~r.,,~,F~ . - ~ - ~ 2 0~ PM ',3 ~ PDS7 OFfICE vOX 1226 TEI.EPN0IVE ~3t•1717 _ ~ 24669 ~ ~?,L ~ ~ _ ' ~ L . OQ ~ LEE COUNTY OFFICE 6VtL0~[~iG AN(VEX ~ 7 F• •4 ~ Q ' ~ 2055 Andc~son Avenuo ~ Coro~r AnGerson i H~itman Str~~tt ~ ~ 9~•~ ~ , ~r 6 c~otf j ~I ~ ~l~=': ~ ~ ttl~ OL! Q~ -r ~t' - . . ~ ~ . '-!r . ' ~ ' . .C y- ~ : , F. , • ~ ~ ~ . " . . . ti~. " ~ CERTIFICATE OF DEATH I~rp~rlw~tnl o( 1 k~~tb ~nd Relwl~illt~llre Gnict~ BTATE FILC NO. ~~A~,~~ F L O A I D A Tr?E. O~ •tiNT IH ~'~'~~^~'"f'~° REGISTRAR•8 NO. ~(J PSaMAN[NT INK OECEwSED-NM~E ~~n~ S[I NilMJ100[ FO1 ~X OAiE Oi OEAiM ~ rOw~w, tl~~ ~ wsrcuctwrt ~ E L/~ n~ fC . lZ 0 D 1~ t ~l~E.~•-~. a rc ~ S~/`' 3 / 9'~ 1- twCE ~+~.n. «eow. uuncw ~nwr. wGE-ui~ u««. ~ nu u..oe~ ~ w• O~tE OF WaiH ~w..n~. e.~. COUr~TY O~ OEwiN ~a. ~ ~sa~n ~ w~nw.~ ~ ~a~s~ ..os. w~i .wn ~ ~G-dZ . W i~r s. 3 s~ s~ • Ss~~/ 6 fo L- F E Ui1l, ~OWN. OR IOCAiION Of OEAiM ws.s~ cm ~rm HpS?~Twl OR OTM[R MISTiitlTlON-NM~f ~ u rot tuwe~, oM f~ut~ uo »wru ~ i~iiN. .fi w wii. ~l_~J/G H C.2Et n N !r~LF,,I/G /Lc~t Gr.•iF_2A OSO~T ~ SiwTE Of 4R1H ~ r rot w r•r~ unzfr+ of ww?t tdx+r~r MA4RIED, NEVER w~itRiED, SUtVIVNG 5?OUSE ~ M 1~N~, o~ve r~wew wwe ~ towm? W~JOwFD. OiV'ORCED ~srec+r~ ~,t., ,uo~~a . E../ t vA , A ~ S~ u ~u.C C ~ ~P /S 2 i o K S . ~l~e oec~.se• rM p~~M SOC~AI SECURIT1f MJM~ER USUM OCCV?ATrON ~c..e ar.o w~rwi oa.e ow~.a rosr o~ ~(WO Of WSWESS OR ~trDUSTRY - ec:~~.eo w wwcra w~, evt« u un~eo ~ ~ d ~ ~ d <<~ ~ ~ j ~ I~ D ~ s , ~ ~ ' F ~If~ottiC! µq~l V "~i~'~• tESWENCE-SlAfE COUNi1f piY, TOvVN, OR ?OCwiIAN ~ N+sw+ cm ~r~n STREEi wtrD NUM~Ea I YlCI/f i13 M MOI ~.f102~D~a ~u ~~E~ ~aLFi~iG~~{ Acr..~S ~~u /~/p u. ~LBVII/ANA tie•+0 fA1NER-NAMF ~~n~ r~oae us~ t~OTMER-MAlDfN N4Mf ~ufr .~oa~ ~wa~ ~s F 2~a.~~L i /~n.a2 X~ T`a Y ~Pu~lFY INfORMANT-NAMF ~+~wiwG wDJRESS ~itnn o~ ~_r.o. no., tm o~ ~crn., ~~.n, er~ 3 3 9 3 L v. F2-i?n~l< QlI.~O~~S '~n ~Lt~~.~itin..,i~ LE 4 LIL~t .~[.a ~IHOih~11 ~MTl~~N ~~i DEAM WAS CAUSEO {Y: (fNtER ON1Y ONE UUSE rER l1Nf fOf (o~ (e), ~?NO (c)j ~enre~M ow~r •.ro a•m . 1~. w+ra.n u~fa ~ (el ~`r-~-~' ~ i i . • OMylpyl l 1 co~o~no..s, n .~n, ~ J~~~~~ ~w~C~ G~~~ ~~S! f0 j (p~ • / "^'/'VJ. J ~ IrrlD~~!! C~YS! 101. ~ py~ 10. W~S Ow3tOVlK~ W: ~ i~~tlpp lw! YwDt~- ~ ~fIMG (~YS! ~~1i ~ ~ ?~IIT u OTMER Sh"."~~i.CAht CONuiTlvl:S. ~UanO~i [owir.fo:..o p o[~rw w0* .a.