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HomeMy WebLinkAbout2407 CERTIFICATE OF DEA7H j,t~ ~ ^ De~.N..~.~ .1 f k.ItL ..1 ItRL.bllkd~r. Se..1rc. trwn M<t Mo. ;o FLORIDA . t'I?E. OR /HM IH 11COISTNAII•! HO. ~tlMAl~M INK ~~~_NAME r~nr rew ~wsr ~x DATE O~ OfwM ~ rortw, s~~, ~ ~ SEf ~00[ FOt _ cxn~s F. r~oEx~ r~r ~ le ~ J e RAtE wiw. .uaa. u.euur n~w~. wGE-un wee~ ~ n.~ w+a~ ~ e.r OA?E Of MRrn ~.o.wr, w~. COUMY Of OEwM ~K. ~ Wcrr ~ 4nw~ ~uuf ~ ros. wrs wO~RS .u~ d~ . White A k .Jul 18 1 04,~ Indian River C Crt1/, TOwN. OR LOGTION Of-OfwM ruw cn ~rns MOSMfAI OR OMER NSTrtUT - ~ w.o~ w nwe~, c~ ~nen .w wu~~ r ~ t.eca. nt w wo Yero Beach Yes H.Ro al Palm Conva~escent Cente StAiE Of NRT1 ~ r ror w ~.a.~., CIi~Z9~t d W11At COUNTt11 MARRIEO, NEwER MARt3f~, SURVNfiG SI'OUSE ~r .rw, a~+e r~~oe« ¦~re ~ ' T cown+i Mn00wED. W~ORCED ~ xa,n ~ i .rwe~e ~lCCUS~ ~ 1~ • Q • f. - 1~. 'i IL ~ ' ~ ~~.~eo. r our SOCW SECUMTY NUM~ER USUnI OCCWAT~ON ~u+e a.+s w~.ou sa.t ouu«a .n~ w~iWD Oi MlS~ESS O[ WCtlSRr ~ oCCVaM r~ wo~aMO urt. ever r Kn~p r i 262-16-8 18 General Contracto ' ~ .a.ussa.~. RESWENCE-SiAiE COIJNT9 Uir. tOwtr. OR lOGT10?+ wsw c~. u+aa STREE~ ~nD t+UWFf i ~ ~.enn ns a w ~4 Floriaa ~»St. Lucie ~k. Fort Pierce ~~•'V . fATMER-NM~E ~~~it rwaf uSe MOiI#R-MMOEN NAMf r~ woa! - W~ „ Hen ltZoehls ~ ~?+fOltM~wi-N~ME NuAwG ADDxfSS ~s~nn o~ ~.r.e. Mo., cw. o~.o..~, s.we. rr~ ~~(~~O ; ' P~~rs. Gertrude Moehle ~n 11 Ol R' rwrr oEwn~ wws uusto sr: ~tMt+t oMtr oN[ uust rtR u+c ?o~ p~. ~sJ. u+o <<n u,~.iw ~ f: e«.rn ~ n rrow . ~ ~ . C (-~,C,L . . , : ~ ~ t coM«nori, u ~.n, ~~KM 6~r~ us~ 10 A) ~ ~ ~rrlW~f! UYi~ 10~, ~ • t 3lOUf ' 1~I~tIMO TM! YMOt~• ' ?tIMO C~Yf! U~t ~ ~ ' " • G ai..'[ . / . ?ART s OT?rt! SIf;NMKwNT C : ca.aews caw ~..a q w.M ~v, ..or nune *o uuu em+ w..n ~ a~ ~ES .e nro~MOS cow- ~as a »o~ ~vee~~o 1~b~NIMO U{IS( O~ OI~fM IA l1r (!~~!ad~1 wtttDENt A ~rpatw,e.•,•e•~~ JR MOM? IN/UR~ OCCUtREO . 1qY1ppE~ pt Ut~D(TEtMtNfD ~ ~ ew4~ wnne o~ ~wrvti rw ~wtr ~ p~ ?an n, n[. 