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HomeMy WebLinkAbout0403 J ~ C~~; tFtCATE OF DEATH ~~4~ ' U.,{aar~weut o1 1 k..1~6 ~~d Re~wl.i~it~ti.e Je~~ue~ FLORIDA ~TATE F~Lb ..o. IH\~L~:IRV t~ I!&~1]11 Tr~~, O2 ?RiNT ~N M1f~YMMR~tR~1tR~ REGIS:RA~ ~ ti0. YC~w1:.f:FNT INK OECEwSED-~+w~wE •u~~ ,SEx .OwTE Of C._ ..+ar~~, w.,~.i.~. SEE '1::.1:GOL FOt •srwnwrs , Axt?z:.ir nicharu ::e~~eth~, :+iale i, Jun~ 28, 1973 RwtE .~..r~. ~ww. •.u~e... ~.ou.., w'vf-..~v ~'~+Ce~ ~ .E.a ~~ai~ ~ o.r D~rE Of ~~in~ ~~.o..•... e.•. (GOuNTY O? OEwiH ~TC. 1111CN~: ?4~inG~~ ~~1~~1~1 rJ1 . Wf~ : wOJ~l ~~.r~ ~l~~1 . ~Jhite is.7b ~ ~_~:ar 25,1897 Stv Lucie ~~.1 ~ UTY• 70WN. Ot 1OG17iON Of pEAiM ~..iw~ c~n .~.n MpS?~1A1 Oi O7nEi Y~ST12Ui~ON-NM+F ~u .qt ~w t~tw~~, trr~ a~u~~ w..wt~ ~ : YkG~~~ ~kl Oi Mp ~ n F ~.~iexce \o Rt . ~~ox 1154 . STwTE OF ~:aTH ~ ~o~ u.s ~GR~ZE~ Of wr.~i CCn:rri¢Y wUtRC£D, t~fv;~c wu?R;EO. ~SUivlvr~G Sp1ySE ~ .rHe, en~ ....oe~ ...w ~ cw.~n.~~ ~wtDOwFO. -rvUAtEDwur.. ~ ~S-~.t1,~~~:~ Iorida :)S:1 ',e "~Yrx~~ i,,. I.aura Shiland .~ue o..e.u~ ~ - - - - ,..e~. a.u. SOC.nI SfCUA.tt NUA4ER ~ l~iVwt JCCUi'.~TiLk^t e...o o~ ~.r.~.a od.~ ..osr o. ~IU1VD OI WSYVfSS OR urDilSTlY ~::~t~lo w J~~~w -~~e. t.tn alr.~to i CZt ru~J .s,.,~:.~... ",E ''G3 1~ 37.55 uroct~c;r ~ .,:.~~»~....o.. ~y i~ - •~"silw. ~ 3ES1DEnCf-S%wii CGUNTY ~~-CtTY. iOwN.04lGCwTlpi: . wsw~ c.n u..~~tEET MD n1,w~?Et ~ s.[c~.. •~s w ..o.i :u lorida ;,.,St e Lucie j,.;!~ Pierce Yes ;,<< 1018 So 8th St e fwi~R-N~w.E r~~sr ...opµ us: ,MOThER-wutiOENnAw~f ~usi ..~wu u.s+ John F:elseth ij~ Agatha Gru~ tlVfO~U+wMT-I:AMf ~wui~rti. ACGRFSS ~sntt. o~ r.•.o .~o . at. o~ .o~». s:.re. lr. Lauya S. rielset:~ 1018 So ath St. Ft. Pierce, ~1a. OEwT~f WwS GUSED iY: (ErvfER Oti:~ ONE UuSf IER lwE fOR ~o~. (b~ ~t+D (c); ••~~o•~~•~+ .+r~a..; ~~Ifir(!h OMSII ~wD U~tw 11 ~+~~1~ 4Yaf DOA at emer~ency room, FP\~II-I, history of leukemia „ . ~o..ua,~.. zo.o...o,.,. , ..H~c~ ~..t .,s~ ~v ~ ses ; _.~a,.,. ar.uwe rwe r aa. t o..e ro. q.a . ee.~it~.t`t~ o~ ~...o e.uae a.sr 1 F"• L ~ci PwRt il. OinFQ SIGN~i:IANT CGNJ~SIO[:S. cu.a.t.Gws cow~a.~~r.w to w.tw •„r „c~ ~E,.rco ro AUT~ISY . IF Y' C~uN Grviw ~r~ IV1 . ~o~ ~ [S 'r/~t s~MJ~~.G1 GCH• ~Rf W~01 ' f:~/~i.~ ir~ Dlit~r~r~ r~!