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HomeMy WebLinkAbout1731 ~~~`~u ~i w~ua~r~~1. Al~t,~.~ F~ ti~lA~ CIERx Cc ~CJit C01JI1T ~ Af}!A~~n y?F.FI[4..~....rw~ Mat S 11 v~ ~N'~3 2~~ - ~S~ ti'~~951 CERTIF~ED COPY WE HEREBY CERTIFY THE GOPY REPRODUCEd BELOW TC~ BE 11 TRUE ANO CORRECT GOPY OF THE ORIGINAL RECORD ON FILE IN TME BUREAU OF VITAL STATISTICS OF THE STATE OF FL~RIDA. ~EPAi~T1it~NT, ~F HEALTH AIVp REHABIl.ITATIVE SERVICES. ~IVISION OF HEALTH AT JACKSOTiYJI,.l.E. , FLQRIQA_ ~NOT VAUD UNLE65 THQ 6F/IL~OM'fM~'lT•.,['OF,~L~p~~A. OEPARTMENT 6~ NEAL~H AND R[NAOIIITAT~VE - tERWCCS. DIV~S~ON Oi HEA~t,~ H'~i([~/.- ' f - w . w: - _ ~ ~ ~ - . 1~ t _ , k . L ~ ~ ~t ~ <~~~t CMI[/. ~UN[AU ~ YIT1~L lTA71~TIC• ' ~~jt~ i+., s~~~~~1 . _ ~ " ~ ~ C''~'~ •~'~''1~. , L~,r ~~.~t~ ~ ~j~' sTwTS wcwsne~w: o~nscTOw. o~wsiow br , ~ ~ ' - M~AL~N - DI~~TY[NT Oi N<AITN AND : ~~`Q~~ ^'~~1^ 11[?IA~IUTATIV[ ftRY1CES " ' ~.'••~~j~~~-'' .~?i,~ _ _ ~ I ~ ~ ~ sT~rc BOARD of Hewtnt ~"~:,,r,~~_( ~_t~~R7'lFICQTE OF DEATH 'S9 - C 3 a I 4 4 BUREI?U AF VITAL iTATH71Cf-.~ F LOR I DA sTATE FIIE ri0. BIRT~t NO nEG16TRAR 5 NO ~l~tt Oi O[~TN iCODE NO• 2 YtWI RENOEMC[~~?...t.r~..f:.r.+ s:.. ~c...t.wp.•,..~a.,...,..7 ~ C CJ.N7Y ,y sy~'•a': N~nS. ~ •-18~ _ A1^(ipP ~ ~ C1TY. TOYYY. JR LC:CATMJN •S ~L~CE Di DFA7H t. UTY. T01NN, OR LGC~T~ON f t5 RE:tDkwCf .4i ~E Ct~Y UYITSI ~ IhStp( Ciir Lw~TS* L+~a~chula _ ~ YES~ No? ~auchula Yrz~ ' I M~vF OF , q aw +a RofyYd, pur ~!•tet aL'-nr t tfNGTM Oi ~ ~ STREET ApC~pf55 pN A fApM~ MOSPIT~L QR p ~$TAY ~N IA ~ ' ~MSTITUT~O~ 31L Z" CL"c~11 n~le • ~ T~IQ ( 31L Pec YES ? NG . - - - - - - - ~---l- - an_ ~v~s?~_ _ 3 Mw~/[ Os F"v~t V~/Itr Latr ! DAiE Mowt~ Da~ Z ia~ ~~`~~u? Jack lneron Studstill °EATM Octc~ber 6 1 : SEIf ' 6 COICR OR NaCf ~ '-"1 e DATE OF 81RTH 9~Gf Ila ~ft~i ««%fA ~~~u 4~DFR:~ NK r~~PED ~ KE?ERYARRIED~ t I~1Cd Gvl~~~l !lwJ~ !MM Hwr~ V~~ (_nale ~whit,e ,.,;,~.F~ _ a1oacEO Feb. 5 1909 1-0 iip "~Ur1lOCCI1PATqNt4u[i~4deJ~U~G~r,f 10' R~:G~~;,S~MESSORIN0;15TR1f 11 B:RtNPLACE(1tdl~/J07ll~ArOt411>) 