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HomeMy WebLinkAbout2052 - _ ~ ~ • ~ _ "1~....'-~ CERTIF'ICATE OF DEATH. ~ 25136~ Depadrewt ol lle~1~6 ~nd Relwl~I~~atlre Cr..~. srwTC F~~c Ko. un~c.x~.~ c~ ia-un~ F L O A I D A i'PE. OR ~RINT tN ~~~`rt~°~'""' REGI6TRAR•~3 NO. ?[RMANtNT INK OECtASEO-NAME ~uft ' u~~ SE1t OA~E OF DEAM ~ rOMtw, s~~, +e.~ ~ I SEE Y.11~D100t t01 ~ .~s«~c,a.s o^,~~ p , fa•`v~ ~ Februar 16 19?3 ¦I?CE .,.n. M~ ...~4c.,. wc~..., wGE-w~ w.oe~ ~ nu u.+oe~ ~ w• OATE W NRiM w.. COUNi1? OF OE/?1H r - , ~ . ~ 90~' Broward ` CRY. iOwN. O! lOG?iWN Oi OEAM fMrtc~i+r s« MOSM/Al OR OTME~ NSi~TUt - ir ua.u~ u~~, ww suui u+e ~wra ~ ; Sunrise . Yes 6710 N. W. 26th Street SUTE Of YliN i r No~ ~.s-•., w~r~ GT12EN OE MRUT COUNtR1t ~uRR1ED. NEwE! MAnIbE0. SURVNING StOUSE ~r .nn. owe r.rcN ~ ~ oww+~ /f M?D .WV~ORGEO~sacn~ us~.i ~~sw..ct ~ f. /~7~ N ~ il. 1 . ~ rheei oece.sis ~ul SECUtITt R USW1l OCCUTATION ~one [w o~ ~wa oo~+~ eu~w6 wst o~ KND OF'MK OR MbllST[r - livlD. U Ol~1M ~ c _u~no ra IG'' _ . ~a ~w. eqw r ~lw~e~ ~ - ~ . ~..~!~...pb.. GM Yy , ~,~c , ~ `r ~ei~o~»ct Krwe .o..~ssqw. fESWE E-SfAiE COUNTY Ulr. T OR IOCAf10N r~s~M n awof SiREE~ IWG NUM{Ft ~ U ~~e ~n i w w. J~ G~~i ~M~o ~e~1~A ~p. ~ Du~A ~ ~N tSt-' Ps fA1ME~-NAME pi ri001! Wl MOTMER-MAbfN NAME /~+as~ Woo~! u~S~ IS. ~ I~. o\liL~i~ ~ ~ .L 1 wuwE MAR AOGfFSS luna w u.e_ No., an o~ a.N . zr~ ~i,~v,~s ~n D liiv/Pis ~ : ~9: . .~~t...~ twRi 1. OfwM WwS CwUSE~ ~Y: (fNTfR OtrlY ONE GtUSE ?ft I/~ /Ot (el. (bR ~+~D !cA /~T/!tN OMSl1 ~MO OI~M ~ ~ ru.ew~A uuru _ ~ ~ N, Myocardial Failure M • x ~ " - (OMMIONf.,..~., Acute Coronar Insufficienc ~ - ! wr~c¦ a.n use w (bl y y i ~ ~r.~a~u c~use ~a. we w, w as w to.+~o~e.~ct a: p ii•u~a ut ~woea- , . ~ ~nKa c.~u w~ - , a Coronary Artery Atherosclerosis ~ARi OTFiER SICNIFIGWT COl~Wf10NS: co~o~no~ toru~u~ww q ww sw Not ~tu.rN ~o twse wveH r~ rut ~~a AUiO?51f IF YES rtn ~~No~«os co..