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Home My WebLink About0726 ti~~~3 7~ w F~lEO ANp RECORpEO V ST. WCIE GOUNtY FLA. ROCE~: ~~~TRA~ x~p ~ CIERK C~QCUIi COURt PECORG VEF.iiEp pAUL GLASEL~~1. A. ~ ,?,tD~,Y n~ ~Q., A~~ J9 ~,~~D so~?~~~ 12 ~Z PN '13 ~ ~ . , F.A:~n~ a~r.., I,~ 7 3"' 7 6 6 6 O CERTIFICATE OF DEATH IkP..~~~~i o{ Ileallb apd Re6ab~lc~.~~.e ~..+~e. STATE Fi~e Ho. • IM~'ISNxV <1F IIFAI.TFI F L O R I D A rrPE, OR •RINT IN w"'Y°`R"~R"fOfC REGI6TRAR~3 NO. ?ERMANIHI IHK OECfASEO-?+~ME n~st rwwe ~•s~ SE% DATEOFDEwM ~+o~rw,o.r,•t•~~ / SEE NAMD100[ f01 - irsnucra~s , R1~hTDOLPH E. SISK , Male , tlarch 20 1973 RACE r~utl. MlGq. u.l~K~N wou~, AGE-i~s~ u.w[e ~ n•~ u..ot~ ~ wr DATE OF ~IiM ~.a+rr, o~+, COUN11/ Oi OfAi11 ~tt. / S~lC~ 1 ~~~Irp~~ /1l~~11 rpl. Wti MOY\S rM. nV 1 ~~Jhite 63 riay 23 1909 „ Broward 1 CITY, TOWN, OR IOCATION Of DEATM u~sae cm u.ns NpSMTAt OR OTMER NSTITU110N-NUwE ~u wr w ~~rwt~, c~ve sran ..+o ..w.u~ ~ ~ ` , . S~tc~rr r!S O~ .W ~ Hollywood Yes Memorial Hospital i STATE Oi {IRiN ~ u Not n+ u.s w~r! G11ZEN Of VIlMAT COtJNTRY MARRIED, NEVER MARRIED, SURViVlKs S~OUSE r~te, pnt ~uiotM ~ 4~ ~ tow+m i WED. O ~ sretu~ ~ !7 ~Georgia , U.S.A. „~°arri°e~` „_Gertrude P:cDani °K~~uO SOCIAI SEGUtliY WM~ER USUwt OCNtwT1pN ~ ci~re cwo or vro~a ea.~ ow~.~c rosi o• u.to. r a~m ~ KWD Oi WSM~IESS d INOUST~Y occvate r~ rwawc un, eveN u~en~eo ~ _ ~ ~y ~ „578-09-2245 Policeman I~:etropolitan ~ .o"'ss'o". RESIDENCE-STAIE COUN~II pill, TOvVN. OR IOCAiION ~s~ ~m' ?r.rs SitEfT AND NWabER ~ fV L~~~ ~ vecu. .a w w ~ ,,.Florida ,wBroward Hollywood Yes ,~5321 Polk 6treet ~ fwTMER-N~wE ~usi rww~ ust ++OTMtR-IN~lDfN N~ME neu r~oae C • Z John C. Sisk A~.ice Fl'~iar 1?MORMNWT-NAME ~u?lwG wDGRESS ~stra or ~.r.o..w., cm w m~.., v.ee, ir~ ~ Mrs. Gertrude Sisk „~5321 Polk Street Holly~aood F~ori ~ ~~ui 1. OEwiH wwS GuSED ~r: ~Er+iER Ontr ONE UuSE ~E~ twE so~ fe~ fb). ~MO eerj~ u. a. 1~. w..touie twse l.~~re a ~k e ~H SS/d - - - tL,P~~S'. . coManoNa, n ~..n, ~ ` S'~ ` A/ n^'~ ~ .w~cM o•v~ ost w (b) ~e~ K/yLL(,p !ly I7 i 7Lt~ u.wou~e e..use a~, we w, o~ •a ~ co..seoue..ce w: st~nMO twe uwe[~- w~wo t~use usr kl . ~ - . //1ti M. OT11ER SIGNIf1UWT COND1i10NS: cOranp.