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HomeMy WebLinkAbout1710 . ~ _ _ _ ' ~ _ _ _ _ Y ~~1'lI1L~~+~r/~ 7A1s D~- BTAT[ oowao or Nwa~x CERTIFICATE OF DEATH - ' eo~~s • HUAiAY OF VlTAL RATI~lICa STATt FILC HO. '•6•1rio- FLOEIDA cL ord ¦h~n BlRTH NO. REGIS7RAR'S NO• VO prop~rly L YtYA< RcNO[MCt(~aw.I.r..tli.a ll:w:wu..r i.ri~rW...i~:ru.) ei~e~t~d 1. KACt Of O[ATN GODC NO. .pa .aii O0tNT1 ST. LUCIE 65-025 ` sT~~ Fi.CRIDA ~~TM ST. LUCIE D~ ~l~e~~ , la p~?- GTY. TMNM.011 IOC~TION t. K?U~tE Of DEA7H t. pTll. TOwN.OR IACATION t. K AEStOEtKE iii.~~ FT. PIERCE ~i~°ECS~DTM ~+a0 F:'. PI~'~.RCE ~~~w~ ~ j tUME Of (1/aK h ~M)ihl. Iine ~6ett Nlta~) lEN6TN OF STIIEEY AOOIIESS ~ ON A FMMt uanTU"`Ta°N~` FT.PIERCE ;~d. HCSP. B~Ar'"'s 702 S. 9th. ST. ires? ~o[X ' , i j. MAM[ O/ fY?~t ' ~ dliNlt LYf WTE NMt~ Dq YtY 4 i?tis•`•~+.~~ J.~~S B. McCABE l~~ov. 1.6 Z962 ' s S. SCX ~ GOIOR OR MCE 7. W1MIE0 ? NEVER YMUKD l. OJ1TE Oi WTM ACE 1N?~ ~ IM0011 YW IFOA ZI IMS. . , .,~,~yw~I) X~.Y. O~w Mwn Mi~. ~ i.. I i W vnoow~ C~ «wncco I~'.AR. 9s 1896 , 66 ~ y 1~~~1~ 10r. YSY~I OtCWAT1011(Q' ~~~~tll Ips• KWD OF N75111ESS011 WOYSTIIY 11. ~IQTMKAGE (9~f[ M~Mtf~ pl~~b/) qTtTfM OI tIMT COIMIfItY1 i •lt, ¦~w~et OF.~i HD'n~. STOt~E L..~ESBURG~ VA. USA ~ )l~et f~t 13. FATNEII'S IUWE 1~. MpMEII'S MA~ptl~ IIAME c~p~~rit~~ J.P. MCCABE LUCY ELI,E:~1 ;~T~R~IS i IS. MAS OECEASEO CYfR W Y. A A1lMf0 fORCESt u. soc,.~ s~a,R„Y n. s uo+r.~+~a ~,ss. :~:a ;lorris ::cCane ~ 11r. r. ~r wTrwl !1/ N. M~ wr w ~w1 ~ ~ Xes WW ~I Aw~.. TYA~l~I ewusc or o~?~ ~ak...rr...ewuv~+~~«l~?c•~.t?~.•~t~~.l ixruv~~ ~ a 1?• e so r ?M1T ~ oE~rN rA5 C~uS[o w: _ OKSET /uw oc/~TII iMYEqA1[ CAYSE (fJ Probable Coro:za 2r:romoosis - lnstant ¦r•t til• t\• e~~- ~i~~`•~p~ a..~r....~~..,, o„E,n Arterio sclerotic neart disease - UnknoWn i . a . i .e~.< - } r~aistrae ~~fi+~/ ~1s *~f~r- OuE 70 (r) f •ithi• T1 z !!rN eaut l~t. { AOa~s • f- ~ ~MT IL OTMtII SIf.Ni14MT OMIO(fD~6 OOMip17t~MG TO OFAiM RR MOT REUlEO TO TNE iE~MW1l OtSUfE CO1017100 WYEM M tMT 1(U . MAS AitTOKY 3 ~ ?E~FORM[07 t~.r d~~ta ~ YES Q NO ? ; or b~fer• l~ ~ ~~uar occuRrtco_ (E.ra w.rws N~h~s i¦ an t~r P~rt 4n~ ~ ; ¦~kfw~ •a~ ~ ~~ocNT wK~oE NowiCiDE R N ,p..!- ~ ? O ? as •f ~ mc. Tu~E OF f/~r sYraW. Dq. Y~r lod ~ wu~r n_ ; o D• - W ' ~ 2AI. INJYJIY OCCURRED mt. tIAGE OF ItUURY (t. I•. ia or ~t.sst ~e~t. I0/• dTY. TO1MN. OII lOGT10M CONNTY STATE - . M~N~IE AT ~ pT nMYt ~ l~w. /~KI. +nee, •fsu ay.. dt.) ~ W011K A7 MOIlK 2i• 1~tf~nd~d tlN d~~ed 1~oer~ . to l~-'~1 •nd /~t ~as h~. ~ di?~ on ~-~3~ • i D~~tA oautNd ~t~n ' ' m on th~ d~b stat~d~bo?~; ~nd to th~ bs~t oI m~ Jeno~l~d~~. lrom tA~ uuaea ~t~t~d. •11 1t~is ~~TYIK •r• to 1• (11+/irr M tvk) ?IO. ~DDrtE55 llt. GAtE S~GxEO ~~•r~•~• . J.H. ~atsche :+.D. 11-20-62 906 Delaware dve. 11-20-62 •Ot~f~t~. u~l~ j~. ~ME OF CEMETERr OR CREM~TORY ~~TION (C1f/. t~vn. M tM~(/1 (3~ft1 1 ~ ~ 11-19-62 LN=CN ~.~.:~T~.RY L~ESBL~RG(I.CiTCOtJ~1) V;.. ' V. S. /619 2{. FUaE~lAl DWECT011'S SICMATU~l :J'P~Trofl ..5~. • 15. O~TE REC0. ~Y tAGtl Rff.. ZC. RE6KTRAl1'S SIGIIATYRE i A~?.~oae 1~ilton hT. Baird F'i'.PiF~C~,FL: . 11-21-62 Anna Lee lienison, d.r. f lEQ ~MD RECORQ_EO ~ - S~.LUCIE COl1N1Y f~A. ; lIOCEii FOItRRS ~ ~r~n~"`''wV CLERK CiRGU11 COURt ~ ' RECORD YER~f1ED~ 8 ' 1 haeby as~tify thb to bs a tru~ a~d oorreet aopy cf t!a t+oa~l ~ +oa Registreri rooord on fite Tn th~ SL (,ucts Cou ~Q Afa1t at Fort Pieroe. Floride. ~~h , c. -i 4 ~ S ~i. M/Of111f1g: ~1lpi VD~ld Ui1jOSi f~jfOd 500~ O~ }f10 V~ .1 !,l~..y~~ ~01N11~/ ~'~OOlltl ~iAR10flt ~ ~7Gi~ , - ~ ~ . . r - `r,: f . . N. D. MILL9t, IUL D. ~ ~ ;;a~ : - ~ -3, ~ . T s7YS~U~ ~ ~ ~ . _ ` ~ ~t~ j i'. ~ r : "7' ~ ` _,+r-.~ i~.y. T,~~,, y- 73 ~ r~``~ y~.-'~1 ~ ~ ~ S R'~ ~ ~ ~ . . ~ • , ~ - . ~ ~hh'Ot , f . ~ ~i.~~'+~:~_;~; . -'~~~i41.-~~ ~ $~x~~ ~i~ ~f ~ _ _ _ _ _ . r l i ~