- ~ns o~ ao~ sioe~eo wn~u..wc uvsE ~ . • _ , *T a o~~tM ~ t~- 1~~ ID ~ p..leW„~ wLCWE?rt. SutG OR A t.o.n~..Mr, teu~ H011R NOW ItWRr OCCURRED ~ ~we~ .unst w uwn w rw~r ~ oa rur w. aer ~ ~ qpµ1CWE; OR {?AEIERM~NED - f ~ ,o. ' ~ ~ s~. M. »t - ' , 1lWtll wt wOlt~c MwCE Of llluRr.. wre. ..e., snen. '~cw~?, tOUT10H ~ smo a ~r.~. wo_fcrn w w.m. sr~a ~ R ~ snn~ n s o~ wo ~ oww roa., at_ ~ s~ecrt ~ CF:i~'w:.:::.::- u: ~w ra+u ~,ua .?e vsr .-r:.•r.u aurc a: ~ ea/ob t~-.xx aurn ctr•~: n.: r::. :.s ~ ~ ~NTfKWI: 'O rOMM M~ 1fAt WO~ ~fl[! ~[~Al IMOV~1~ OAR. ~MO, i0 TMf ~tt~ ~ ~ ~ ' ~ e ~ ~~1[MDEO 1W M ~tT [MOrt[OGt. OtY tla acuuo rror 71~ !Ic tl~. ~N. 1~ ~o e~e c.ust~s~ s*••eo_ t i CERTIfIUT10l1-MEDIU1l El[AMWER OR COtONER: O.. twt utn Or n!- wpw p ot.M . oKtoaat ry ?pnpyrac[O 040 ~ lLrM~t~Or~ p M WO~ ~MOIq 1M! N1rlS1~WfiON. M r7 GMION, iOMIM YA~ ~[al wOY~ w~°~~ p°~ s*•°°. 2:00 Feb. 1 1973 5: 0? aM. CERTIf~E2-rlMtf ~rne a nwn SK,NA DATE SIGNED ~.w..*n, o•~..e.u ».Walter D. Gable, M. D.Examiner~ ~ Feb 16 1973 MAIIING AODRESS-fERiY1ER sTUC~ oe ~.r.e. .a. s~f*e ~ ~ 46 S. W. lst Avenue ani 4 tuRUU. c i~a+. e~ovwt rE~er oa c~uiaer-~ ~otwnon un w~o~..~ ~~//YT it ' ~/U ;:N~' v C~_~ CA Y - OATE ~nourw e.+, ~UNERwI MOwtFf7NAME M/0 ~ sr~eu cm o~ qvr.., s+•n, tv ~ , /,~'it/'7~- r i,/ . H. ~~.C,-~ / ~~3 ~r.t.~. /f ~~~-n-~~~ .c ~ ~,l ~ v. s. *612 ? ~~10[- r RF -S?Gw~t ow~t:s~ct~vc~ a ~«wi ecc~sn~u - ~ ~ev.147o TS? j• • ~ ~ ri..- .11 ~ 7 ~ 7 ~ • ~ . ~ , . . _ . . ' . . i: . - - . . . .>-7~ . . ~ _ •r•-- , . :~r • - . CERTIFIED COPY - ~ ° a,-~. ~ I hereby certify the above to be a true and correct copy of the Local v„ ~ oo~~ ~ Regietrar's record oa file in the Brnward Couaty Health Department at N y~~~= For~,Lauc~~rdale, Florida. , - ~~;~p~ - - ' • ~~M~t 1' f,,~, ~ ~ j ~ ~ ~.~,i v»? ° ~ ~~o ,~~,~~aiag., ~j~~:,valid unless raiaed seal of the Brd'ward County ~iealth W.~ o>.~,. ~ r ~ 0 T Y ~aicta~ent is af fixed. ) Qj = ~~~o ~ _ : . ~ • ~ ..a . + i 'o ~ ~+I? A w ~ . . - . - ~o~ - a ; ,~a. i• f• ~ fl~ r r%=`-: County Health Offic and Local Registrar , Fl:i~.: li~e~.' - . ~ - . : . _ ~ . . . ~ /8 ~'~~r ' ~ ~ ~ 0 R 17 ('~~r" ~ ~10.. ~LJ~r.. ' Deputy Local Kegictrar ~ - _