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HomeMy WebLinkAbout1995 ~ 251328 ~ ~ ' - _ ; CERTlFlCATE OF DEATH j ~~e{~~1~e~t ol I ~ealtb ud Re~a~.ililtltrc ~kea ' STATE FILC NO. on~e~uv or- inai.ni F 1. O R I D A iY?E. Ot ?dM IH ~'~~~°~•1O'° REGI6TRAR'S NO. ?[ZMAlIEM INK ~~p_Nµ~ ~a~~ .,oou ~•s~ SEX DATE OF OEAM ~•ow~w, o•~, w~ ~ SE[ M~lIYi001 FOt ~T~~ ItATl~l2lf?E JACOBINA HILL t. Femal~~ btarch 7 1973 tACE r~un. .lGq. uuucu~ r+ouM. AGF-usr w+aa ~~e~¦ ~u.wu ~ o~~ OATE Of 4tTH ~ro..i+. w~. ~COiNiTY Of DEw1N nc. ~tntw.~ wame~.~~uaa~ ros. wn wows ~w~ ~ ~f . White 71 ~ ~ k ~ ~eb.l8 1902i,. Saint L,ucie ' 66~G , TOMM.OR IOCATipN Of OEwiM v~s~a tm awn MpSMTAI Ot OTME! NiSTitUT10N-NAME ~y w~ u+l~+w~~. Nve a~~tn uo Mwu~ ~ s.a:., •is oa .w • n Rort Pierce Yes 1,, Fort Pierce M~morial Hospital SiATE Oi il[IM i r~or r. h~.i CI712EN OF W1+AT COUh'71Y MAtt1EO. NfVER MAlflED. SURVNNG SIOUSE ~M rue. oM .u~oer ~~ra ~ caw.xr ~ W~DOV+EO. OtYOKEO ~ wcrn ~ ~.w~.~~..~. Illinois USA Married Dean _Ja}~_I-lill ~~eu oece•sso SOC1µ SfNtlTf MlwER USI.AI OCCti?AT~Oti ~wve a..o or .+ou oe.~i ow~+e ..ou w Kw0 Of WSO+FSS O~ ~NDUSTR~ i~vea. r a.a OCCWltO M rW[4+0 UII. \Yl~+ tl'~~tO 1 ,~s^w~~.,~M „ 338-22-8046 Housewife „ ~ .~.~..~...a. •~a~. eESWE?KE-S1~tE COYt~T~f dTV, TOwn. OQ lOUilOtt u~swe an ~rm SilEEi u+0 t+U~t~E! i - ~ . IY~CJt tlf O~ M01 ~ ,w Florida ,w St. Lucie Fort Pierce Ao ,.~10 N.E. Jardain Road fAMEi-?tM~f r~n~ r~oo.t us~ uO1ME!-~u~DFN NM~f ~•~s~ .•ew~ usr Charlie Gunthner Kathera.ne Fezer ; ~WWG~u~+t-~+nME NuGn+G ~D~'..tESS ~smi~ w~.~.o. .a., cn. w w..., sr.n. :r: n. Dean Ja Hill i~~ 210 N E a i~~d O ...ou...n ..a..... I~! pEATM WwS CwUSED ~Y~ ~FMfR Or+:Y Or~E UUSE lEt tNf fOf (o~ (b~ AN6 (c/: ~~r.~~~w orset .w w.r,. WOUR 4.ViI Iel ~rl Fi u ~ / ~C- ~C/ ~ ~ . w? c w3[OV! t Vr. ~ COwOrt.Owf. U ~w~. ~ r+~te e.v~ .~u ro ~ Ipi _ ~+..u~ue e.use ~a. ~~o. w.s . eo..uou~~.ee w ~ srw~~~o ~ne u..oe~- ~t~w0 C~Y3( ~~1f - ~ . ~AtT p. O1MEi SlG?iIiKANi C 1«'~S: CWdTpM] C4`G[NYi~~ Tp OF~M ~u~ NO~ ~~~~:ID TO UYlf o.rew w r.n ~~m wUTCKY If YES «t~~ r~wo~Nas ea+- ~.ns w~ Yw~to u. o[~te.