HomeMy WebLinkAbout0974 2~'793
CERTIFIED COP'Y OF DEATH CERTIFZCATE
OF CLAUDE J. JURGENSEN
IN RE: Lots 6 and 7, Block 4, SURFSIDE UNIT ONE, Plat Book 10,
page 17, St. Lucie County, Florida, public records.
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1. Pl~ce of Death:
a. County ~Y E
b. city QR08~[_~!Q t 1i?E ARK .
2. Nazne of Deceased ~~~E J~
3. Date of Deat ~~~Y Zg• i~
MA~.E Co~or IiM 11~ Age~ Birthplace A IRMI NaNAli~M 1 CN i o11N
4. Se~
S. Mamed, Single, Etc. i~ Name of Spous~ ~~E~~ -
6. Occupation ~ SS#
i Father's Nam~ ~ Mother's Name ~~R~~ ~~x - - -
~ ACUOENi (swc~h)
! SUICIDE
~ ~^~jaY 1~1dJ HOIMICIOE
f 8. Cause of Dea ~r`CT
i
9. Place of Burial ~~~Q~ ~DYE ~~~Y~~• ~'~!h iCN E tiAN
STATE OF MICHIGAN ~ ~ -
COUNTY OF WAYNE
I, ED(~AI2 M. BRANIGIN, Clerk of the County of Waqne and of the Circuit Court thereof~ do
~ herebp ,Cestify th~t I have co~parygd ~ye foregoing cogq of Record of Death as filed in my office and
recorded ~I:iti~r• . or Fi1.,. ?'~~"T~ and found the said copy a conect transcript thereof.
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~ In testimony whereof, I have he~eunto set my hand
"(Sg~~' and affixed the seal of said court thi~ i~
~ , . _ _ ~ 11. - ~ D. 19bz
~ ~ day of -
~ ` ~ ~ EDGAR M BRANIGIN, Co~y Cler
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~ 258'793
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