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HomeMy WebLinkAbout2070 ` . f - ~ , - - - - . - ~1369 _ CERTIFICA; OF DEATH , Qirpul~ewl e~ ~kaltl~ awd RcG.I.:filal:re ~nrN-n STA:E FILE NO. ixv~:x~ in.~rn~ F L O R I D A ira~. ~t rnH~ iN .~...Y...,....,.~..~ ~[:MANENT INK AFGlS:RAR'S KO. ~ . SEF ~t11D1~i[ fW ~~~-NM~f ~ua~ ..wu .•~r SEX ~~wtE Of Dfw1?t ~ ro..~+. o.., ~i.~ i ~rsrtuctw~s AQ~ K. XRP*~R Female 1~3arch 27, 1973 ' RACE w7t, M~4W. 4.IaK~w wOU+~. A('iE-a~t* u~.:,e~ ~ tt~~ :uvt~ ~ D~• DATE Of i1tTN ~.~:~+rw, 0~~. tCOUliTY Of OEA7M tK. ~fNCYr1 ~~adO~~ i~t~~1~ rOf. ' ~ D?f1 wOU~f ~ rn~i ~ \U~ ~ • A . White 80 „ ~ Sept. 15.1892',. St. Iucie ssu2 Crt1f, iO~MN, O~ IOf.AT1pN Of OfAiF1 wa:ai c~n c....n efOSP:TAi OA OSt1Ei ~TSIITUSIOI3-NAMf Iu rOt w ~~Uy~, 4n! Si~(l~ u0 i+.1YU 1 Yt:~~. •(1 Oa nJ Ft. Pi~eroe Yes Ft. Pierce Memrarial F~spital F SiATE Of Wtlff i u aiot w ~.s ~u[ GT12EN Of w'NAT C01M+ieY--riaARA~fG. NE~'fR M~tkitlE-0. ~SUtY1VNG 5?OUSE ~w rw. Gm rwetw w..~ ~ ` cawm, i w G~Y: Cf0 ~ vecr, ~ ~,w...,o..w , Massachusetts , USA '„'~fr,~aw~ I~~ N~ne ~ t rwu wa.seo -r--'-'---- - ~ uns. r ear ~~K ~~iT ?~ll~iER USUwt OCCUt~710s~ .c~vi awo o~ .+on oo~.i cw~..c wsT w (~(Wp Qf WSWESS 02 4NDUSTRY ~wx.rvna+. ae.e occwuo r ~I Q~' ~iV-Z~0 - ~,•w~~CI[l~ D ,~~CP~o ~ +~A QIdYl ~~1~. ~eyat..ce ~eron •o'~'is'~"• tESIGENGE-StwTE COUMY G7Y, TpWN. OR IOCA(ION ~~m ~Wps STREEi wND NWRiEt Florida St.Lucie Ft. Pierce ~„~",~I~s«~" 774 Lindo Iane lh f0 .14 , 1~0. 1~~ fATHER-NAMf ~~qt ,,,pp.t ..s~ ~MOiMFt-~uIDfNN4ME ruu r.oat a.u . u ~y ~~a C:3~1.Ib@ Ci~l.ff].ri - INfORMw?~i-ru~+E . ~~wx;r;G wDC.RESS ~uui: o~ ~..o. ~.o, arr a to..., sr.n. :ai N'tarY CYant ~in 774 Lirido Iane (P~ort St. Iucie) Ft.Pierce,Fla. m ....o.,~.,~ DEAi11 WA5 CwY5E0 (fnTfAOnaY ~ UUSf Iff /wE FOR lo~, wND iUl ~~eT~.~e~ o..set ..a w.n. r.rwn cwu ~ ~ 1 / a Ial " Ce~~~•L^J:: ~ /•'j~i.~H•~% fl.(.~ - - - ~ 6 G.'.q~~`/ ir7'ro, w .s . co..scn.~i~t o.. -7 ! ~ cowomows, u ..n. ~ ~ , ~ ww~Cw G~~~ uf! r0 ~S) IrrlDlsit C4Yf~ 01. ~ ~~f ~ CO+~MJJfKI W ~ t ll~~lw6 if~! YMO[~- ~~.MG C~Y3l ~ t~l ~ ~Alt Y. OT R S1GN1fKAN CONN IOhS: cO.~Wr:o..~ Cowim~n~ro w.r.. s.pi ~c.