~...na e•use ~ / ~ q ot.rM ; _~frTt Yt O.SY' P~o7~ c~c:.t'T S PQSe l~+. /V~~ ~ ix ~ O,opol,I~f K.C.Oi~+i Su:C~[~ 6l D~TE~i W/IJRY . ad+:~. w.r, re.ii MOUR HOW IN1U4Y OCCURYEO 1lMf~ rutW~ 4~ ~MN~1 IN I~~i 1 q~~~1 :Kr ~ E lUMK.tDE: Ot YnDEftYYlwiD ~ ' . ~ ~fi ~ ]w .14~ M. ~ 20! IN1V~1I AT WOQK hACE OF Whl~r Ha.e. s~ris, r.e~ar. i tOCATIO:r ~ u¦tn o~ ~_r.~. ..o.. e~n o~ ~o.... ai•n ~ ~sreun .ei w »o~ p/.U ~iOG.,fK ~srieur~ ~ 79. i A1 ~4 . ~ ~EiTIFKATIOP~- ~O~~w w~ ~V~ ~ ~~M D~~ r/u uA uf~ s~rbw/M~ uM O~+ MO/Ow wD~+eEr u~t Of~iN OCCU[~EO ~t Ma ~uK.t. G~ ~.e ~ IMrSIC1~N: TO 1 ~~M Mi ~(~1 LJO~ ~~A~ OI~TM. IwOY~1 O~1l. ~~+0, i0 1~! Yii ~ •rti»oae r~e } d /~f l1LAV~~CGl, OH! tla O[c[•uo •.o+ ~O ~7i? 3 7 73 iti~. tl/ n0 y 71~ 6~ 00~ o nN u~st~s~ s~.nc. f CfZTtFKAT~Oti-MED~CAI E7[w~vwfR Gt CORQ~+ER: .r+ rw s.s•s o~ t•e wo.n d a.n. oeceoe.+r wu r.o.wu~.ceo w.o e~u.r..~r. or na Wo~ ~w/o~ n~e rnnt~wr~o~+. r• W.:.y+. t ra+tw a~~ •e.~ wLu~ ~m OCC~.-~nu O~ ~t OaR uM OM W~l 4VSt~1~ Srwrto. 6 i oOg MliT2~ v aJJ r M. CEtTif~ER-NM'f mn o~ ~uwn ~ S~GI:wT1;k~ ~ne • DATE S~GNEO .+o~u~, a•. ~H Bernard D. Ross J.]:_~..~:.~ ~1-~ i~. /l.ti<<~ d/f~~ ----,nE~~ e. o. .b. uri a ro.~. . ~~`P'~`or~~t ~T~'~ucie Sho ir. Centar - Fort Pierce Flor~.c~a 0 - w~uwi. ucwuno?+. e~ovw~ fINETEtIf OQ CREMATOiY-Nnw~f .ounoN u~. o. ~o.... s,.,~ ~ aracrr, Removal-Burial ,.~Fairmount Cemetery Willow S~rinas, I11_y_ O~iE ~no~+~~. o.~, ~e.~~ NNfRAI HWrE-~v~E AND AOGtf51 : su[u w~.r o. wo., enT w torw, s~•n. i~r~ ~ ,w :~arch 8 1973 ,S. ~ates ~ uneral f?ome Por .777 Ft. Pierce Fl 33450 Y. $.lblj fWE l ' iURE REG15~-SiGNAliltE owrc ncEr+[o n t04~ fFGI i a. w 19 70 - r,. ~ caa . ~ ~~w Ma~rch 9, ~~13 I ~ f~E 0 ~MD RECOR~~ ! ~ 1 hecaby asr~ify this to b~ a tru~ and oorroct aopy of fhe Loal=t.~f COUNiY ~ 251328 ° Reg'ssirers ~eoord on file tn th~ St. (~uds Counly i~eahfi Q~sar} ROCER POltRAs ~ ; ~ ~ ~ p~~ ~ CL£RK CtRCU1T COURt . , . ~ RECORD i?ERtFlf9 , ~ cw°'"'c ~ ~a. ~ ~p e~ ~M'73 , _ ~;~,~•-_~i . ~nt S s~<~ , f` a; • .ti~; ~ -:~_~f ~C~ ~ y . i'. f. N. D. M~LL6t, All D~. - ~`'3: ` , ; . • .~y _ T HMlflt Offio~s ~ rar ~ ``4 ? ~ :r .cT. i~, ~ ~ ~ 'R 3 ~ ~ ~ - l ~ ~ . • ~ a ~ ~ .f .4~ y~S ~ = ~ s'A~ 4t _ t /t ? {ir r. • ~ ~ ~1? t~i i~0istrar ~ : a ` 7,~~' ~a. ! ~ . ~,.~y~~~'' . . i• ..~j i;: : . . , ~ ~ ~•-s~ ~~f~,~~SY ~~r ~ • ' `"~ii. ~ ~ ~-e~i` T~_ ~ ' .j eooK212 ~c~~~J