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HomeMy WebLinkAbout2523 - ~ . , - - : ~ _ . _ . _ . _ . . . - ~53'7`~rS ta,~ D~- ~"fAT[ BOARD Or MCALT1i CERTIFICATE OF DEATH eo¦es • ~URGU GF VIT11L tTATiQ17G . QTATC flt.t N0. ~•ai1 FL08IDA ord ¦A~n . BIRTH NO. REGiS:RAR'S NO. ~l ~ prop~~lr 1. riAC[ OI OtATN . GOD6 NO. 2. YiYAI 11[NO[NC[I~VnMrrdM/ 1F~=~• to.Iw~.MN..~ir.r:rd ~ ~ wi~tYt~d a, STATE COYMTY ! aad ~111 ~'~Y • ' ' D~ ~l~e~A I• F in p~r- A. CITY. T01~M.OR IOCATION t. ~S ?LACE Oi DEATN t. pTY. TOWN.O~ IDCATIOM t. K RES~OEIICE •~nf~t NISiOE CITY UYITSt IN510E C1TY 11Y1T51 fil~• FO YES NOD ' t, NAYE OF (//lMl q ~M1iMt, /if Nt~d ~d4sa~1 1E11GTN Oi I. STIIEET A0011ES5 QN A iM1Yl ~ ?aviT~~ at ~sTY w te ru? w i WST~TYTqN 3. NAM[ 01 ~rM ~ Ni/Ws LW 1. OATE X~sN pq Y~ O[CGf[O ~ . 17YD~M~.~~rl tIGH1V F~.L°~O~F }:':RR.ISG•~ DEATX AU . 16 ~ O S. SfX OOLOR 011 11ACE 7. MAAll1ED Q NEV[R MMRKD? OATE Of WTN 9. ~(Ia K~~ ~i V~OU 1 1W Y~O[1N 1!L Nw1V Orw Qw~ Yis. . e• N.ale ~ I:h2te rricowco 0 avo~ceo Se~t . 2 18 fi ofi rl ~ 1 a 1~ 10r. USUAI OCCWAT~OM (Oiu ti~ ~/sMt INt IOe. Ktu00F WSU~ESSOR WOYSTIIY 11. WIITNKACE (8~ft r~Mry~ ps~b/) 1 Ort~ Oi ~w?T ~0111a~Tt ; ¦lts ~~r- I.~ia~awMN~twuk.a~1/r~tud) ` A ent Insur~nce Earrison Ca ~ L' S 1'+ ~ ll~ek lsk ~j, fATNE~'S Mu~E ~T~s er ~1P~~~i~~~ John F. Ha~risen ra.~nie ZS~t na-ne unavailable IS- wA5 OECEI~SEO EYEJ1 W Y. A ARYEO fO11CE51 16. SOCIAI SENRITY MO. 17- IN?O f fiOIUTYR[ T~~,+. ~;az.ri son ~ 11r. r. ~r s~lrwl U/ ~w. wK w~ r Mw ~I rwnl ;~0 261-0 -602b A~«~ 212 S. th. St Ft i'ierce F'la. lun~f~l 1~. tAVft OI OtATN [6~4? wJf Mt t~w~ D[r ti~t fv (0). a~! (~1.~ tIrtEAY1LL ~EiMfEUt ~~RT t OEATN MwS CAUSEO ~Y: OMSET AwD OEI~TN s•~.esor wrcou?.e csusc ca Leueke:^.ia 1'' t~- E ¦u~t fll• t?• e~r- ti[ie~t• ~~y~.i/uI. pyE Tp (8) tiN t?• 'v~? MK ~~i) 1 e e • 1 r• fstr~r x~ ~ 8 l/iy d~t 1~at. ~E TO (tl : • 1 t D f A 7 i O ?MT IL Oi?Ew SKwilCY1? COIIO~TqNS C011f~oMliwC TO OGTM ~iR q0T 11[tAi[D TO iM[ tUtr7ML OtYAi[ CO+i01i~OM GMtw M?Yi 1(al . 