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HomeMy WebLinkAbout2234 ~ CERTIFICATE OF DEATH ' De~parlnNw! o~ 11e+~~lb ena Ke~billtatire Cenices aTATR FIL[ HO. ~~•~•~~~~A~-~~ FLORIDA TY?E, OR ?R~HT tN ~"'O~"'T"'"~"° REOISTRAR•~ YO. P[RMANfNT iNK O:CfwSFD-N~E •:u. +,»:e ~.sr ~~x ',ATE Oi •JiAiH ~ ~o~~•, o.•, .e.~ ~ SiE K~:tM[ Fpt ~ I 4S7~UfIICMS ~ ~.'~~'ia~v'~ ej• i?tiv ~~JIJ~iIl ~••.~^•e !IUF~'!~.ic'.r'~ 17~ 1973 RACf .r..,n. ~eaw...e.K.w ~GE-use r'~x~ ~ u~ vnoi~ ~ oa~ . ~ATE Of MRM ~.Or~. ew~. :CfX1NTY O~ C'wTH ~'C. ~ 1~lCHt l ! t~fM'~~~ 1~l~~1 • rQ3. ; ~~3 ~ M~~1 ' YM. 1~l~~ 1 . ~Yhite 65 i~ ~an. 3~1908 `.7. Indian :~iver J~^ ~ CffY, TOWN, Ot IOUTION Of OfAtM ~~.froe c~n ~W~n ~ NOS?fTAI Ot OTi!"tR SNSTITtJiK;N-NAMf ~n ..o~ +w er..~e, c~v~ ~TUe• .~c r+uwe~ i {..f { v ~ s.a••. .es o. .+o j n Yero Be~ch Yes ~ Indi~n~ver 'ce~ori~l Hospital STATE OF t~Ri11 ~ n.or w a.a ~~yt Ct712E~t Of wr'.qT CCt'r~TRV . MwRtiED. 1.'_vEt Iw~Pt.EO-rURY1vY.'G S~pUSE +~•e. cr.e .,~w~ ~ E «w~+n. ~ : w~pOwED. Crvp[~fD ~ wc+~ ~ : ~ ~sv.«.~~~ ~ tietiv Yor:~ U.S.A. ~~o u_arried i~~. Dorott r~Courtot ` ` t'e oeuc.`es=~ ~:u SECUittv MJMEEf j ~w.i ac'7AtpN ~ c.•[ awp c. +o~. ecwi oi+:rc ~wsf a ~ KIND OF wSWESS OR It~U57RY OCC~r~flD •v ~`h~~:^~G Utf. [v~r t~ t!•~~t: ~ ~ ~t 067-09-49~5 ~~k ~'et. F~ecutive ~tA. A~itomabile .~.o.t •a"'~~'a"' RES~OENCT-SlAiE COUNTII --~C~T~, ipw'ti, OR tUC+~!iON ;'¦sw~ cm u+m~~TS!REEt A.~+O NUM~E~ i~s.ecn..es o~ .a~~ F Florida St. I,ucie i,.; ~t. Pierce ;;o '~-4~A Pensacola P.d.~ ~t.~ ; fA~YER-NANC ..q~ r~crae ux ~M~`~ER-A4iD:NwAx.f ~inr ' wrxt u~r ;7 .a ~ ~ ~s John D. t.:ac.: i7.1^.r i+~ Jess~ e~7 fer - IKFORwNi-!~wE +~u1u~G ~ppAESS ~snee. o~ ~.r.o ~.o., er. oe .ov.w, r•*c, :+i ?:rs. Dorot. 2:~c_~illan ;~n 0- 1A Psnsacol~ Rd H~. ~2 ^t P~ erc Fx' t. Ofw'M Ww5 CAL'SED !Y~ . ;EV'fR O~tY C~vf f~cVSf ~'fR lb~E fOt lol. (b1. A~ kl( ~~i..µ~ o~~i~ +ro w,~~ ~...ea,n e.cse ~ ~ _ ~ (a) , ~j/, ' _ ' ~i ~ ~ ~`I~.~ ~ / ~ , • . w. c _ - - . . • _ . ~ ~ i ~ r' I cowomors.n..n ~ / , ~ . ~r_, i..~~ •i•~ fr / .~~er e..e ose ro ~ {A) i ~ ' . i _ ' ' r..[e~•ti e.vse ~m, ~ ove n~~•f . co~u ~ ~•.ee e . f ~ S~~T~MG Tw! Vti0l~- / l~!MG C~Vlt l~ft ~ ~ ; i~~! tt. O!nEA SM..N:tCwryt ~pK~Tb~- ca+r•~o.s co~r.~~~;••..; ro^J~M ~J( M~T !(t~'10 TO C~VS! GM1lM ~...e.. w~ 'AU~OrSt ~~tf YES ~e.t .~~c~.es ec++ S~ns ee .o~ i 3'D!~!J 1M DtitWvirG c.: ` / i - - • , . _ o. ~u.~ . ~ r n+. :VO ~ ~n ~ ~v.s4eL~,1 ~CC~JE`:t :L~C~~f OR QA'E f\:!,~Fr , n..+._ :~-UL'R HQw t!31UR~ OCCURRED ~ P~tt~ ..