1 . M !M. 70t. M. ~01. i INJIM~ AT WORK ?UCf Of NA1RY.~ wow. r•u., s~~en, .,~non, tOUT~OI~I ~ s~en w~.r.~. .ro., c~n o~ w~r. sr.n ~ ~fnunnso~.o~ owrceMSO.,ea. ~sr[cwr~ . »r. - . rr CE~tTRiCwT~OH- ..w~« ws ~eu ra.r o.. .u~ ~u.o us. a.v w~wt~ u.ve o.. ~ or/oa .o~ .~c. n.e ourN OCCU~R[o .re rua. o» n.e ?M?SKrwN: 1p +~WTM Das nu ~OO~ ~~te~ ~wm. ~wpy~~ s~n. ~sr~. q +n ¢S! ~ ~nlwOes tw! 1 / ~ '~~1 Jti 1 AO• t4 oreuuo.ro. J ~fl~ i m 1r n~ V/ I~..J.~ : KQ~ef~Pl~d'~s~i:n^ CERTIf1UfIpN- l EXAWNER OR CORONER: n~e ~.us nw .~p~~ o. rw Me CK~ N~S ~~WWN~fD Dl~D _ ~ t4YNw1~0'~ p~ ~W/O~ M MIlSfY.~~OM. r+ WIaWw. ~ rO~~M D~t 1f~~ MOl'~ : Otatw OCCV~flD W~! Y10 MR q M! 4VS1111 St fp S . Tt~. M.~lA M . CElT1FIER-NAMf ~~nt w~wn ~ SiGNA 'RE i ac~ +mt DATE 51GNED ~..o~+«, o.r..u~i Broadus Sowell .n. ~ . r-~ rv,4NG AODlE55-CERI61Ef ~ sneer oe ~.r.e- c - sr.n 'I~ ^ i 2 00 r 1 t A••° r; O~ ~IMUt, CREMAiqN, REMpYAI fMETER~ OR CREMAiOR1/-NAMF l(XATION Gn o~ qrw s~~!t ~ sn[rt ~ r.. Removal-Burial j~t. P~_~rc~ ~e-~eter :ti _ T., OAfE ~..oun.. w~. ~tu~ RAL MOMf-NM~f AND wpDffSS ~ fmn o~ ~.r.s. ..o., cm q~o~+w, a~•n, i~r ~ w J. 1 1 ox-Gifford-Ba1t~Yl1. 1 CO-2 S V ~3 Fi ~ n y. S. ~612 f LEGIST~/Yt-S~GHAlURf d o~rt ate m n i«~ acnrw R.~.i9~o 'c.15S - /G~_ "I hereby certify the above to be a~tzue and co~rrect copy ' of the local registrar~s record on filc in the Indian ; River County Health Ilepartment at Vero Beach, F~,orida." s ; ~ o~ _-~a~_ This is not valid unless the raised sea~ of the Indian ~~~o 0 River• County Health Depart~nent is affixed. i, . ~ . . .yiato.:~. z~ ~0 . _ . N e. r ts n ~Oa y . : ' O o~acw~ _ _ `ti,~Y ttt.~~~~~!ti . _ . •y<_. « r ~1~ • n o~~ ~'~:o;'. ;,~r~-~ Coanty Heal Dir. Local Registrar ~ : ^ ~ ; t =f3, ~ . - ~,.~r; + r° ; : -:i • •:r • w ~ . : ~ `t~~ ~",,c~ M1.. . X~, ~C~'t/ C Q Q/~yl,/A.-~ ~ I ~ .-,y Deputy egistxar . ~ r,~{, S~~~st`- _ u R ~ 25~"y~ifi ~ . . ~C~r~15 240.~. ~ ~ _ . .~v~ - ~ .u_ _r_~. _ T~