12 C:iliiAOFSW1iCG4~+:llt~ ' /rriay ~wwt ef rciR~xo 1~p, rr~q +rtv~3 1 j ~rocer--- retired ~:teta=l Groce Bowlin '~en F'la U S ~ i S- FAIXER 5 NIIYE " 1~ MOTMER S M~IOf11 NAME ~ John L. Studstill An:1a Jane ~orntop ~ IS MAS DECEASfO EVER IM o 5. ARYED fOR~S 16 SOCIAL SECtp~TY NO. 17 INfORYA1fT t f1O~MATYA ~ i l re. r. ~..~lr~w~ ~Ir s.. s•v ~a. ~ iar~..1 r*wor ` iCes i~:~TII C2-~12-9770 A~~«, Stuart Fl?. ,I 1• fAU~[ OF O[ATN (Eaft~ sell ont c~~ut yr? Gat Jer iel. ~~~i. a~e ~cr ) 1?jTFNY4l OfTY?EfN ' ~AqT pE11TM MAS C11U5E0 BY' n~ - /n - ^ • - - _ ~ET Ah0 DfA1M /a ~ ~.i~ ~ ~ IVMED!ATE UUSE (tl i~/ 'v~~yl%"~~ri~ N~iL r-~i'aFfL~ r ~ ~ Coxluto~l. iJ avI- DuE TO (Ol _ - ~e~ic? /ue ru~ r~ 1 + ~ ~Dort catu (af• } . f rtdiwl t~t aalrr- 1 ; ~ ~i~0 ccct: la:. ~ GGf TO ~r/- - - - - ~ O ?ART !1. OtMEA $:4~iF+C.A.YT CM.::IOf~: C~M'iqf~ TO CL4M 6`JT R[U'FD TN TERYRI? DtS[ASE CQ~~i1C~ G~YSr t!~ Pai1T Ifal . MAS AUTOPSY i F CERFORMECI t~..' ~ i rE5 ? MO ~ tPrepaO ) DfSCRIeE NOW uU~NY OCCURRiD (FRfft Ra7Lf[ OJtAjtt~ (A /~6f: ~ N Ppl l/ Of iftq 11.) ACG:GEN7 5(i1G0( NpYiClp( v ? ? ? - - '~l~/Z O[-_ - - - - - - - - - ~ 2O[ TIME Oi ir~. ~t~r~, r,~~. r~o 3 uuuAr a. a~. ~o P-R. - t~ 2Dd ~iIJ~RY Ot~U RRED 20[. ?lACE O~ w.UR11 (r. iw w o^~ort towt, CITY. TOf1tN. pA IACATIOM ODUNTY STATE ~ MrHLLE AT ~ NpT w?.~lE ~°ft. X~rd. e~[tt Dil/.. ett.) ~IORK AT MCRK I Z~ /~treod~d tAs dec~~~sd /?om _ to _ end l~st a~s h~ •Lr~ on De~th «curr~d ~t ' m on tM d~t~ ~f~t~d ~bo~~; ~nd to l8~ beat o/ m~ kno~bde~, frota fh~ quqs st~bd- ~ ?Is fi ( tt M fYk~ ~ ??D AOORE55 22t. WTE SIG ~0 . • Wauchula rla. , ZL BUt?L. CAfw11i1W( 2~ WTE Z3[ M11ME OF CEMET[RY OR CNiMATORr jJA IOCA?~N ICI(/. (plcp. Or ~+p41{(/) (STdl1 [ g'~,~`~;'P""~~ ~t ~ i Bafrling ~reen Ce~:etery Bosalin ~en F3.a j~AAI D~R~ E~C pq S ~TU AppRES'S 2S. pl?TE RECO. ~1f tOCAt REG. 26- RE6KTRA11"S SIWIAT~ ~'f-'i wau~ulz, F`1a. e F~ OR ti,/ . " ~ ~a~x21~ n~~:1"'l~ g„'h' ~ ' ' „ti ~ -fl, ~ _ - ' - _ . a ~ ~ F . ' ` '~S'' -'a ~~~T ~ Y. „ ~ ~+~-z_,,.-x., w ~ ~ ~~`-a~~.. ~