HomeMy WebLinkAbout1711
` - ~ _ - = - - - _ _ - - _ - - - 253209
inls D•- i; cTwTa sowno oF H~rN CERTIFICATE OF DEATH
co¦ea • HUAEI?U OF VITAL iTAT1~TICY TirATE F:~.i NO.
'e;'' FLORIDA
ord rpen ,B~R'H NO - REGiSTRAR'S NO. ~
pro erly -
ceeuted , PL~ CE OF DEATH GODE NO. ~2. USUAI. RESIDENCE ~~~ae~reeawannd Ir~tu~r.:a.u~.t~k:.re
e~ ~ i:::e ~`~~N~ St. Lucie ~ 66-12 ~ `'~~'~Florida CO°"'r St ~LtCie~~
P
tn p~r- b. C1TY ttt +ur4 ae~xsu ua~u. ~rts~ SI;Iw.~ c. lEN6TH OF a CITY ltt wt~ld~ ~wnu iWt~. .ew iL'luL '
..e.oc oR sj"ryx~s.~ ro°wH '~t. Pierce
t~~.. TOWN Ft. Pierce 6 ~
- d FUII NAME OF IU wt L~iW ~ WlurNq, ~iw K~aet ~dQ•r I~qtW d. STLEEi iif ~saL s~ ~1
NOS?ITAL OR O S S S
INSTITUTION
- 1
NAME OF a. (F'irse) ~ D. (Yiddk) e. (La+t) L QA7E (rioas~) (Dq~) lYear) - t
DECEASED ~ {
~,y,.,,r.;,u Lucille Ho1.*res I~cCabe Jul 1 1 1
S- SEX i. COLOt Ot ~11GE 7. 1/AtR1E~. NEYER WRRIEp pATE OF {IRiH A6E ~L u~~wa i~w M~~K~ a~ ~q .
WI WED, DIYORCED «a) ! y.rrt Las%Bi.s Y~.. f
~ i~• Female White ~arried ~u . 1$ ~9
~ s!{
~1 ~ `!Oa. USUAL OCCUPATION~Gh. Ld d w~s IOb. KIND OF ~USiNFSi Ot IN- 11. {IRMKACE ~~uu rr ~ w~qi FIL C(TIZEIi OF WMAi
•i.a p~r- i~! «~vntyr~ _ DYSTiT I O NitY7
'~.ousew `~`e hor~e Pocahantas Va. U~~
Dl~el• lak p, FATHER'S NAME I{. IfOTHERY I~fA1GE1~1 NAYf
or
~rp••~1~•~ ~:dward Lincoln Holmes kn ie ~e ne
(S. WAS OECEI?SED iH u. s.w~wEa roacES~ u. soci~u sECUiunr n. INFORYANTS 516NATYRE J. wf . Yates
(ia. r. ~ wttr~U Ill M tln r~r t rass d~) N NO. ADOtESS
e e
Funer~l 1~. CAUSE OF DfATH MEDICAL CERTIFlGT10N w*cnvwt ~crws.o~ ~
atr~etor : ntcr onb oa~ ame t. 815EASf OR GONDITION ~.p ~t s~
•uat !1l• Der 1ii+e for (~).lb). DIRECiLYIEADIN6T0 DEATH'~~~ L r 2T~ IL ~i03~1Z1$ t
she e~r- ud ie! ~
cifieac• ANiECEOEHT GUSES
. i t A c Ae •7~ia dxs *~t wss* DUE t0 ~
1 o e. i tts a~als oJ ~yisD Y~rOil cwlitio~~. ~l or. T*~~v
~a~ll u Acart l~~hra ria~ N tAt ~iek u+us (a/ ast•
r a g 1 s t r a r ,ytAswis. stc. Jt s~ea~u "'D W~'~p °t"M
.icnia 7s t~ dia~w.:.)a+t. o+ DUE TO e ~
hours af- coaplicsrioa r~ie~ II.OTHER116NIfICANTCONDITtONS ~
cer d~~tA ~~d dntR' Cewlitiowa toatriLatisy W t[s dcaA 3rt~K '
or D~tore ' +~rrd b tAe diseesc or c»sditio+~ oaasis lnti. '
¦~kln6 ~w~ ~ 11~. DATE OF Ot'O
-N t1b. 11AJOt FINDtlI6S Of OFERATiON li. AIfTOKT7
diapos!-
t' OC ~ TE! C~ KO C~
t ti7.sasb/ 1l~ecWS) 21p. fLACEOF INJURY f~.t.fa~r~aos 21c. (CInO~70YM (C01/MNI ISTATEJ
y 2Ia. ACCIDENT MM, fY~. tkWf. W~. ~aL. k1 I( n~,6 ~tr/~ syyl.~
1YICIOE
2rld.~iiME ptrul lD~s) IYnq ~Hw*) 31~, IHJURY OCCURIED 214 HOW DIO INJU[Y tl
OF ~r,u u ro1 ~~uas P
~ INJUtY ~ ro~[ ? sTrro~R ? ~
u. I here6y cerliJy t6ot 1 ateended tht deceaud /rom 1~-73'= , 19~, to ~ . l9~ t)+ot I last raio u.e dcucs~d
"11 1 c•¦` ~ a!iLe ~n~ . 19 C~ and that d~at3. ocesned at • m/rmn tAt causa ond ow f3~t dnls seated abo:r. .
are so D. 1y, SIGNA7URE ~De;ree or tittei ~b- ~DRFSS 13c DA7ESI6ltED
eoiylete 4 . ~
•etu~at~. ~ n ~ -~r +
'r26s_ 6 U R 1 A L, GREMM 2ib. DATE ~2k. NAME OF CENETE2Y O[ G~EliATOIT 21d. l0~'.ATIO?I (C-V. twa, ae coos~) (Stue ~
tri°~e oovw~ ~s~w~ J q I: C F
~ a
~DATE AEC'D ~Y LOCAL tE61STRARY SI6NAiUtE 2S. fU EML OI~ECTOR'S S16NAiYRE ' ItDORESS
~~.s.faoo J yi( Y F
:
25~209 ~
i11E0 Aft9 AfCORQ_EO .
~ herobY as~tFfY thb to be e trw and eorrect c~y of tfie (,p~. ~UCtE COt1Nri ~~w. `
Regirnafs reowd on file in th~ ~t. ~ CouMy tieshh R~EF ~ul;itAS
~ytEFR C1 :CUI? COtlRT ~ • ~•.F~.'
meM ~t Fort Piarne, Florlds. RECORO Y~R!f1Ea.~..~~ ~ ~~_~r+'~~ ;
~
: Q~:: , ¢ , ~
(1lYarning: Not valid unlsss nlted sesi o~ the Sf. ttuJo ~ rsr'p'-~'-% '
~ ~ ~ ~a Att 30 2 oe PH'73 . f~`- - ~-`:~:~~:~i _
T D. _ ~ S!; 'i . _
+ ~=s . :w ~ . -=h~~:
MILLet, IUL D. . - , .
_ f'~M~~1 ~ isiM~'~ ~ f~ ~ , .s : . ' J : C~t
~ ~ I - 7 ~ . T-r.°~, : t
~ t,,,~~
(~N G~ . ~ : ~ / ~
-c , ~ ~r~.,,~; '
~ Oap~Ay tocal Capbdr~Ct ~ . ~
,
f ~ r:~~ =~Y_ .
~o~ici~'j~ ,~i'~
~
.
~K ~
-r"i' ':_9s%Gk%K'i: