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HomeMy WebLinkAbout2944 . . S _2 q 3a _ - ~ ~ 256139 ~ De- iTATE sowao or HEw~„{ C_RTIFi~:i~Tc OF DEATH .oars • BURGU OF VITAL 67ATIG7ICY i7A?t FILi NO._ - i~,.i r.~- FLORIDA ord •Aen BtRTN NO. REGlSTRAR•3 NO prop~~l~ e:teut~d ~U« Oi O[ATM CODE NO. t YtUw~ R[NO[NCC(r~...rrrda«r. J/we.m...: R.d..MW~..b+w~..) •od rlll ~NTM a STATE A. OOUMTY e. ol.e.a . L • ' _ 7 • . io p~e- 0. C~TY.TOwN.OR WC~T+a+ t. 6?LACE OF OEATM c. cm.torM.oe wuTaN K REStOENCE a~p~O~ t~ {NStl1E C~IyTY UMITS) IMSIpE CITY LIYiT51 tll~. rti. Pierce YES{y MO? ~ti. pZQ YES~ NO? . 1, NAME OF (IJ1N nt ~Mtif~[. IirtWU! ~:ua~) IENGTN OF STNEET AODR[55 ON A iA11M/ iTUTa°wpFt. Pie sur w ~ ~ YES u ra ~ 3. MAM[ OF .~K Vidd7s Lvf 1• DATE Xu~f? D~I 34Y °Ty~ N wiu~ Fred 'r'aul~cerson Ratliff °EATX 3u1 12 1' • S. SEX 6. OOIOR OR RACE 7. MARNIED ~j/ NEKR MARIIKO ~TE OF ~1RTN 9. ~6E (I~ ~tW ~ w~~ ~ Y~ uaC[q N wK. lM~ Ov11~q1 N~w D~M f/wn Mu_ r i c• ;,q~ ~y~ rnoowcu~ WYORCED June 11 1888 1 ~1.iai~ la. uSU~LOCCy~ATqN(Cirtti~le/r~rkb~t IOO.KNIOOFYUSUESSORWWSTNY 11. iINTNKACE(57~ftM~MtliAdrlf~/) tt. unu..os.rw~rcawrnrr ~1tA p~r- Inri~Iwtyrati~Ibft,atai/ret'vtd) ~~p~p~ Bookkee r Auto A enc :'~orrowbone K. U. blatlc lqk FATNER'S A~E 1{- MOTMER'S MAIDEN NAME or •~P•~~~~•* John E. Ratliff Emil Venters ~ I5. 1MA5 DECEASEO EYER IM U. S ARMED FORCE51 16. SOCUIL SECURITY NO. 17. ~MiO s uc~uruwc - Fred Rat t ( Yw. ww ~r w+trwl 1!1 M~. w~+ wr w 1W~ r~wl - - ` ~ Alt?uJ ! Fua~r~l 1~. CAYK O~ O[A7N (61ttr pl/ ont nras pn liae/ar (D). ~R~ (r)-) INTEaYAI BETWEEn . d1 r~e to! ~ANT l OEATN WAS GUSED ~Y: ET A!{0 OEATN IMMEDIATE CAIISE ~ocar3ial infarction ~nstar.t ¦u~t fll• tAa e~r- tlfie~t• Coadi:iou.i/a~/. ~ p~ TO (b) - ~lt~ tA• ~eRic~ pst ~+a~ l~ ~ 1 o e• 1 oDou caru r• Sst~~e K~fiy t1t r~~rr• ¦itAla 72 !!~t/ t~t~t lyl. ~E TO (c) O fMT 11. Oi~ SKMIi14MT CANOIT~OhS COMTR7UTYrG i0 OFATN OIR 1f0T ROAIiO 70 7NE iFYM11Ml 06EASE COIIOIi10M GM[M M fMf 1(~) . WAS AUTOISY ~OU~t •f- f, ?[RfORMEDi t~t d~~te < rE5 ? NO ? u or D~[or• lp+~~ ) ~1D. OESCRIYE IqW 1MlU~Y OCCURRED. (Ea(~I RNWt ~/t~Ja?I it POf I'YI Pp! JI NYt4 !I-) ¦~klns •ot ~ ACC~DENT SUK~OE MOYKIOE I 'vpesi- u ? ~ ? ~ ~ an o! TwE OF 1lwr rf~at~. !N/. Yro .Od7. V IMIURY A. m' p ~ ~ Ztl/- IWUNY OCCURR[D ~ ?Dt. tLACE OF u+JUNY (s. i4 a Warl L~~t. 7DJ• G7Y. TOMM, 011 LOGTqN COUNTY SiATE t W HICE AT ~ NOT WM4E ~ ~u~. /~oiy, at~ttl. of~[t[ 0/l0.. dC.) ~ WONK AT WORK . 2~ • I~tt~nd~d fA~ d~cw~~d liom . to •nd luf h,m ~Ii•~ on D~~th oceur~~d ~t 10 : 2~ r' • m on Ih~ d~b at~t~d ~6or~; ~nd to fh~ bNf o/ mJ i+wrfd/~. /rom tM ua~~s ~f~ted. 1 1 Na• ~j. f16NATY11t (lXprts M f'vk) ?ID- ADORESS ?2t. OATE S:GhED .r. co s. ~,.p~.~. . Richard Sinnott, ~j.U. Ft. Pierce, Florida 7-13-59 •CCY~at~. ~[WT~. j~. tU~ME OF CEM[TENY OR CREMATOflY 23/. LOCAT~ON (GY/. lM~w. M tN~~f/) (~ft) rOY/1l tipK~/I1 ~`nr-~a`1 ?-15-59 :'t. Pierce Ce:~etery 'rt. Pierce, Fiorida Y. S. i aiz j~. ~~iNEAA~ DWE OR'S SIGNATURE AOpRES$ ZS. 6AT[ RECO. tY IACAI REG. REGtSTMR'S 51GNATYRE a~•.ioa6 ::ilton 'r~. isaird, 610 ave. C,: t.F'ier e,ria. 7-20-59 Anna Lee L'enison, d.r. FILE?:.!~~ °~COr~DE~ ! ST.LUCIE ~~L'NiY FLA. ~(t RL~~~~'. pl:tRAS .V CLFRK ~~'::•:1~T CGURT . p c~~ = G y=..c ~ E 1_~~~.~. ~ ho~+e~yy osrtify thfs to be a trw end aomec.Y oopY af ff?~ laal i 3: ~ Qogishe~s rooord on fite ln th~ St. 1+~x3o Counry Keshh Dc.*~sri ~JUN 6 12 4s PM ~~3 4.~„r _ r. ; ~ , . tncitt st Fort Pieros. Florida. • , . ,r ra l • ' ` 'YY R ~ . ~ . ~ (Waming: Not valid unlass raisod sosl o~ tha St. L1ufa 256139 . , c«,~, ~ usw~m ~ ~a N. D. MlllHt, A~ D. J Cots~ty No~ltt~ Offic~7 tc L~^J t~'~a~ ' ~ ~ ' ~ ` ~ , ~ . , ;1:~ ~ ~ ~ ~ - ~-t ` ~ _ ^ , - . . ~ ; , ~ ~ ~ ..l. .,,~t~ , ~~i4 ~~~!~C~ ~ } , ~ ~ ~ : ~ ~ - A~~~- ~ . - _