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HomeMy WebLinkAbout2807 4 - . - ~ ~11_3/ V ~ ~ ' ~ CERTlFICATE OF DEATH nr{wlweol 01 Ikaltb awd Retial.ilil~lire ~efricn 9TATE FILE HO. ,~.~,..~K ?u.~„~~ . FLORIDA T~Pf, Ol ?[INT IH ~Ytl~~R~~~ REGISTRAR'S No.33 ~F ~ iSflc IDwTE OF OEAM ~+owr., o.., ?E~MANINT IHK ~EwSfO-~+~E "'°~`e ..°T ,rsieuRa~s , JA:~IBS Tt:C~:AS IAtJ ;•tale January 18, 1973 RACE '~~n. MlG~O, ~rllK~M ~wO~~M AGE-~•i~ ~ ~^wt+ + o•• DwTE OF i:4TH ~+a+~r, o••, ~~puNTY Oi OEwiH 6602 ttC. ~ lryC~I~ ~ • •~~~wD~~ ~ fl~~s ~ ..~s ~ M~~ ~J-i.~l rrw t~~ ~ ~ ~ White 62 ~ , ~ ~.a^ro 3 1910:,. Saint Lucie CIi1l. TOWM. Ot IOCAi1pN OF pEATM u.sio~ c.n iu..n MpSMTAI OR OiME[ INSTRUTION-N4Mf ~ n.qt u. tit.i~. p~rt s+Ki~ ~w ~uwt~ ~ s?KU. rei o~ ~O r Fort Pierce Yes 'r'ort Yierce :•:emorial I:ospital STATE Of ~iRTM ~ u w0~ n+ v.s.~., w~.e CIi1ZEN Of WMAT C01eNi~Y /+URRlED, NEVER MARt1f0, ~SURVINNC S!'OIISE i~~ rw~, ane uwt~ .ure ~ cawm ~ ~ W1DOwED. D7vQcCfO ~ vetr• ~ i ~+~.~•~.b.~~ , Geor ia • USA ::arried 1~__ Eugenia Thom~son 9__ - .~e~e au.xo ~CU~n M1aNE¦ USUwt OCCU?wTq~ ~e:+~ ~r.o o. von oo«e ou~~..a ..os. a? Kwp pf WSwESS Or tWUSTtv ~~.to w q~m : OC[u[~f0 1M r'p4rL U/f. Hiw U~Ir.~101 ~ , ~M 255-44-9714 ' ~ .~,,,~,~~.~,a, „ Su:~ervisor ;~a City Streets Dept. .o..~sao... RES1pE~aCE-Sf~?E COUNTr dtt, TOwr~. OR ?OCwtiOr+ ~~see cer ,..~rs ~ST[EEi ~w0 NUM~ER ¦ j I YlCMr r!f O~ MO~ ~ T ~w:~lorida ~u St. Lucie I~k r^ort Pierce ro ~~..355 ttosbine Street FAtNER-N~uuf r~n~ ..wa~ i.f+ iMC.7NEa-NUrDft~etvwf •w. .uoae w~ ~s Williatn T Law 1:amie Johnson INIWMANi-HAME mAHWG ADGRESS ~~rue~ W~. o. ~.o . e.~r p ro.r.., s~•n. tv~ James T. La.w Jr. !~~355 iiosbine St. :'t. Pierce Fla. 33450 ....o.,_.:. ~~T ~ DEATH WAS GU EO ~11: !ENf(R Oti:v Or.F UUSf Iff i Wf ipi jo), (Di. ANp (t~j ~~(nrfe.. puan ~..o w~*w 1/ r.ee e•u ~ , (e) Y"~~~~J~.. -V-.- Y' C ! ~ a-t"`~ ~t. ~ .s . <o..Kw~..u o. co~o~rw..f. e~~- , ` ~ ~ ~ '~d~_ l`~c~ r.~c. e.•i ase ro) (A1 ~w` t 7 V-~'~~vy~ls ~1V+_. ~ rY~D~~~f~ C~Ylf 101. O~ ~1 ~ COMNW~1 O~ ~r~-_ ~ ii.r~ e +~e uroe~- ~ _ ~t~MO C~YU l~~f i I I ?A[T 11 H(R 51GN1fKMlT CONDIT S ~~~~~o^~ J•~~«~ •o p.~~~ ..o~ u.