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HomeMy WebLinkAbout0415 I ~ ~ . . ~ / ~ - 25~~ ~ • CERTIFiC:~TE OF DEATH ~ Dirpr~t~ewl ~f ~lealt6 aud 1~cb+b:lilatire Jer.riata - iTATi FiLC NO. ~.~~o,. o~ ~~.?LT~~ F L O R I D A t~IE, Ot IMNT 1N ~ r'~'~~qf°R'~° ~ - REGI6TRAR•8 NO. 34Z ~ j 1tlMAtttNT INK ~~p_N~ ~u~t - ~,~,s~ i SE[ ILL~Ot00f f0~ SE7f owre w o[wn~ ~ ro..«, o.r, uu ~ LEON H. PETERSO Maie ~ Au ust 2 19'7Q RACE rwa, wtaw. ~w~KU~ u~WM. AGE-uat u~.oe~ u.ot~ ~ w~ DwTf Qf WTN ~..o..rw. s~~. C011NiY OF DEATM nc. ~ s~ecm ~ N~nw.~ ~u.~i~ ros. w~i «ows .ua. n.a ~ 6602 . i~Thite 23 I . Mar. 30 194 St. Lucie CIfY, IOWN, OR IOCATION Of OEAM wsoe cM ~r~+s Np5?tTAI Ol OTM£it NSTIiUt10N-NAMf ~r .+o? ~mr~, ome s~r~~ .w ~wt~ ~ snun ~es o~ w n Ft.Pierce Yes Ft. Pierce Memorial Ros ital STAtE OF MRTN ~ r ro~ w ~.s-.., ~.+e G1~ZEw OF WM~T COUNTRY NuRdED. l~vER ~eCfD, SIJlYN1~G S/OUSE ~ r~.re, am r~w[.. w..t ~ cowtni I W~DOvVED. D~VO ~ sritrr ~ ~w~..~...~ New Jerse ~ USA ~iarrie~ Shirle Sa rrta wa.ue uwo. r ee~m SOGAI SEQWTY Mi~NER USU~I OCCU?w~rOrV :c,ve a~.o o~ woe~ oo«e wre.+w nos~ a IUND W WSNESS OR IND1lSilY OCCYl~/0 p rWa..~ ~w. ~vt.. w nn~~o ~ - „262-94-8742 Production riechanic Piper Aircraft .o.r»w... eESioE?+cE-srwr~ couHtr uTr. TOvrN, 02 IOCwT10N waw twr ~wws s1a~T N+o rw.~~ce i'-?" Florida St.Lucie Ft.Pierce ""`Y3o'°'"°' 3404 Abbott St. • IM f4 14. It~. It~ ~ fwinER-rl~E .~a~ rwo~c ~.si ~+~OTnER-w~rDEr~ N/wE .rst rwae usr ~ u „ Leon P. Peterson Helena Newmaster INfOMMNi-NAME ~ 'Mw+tWG wOG4FS5 ~s*nn u~.ri..,o., cm a a~+~, sr.ri, ir~ Shirley Peterson 3404 Abbott St.,Ft.Pierce,Fla. 33450 ~nqauut! ~w t~r.~ ?w~T 1. DEAi11 WI1S GUSfO ~T: - ~EN:fR OrtlY ONf C~USE IfR lM1E FO~ (e1 (61 AND (~l~ ~at~.~er o«al~ •w oe~rr ~ I~. wra.n c.uu / ~ ~e~ G~C-r t 6 r~~ ~7 g,x o r r h a 9~; L~~~.f ~ . xo,,..« ~ ~ cown,r~o..s. ~ p -~Qyl S ~ ? t V QS L~( ~ / S'L"QSC ~ rs O ~«~Cw G~ve us~ to ~ 101 ~...eoun e•us~ a~, si.nwo ~wt V MPI~• 10. q• • ta+uoue..ea w. ~ \~1N0 C~YS! l~~t ~ / ` ~ ` J ( i ` ~ -,i i a ~ i-.s ~ ~AIT Y. OT„ER S1('sNY1CANT COIVWT : ea.~ano~.s taauwn..e ro'oe.n. ~u~ wOr uuno w e^vse oi+er rut ~ a~ ~~~r ~ YES r~~e ~~tin~.+ea eu.- ~~.u a/w~ a.o~no ~w wr .~«~wc u~u Yr s ~'es IM :.'~pn~f~.t wCCwE~/t. Su~QDE Ot Ow E WiURY ~~o..t., w~..