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HomeMy WebLinkAbout2758 <<< : o Z I ~ut' i1ji~ ~11 ~Fy ~ ~ ~.~c'~~,~ . ~.T ~'.~U~T r.~~ q: f ~ ` ' . ` , ~ y7 ~ s3 F~a 11 1~ ~n'13 - - - - , ~ . . . CERTIFICATE OF DEATH ~epa~lw~ent ~ ~1e~11ti ~nd RetiaEd~il~llvt C~wlch STATE FIL[ NO. T a.~N~~k ~n_.~iu FLORIDA trrE. OR ffIHT IN ~'~°~°`°Q~1°° ~ ~ REGISTRAq•5 NO. ?[tMAH[NT INK OEGEASEO-NAME ` ' 01~~ Sfi. WItD100[ 101 ~x DAIE Oi OEwiH i•owt«, o.•, n~~ ~'~'~'"K"~'~ ~ SAMUEL A. MERRITT anale ~ March 7 1972 ~ R/1C[ rrn, MtOw, u.ttKu~ u~ouN, AGE-uS~ ~~~t•~ v.a~~ ~ e.r DA1E Of 4RIN ~rw+n~, e~?. ~p~p~T~ pF pEnTM ~ ~14 IVECY~I a~rro~~~~e~~s~ .os, e.~s wou~s rM. ~a~~ ~ white 80 ~De w ~l ~ CITt, iOwtJ, O! lOGT10N Of Df~TM ~+s+e tu+ w~+s eWS?ITwI pR OiNER InSiiiUlpN-wuwE .w~ u+ ert¦e~, cwe snu~ .w ..uwu ~ f vecr,r ns o~ ~+o ~ ~ Hollywood es M morial Hos~ital STATE Of NRiM ~ r ro~ ~M u.s.•., .....e C1T~ZEN Of wnu~T COINJiR~ MAttlEO. NE~E! MwlRiEO, SURV~vNC, SPOUSE ~+w. one .uwe« .u.~ ~ car~m ~ WIDOwEC. 01vORCEO ~ vecr~ ~ ~w~n~~• ~~w York + U.S.A. married Gla~s Mayer vweet eec~•ste SECURITY NUMbER USVAI OCCUiAT~ON ~c~~r! awo or wo~a oo«e puo.q rost O? KWp pf WSWESS OR INDUSilY tn(O 1~ N~M OCCY[q0 N rOrMG U~l. hl~+ M upflD 1 ~:062-07-14 1 Ret. Salesman u. Real Estate f~YDtrKf N~OY •a.+fs~ lESIOfnCE-SiAtE COUNi1f UIY, TOWN, OR IOCATION Msp~ ~m ~Wns 51tEE~ n+i0 NUM~ER t ~ ~ s?etr+ ~es a.a ~ Florida ~p Browa~d Holl ood es 1607 ArthUr S reet fwinfR-Nw,wE nnt rWW! 4ti f~WTMER-wutOfN N~ME irs~ .uoa~ uf~ ~s. unobtainable unobtainable INFORMANi-HAME MANa+G A[~6QESS ~s~nn o* ~.r o. wo., cm o~ ~o~+~, sr.n, tv~ Glad s Merritt 1607 Arthur Street Holl~ ood Florida fw~i L ~n~o~~...fe ~..rt~..t pEATH WAS U?USEO !Y: (ENfER O?rlY WrE C~USE ?Ei lwE fOR (o), (b~. ~rr0 (cJ~ ptie~r o..sn •~o oe. wrto..n nua . NI ~O , . . ..u e . towo~no~s. n ~~n, ~ rM~cw e•ve us~ ~o lb) ~r.io„~e e.use ~o~, ~ ~o. w .s • co..xax..ce w: si•uMC ~we u~oe~- ItING C~Yif uft ' ~t~ ~AtT O1F1ER 51G?11i1CANt CONDITfOWS: co..ano..s ea.nwun.w q u•r~ aur ..o~ nureo ~o e.us~ ei+[N w?.er ~ w~ ~0?S~ IF ~ES we~e ~INDIMGS CO. ~ns w ..o~ 1~Of~lO IM ~1~~~~ti~NG ~~i: o~.fw IN n~ IM ~ p~.~poW~~ ACCWEntT, Su~CME OR A WIURY ~raarr, p~~, T[•~ ~ 1sOUR NOW INIURY OCCURRE~ ~ wna ~urvet M~NIWi /M I~~T ~ O\ 11~N 11~ H!r ~ IOrtICWE: OR W~DFIftNtt?