~c~p ~o uos~ ontw u. ru~ ~ w~ ~AUTO?SY iF YES 'ru[ r~wo~wGi CO~+. . i J f!S W M 1 ~ LDI~lD IM OtiHr~rIMG 4~rS~ ~ u oewrN A J~ _ _~-r ~ v rc t~ ~ i-c ~fc'. s~- ~ f~ N~o ~ ~ p Klyl. ~~iStlF~O OATE aF Wl'J~Y ~..c..~w. w., ~t•~?-M017R ~„OW INIU~Y OCCUlREO ~[r.ri~ ...rvn p~tiwn iw r.ar . p~ r.~t ~ser ~1 i ~o koE ' T0~ ~:k M t$(d 7W{/RY AT WOtK qAC'E Of WJU~Y M+[. St411, 1~00~~, i ILKATION . St~RI O~ ~.~.o. ..o., un o~ +o•~. ~r.n ~ 1?~~Gn ~t1 O~ NO~ QI~1(t MYG.~tK. ISIlCNt! 1 70f. ]7t ~ Z'~4 CEtiYKAT10H- .a.~w o~~ n.a . .o~+~w c.• .~u ~.~+0 4at s.~+ MW/M(~ .i..~ p, ~~o.~ „p~ rur rw OfATN OCCURltO •r n~e ruce, a.:..e -~M~SK~u~: - TO - ..ow~h w. r~.~ ww .~n• ot•Tw. ~.wu., a•re. .wo. ro a~t usr ( ~•nt»oeo twe ~ ~ ~L ~~7[ 1 D3 d 1' L~ nr r~ arqvuwe, u~~ 21~. oete•un ~ea. 6 t~~ o n. ~o iu- • KAM. =o <..,,u.~~ ~T.,Ea. CERTIFtCwT1pN-MEDKM EXAWHER OR CORONER. a. rwe w~f o~ r.n ~q„~ o~ a.,. ~ r•t w:ew~~ .s rw.q~,..uo oi.n " . ea.rr~.r4+ d M qC~ .++D/O~ ~wt r.v~snG.r;p... w.r O?v.id.. i ..0~•rw W~ rt.~ r.o,.~ ( 77~~ OCCVtlEO W 1~! WM ~NO OY! q M 4YSt.a~ St~iFP. ~ ' - ~ AR. ~ i1? ~ • M. i CEtT~f~ER-wM~tE ~me o~ rw.n ! S~GNATURE ' - ; olaut O~~ . DwTE 51GnED~ n., a.~,.u~~ ' :H ard D. Ros~ M.~. ~ %=:.:..u~.,t i ?~jt.~ ~ . ~ ~ Po.~ust•n?~~u i Sho i nrs~ Cenfie..o a a,... . u:n ~~9~ . t ~WU1l. CREMATIOrI. REMpVAt GFMEIER1f OR UtEMI17CRY--H/w.£ iIOCATION pr~ w pv+w siwre ; ~ sretvr. B~aal Hi.l.laest M~t. Gc3r~s. i~.. ~`t. pi,~rCe Florula ; Oyi~~ ~~Q.rw, iYK[RA[ MO~tF-Ntvr AH~ ,~;~ijLFS itr o.. t~ o~ t sr .ti. ~ ~ FUI~,R~'~L Ii~i~; 9d~ 1~. `/t1i S`~. ,~C. '~a,erce, Fla.. 33450 v. S. ~612 F ~ -S+Gr+wtu aEGist -SrGv.ctu~F , owa ae}~1fD IOC~~ tEGISTtwt ~ e. y.19 t o :s. ~i~`.- c' ~L H. ./f u•,•- t: ~ c-+r-.,. n-.s a.-, .:w ,~z~ch 30 , 197 3 i ~UCIE COUNTY f~A. ~ t M~ebY ~°rtifY tfiia to be a hw and cort+a.Y copy cf ftw tccai ROCER POITRAS ~•t~n . meni st Fat Pi~. Fioride.~ K~~ ' pE ORO YERRFtEO COU_,,..~_ V~7 (VYuning: Not v~~nlsss nised seal di tha St. 4ac~i ~ 40 P~T~ . CountY ~owArner~t !s aH~xada ~ , ` t . ' _ ~ f . N. O. MILLBt, All D. ~ ~ ' ~ , R 'J' , . ~ He~Itfi ~ . - ~ • . Off~q' L~ C:~'~St1'sr . _ , 3_ 3d 3 - - . , - _ , tk~pu~r t,ocal ti~gE~, ~ " . • ; . , . ' j ~ : : ~ ~ . ~ 3 . 1 • ' • ~ ' - 1' ~ booK ~12 ~ ~U'~0 ~ N- ` , :_y _ .