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HomeMy WebLinkAbout2232 y' - - ~ - . . . ~ 24~~8-._. - . 1 ~ CERTlFICATE OF DEATH Dep~A~ew1 ~1 IIea11L ~wd ReL~bili4N~e $e~kn s'TAt[ FIL[ NO. orv~oFes.u.rn FLORIDA ~fp i~?E, OR ~bNf IN REGItTRAR•t tlO. 210 /[tMANIfIT INII ~~p_N,~ rw~ .nwe us~ SE1l OAiE Of DEwiN t~Owfw, ti~, ~e~a ~ SEE i1M100[ F0~ i ~ R03BRT STUAP.T DC~.'Ai n t~,• , 2 U1CE.n.u, rNq. u~rcw rw~~. AGE-wt u.we~ ~•a~ u..oe~ ~ o.~ OATE Oi NRTM ~.~o.w~. Mt. CONNi1f Oi OEAM ~x. ~ wt~n ~ plll~~t 1 ~W11 ..p~, y~n wwu w~ 6602 '•Vhi t e 59 s. k . n~.- dn, TOWM. O! t iN wsr~ car ~r..+s HOSMAI O~ OTMER NSTIMION- ~ r np w tm~l~, a~n ~rnn uo ~e~ ~ v~ar. •~s w .a n Fort Pierce Yes ; ort Pie?-ce ~temo.ria H - STwTE Oi M!M ~r »o~ r u..~ Oi Ww?T CO~R~TtY MMtMED, NEVEt wufLED. SYtVIVHG S~OYSE ~r ~.r~. o .~rt¦ «.re ~ mww+~ vM1001MED. OIV'OtC~O ~ wtrv ~ ~ Canada Car.ada ••:arrie~'• .I(,'%i;l 3 n ; rwt~e Ncu~ee SOOA? SE~1MIi11 NIW~ER USUAI OCCU?~T10N ~un c.u w.o~a eow e~wo .ou a KWD Of N/SY~fSi Ol wD11Sit1f ~nu. r ww~ E ~wa nrt.. u aa~to ~ { °.`~.."o«. l~one ~Sa~es:~~an Printinn ~ uy...K. .aon - ~ESIDE?KE-STATE GOIN(I1t GTll. TOwN. O! tOGT10N '~s~w c~r urw~ SisEET ~NO HY~Et j ~ ~ sncrs ns w w ~uet~ec ,~Canada 14. Lachir.e Yes ~..725 53rd :'_v iAT1~R-NAME rau roaa w~ MOTMEt-MAIOfN NUME ~+s~ waa uw ~ ~s A. -D. Dc~nal ::illi~ent Si z IfilWMAHf-NAME MwILwCs AOGRESS ~aneet o~ ~.r.~. wo.. tw+r o~ wr+. s~.p. tr~ ~ ,h Jean Sriags ~ ,n 725 53rd Ave. T.~~chin n n r'„-~~~. ~ ` /M7 L OEw1N wwS CwuSED ~r: ~EniE~ Orxr OnE GuSE ~ER ~wF f0[ hl. NL ~ kN ~~TrtM OMSI~ ~MO Ol ~w 1~ twu ' (~l.ltio r~'n~ ,w• Y~/~~- . . • - ~ cow~nw~s. v •.n. ~ /jt ~ ! v wMKw o~~~ rst W (N Q~ ~ /"~0 ir.~~.wn c~~a a~. M q. w u. oow~we.aa w: . at~nwo twe vM~t~- • as~o t~~w uft ,l +t1 i . Iw~T OtNEt SIGn1f~GwNi COM01f10N5: ea.wwo..s eaawK~..~ .o oun. ~~...oe .euno ro e.~se er+e. rur ~ w~ wYTO?SY if YES ~ri~i n..o~MOf ea+- ~~es no~ s+w~ta .w ea~ uu..o.o ewu E . . a ~[~tw . ~ If~ ~S lf~ C ~ ~?wbaM~ ~p ~ NWr100E. OR tMO~Tfl1~1NFY A ~.a+rw. wr, nu MOUR HOW ItiJURY OCCURREO ~ ew~e~ ...rwi a wwn ~w ru~ ~ M rut u, ~~u. ~ 70[ M 7M ~ > ~ Iw ~ INAM~ AT wOfl( NI?CE OF RiIURV u ww. srrn, ..na~, IQUTIOw ~ suen o~ ~.r.s. ..o., an o~ w.r.