~ Uui! O~ Dl~tw No ,~«a;o'r~ w:C~CE'.T. SUtCi~E pl~ATE~f ~W/U~Y ~rqwrw. y~, rt.t~ ~hQUQ ~MOW IN/URY OGCUtAfD ~~^xea ~utru Or ~w.un ~w r~~r . O~ r~u q atr ~ ~O~a~G~E, OR ukJEi(iMU:fD ~ i t is~ c.y1 ~ t - ::w Err. N fmi ~r+IURY wT WORK '?.wCE OF W)UR~.~ ~~.e. srait, r.c*:n•, ~ 1 SrtC~~~ r!f O~ ~+01 ip~~ NBG .lK. 1f~[C~n. ~ I~AT:~IV t Si~lFt O~ ~.I.O. n0.. C~n O~ TO~w, ff~T( ~ ~ ' 13t ! 2J9 Cf~itF:C+~1~ON- .a.:w w. n•~ ' ~o~.m o.. .t.a .~:o ua~ s.. w~..Iw u~v[ oa ~ ao/~a'n~ .:er r«e IMTS~C~ara: TO ~.*w W~ tf~ I Wo~ .rie~ x.iw. 1 OEwTn OfeC~?Z[9 ~t rw~ ~.K~. G. n.f ro~~ ~ 7 iJl7 ~..t, ...o, .a n.t ~is* .,r~.oto \ever ~ ~7 I ~,~.,~q~ ..~..a~x~.:.~t i~a oe:e.•.ea ~.J+ '2p ~21a i7t1 ~u j7:e a+"^"~~n ~or..e e•~si~si s~.no. CE;T:f~Gi:p~~-rwFpwwl EzwHUVE¢ OC CO~CtiEl1 0.. ~~e ua~.a o~ ca Ko~. V G~~.. :+w[ OKfOe~.r r~o,.ou,,,ceo oe+o i~~~w.:.pr. O~ :~t ~D~ ~*.7:0~ SN +~rlSt.:~~'hti, ~w rs pl~wqr.. I Mpr~iw O~~ ~1~~ M:,rv ' J l. :.t+fn GiCa.~~/fJ G'. n.t D~if ~+D Duf TO Tw! Cn~rSl:1~ SJ~!IJ ~ f] Q ~•bb p~ m• 1"~ • M . 7h L M CERDi~ER-r+4Mi ~nn o~ .n..r, ~ SiGNw1U:' o[6n~ q uru ' D'wTE S~GhfG +-~o-.*~, o..,.i.., Hooshan Kadivar ~r1. D - :,k _ /.M:::ti S C ~tf' ST~ttz o~ tr.D. wJ. ro~rr. ~ s*.tt ~ `'~c'a~i ~or~h St. Fo ~ e FI 33450 3JR1AL C0.EMwTi~N, iFMpVAI ~CEMFifA1 GR Ci:MAZvRY-n,tntE 10C.~1lpN t.n w q~.. s*.~[ i vlan. ~ :ta ~ ~l~S ~j1~C',~.::<: L.t~.;:vi.El T iltc t'to ELrial l ` Pierce, Florida . i, DwTE ~..~+'w. w~, .t.~i ~ fUKE2w1 n0~-~.:u~ avp au'.iESi ~ srner o~ ~.~.o. ..o un o~ rorw ir q. tn i :~,.;une 30th, 1~73~,S~Ya~HS : L'?:Ci~~ ::a.:~e Inc ~i? Box77~ t~to Pierce, =la. Y. 5. f612 futiE.ui9RcGOt-i}''~uryrF :FG+S :tvI171iit . D.~R ~fCE.rED LOCw~ 4'GiSi4A! A~v.:970 :~s L i~~~ ~i •.`S/~ T!.Ii~~ ? ~ ~ ~ ~ ~ ~~r~~ ~ F11.E0 AND RfCUROED ~ - Y ~Y m+~ ~ be a trw and eocroct oopy cf ifit~ t~~ sT.l13CIE COUNTY FLA. R~;;:~trYs record on filo In th~ St. L,ucio CouMy Hrz;;h p~;.~} IiOCEF F0~=R~S l ~ f'~~. . r:s.^.rrt at Fort Pierce, Flortda. CLERK CI~CIitT COURT H,..,~•. .;;j;~ =r RECOR. VER~~'~E~ ' i ~ ~3?f ~ . . ;ti (Warninr~: Not valid uniess raisod s; sl af t~ L~p ~ ~ ~ - ~ ~d~d~ ~n~,? ~ ~ ~ g ~ ~ 36 AH 73 ~ • .r~,. G ~ . ~ ti~~ . ~ s' 1V. D. MILIR, ~i D. ~ f y"J•~Y N ~ G f~ ~ , - . , Nc~eelsla O::-~,:t s ~ , s- 7_ r ~ 422 ~ G~ rI 'i7:~-' ~ 7 3 cso r'i~~ 1 ~oe ; , ~ : :r. :,3 p~„y t~i ~.:,l~tr~ , \ ~ ~ ! A: ,'t S~--~ . ~ bo~~ 2is ta~~ ~43 _ j ~ ~ ~ - ~~~2~~-~ s ~ ~ - , ~ ~ .a ,,,v-~... . _ a _ < _