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Home My WebLink About2672 . 1 i~t~ sTwTC eo~o o~ Nu~~x CERTIFICATE OF DEATH '2t~3 ~ e o¦ e s • •URtAV OF VITAL tTAT10T1Ct F L O R I D A sTAT~ FILt NO. ' lea.l r~e- 1 ord rb~p BIRTH NO. REGI6TRAR•S NO. ~ pfop~~17 GODB NO. 2. usu~~ wcs~ocMect~a~..~.~w.ia..r. 1!~~I.titwa RrdwwMl~.~~Mwiw~l , eattutN ~~C[ O~ O[ATN • ~ STATE COUNTY j .,,d COW'~" Bro~rard ~-D~(, Flori~a Bade e. ~l.et~ ia ~~i• C1Tr.TOMN.OR WC4TqN t. K K4CE Oi OEATM t. C1T1/. TOwN.OR LOCATIOM t. K 1lE OCNCE •~aent INS10E C1ri IIMITSI INS10[ C1Tr LIr11St ri~~. H81~11d81e- - res No? • Rt1I'al (itiiaai.) vcs w . I. 1u~~tE OF (J/ ~u! is ~yit~f. ~irt ~tred d/rs~+l ST1lE[T ApO1tESS • ~`T~` ~,,olden _sles ~onvalescent Center 1131 N.E. 21~h Terrace MISTITYTqM ~ T a..u?..~ o. ~r'.r phiLp v~xr.A ~:fogavero ~c ~t.~. ar y~.. oeeu?sco D ~ A ~EAVCI~O OEATM A~1F.liSt 26 ~.9v7 ~ (71rDt r pi.r) 1~i. S. SEIt CaO~ OR MCE ~ MARRIED ~ NEYER MAIIRKD ? ~ ~TE OF ~~IITN ! ~GE Iea~ ~ ~s+~+=~ ~ ~ ~ i895 a~ w~...n x.,~.. o... M.... x:.. r~ i s. I~1ale ~i~ .noowco~7 avoRCCO Jarna ' 15~ s y 1~ 1 n 1~ 12 qnm~ os Mrn?T a0u~nen ' ~p~_ occ~,r~?T,o„ ~r~~ t;¦~ yr.•t a.. IOA. KINOOF WSIN[SSOR INOUSTRT 11. tIRTNKACE (St~tt M/MtyA t~~t~lf?/1 • i t A p~ r- Isruy .w+t y rati,e/ h/~. eees tj utird) ..~~pt tou+et Hex York Dlatk !qk ~j. ~A? R'S IU?ME 1~_ M07ME11'S MAIOEN N11ME ot , - t~p~~r~e~r ROS63+8 Fo?ice 1. SOCUII SECY~~T9 NO. 1~- ~MiOR11~AMT i t1GMATYR[ A~«+ 11,31 N. 2~'~h Terraca ~1• t- s •.FS V. r~a~+.vero Miami Florida 3 Pun~ 1 1• CAUt~ Oi O[ATN [6wtt~ ~d/ ~wt c~we pt~ l~ut /~v (U. lDl. (t).I IpTERV~I ~WEEN ~ t~11T L OEI?TN MfAS CAUSEO ~1/: N ONSET ANO OEATM dl~etto~ WMEDUITE CAYSE / '(~1~' ' •ust f11• tAe e~t- . ~ ~ ~ ~~[f' ~ tlflcat• Lp/yj~.i/~af. p~TO(6) Ll~"'~'~~ r ~ c n t~ e . r~ic~ ~sre ru~ t~ ! o e • l re istrar t~ - - - a t~i~~ t~rx /ul. ~ TO (t) i e n t n ~a • o ?MT o. oT~[n Sw~os~eun eonaraws eo~nawrwe m ourM M rat ~cuTCO ro iMC t[ieruu~ o~su?sc co~anoM Gnrrw a?iuT ~p) . wAS ~uTO?sr ` Aours Q M, - ~ fE1lFORMEO~ F ter desth ~ YES? MO~ it o r e~ ror• i~.s ~ • • 2p6. pESU~~c Npw uuuRr octusrtco (Eat~. ~~u yiyw~ i~ Pat I~r Aat 11 y i?ea /~J ' E ¦akins ~n~ ~ MC~p(NT SYKIpE MpY1CI0E R d1~Posi- ~ v O ? ? efan •t E 20e. rewE os llw. No~t~, [~r. Yso DodJ. 3 ~ ~uRr w. ~ o s. . ~ 7M urn~~Y~v~~.~~sn 7n. ~...r..r. ..(t - . . :S:_..:~w..wn. . u WM~It AT a ?qT WMiLE ~ Ncta/.'it•tN. s1~~ Ei0/.. tlt.) ~ ~ . - MfORK ~ A? 1YORK Z~ • I ~ttend~d th~ d~c~~s~d /rom ~ ~ ` ~ ~ ` ~ , ~0 2' ~ ~nd /~st a~w~ •/ir~ on , ~'h~rs~ p~~th «eurr~d ~t • m on tA~ d~t~ ar~t~d ~60?~; ~nd t~+ th~ b~at ol m~ hnom~~d~s, /rom tAe c~us~s stat~A. A 1 1 ! t~~• jj~ fIG1iATYA[ ~[t M t41e1 2?b AOORESS ?2t. WTE 51GNE0 : to , /f~Cct.~y,«~ ~ D yo~r-. s~ ~(a/Jv~ fi~~[Y~=~~~ z y-G~ ~ ~o.pi.c. ~ a t c • L 2~ ~~rt~, 2~ j~. tiAME OF CEvETERY OR CREMATORY 23d. IOCATqN (CY/. lw~t. M tonnf~) (St~ttl RCMOtIAI (tiptn/~~ ~ w • ~ Sout~ern I•~e~orial Fark dorth :~,ia~i Beac. _ i ~ »r; ai ' ~'lorida ; ! r. s./ 6~2 ~ P~ERAI NECT v' Ui AODRE55 ~t. j]vQj~ OATE RECO. SY IOC~I REG Z6. IST 11R 5 SIG TURi, ; ~ ~~as l~otn st. cr.~~~ ~'/96 ~ ' ~ ~ ~ _ ~ • ~ ~ ; . ~ ~ ~ ' ' . . . ' ~ . ~ . ~CERTIFIED COPY - ~ • ~ _ . . ~ I hereby certify the above to be a true and correct copy.of the I,ocal „ ~ 7 Registrar's r a d on file fn the Broward County. Health Depart~ent at ~ o~ ~r ~ ~ For~ I,~fletda~,~,orida. . . , _ . • • . op„~~ ~ ~ = ~..~~"•••.,,~r~ . • . _ - : m ~~o~o ~ . ~ ' - (w~+'iqtn~ l 7~c~ v~li3 unless raised seal of the Broward County Realth ~ ~ ~ ° r ~ : . ~F~~~r.t ie affixed.) . . _ • - o o~=,so ~ • ~ : . " . ' -~D as~° , '.iY. :;.:v a5c~~ .`/~,~~,~r = ~~^~o , . ~ ~ - ~'•~..i~'J . • ~„t 's County ~icalth Offic and Local Registrar w l~~,D l''~ ' • • • • ~ .~cll ,~~'~ra . fi . • _ ~ , ~.l.Q/"~VJ ~.P . . . ~ ~1-?3 ' Deputy Lucal Re~istrar ~?p ~ ' - bDOK~~~ ~.VIJ7 . t-- ~ . , ~ ~ _ _ _ - - - .n~:~.