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HomeMy WebLinkAbout1518 253U~9 ' .-_t - ~ . ~....~.~,..-y,,.,~~_ - - ~ - - - CERTIFICATE OF L~EATH , Ikpar~wkul ol (lrrl~b ~od l2clwl.iiil~lirr ~r~vicca sYATE i1lC h0. ~ ~~~~iwx~ ~x ik..~.,~~ F~. O R I D A 110 ~ 1rrE, Ot ?R1NT IN ~'~~~'~s°~ REGISTRwR•S NO. ?[tMAHtNT INK ~fASEO-NM~E n~a~ +~oo~~ ~•s~ ~X ~OwTE W DEwTe+ ~ +o.~.. o... .e.~ ~ SEE M~IIDI00[ fOt ` , "'st'~c"°'~ ~ RICt1ARD JOSEPH ELLI02T Male 1, February 23 19?3 RACE ~+wte. w~6W.••vaK~ wwr. AGF-us~ uw~~ i ru~ •vtiee~ ~ oa. DAif Oi ~ttM ~.r~rnw. 0~~, ICOUNTY pi OfATN ~ . erc. ~s?~~lt@ ~ m~~i~~~~s~ ~..os. } wrs t •a.M~ ~ `i~~t ~2~ 1899 ~1~ Saint Ll]C18 660Z ~ Clir. TOWN. OR IOCAiION OF pEATM wsiw cm ~..m elpSrytwl QR OTr~fR NSTITU710N-NAME ~ u..p~ ~~ur~. Gm s~~lu uw ..urt~ ~ sn:~.. ns w .w ~ Fort Pierce Yes Fort PierCe Memorial Hos ital SiATE Of W1M ~ N ro~ w u.~..., M~ri CITIZEN Of YNiAT COU?,tTSY w~tpED, NEVEt hultlED, SURVrvNG S/OUSf ~ u.roe. ~,rt .uq.. wr! ~ «n*~ 1WIpO1NED,DIVf~RCE ISfKwtil ~s~•~•~~~~ New Jerse . USA Alarra.ec~ „ Rose-Carolan o.~..~.e ureo. ~ ot~~w SOCW SECUtlT/ MlwER USUAI OCN~wi10H ~ave c«o o~ wws owe owuw ..ps~ q Ky~p pi wsy~EU pR ~NpySi~Y OCCWpO ~ MO4+~Ci uM, tYlM U HT~lO! ;;'.ro:"~ ~r 087-10~5822-A ;+iechanical Enazneex Banking •0"'u'O"• tES~OE?+tE--Si~trE COUMt~ dTV, TOVnv. OR lOUtiON ~sw cm .~..x~ SieEET wr+0 ~+Wt~E~ ' ~.vu~~..~s w ..o~~ ~~lori.da St. Lucie Fort Pierce I~.. No «~.755 Aixosa Eoulevard fAiNE!-n.wE ~~n~ rwae wT ! MOTMER-MAIDEN N~ME ~w~ «wa! uf~ 1 ~s Geor e John Clliott i,. Jane Cleaver IMfO~.WI-N~M~E . itiulWG wOGRf53 ~sh~ir o~ ~.r.o .a . cn. a ro.~. a~.n. iv~ Rose C. Elli.ott 4,,,755 Airosa L1vd. Ft. Pierce Fla. 33450 ?ART 1. D[AM WAS C4USEO {Y. (EHiE~ ON1Y ONf UUSf ?ft [W[ i0I (u~, (61. ~,rq (cIi ~ ~~rwur~'t =w ee.., ; unew owsu •.o o~.r» j 1~ r.rt0un cavft ~ y ' . `O, ! . • co~xwo.ct cr. • YMeCw G.~1! ~~f} W ~0' ~ ~ co~a~t~ows. ~~`S?~^VLl}! ~ C'iJti~? ~-!~J~J~. i `^^^irG~+l{~~~ 1rr~0~~11 C~Vlt IYI. ~ t0. d~f ~ CO~+LONwCI tN li~t~MG 1M~ yM0l~- It/MG ~~Y31 ~~3~ I'- I ~t~ ~ ~c~ i~', cc,~ ~ ?/1~i II. OTMEt SKsw1fKANT CON iTIpNS: eu.o~no.i ccreey.r~w ro c..u n...eo ro c.us~ oner r•~~ ~ 1 ~T! Y ~ rE5 ~.i.~ r~..o~..as cw+- ~ n~a u.w+ s~w~eo ot.u+w~wa c.uu { . ~ W Of~(M t tN~ Iq ' {trsLnt.