~s edaa~unae q puir ~yr .qr Kuteo to u~sf GMn w~Kr ~ w~ wUtqSr If 1/ES ~e~~ nMwwas e - ~+es a ..o~ s~eeno ~w an~»r~a w/ - • 1~~ W Ol~tM pw~a!~~~ ' IU ly0 N~ IqMK10E; O~! I~iNDEtEIW~i+ED« ~ rw~tw, o•., ~e.~ ~ F10UR XOW INIURV OCNRRED ~ t.m~ wru~e w~M,un u. r.~r ~ w~.er rtfr ~ ~M !w 1R. M !Y iNJUR1f AT wORK RACE Of WJURY ~i MOrt. u~r, SiNO, IK70~~, IOCATION ~ snen w~.r.o. ..o., an o~ rorrw, u•n ~ ~ srean res o~ .a ~ orrKt une., ex ~ u[cvr ~ i 7A. iM ' ~HT/ICATIOP!- rONtM G~ ~uu rO~~ne O~~ tW wwD uSr Lr wwi ~M OM ~ M~MD wOt v~t~+ 1M OEAiM OCCUNED ~1 D~! ~tKl. W M! { ~M~SKIU~: T~ ro.~n~ w~ nu soos ~rrt~ o[~m. ~wo~~~ ~ ` ~t ~.rre.,oto rNr / i~ } 3 Z ~ 71~~Q M- ro ewseis~ sun ~ tla oeeewsto rqr ~ ~7 tl~ J ~ !li ~ l1~~~~?D T { CER'fIFKATION-MEDICAI E7IAWNER OR CORONEl: a+ me us~s d rwe ~ou~ w oe.n. *w~ o~ceoe~r r.s ~~a.au.ceo ouo F ea.r~•~wr. w n~e woi •w/o~ n~e w.esne.non. w~+~o». •.o..n~ ow? .EU wo~~ ~ eua~ oetwan .y+ w wa ..a oue ro n.e c.use~s~ v.reo. Mm CERTIHER-NAME ~m[ o~ rw.n 51GN oeene p nn~ DwiE S~Gr1E0 ~.~o.m~, wr_ etu~ n.. David J Lehman ~1 D n? - ,3-zo- 3- . ~ 27~~~_~~~~R s'~"°"' ` Holl~~ ood Flor~da 33~20 wm~u, CrtE~nor+, ~Movw~ EINETERT OR CREMAiORI/-HwMf ~oc.no?+ un w ro,.~ zr.n ~ xare ~ Removal H,Fort Nill Cemete L chbur Vir inia ~ DAIE ~ , o.~, m.a~ f(JNERAI HOME-fJAME ANO ADDRESS Si~lE~ O~ ~ r o. ~o., arr o~ iov..., sr.re, tir ~ „ ,yMarch ~1~ 1973 ,,.!~ladlin ton Holl a~ood Hi~ls Holl ood Florida ib l'1 ~1Rd OR- iURf RECiI$TRAR-$IGN4iURE c O.~iF lECE~vEO IOC~I lEG1SIt~! R e v. 79?0 7s~ 1~ 7M 0. c~~ ~ tw~ r` ~ ~ ~ 7 CERTIFIED COPY ' - " I hereby certify the above to be a true and correct copy of the Local ~'s' Registrar's record on fi2e in the Broward County Health Department at ~ Fort Laude e, Florida. , ?i~• ~ O - - . . y., . ~ (Yar~~?~Y~.~p~ ralid unless raiaed seal oi the Broward County Health ¢ ' : ~ • ~~rtment is affixed. _ ~ :X~ - _ ~ ' z tcPU'; 7; ' - r _ v I- ' ~ ~~'ToR :y` • . ~ ~ 1 ~ County Health Offic and Local Registrar ~ ,~a , ~ t ; ~ ,~Y. "1„ 3. . i i . ..c:; ' ~ ~ ' 1 t , • . ~,~LcL~+~ ~ , • ' ~ . f .Q . . ;.:=t. . . 3-22-73 ' Deput) Local Re~istrar , _ . . . _ ~ 213 Y~~~ 7?.5 _ , _ "r~' , . . . '~',y- - - ss~,i" r`^ : 3 ~ .