~.. ~ MOUB . NOW IWURY OCCU~~FD ~ ~«n~ ~..euu a~wwn ~r~ r~~t ~ o~ r•¦i u, m. ~bM1G0E: OR ll?OETEWI?iED . ' ~ ~ 7N ~ 20~ M N/ , 1?WRY AT WORIC tIACE Of WR1RY •T wo..~. r•a.. s~ue~, ~.n-ir., ~p~wT10N ~ sne[~ a e~.o. .w., un o~ ~o~w. snn i ~ ~ wan ~s o~ .ai w+.u rno., e¢. ~ anc~s ~ i t0. 7M xiS i CERi1f1UT1pH- .wrw O~~ ~fIJ rOti~M D~~ •!Y ~M~ 41* L1M MW/M/~ µ1v~ pM ~ plp/pp ~Qf vllV M DEwTh OCCUtiED Tw~ I~a[f~ ph DK ~ /M1SK/wN: ~7 r TM M~ )~rrl.~ ~OM ~rri~ Dtwn~ ~MUa o.n. u+o. s0 aE ~ESr ~•n[wwo ae A~ • Z ~Q7J 70 -a~~ 2. ~Q JD j~(,( Z Il !l~ ~ 21• M. O rwf uus[ s~:no ~ 3 fl~. otu~~eo nor 11? !T Ili CERiR1Gi1pN-w~EDKI~I f OR COitONER. w• r~i o~ r.~e ,w„e a oe.a~ rwt oaeeot~~ .r.s r~o~o~..cto w.o ~ F_T ta~rw~nOw W Tw! ~00~ ~+O/O~ M~MIS~~p~iU~+. Or~.p-., ..OIr~n~ wt pe~¦ ~q~~Q • OlaN/ OCCW~lO 0+ M W/t uM Wll q iR C?vStia~ 1~~4D. M. i jj? A YL ~ ~ i/~ 3 rn CEtTIf1Et- in?t O~ r~wn ~ SiGIVATURi qc~~t o~ ~ru O~TE i ~t~+~ ~ w ~Ftt H R R 0 J~'~. IPo ss IL~-1? 3~ ~.T ? ; AuIKN~~- ANE~ l P. o¦ ¦.~.p , A,~ r-^~ Gn st.n L/ ~~C, 77r r~ i ~f.~ic S~lo 7F ~ . il:R1At. CREw~AT10N, ifMOVAI 'Cfw~f Flrn CJiEwv?TOR -x.aMf TION a.• w wr.. ar.ti ~ uK~n ~ Burial Ft.Pierce Ce:netery :k. Ft. Pierce Florida • OwtE ~ ro.nw. wr, ew~ WNEIW MOMF-NM~tE AnD .4~DiEiS ~ snur o~ ~.~.o. ..o., em w~ora, si~n, tv ~ N. ug. 4, 1970 B:i_r :~uneral Ho:~e,901 N. 7th St.,Ft.Pierce,F1a.33450 V. S. ~b 12 f at RfGIST~ SiG+v.~iuRF ow~ ~[cccveo ~oW ~[asrue ; Rrv.1970 ~~1~E~~%K ~ t~. iu- AUf:t1St Z~ :~:.q7Q i . • ; j hcr~,by oc*rify thls ro bs a true end aerr~t copy ct ~a•~ lu~l ^'~'s"'-"---~_~ ~ Re~imar's record on file in the St. Luc1o, County Hca'rrh Q;~:,::rl~ , ; '•~.f ~ ~ ment ~t Fort Pierce. FloNda. f• r: ~~~~1 ~s -~,1~ a-'='._ ::i = ~t (Warning: Not vaNd unleu roised soal ot tha St. Luc;s ,~,:,~t r;,s~~~'~~s'•'" Counry Health Department is affixed.) ' y• Z i~=; . 'i~ •~ps; _ ~.~.r~ . . ~:`s . _ 1 •~f'•~ , i yr~.. -l~ ~ N. D. MIUER, M. D. .=~~~r.~.~:~~~~. ~ ti~• ~ ~,ai ' County Heahh Offlur d~ t~ocsl Rc~isrr:r ' ~ ~.~'r"•,~~.~ ~ • - , : ~ . . ~ ~ , `.r~ • . ~`~r~r . , s . • Deputy lroc~l Regirnat • ~ t. . ~ ~,,r `{~,f~~~~`~ :i ' t~, p ~l~~Il~l:~. ~...~•fi~.:.,s ~ f~i~lp E CO~N~ As~~ fC~/ ' ` IIOGEa 40; Qpil~t m a ~ C~EtI vEAiF1E0 r'~~ aeeoao j~ ~13 25225'7 ~l ~2:~e ~~K2~3 ~4 ~ ~5 ___r~,