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HomeMy WebLinkAbout0738 , - . . . ~ • l~ ~ . . - ~DADE COUNTY ~ ~ ~ . 2489 DEPARTMENT OF PUBLIC HEALTB ~ MILTqN S. SAS~.AW, MO, M/~M. t9s0 N. W. IrOURTtENTN STREIiT DIRECTOR _ . • . . MIAMI~ FLORIDA 33125 . - - - - - - ~ . ~ _ . ~ . •,.'i~ - • + I HSR~`BY'EEt~IFY 14iIS TO BE A TRiJE COP'Y OF 74IE LOCAL I2~GISTRAR' S RECORD OF DEATH. ~ Pr,dn~ ~~•z - ~0 , . ' ~r ^ .W11~lI~~,i' L~~% . ~ • ` E . c? ~ ~ • ~,(~a~id . un2ese the raised seal DEPUTY RBGISTRA : ~ : ~ ~i~ ;of ~he =pureau of Dital Statistics VITAL RSCORD6 UNIT : ; is 8f~i7ced. ) OADE COUNTY HEALT'H DBPARTI~NT ~ . i. ti ~ C _ ~ • ~ . , : , ~ . • NIAMI, FIARIDA , ~ ft r ~ti . . ~ . CERTfF1~ATE OF D~A'£W - ' ~ ~ ' 4~~ - ~x~• oF Htw4tH - ~ ~~~~*~m~~~~ .,~,~,n„~,~ F L O A I D A r*wts FiLt NO. ~ REGISTRAR•S NO. I~f~J~,~ ~j~ -`.CE~SEO-NMAf ~ r~esr rwwe ~~si ~X OA~E Of OEAM ~ ~oMrw, o•~, +eur V~Q SAMIIEL BISCOE , MAL~ , FEBRUl~RY 22-1973 v w~irF, wtGW. ~nt~.C~~a ~woun. AGE-usi u.~o[~ ~*[u w+ot~ ~ n~• ~,OF ~IQR1 ~ro..n., o~~. COVNTYOF DfATM ~ ~A M~ , _ i~WHITE on~c.~ ~rE~~s~ .ai w~s ~ows rr. ~r s. 72 „ k. . AUG . 25, 1900 DADE j- r, ~:~.T r TOwN, O! IOCATION OF pEAM ws~oe tm u.un MpSPIfAI OR QTHER NSTRUiION-N.~ME ~l{ !bi IN lITY.l~, GM Sf~(fT /~14 NW1{E~ 1 !'C ~~~~b S~EC~~T ~ES O~ MO hn r- r+~!? . MIAMI YF5 VETEEtANS ADMINISTRATION HOSPITAI. _ ~ :iE OF siRM ~ n Moi ~M u.s.~., nwre U11ZEN OF WMAT COUNiR~ MARRIED, NEVER MI?lR1ED, SURVNNG SPOUSE IIf W~~(~ (~m Wlp(N IfM~F ~ ! ''O` cowm ~ w~0 W O O~ sncrr ~ ~ c c•, ~~A-s ~ PENNSYLVANIA ~ U.S.A. ~M~I~ CATHERINE COMCO`~,iICH -L---- " ° . i ~.l SECUihiY M1Mlf! USUAL OCCWAiIOM ~cnt iwo or +~o~~ oor.f cun+a~ .wsr Oi KWD OF WSM~SS OR INDUSTRY ~ t~A ~ = 0!~lt~-0 02 ~~MEAT IPJSP ~ECTCR ~ c~b u, CNIL SERVICE, AGRI. DEPT. ~ ~ t i~~,~ENCE-SfA/E COUHTIf pir, 10WN, OR IOCATION ~sw~ cm iw~n SiREEi AND NUM6ER ~ 1 SIEU~~ r[S Ot MO l I:ORIDA 3T. LDCIE FORT PIIItCE 301 BROQKLINE A~FEt;UE ' R- NA1ME ~~n~ rwa[ usr MOTHER-~urDfN t~~ME rrs~ r,cat us. ~ ~ ~ i: ANI7RE.