~ 1%KGGFNI. SU!CMJE O~~-TOAtE CSF LY1U4Y ~ ~q,rw, ys, re.~,'~.HOUR 1MOW INIUtt a~UttfO ~~w~l~ ..~tuM M~..rv'~ ~w ~aft ~ p 1•~~ .i, n~r ' MOrtC~'JE, Ot {M.EIftMtAED ~ t i IsNt~M! ~O ~7Y~ 7x ~w ,JOd ~NJU[1f wi wOatC hAtE Of wNAr...ar..,,., srni., ~.es~., IOCwTIOt~ <?o~ee~ o~ ~.~.s. ~o , u~, w~or... s~•r~ i unun ns a..o~ pqKt wOa ,~lc ~SnC.rn ! t!~ 7M . T0~ ~ ~ . CERTIFICATION- . ro..n. w~ •a• ~ +o..n~ e.. Te•~ . uw us~ wu u~.t w~1 o.D ~ M,+0~ vwtw fwt DtAlN O[CUUto .i :.n ...u. o» r.~e ?N~SiC~~N: t- { +o~t. a.. .e.~ .rn~ a.n._ ~..eu~. o.n. .w ~o a~e asc . . .newaes i~t l~] I'_~~~ 0 ` ~ ~ I * w r. ...cw,iou, ovt 7~.. ace.seo .~e. ' ~ + ~]tr- ~-'-'v~+~ ~)1~ / 2Zrl 'tt/ ite ~ ~ ~ ro n.~ uus~~~~ sr.no. CERIIlKAiION-MED+UI E7lAMWfR GR COkCe~ER~ o~.. i»i u,s~s a r..[ - t t+t u:w» ~.s •~a.a,..uo oe.e wu~ e. oe..w f. ~....w•na+ a n~t ww ...oiw ~~e .av~s~~w~a+«, o. a..+o... ~ +wTw w. .e.. „pu~ • w.m xcv„io w wa wn ..w oue w~e c.us~~s, s,.n~. ' I~ ~ S y~ M. 1 CER7~f~fR-r~~wF ~me o~ .~wu ' 2» . S~(',NA:URE ~ ~ .q a n~ `~'DAT SiC O ~~..~•~•w..,[... ~ David M. Bleech, M.D. ~n. ~ V~.l.t V. ~L~2 3 ~ . # y"'"6iDp1~u-~"6t19 N. 7th St., Ft:•`~"''i~i~; Fla. 345a"°"°"» ".TM i ~URIAI. CREMATION. REMOVAI . {CiMETERY OR CYEMai6RY-h~Mf `IOCI~TfON c~~ o~ Wvw s~..t ~ i snnnr ~ ; Cremation :.,Ft. Pierce Crematori~la Fort Pierce, Florida ; ~ DAiE ~ o?r fUNERAt MO~E-~v,v.tF wN0 SS . fn~p w~.~.a_ wo On p~ to~+n. S*•tt {r ~ . j ,y Feb. ~6; 1~~I3 Yates Funera~~?ome, Bo 777, Ft. ~ieYCe, F2a. 33450 s..612 f- E 4KT i~~ C~1~~! ,~cssT.~~ LGNAfi/Rf , o.~ .~e~o ,ow .~,~,•••19?3 Aev.19TG ~y~ ~ ~ ~ ~M~ 4. ~ ~ ~ ~ ~ Q ~s3a~s ~ ao~r ef ~hs Lowi ~~o ~?~re R~coa Ep fte9~tra~'s rooorr! on fils In fh~ St. (,ucle (;pymy p~~ S~.LUCIE G4UNTr FIA. • m~! at Fort Piaros. F7o+'k~s. ROCE? PO~TR~S ~ CLERK Ci~:CU1T C01lRT ~ . ~ ~t ~ . ? IWemin~• No~t valid tmless nised sse! of the 9f. L t~ RECOR~1 YERtrtED.~~...~.. _,f~ : Cot~ntY Heelth ~epsrtma+nt b affix~d,) : ~ .L;; . . i : , _ Aes tl 10 z4 AN'~:~,~'' ~R; ~ ~ ~ ~ ' N. D MILLH~, J1~ A : ~ . , : ~';;a~,F , _ Hes(ti~ Offio~ i~ ' . > ~ l ' ~t ' " w , r . . . a+ . .a` jy = ~ - a L - 7 3 t~~.. w ,,,,r..,,,~„ z ~ ~ • : ~ , ~ . y,- i~~: ~ . ~s o~„h, ~ ~~m~r 31,~`,~ ` ~ : : u.. a . ' - - n~, . ~ ~ ~~aK 213 P~f 1516 ` ~ ~ {~Y~ : x - ~ :~s . -