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Dt - ~TATE eowao oF HuLr+ CERTIFICATE OF DEATH
o~es • BV11GU O~ VITAL fTATIfTIC~ fTATf FlLE NO.
t«- FLORIDA
or1 .nen BIRTH NO. REGI6TRAR~3 NO. ~~S ~
pro~etlp CODE NO. 2. YtYAI R[SIp[MC[(~?wt~rr~dh~r1 I!~V~W~M- RY~/AMMI~~~~Y~w)
• r e u t~d 1 rUtt Q? O[I~TM a STATE A. CODUITY
.,,s COUNT" St. Lucie 66-025 Florida St. Lucie ;
er Ni.~ea K ~cs~aticc
1 n pet- CtTY. Tp~IN.011 LOCATION t. IS KACE Q~ DEATN CIT11. TOMN.011 IOC~T1pN
•anant INS~OE CtTY UM~15~ IpS~DE C~TY IIMI(S~
fl1e. Ft. Pierce .ESpg ~p Ft. Pierce .E:t3
f. M~YE OF (IJwM is ~a~ifd. f+~ ~~~N d4ts~) l. STREET aDDR[SS
u~stiTUTas
~r~` ~Ft. Pierce Memorial Hos . 608 S. isth Court
] Nnr~ os Fast .Viifle L~N 1 D~7E MowN Ih~ 1 i~~
°iy`v~`M~°.;,~~ VIAGINIA 0. MILLS o°u`~TMApl~il lfi, i969
S S[X ~ CO[OA 011 ~CE 7 yARR~ED.p~ NE1I[R MARN~EO? ~ OATE Of WNTN ! ~GE II~ poa ~~a~ U~0[d 7~ W1S
(~~p ^ March 9.1899 ~ pn'.."' w..,.. a.. ~ x...
r r i t• ~ ^u • 111fIppYl[D U DIVOR[EO
1~ 1 n 1~ ~a USL'~L OCCU~ATqM ~Cltf Y~~t N~!'N~ /SAt lOD 1(IhDO~ WS11tESSON ~NOifST11Y 11 Y1NTN?~1~( (.VK( p~I~fN+ [NIAf11% ~Z UTIiEM OL ~1M1~1 (A4NI1~?~
~ 1 t R p~ t~ria0 wwf r~rl1~ hp. ne~ ~f ?rfvN1
..h~^~ gousewi~e Own Home Louisa Kentuc ~ II.S.A.
o1~cr ink ~j. ~~TNtR~S ~r[ f! YOTNEII~S YAIpEN iIAYE
t T D~~~ 1 t.. Marion M. Jordan Kitty Cunningham ~
tf SOC4L SttU11~TY q0 q NtfOAYA ~ N411ATYA~ A[4n~
-01-5459 Mr. Luther J. Mills 608 S. 15th Court, Ft. Pierce, Fla.
F ~ n r t~ 1 1• iAYt[ 0? ~[ATM ~A~fa ~dI nrN /er fi~r jr (D/. (t).) Iw7ERY~l tETME[N
?~IIT 1. OEATM wA5 GYS[O ~r- ~ / / / ~T ANO DEATN
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c u e t f 11 • IMMEDYTE C4USE ~-l.! ~--5-
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i ~ 201 wJU~Y OCCUIIR[O 20t. ?L~CE Oi nUU11~ ~f. iw w~oef Aowt. b..lJ CITY. TOMN. OR IOUTqN tOUMTY STATE
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i 21 J ~~~~nd~d th~ d~c~~sM /rom -1____ . to _ ^2~ S ~ L •nd !uf ~r A .m ~fi?~ on
~ ' De~th oceu ~d ~r y~ ~C~ m on ~A~ d~t~ st~t~d ~Ao~r, ~nd to th~ b~at oI m7 1~~rlM/~. J?om tA~ uu~~s ~t~t~d
~ n~: 1 te~• jj~ fICMAT (Nlrtt 0~ h 22. •DW~ESS ?1t. WTE wNE
<o ~G- ~lu~ ~P , GG ~ ~f" / /c !
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~ i c c u r~[ e. ~~»,i~ ~~T~ jJ~ Iy~ME O~ CE METENt OR CAE Y~TORY j31 COCATION (C~~, lMC7~. M fMIU/1 STUtI
~ RFYpYAt (~1 f/J~1
4 Eemova~ 4-16-69 Ft. Stueben Buria2 Es . 3tuebenville, Ohio
f O1 Z iUNERAL WMECTOR 5 S' M~TU11E ADDA 2S MTE ACCD. IOC~L 11EG 6TRAA~S SIG TUR~~i'~ ~ •
_ n±~•ID6D HOM A ril 16 1969
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l~~~~VCIE GOUNTYRfI~ ~
i hereby oenify this to be s true and correct copy of the Locai ROQcn tO11R~g
_ Registrars record on file in the St. tucie ~ounty H~alth Dcpati- OIERK C~R~(11T CQURT ~19
ment at FoN Pierce, Florida ~ t RfCOkD VER~F~Ep
1 (Warning: Not valid unleu raised seal of the St. l~cie
; ~ounry Heelth Department is affixed.) 4 I6 FH ~~3
3 . -
~ N. D. MILtER, M. 0. ; ' ~S~~SL+
County Health Officer d~ lotal Registrar ' ~
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~ pi}~ Deputy t~ocaf Registrar _
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