~, u.n i [ ~ ~ veun ns w Mo ~ on~a wo.. e~c. ~ ~nan ~ 7M IN. ~1 ~ CEeTwUnO?~?- .~w~w ..u ..o..w~ w, .w ..w wr s.. »..i~e..~m a. ~ woiae w..w. w oEwrN occunro .r ~w w~ce. o-. .r ~ ~MTSKIAN: rp~W M? nY WO~ YlU M~M. IwOV~I 0~1l. ~wO. 10 M! MlT ~.rrc».. e. ri/?_ 0/??_ ro l/7 ~ 1 C/? ~/7? r2 .i 7 7` w., .w....ac.. a,~. tt~ aee.uo ~wr fli - • flc 7N Z tb.. ~'?r. ro iw e.uu~s~ sureo. ; ~ CEtT~KATION-MED~CIU EE/1MM1f! O~ CORONER: a. n.e ~.ua p n~e ww~ a oe.a. eeeeoe..+ rns ~w.au..ee~ euo . eur~.•nw or wa ~w. .M/M w~t on~snwnw. w.• o~«~o... ..w~w o.~ nu .o~~ ~ { N~A OCCWY~ ON M M~! ~M OYt q~ 4YSl1l~ ft~ne. M: rn M. y ~ ~ CF~T1Hf~-NMrE ona w ns.n S~GNw a- _r~j~ aeaee o~ mu DwTE S~W+EO ~+wm, wr. rw~ ~ t~, F' Y':'.~'`C1S •T . ~i2'_'~'~:'_^.'_"^ ~ . T'~ . jzl~ ~i~lJ~n...-...~1 ~l/J ~~k ~ /'7'~ i MA4NG~pp~ u-CEe s~H~~ o~ ~.~.o. .+o. t~n or a.~ u•a w tH p ~t, ~ rny.+ p; ; ~,..i „ q~~,,Kn ~URULL. QEI+lAt10H. ~EMQHAI ER1 OR GtEMnTO~!-n~uwF IOCAT~ON un o~ rar.. sun ' ' ~sMtr~~ ; ,N Removal ,u Ride~~: ?~emori~l Gds. :•~ontrezl ru » ~ ~ . OATE ~..o.nw. w~, nu~ RR+ERAI HWrE-w?~wE ~?~M ~DORFSS ~~~aeer o~ ~.~.e- «o.. em w ror.., sure, tv ~ ! - ~ ~ i•~K-~ ?_3 1972 n.. Y~tes rz•r.~~-n 1 i`~•-:• ~ r,+ n3~'~O 3 own ~eeE~veo ~.~fioui ~Ed~~sfi~ufa # V. 5• f612 f1R~ - i REGIS -SrG+~~iJtc ~ 7N (~V L2 19 / L ~ R~v.1970 ~ ~M . ~ , ' - 1 hereby osrtify fh[t to b~ a frua ~nd aorrott oopy C~f fhe tocal fILEO A9D ~tE~tDE~ ~ t Re~im~~a rooord o~ flk ln 1h~ St. LrucJ~ Cpun 1{eait}~ ST. LeC1E CO[tNnr ~,f?- ' ~ nlsnt at FOA Pisro~. Florlda. ~ ROC.cR ~OITA1?S t~ ~ CIfRK GIkGUIT ~0u~r ~ , ~:.i1=r . ; ~ (Wamirq: Not valid unlsss nlsed se~) of ths St. Lu~ RECOau vE~'<<EB 1~,~ f ~ ° Counry Heelth Dspartme~t b affixed.) ~;Q ~ ~ . _ ~ ~ Fp ~ ~ si ~l'23-: ; ~ , j : ~ ~ ; .~5: ~ ~ ~ N. D. MILLER, M. D. 1 n r,-~'~ , f-? f ~iONfl ~1tt ~IOtf at LOCt~ ~~51f~f 2~~ w_ ~ • - s~L ` ' ~ ~i • ~ ' • 1 - ~ • ` 't~ ~ ± : i ~ ' ~8 : ' . - ,1:- . ~ t: • ; ~ , r ; ~'A - ° ::sy~ ~ , ~ °~1~1~- , _ . . ~ y,. . ~ ~{A~/ ~~OCi~ ~lft?a/ • ~'~fs• f ~:1~.c1~~ ' ~e . . ~ s . ~ ~ - ` • J~ , l~``` = - . ~ '1 ~ b ~ • ;`1. 1. 3.i ~ n~: . ~ ; ''~.,;,,,;,!i''` . ~ ° R 2~O ?`~29 600K PACE ~ _ - . - , _ ~ ~ ry : -