11rA5 AUTp57 I 110Yfi F rEAfORME01 ~ 1 i Nr d~~tb ~ YES? MO~ ! E •.~~n~ •¦J ~ 10i~ ~ t00. ocsexwc Mow uuunv ottuan[o. (E.to awn Nu~iwt U Pr?t I r P~rt 1J yires iIJ ! •ouocMr SUK~OE ~K~oE { 't~p~si- u ? ? ? • OA OC J~. TtYE Oi NNt ~Mpt1. Df1. YtM r -~d7• V IKJYRY f~. ! G D- ~ • . Z 20f. WW11I OCCURAED 7Dt. rIACE OF IIUURY (t. it~ M 1yW ~wt. ?A/- C~TY. T~OMiM.OR IOC~T10w COYUTIf STATE - MMN[ AT ~ wor rrNxc ~ 1~~. N~o?s. r.ar. o~tu uq.. ar.3 - MIOIIK AT MOiIK i 21. I~ffend~d fh~ d~u~~~d /rom d2C~ Il0*.. attE;:~ , to •nd l~at s~r A~~ ~/i?~ en D~~tA oceurnd ~t S• ~ _ m on tA~ d~t~ st~t~d ~Dw~; ~nd fo th~ M~t oI uy tnorl~d~~, //om tA~ uuws ~t~t~Q. ?11 it~~• jj~. tIC1Y?TYRt (Ut/~n ~r t'vki ~ ~~~SS ~~O l2~ i •r• to D• ; ~..'l.e. • ;=illi~.m H. ~:e er Jr. i-:.~. 708 S. bth. .~,t. r^t.?ierce 1 6 • • j~ 9~a~ ~yaTqw. j'~A p~TE 23c NArE OF CEYETERY OR CREMATOII~ 23/. LOCATq1f (GY), fMV~. M tlw~f~) LB~kI ~ RErWAI l~DK~/~~ ~ 3urial ru 18 1 ~ ~ ~.?ierce Ce:aete. Fort i'i.erce Fla. v. a.,~e~z u. fu~~ owc o~ s sw~.T~.cYateSOO~.ff:er~? : o:ae, 25. DATE RECO. ~Y IOCA~ REG. REOISiIUII'S 51GNATURE a...~oss Jose~n tv. Yates F't. ?~erce :la, a-zo-o3 Anna i.ee ~eaiso-~ G.r. ' . . , _ - ~ r;.';; ~ 1 heneby aertify thb to be s hw ~nd aorred oopy af tfie Loo~l ,;:'~~;~~,,'~`•~iA~~`:, Registrars rooord on fils in th~ St. t~uds CouMy Hoahfi D~t~ ~;;,i'~ - ~ ~ tr~eM d Fort Pietoe, fbritls. = ~1U~, ~.f . ` -iI ~<:2 M/Oflflllg: NOt v~id tJI1~ASS filfOd f00~ Cf ff10 Sf. ~il~ ' a. -~Q ~ , CONf1~ ~'~O~OIfE/ ~~fTl'f10fl1 ~i ~f~~ ~ ;'.~.i ••~~',r: ~ • y ' . ~ `.'i . ~ • . ~ ~ f i~''- + _ . . • t~. n. Nuues, ~ a , ~ ' ~ _ Ne~lth Offioor l~ CepWrar ;~=-.w' =;:j;; " •,-'r~t;, : 2 ~ _ ~SS- a` ~ ~3F .,y ~~-7 ~3 ' _ - . ;p~„--~`;~-t-;4-' 3 ~~~~~i• ~ ~t . f~ . . - . y i \ r ± ` t k ~7~ i~.. ~ ' ~ 5 , 1:_~li. ~ O~ptAy bo~l i~ptmR ~ ~ ~'~S~ t,:J..~a~'~*'+' Ec ~NO ~Ee w t T~~ ir,?:.f - a~ ~uc~e couN~r ~y~...~ . ' P~JIiNA~ ..~~~i;~ ROCEe~ ~ CLE4~K CtRGlf~f ~~URT ~ ; REC~R~~EP'f~EO ~ sooK213 ~t 25~~ M~r 1 3 s~ PN'~3 ~ 253'7'7S _ . . . _ _ _ _ _ _ . . . . _ . " ~ ~'a ' _ ~ ..rir ~ ' ,