•TCn o• ~+,vt. ~w ~ c~ r.•~ n, rr. ~ S ~.CM'Ctv:: GR Uti7[:EW~~.ED ~ ~ ~ ',wc~~1! i ~ i ~.'6! :G M.:.'Bd % i ~NluRr wr w0q~ ?rtwCF CF sYri:vv .y, r~ar, ..n~•. tOC~T!Or~ , s•ren oe ~...o. ~o.. on oe •o...., s...e ~ ~ ~inun.no.~.o~ 'e..:ceroe.ec ~snu•.~ i{ w ;ro~ # CERTtRUtqrt- ..ay~ o.. .eas ..cti~• c.. .e•~ •••v us~ s....:..iw..~~.~e o« ow:o~~r.n. r..e~4'~•M OCCVRtED .•,..e .ucr, o.. - 4 ?M'SICI~Y: r0'~in D~~ ~lV ~OC• ~1'F~ ~t~'~•. ~K`L'~1 D~'F. I~vO, "O T! •nenpro rwf t~ _T/ T-^/ n i I~f~ or r~ .,,~..i.y. I ~ Z~f O(C!~)17 ?O ~ i-C~~ i1~i ~ i1~! ~J 2~~ ~ Ii~1 ~SCr. O MF C~~S/ S' S'~": . ~ CEtT1~~UT~OU-+.tED tN.+!rtc¢ COtV?n+ER~ ; .,s~s r • . .ro~~. o• c . ~ . . •-~~~(`=~w* ..•s •.o.oa.ceo cu~ ~ ~~~r~r~r.pH W mt ~OO• ~.biOr •nt eHrti•~G.tpv, ~v Cs:vM.~, ' rJ.'^ r.7:~ ~ > ~ ~ . J!~rw OGN~~FO ~ 1.! D~'! u~D DL! ~O 'r~ f~:lS!'S; S"~-r~. _ _ • i ~ ~ , . . r 7?a .N. ~4 ti• i CcATIFlfR-NAMf ~vn o~ r~wr: ; S{ VpT . , . ~A? •t,•, ~ _o~eree o..,nf E S!Gf:ED ~re~'. L ~ MARING ACDRESSOLlC1'T't ~i" iii ~ 1 ~ ~ ~ '~T~ „oy'~ . , ~ in c. o y t' . ~ - s•..7k T~Y!~ 27_ ~9 i ~ ~ :e e • c e . , ~ ~ i~y01-25th S~ree~ l~ero Be~c~ ~1o!~ida 2 60 ~ S'vn:A~. L'iV~?fON, CEMOVA: iCEME'ECY C':N/CiCRY-T7s~.tf -l~lA~i7~. Crn Q~ .p ti 1•~•e f ~ f~tt~n ~ ~eW~v~. I,•? S:. , ~o~d Ce~ete~ T Brom:, ;.e~v Yor~ ~ 1 L S_._ f• ^ ~1~)0 O~ ~ ~.Q. ti0.. CI~~ Of tOr.~, l~~~t. j~~ ~ ~ D~t. T .rpp.r.., o~A~,~ 7aw~~ ?U~f~~t NQv*-r.~e•, r_ c_ fSi ~ srr~.e/~ ? ~r 7~ :td tJ •~(7~ 17l~ !ZS~. 1~T~ iti.rn~"nl~_-_'^rt{~• L~'Ji~l44~1 liV~~• Y~rO LC.:1~1 T~~,~~~~LQ~!~ . Y. S.f51? ~l•.}°-.wt~~°1~/pz~ S~r/~.t, ~ , ,~~~;CSA ~ . ~ ~.•e IE.:.+eD ~7 :f..A[ Si'v:STR4[ ` Rev..9i0 ~il~~~',' / ~ /~.iL~l~?? /~i` i ~ , ~ ~~Z.n,'~:~'f ~ - 1 ~ t i - - ' "I hereby certi~y tne aborn to be a ~~cue and correct cony ~ ~ of the local reazs~rar's r~cord en file in the Zndian ` :tiver CoUnty i?ealt;~ 7~~a~ ~<^cnt at Vero L2ach, F~orica.'' ~ i This is not valid un'!ess the raised sea~ of ~he Indian ~ River County Healti Departr~ent is a~fixed. 1 ~ _ _ ~ : ' i; ~ < ~ FILEO ~y^ RECOROEO ~~1- ~~s~, ~ ~ ST.LUCIE ::OIfNTY FLA. o~t~~,,••• ,s y ` RGGEc. ~Gi7RAS c, ; ~ ~/1 1~.~ ~ : ~ Clf=t .~G ~ COURt ~ ~r ' ~ ~ : ~c~-~., :7 w;{ ~Co~:n~y ~i'~aZ~~ Dir. S,ocal ?egis,.rar ij i • . . -~'1• i ~ .G- % . ~ ~ ~ ~ 11 Zs aN 73 ' - ~ ~ Ff8 6 { , . - C/ ~ _ li. • ~ r !/.~~(/L~~. .i.~ ~ 1 . ~ ~ ^ .f ~ 4 c~it~>;~~Gistrar p' ; 24'72'"l0 - ~ - t . - ~ ~ eooK 2~.0 P~~E 2231 r ~ _ _ _ ~ ~ . : _ _ ~ ~ r^,. r z- ~ ~r''"" ~ i:.s~ ._a. . , _~...".`~w~3