+EO ~,M 70? IOc M. !M IWURY wT wORK ?twCE Of wHIRY.~ ¦o..e. ~•u.. sryn, r~non, IOCwT10?r ~sue[~ o~ a.r_e. No., em o~ ro.M, sun ~ ~ sne~n ~cs w..o ~ oH~ee ~.n~., erc. i snan ~ 7h- 7or ~M CERTIfICwiqN- •.or.~w w* ~e.~ +a+*~ w. si.~ .~o u» s.~ MW/w~~ ~ll~~ QN ~ oro/o~o .cat v~nr n.e DEATN OCCUliEO .r r~i r,~ce. o-. ~N~SKIAN: jO ~OMM D~f TEU {pp~ ~itl~ Ot~M. ~wpufl ~ D~tf. tJ ~M! ~L ~ ~ntMDlO iMt J f ~a ~ O~ r~ lrUwtlpG~. : ZI• Y[Cf~StO ~fpr I t- ~ (i j~ 71~ 71~ ,7j ? L }I• ~'~+q II~ M. ~O 1w! C~ulE S~ St~'2' CERiU1CwT~-MEDKwI Ex,v.uNF~ R CO?ONER: o» ~+t ~•s~a p rnt ..ou~ o~ u•n~ ~ oecenNt w•s r'o..w..ceo oa~o 1[M~+M~11~l~ p1 M( ~Oflt ~MO/OI \n! IMYlSIKr11~~CN, IN Y~ ~IWIQM. YONtM DA~ i(~~ MOY~ ~L Of~/M OCCY~~[D ON M! D~Tt ~MO DYE t0 ~wf 4YSl~1~ Sf~~tO. ZH ~ Zh ~ ~ ~ ote~te w~aat . ~AiE S~G+~ED ~ . o.., .u~ 3 ! CERTIfIFR-NAME ~nn o~ r~~..~~ SKaNATUR Dr. Dale T. Anstine ,r,~ ;:<<.~.l~--E!- ~ ~j~--~t--ti~ ~~I~ f ~7z- f - MA~iNG ADDRESS-CEPl~1fR a~~ee+ o~ ~ r o..o e~n o~ ta.~ s•.•t ~Ti~r ~ 1206 S. Federal Hi hwa Hollvwood Florida sF M CREtitATqN, RF~.~Ovwi CEMEiERY Oa CQEuMTORY-N~~nE {lOCnitON ur. oe ro... ~ sr.n 1 ~w Burial N? Hollywood_Niemorial Gd~s~. Holly~aood Flo~cida OA1E ~rOMiw, 0~~, ~[~~1 FU`~ERAI MOMt-NAMF ~'~O ~_i~ESS ~ ST~leT O~ C rJ, C~it O~ ~0~+~ S•~Tf, l~~ • ~.~Mar h 10 1972 JOHNSON FOSTFR 1650 Harrison St. Holl wood Fla. - ~ V. S. ib l2 fWEi ~fEC,~ ;r~wi;,' 2 ~EG~S?R~,,~. G•.~;/ci4E ) ~ ~ ( ~ C~~e ~ECE:.EJ ~r itr!fr, rE : c-s.q ~ R e r. 1970 7se ~ ' D~+ tte i' KL,j'.t.~~`.~~G'¢-f ' 1.~i+~tL~/~^ tas Q/~l~C~~fiJ ~ ~ v ~ ~ ' ~ CERTIFI~D CQPY ~ ~ ~ • . ~ - - ; ~ I hereby certify the above to be a true and correct co .e Local ~ i py of tr ~ ~ .Registrar's record on file in the Broward County ~'ealth Degart.~ent at ~ Fort Lauderdale, Florida. - ~ ~ - (Yarnfng: 1.0~. valid unless raiaed seal of the Broward Cou.zty Health ~ ' ' ` ~ ; ~~p~rt~ent is affixed ) . ~ ' . • . ~ h ' - J E p ~ i 1~'• v `3 ~ 1~ ` G ~ i1 T 1~ ~ ~ • ~ • ~1 /',I !.~~~~~!~4~? 'f f / . _ . . ~ ; ~ /i `r _ ~"O"°~~~ County iiealtn G::icer_' an~ Local : eoistrar _ :~1.~A3~i,'D~,E. . _ ~t~R(~A• . • ~f . . . . . `.'j ~-~r~ ~ ~ . - ~~3-~?' ~ t ~ ~~f:. ~10 U~t: ~7~~ Dcputy Local Re~ictrar ,,:,F ~ ' ~ . • ~ ELU9. SPENCER, BUTLER AND KISSLAN, ATTORNEYS AT LAW, HOLLYWOOD, FLORIDA ~ ~ ~ _ " _ _ _ . _ . . - '.r~s~'G°..r~