~1 BISCO~ HEI,EN SWETZ '•wJRMANT-NAMF taken fro ~~ESS ~1f~lEi M!.i D. ND, C~TI Ot ~Ow.., S'~rF, tpl IAfO • : ED;Ji~ WILLIAMS VA Records ~n Vl~i 1201 N.W. 16~h ST. , MIAMI, FLA. ~ ~ DEATN WAS UUSED tl/: (ENifR ONlY ONE GUSE IEIt tMVE FOR (oJ, fb). ~rr0 ~cl wrr~ou..~n ~N [ - I ~cn.ec~ o~srr •.ro ot•n~ ~ o..~oun uuu f l ~,>~t~L 1~l2 Y1~~f/l~ i , wi ~ C NSlOY[rKE 0~- »o~~,o..s.,~.~.. i ~~GILGE_`~T/~G `I~Ki 'rl~~t~C , ~~c~ c.re uft ro (b) +fo~•T! C~Vlt 10~. pyf t0, q~S ~ CtM~S~OUtNLE Or: G IM! VMD~~- ~ . ~ G C~~~S! l~S. ~ . _ <<? c ~~c~:~fz`i~_~~cscCc~r -Y . On~ER ~~C~uiT C0IVDITIpNS• a.ano.~s cow~wunwc ro ot~a wt »or ~EUtto ro uuse ~~vE.. v. ru~ ~~a~ ~~Y_ IF YES wE~E 11r~D1MG3 COM- ' 1 ~iES d MO~ f~Yt~tD Ir~ Dl/t~r~w~wG C~Y~[ ' ~ F~ <<s f ~~c ~f c 1+. Y~'s ,h oe~r~ . . ~:4 C~~DE. Ot UNDEif~IM~ p~ AT M~~ 1 rOMTN, yt~ ~t~n MOUR HpW INJURY OCCURREO ~ w~F~ .urvn or iwiun v. retr ~ m r~~r u, ncr ~ `~l - ~ lh- M 10f ;_;R WpRI( ~IACE OF WAJRY ~r wO.Y. r~~r, SnER, e~ppn, IOCATON ~ sr~~n w~ r.o r.o , oT. oe towr., sr~re i ;rt;'..r. ttS G~ MOI OftICE NDG..tK. ISIlCI/71 ~ T: ~ ?M H! ~EP?IfIUTf~N- rpr~iM O~~ ~tY rOpM O~~ •E~~ MSf ~M MW/tl~~ Al11IE ON ~ pp/o~D HOl v~l~v n~t OfATN OCCUt~ED ~i ~w~ ?uKl, p+ 7Mt ~ F~.s c:.N: T~ no..n~ o.• ?w ~oo. rn~u~m. ~wu~~ o•~c. ua, ro m[ ~esr ~ ~y .,E..o~o T pry Feb 22 1~r/ Feb 22 1973 2:OSs ...~..u~. ~ y~Dtce.sen rror Y~ 22~ 17I~ ~ 7~ 3 tlc. f ~1~. f tle M ro rw[ e•uucs~ 9~rto. ``~fi~~UT~ON-MED1Ul EXAMWER OR CORONER: oe~ ~Me ~•s~s w n~ Mpyf 01 p(~M fM! DKED[ai w~S ?~On01KKF0 Dl~D ~ ...o« w me wo....oiw rw e.vESnwra.+. w,n o~.oa+. .o« ~ o.~/~ .E.¦ wu. , ~occ~~~[o w w o.*e u~o out w mc uuse~s~ sr•rto M]ri JQ ~ nt,( I~~~ . - a M. %?,ciER-rvM~f ;nn o~ ?n..n SK",NwTiJRf ~ cnr a.m[ DwTE SIGNED iwa+++., w~. ~wi ~~NARD EISER M.D. n. E-U~Ccc-t' ~--f~t/ /~(h In, 2-22-73 M~ .:^+G ~DORESS-CER?~FIE~ . YAH 1201 N.W:'~~~t~h~S'~RE FLORf~A 331~5 ~ EMAtqN. RE AL EMEtERY OR CRfMATORY-N~Mf lOCwiION an o~ ~pw.. s~.rE ,w Hillcrest Ceinetery Ft Pie~rce, Florida ~..o.~n., w?, rw ~ iUNElAI MOME-N~r AODBESS ~ sne[r o~ ~.r.o. wo., em o~ vrw, sr~rE, j~r ~ ' :u 2 z 73 n.. AIRD F.H. 901 N. 7th St. F' Pierce Florida , 4+-a~s cwrE mo n ~ow ~eaisruu t~ ~ ~M. ~ 21973 ~ - - - ~ eooK ~~e~ ~cE ~ 73'r - - - . . ~ ~ _ ~ M ~~_M,, _