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T,,, ~ CERTIFICATE OF DEATH ~ ~
c o.. s a (k~Nntwl ~1 IIt~III~ and Rc6abililallre $enrlces FZ O R I D A - **wT` ilt[ NO.
~~aal r~e- f11~'tSIQ~(M Ilf.~iTll •
erd •Aew ~'~~~'a~~~i1° REGISTRAR•8 NO-
p: o p~ r 1 y' 1. ?14t~ Oi O[ATN COD[ NO. 2. ilfYat Rts1o[NC[ ( ~n... ~.~....t n..t I!~+~~~~M.w: R~Jws~ Mw~ ~wiM)
. ~ a`: i i i cou«T~fJG1ARD ~ s sr~1cF`LCIRIDA cou~~~ BR0~IARD
Da plaeel
1 e O~ f- C~T11. TOwM. OR IOCATqN t. K IIACE Oi Of ATN t. C1TY. TOWN, OR IOCATqN f. IS NES~OEIKE
~IMSiOE CITY LIYITS? IMSIDE CITY IIMIT51
p'lantation rE:~ No? Fort Lauderdale .~s ?,o
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f. 1t4Yf Oi f//~~t iA lNpYd, pe N~ed Mlrea) t. STREET AOORfSi -
NpSMT~L W1
ptiT/TUTqM p~ntation General Hos ital S9'Tl N. W. 16th Place
NAMt 0? ~~t I~/Wtt Lslt OA1E A/MU , Dq Yt~?
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«~.~u~ GE~GE . WARD o*N Jan. 5 1970
B.
S. S[X 6 CO:OR O~ MCE ~ Mwlllll[O hEYER MARIIIEC a uRTN ! 4Gf ( l~ rts?a K~~ ~~W Vn0[a t~ ~S
r. i c• 2'iale Wh1te rnoo~co Q avo~cco Feb. 18 ~ 1~ 8 e"~u.r~ x.,w a,. e.... x... ;
y 1~ 1 n 1~ ~p~. YSU~I OCCW~?Tq+r (Girr tieQ ~Jr~rt 4se tdl .KtY00i ~US~NESSOR 1NOUSTIIY 11. ~fRTN/LACt (State N~Ntyw tOr~f+~) 1- qT~tEM Oi ~fWt OOUMt1lY1
• t t A p~ t~riw~ ~wt y rorli~eJ h,fe. ~nr ~J rd'ue11
••~•pt e f e ~lo ed Wood Patterns Kentucky. ~SO
E1 ~ek lAk FATMER~S N~ME I~. MO?NEA'S rAlOEN NAME
~,P•.~~~.~: George J. Ward . Nelen Anderson
16. SOCIAL SECUR~T~ h0. 17. tNiOAMAMT Afl~ti! • ~ aC0
~_34..9p51. Mrs. Vera F. Ward . Ft. Lauderdale, Florida
i~neral Ia CAY:t O~ Dt~TN E~f~r ~~lt ~R~ c~ru ~~r (a). ls). ta1 (v.] INTEI1VAl tETWE[N
d l i e t t~t I~*1 I. CtATN W~S CALSiD iY• /~~~~j~'~/r) p e^~~~~~n ~ G OMS~~ G[A:K
WMEOIATE CAUSL ~h / ~J / 4li ~GG .r.~,iVL~-t s-
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+ t t h t n 7= O ~AIIT 11. OTK~ $IGlafICMIf COwOITpKf COn~RtqlflNG i0 047N WI Npi R(L1![D i0 TME TERNIARt pSUS( COMOITpN GtYU1 Y1 ~Llt . W ~S A~TO~SY
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o r beLor• ) ~q. pExai~ ?qw u~~u~r oCtwREC- (ERru ~urr~ yi,~j~.~ is Part I a Fwt 1/ yite~ lt.)
¦~klwi •~1 ~ ACCIGENT SUICIOE MpMIC10E •
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i 20C. 1NJUR~ OCCUaREO 20r. t~~tE os iN~uer ~e. in v~eel ber, 20J. C~Tt/, TOYrN. OR lOGT10N OOUMTY 57A7E
1MNKE AT ~ p0T WMN.E ~ 1~~~. IectM/. M~tet. s~f[t DII/.. ~l:.I
~ Mf011K AT ~NORK
~ 1~ttended th~ dec~~sed /rom ~ , to Jan. S. 1970 •nd l~at a~ir h,m •1'r~ on
D~~tA occurr~d ~t ~.`~3_ _ m on fhe dst~ ~t~ted ~bore; ~nJ to fhs b~at of m~ knorl~d[~, lroin ~hs c~uss~ at~red.
~11 ite~s jj~ t TY11E •
a r e t• 1e ~ `~Y~«jJ ~Uft: 2ID AODRESS 22c. W?TE SIGNEO
co~plet• k ~ GGGG{i<-(/~
/ Pla»tation, Florida ~~G- `rD
~ c t y r a t e. ~~Mll. CREV~TpY. Z}S pATE ~t N~1~lE Oi CE?~ETERY OR CRENATORY LOCIIT~CN (Clf/. lMrw. M[04~:~1 ~~~tl
/ Rf~~t (Sptt~JY1
( ~ 1 8 0 Lauderdale Mem. Gardens Ft. Lauderdale F`lorida
` , , ~ 61$ 2~ RA1~9~R ; 5 S~GN~TU E ADOaESS pATE RECO. /T IOCAI pEG. 26. RE TRAR-S SIGN URE I
> e r . 19a ~ ~ F irchild Ft~neral Ro:~as ~,U, ~ / _ ~~~d ~
~ iM t u~ er~ a e Florid a i ~P ~
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_ , CERTIFIED COP'Y . - ~
I hereby certify the above to be a true and correct copy of the Local
Registrar's record on file in the Broxard County-Health Depart~ent at
Fort I.auderdale, Florida. . , , .
(Warning: -iiq~,valid unless raised seal of the Broward County Health .
- ~~:~'~~i~twent is affixed. ) - ~
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:;y County bealLh O: fice.:~ and Local itegistrar
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