•eo .o c.ose om~ .ur ~~o~ ~UtOtSY if YES r+~~e r...o~~cs co.~- J ~4 G~ O~ LDUt~ ~w GI1Ua~NIMG GYS~ ; ~ , - n - ~f~. ~ ~J i o. o...~ ~ -.r / ' ` - - - - u•~e.~~.+ ~u~~r~,i wic~~E oa ~nw f w~urr •..n~~-Q -+T. i M:w~-.7E.0lU:LETE~~i.NfD - ~ ~ ~~vY: ~...'vw: v~~~i.wiv , tSxc.~y1 ~ .l'° L7W ~ :.c .tit :,iE s IN3URY AT WORIC '?uCE Of wNRY •cw. snea, r.uo.r, i~p~wiiCri ~ srne~ o~ a.r.o. .w.. un o~ ro.~, si•r~ ~ S IlrtOn ~el Oa w0~ IO~rK~ Nl~i,tK. ~S~tUn1 . € :~f I~y, - ~ CE4iK:CwT~ON- +wrr W it~~ ; rpnM p~~ ~r.0 u7t y,r ~Iw/M~~ Al~rt ON ~ ~ D~O~.'~C ~+0~ v~t'~ :wl, pfA'N OCCVI~fD •T n.~ ,~v i.~ ~ rM~S~u~.a v TO ra.rw o~r ~eu f~oo~ u~u a.r~ „o. ) j7~ ^ I o.n. . ,t~~ : ~ •r.Ir~DID f..f I ~ ~ ~ Or / ~ I O~ ~Wr~IOGt. ~ 71~ tf:USlJ rt0.. ~ ~ ~ll~ / ~ ~74 2 3 7 ~ ~tt~ ~ n (1s~ ro r.~ u~s~~s~ sr•,w. . CEQTtf~C~TiO?r-~wEOKwI EItwMlrrEi OR CORO?~ER. o.. ~~t ~.s~~ a rw wpu~ a•n, t•i oecwu.r ~rws ~~o..ou..ceo oe•o ~ fa•.....r.p.. w n.t WO• •r.0/o~ tq wvu~~G~uoN, u~ r~ WwW... ' i .Wwn~ O~r •e~~ wOUe , ~ ~ D~~lM GQY\tfD Oti Mf 0~ ~ 1 u.o o ~ t ro~ w e c. v s e~ s ~ s~~ n o. rr. M~m M ~ CE41~fiER-tv~n~.E ~nn o~ ?~wn /S~G?+~iuRE oecne w nn~ rpwTE S~Gt~ED w+sa. o. .e.u 7)• ~ J ~ ~ v //1'~ ~ ' ~ tk " Z Mw6~NG wpOaESS-Cf+i~~ER / ~ o~ y cm o~o... ' . 2 ~ 7?f ~r Q h / ~ ~ ~ ~ ~ ~ ~ - ~ Iu ~1iiiAi EMAT~ON, RFMpVAt CEMETERY OR GtEMAi04r-~v.?w~f ' lOCA110N c~n p~ q.n ~r.r~ ' ~ ~ 1?tC z~. l; ~ c, H ~ t~? r~~ r.. v ~ o.~ L F N ~ ~ N ia c,~ F- r ~ - : OAIE ~..o..+w, w~, n•n N?J[iAl MOME-NAME ANa A'HKE15 i fiun o~ O. MO.. CI~T O~ ~O~M~ N~t1. II/ 1 T; 3~~~ ~ ~ ti S F O: ' ~ Z n. t c~ y i i D~ l ~c f c~e ~ FN/~ N i~ c r f~~? • n~, ~ S. ~~j1Q !UNS C~ ' ;7-:l614i ~E REGISiM rY'+-SN,NAfU1 / O~tt 1t. ~r10 ~J~~~ ~(6qf~~¦ ~ A~r. 1970 ?s A l../ tb S~G[~ ~ . , ~w . , ~~7 / Z ~ - - - - - ~ - - - - - - - - - - :F .'y~^,i ~ :-.c-re~y cc-•riify ~he above to be a~rue and correc ~ co~y o: t:,e :,o: n, : ;-~tr•ar'., ~r~cord oi~ file in the Ofrice of the Lee Cou:~~y z?~ ~r:~ ; .~I~CZl L ~ Jl .1 ~ _ .'oz' ~ ::le: > F302~lCia . - ~ u°=; ••:~:T_~~C,: ";:o~ valid unless ra~sed seal o: ~he L~:: COUh:Y :iL:'1L:c: D~:'~,.~.`:= ~ dt: ii:i:C.. ~ • • • . ~ i ~ ~~'c - \ Y.it' ~L ~ . \ . / ~ . ~ • h. ~ , ~ ~=-~c : r , ~ ~ / _ ~ ~;OU~Y.. t~CcZl~ ~ ~ . ~ y rYic..r ~r.:~ :.o..~~; it~~istr. r ~ / ~ ~~Z~ / l ) Z A~tc~~tc~ : ~ L .c SC'~ ~G ~ 10 i41i ~ - - _ ~ . _ ~ _ - ~ _ _ ~ ~ a-~