•* .oi -rAUTO/ • ~{f YES ue i owos eo.+- Q/w\~ lo` ~G c•ufl G~r\i+ w~ur ~ ~ ~ I - 1~' W O~~~w ~ ~ ~7r~~~0 O~ ^ i__: IL~~ ~ :1~~~I ~ I~S `~!D ~ OIIf~r~w~wG C~Ylf ~ 1?.~1~ i A UD~Ni, 5!/ICID( Q~~DATE Oi W1W~.~: , r, ~~HOUQ 'NOw INhiAt OCCU~RED ~~~r~~ o~ ~+iu~r iw u~t ~ p~ r.~t n, ner ~~~C~6[: Ol IMAfIF~1W?iFD . ~ i ~ ~ ~ .h~ ~ : - ~ ra ' ~a M n. 1N1Ult AT WOR1( qACE Oi M.)4RY ~.~t. r.~r, fntn, ~~aw~, IOCAiION s~nn O~ o Mo . un o~ ~o..., i~~*~ ~ t ureun •u o...o~ ana koe..ex. ~sno~n ~ • 3 ~ I~ ~ ~ ~t~/ ~ ••~.~.M O•r 1~~ ~~wD 41i yv~ n.r)w~1 u f ow'~ ow/' ur n.t OlwiN OCCU~~f try ~u.tl. O.. r.N : Cfti~iKATiOH- w.1 0.• .~.,K,.~: ~6 ' ..o~.tw e n ~oo. •~*e• tw iwLw~. o.n..••o.'O ~w1 ~esr ~ , .,,~~o~o o. o,.. ~ o«~.,.o ..o. ,y `j ' ~ ~ ~'i~,~ 1 f~ Z~ f ~ ; ~ ;'3~ .a <.~u,,, ,,.,.o ' 7 CERTifKwilpH-MEDKAt EYwMwE~ Ot CORp~ER. o.. r..~ ui.~ a+.+ ..o,.• o. a•~~ oe~~u t ~~S ~~O~+OYK~D D~~D ~tuw~~0~+ d~! q0• ~.O/O~ rM w.v~i~w•h0... rr c~r....0•., ..O.rw o.? •1•• .OU~ 5 Ol~TM OCCY~MO Oti M~ Y~tl w0 OH~ q Nf G~VS~~)~ 11~~f0 ~I ~ _ 1ATIF ~ - --Ary`~4O • vn \ ' SrCiNATI. R JOIVi~~ r:~ ;OwiE IGNED w..r•• o•• ~W M ~ v\t 7L \ \ - - - - C , ' 7Y ~ ~ ~ ~.uR SS F ~ sine~ o~ ~ »o. ' ~ ~ ' ~ ~V ~ ~ • ~ t ~i~Ci-\ ~ ~WtIM. «OH. REMOVAI G4KTE~~ OR UtE~70RY-N.aMF •~OUTIOra c~n o. +0+~ it.u . i srec... ~ ! ,..Removal-Burial ,.~'tehobeth Cenetery ,~w Shellman, Georg~a ~ _ ^ ~ ''t. PieTCe F'1 33450 ~ oyTJan. 20 ~ 1973 n.Yates c,nneralfi-.o:~e~e11 Ir.c.~~i3ox ~777 ~ S. Ib 12 fU/E REGISS(~ir-S,Gr+wiUiE .t owit HGt~vtO ~OC~~ ~t4~3tu~ ~ - ~ / ~ ~ Aer.i9T0 ~p :M J ~ 24'~685 ' ~ ~ ~ ~y rD ~ ° ~ ~ ~~'O~ °OFY ~ ~-Loca~ fILfD 1kG ~=CuRDEO ~ Regishara reo~rd cn fits in fA~ $t. Luck Courtty }{oa}th pop~} gT.IUC~E C~UNTY f~A. msnt d Fort Pience. Fbrida. RGGi P~:,ITR~?S ' CL[r.r, : .:~~~,T COURT ~ (Nfeming• Not valid unleas raised teel o~ the 9t. Luc~O R f. r, C R ^ ~ ~ ' • f, • ~ _ . 'i-E CauntY Heeffi Departmenf b ~ffl~coda ~ . ~ . : . ' - ~ r~.o.M~u - FEel1 22,PN73•' M 6t. All D Y. T c,owy f,e.i~ ofr~ ~ t~ c~r,~~ j,~~ : . l ~ ' ~ ~ ~ ~ 1/ ~ ~ ~ , ; t ~ , ` st • , -T-'I ~ ? • ~ • / . . ' \ ' 'fi \ ? ~r % 1 l~ . _ • . - ~ • ~ = ?~v~~ ~lo ~ %•f~ ~~O't ~ _ ~ ~ _ . . _ _ . _ _ - ~