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HomeMy WebLinkAbout1771 ~---~x't: ~,w~~ ~OARD Or NGLTN CERTiFlCATE OF DEATH y?~ ~ - • ¦Y11~/1V O/ VlTAL ~rtATlrTltt lTAt~ ~ILR NO. FLORIDA e?d •A~w e1R~H NO ~ QtOliT11AR'f NO. p r e~~ r l f 1~tt O/ KAM COD[ NO. 2. W VAl RtNO[MC~ l N~ ~rr.I ~...r !!.ww.w~ A~+a.w Wr~ w..w.~.) •a~e~t~~ ~pyM7r - O • StATE ~ ~pyMTr .~a ~ Lndi an. e e. C~T1. TO~~. WI ~OC~TqM r. K ~CE O~ OEA~ t. C~T~. TOMrM, OIl LOCATq~ t. K RESID(~tC •~a~wR IMSfpE C1TY UwITS~ ~wS~O( C~n? l~~Itr ftl~. QQX01~~. rE5 MO? ~ Vt Mp~_ f. MA~t[ Of ~!J iw1 M ~N~it~1. /it WfH MbfNl ' I. STI{EjT ~pp~CSS . • NOSlITII OA ~s,~t~?w~ sa R~.aer- ffos - ] lu?M~ O~ /'bw Aluft~ L«t • o~s~ XraM /w~ Yw nr«r~j ~-~1113ea Wf113saa a"~ 2 2 68 ~ S SE1I ~ COIOA 01~ R1K[ ~ MM~IED MY[A YAl1A1COO ~~TE OF ~111TN ~~G~ (I~ /fY1 1 iW {/i10[~ N MS f Wt~fq) M~~ WM Mwn Mw • . 1 ~ . Femnle . ~ _gegro ,~~oo ~,~~0 4 5 04 ~ ~3 yl~l~l~ ~a yw4lOCCU~~?q4(OKfli~/~/1tM~/Mf I~D K~tipOi~YS1/1ES50111NDVSTI!? il ~r+eTwK~CE1S'drw/Mey~c~~tr~1 1 M 0/ ~{ATt~~ • f t~ f~rt ar~?1 ~ ~p, ne~ ~J rttaN~ '~o ~e~~e Rone Florida U.S.A. 014tk l~t ~.~ATM(A S NAtl[ 11 YOTNCII S M111Q(M NAY[ •f ~ t~'~~~~~~f i~ U HCU11~T~ tq 1 1 t t10NAtYRt +o _ _ ` ~ I l~ d-~ ~ ~ ~ ~ N• ten~?~1 1• C~Y~i OE ~tATN n• ~s~us~wr>a /~.IS).1~~.~+~1.] • ~~TE~v~IIETtK[• e t e~ e c~ r ~~A~ 1 O(~~N wR5 C~t/S[D ~T' L ~ D ~i ONSE? A110 O[~TM •u~t til• IMYCqA~t C4YSC U) 7~1~'_LJ .t~i(r~ ~C'CG_ _ , _ u• c~r- / ~ • titie~t• C~~lYIMbI/~w~. Out t01?) ___c<~~j 1~ O~ ~~~.'V •lts t?• ~ ^ ' _ - ~?it~ ~Mr ru~ p - 1• e• 1 ~Awt c~a~r li). 3 K f~t t~/ri- r• lat?~r q~M ~~rrr fW. ~ TO (It---- . - Ae u ~~•a l O IART It ptMtt SKrlf~tut C ~0'6 COwflrMrtwC to pU~h ~11t wpi ~[URO *O nH ~tw~RJtt OtfUSE CO~O~nO~ Wr[M U ~M1 1(U M~S AUTO?SY ~ c{/~~ }J- • KRiORU[D~ t~t Nat? s ,RO'S S'=~ ~ l~C~/ _ fES? NO~ er 6~f~N ~ ~ 2a ~ 20ti usc+e~s[ +a~r uuv~~ otcu~~EO f E~ter Rrx?a3a~}~i rt !"r P~rt 1lylr~s If.) •w~ ~ ~cuoceT wKeu NorK~o~ ,..t- ~ O O O ' .r ~ - ?ed~. v 20r T~rE Os !!w• A/w~~, Itit. )'~a 1lUYRY 1- ~ A- W = 20/ MUYIIYOCCV4R(O 2Dt 1lACE O~ IMJU11t le. t~ Y?yrf Mwt, 20J CtTr, Tpl?N pR IOCAT~ON t01JMTr S*R~[ wwK[ ~T ~ MOT 1MM0.( ~ NttN~. Mrret. ~Jltt Df//.. t1t.) ~ . MO~R tT MORR 21 1~~ued~d ~A~ d~eus~Abow~ td.l . to 7L L~y1 _~ad b~f wr -R~~~1ir~ en D~~tA «ev?r~d ~r _ in on rh~ d~~~ ~t~rW ~bor~: ~nA to tA~ 6Nt o1 rn~ Ano+l~Ap. Iiom ~h~ uvsu ~t~f~I ~11 lt~r• ar• a• 12~ lIYNA7Y ~r~~ ~r ~4/t~ 22h AOO~t55 ~ jj~, p4Ti SK•w(O ~..~~.e. ~ La. ? ~ - ~ c-.r----• f ~ -~~.~-Z~47 ~µh.. f ~,hJ~rGjl •eeviat~. 2y ~~l.C711~~? jb T[ 2Jt ~MLOrCErET(MO~C1IE~~TO~Y 23/ IOCATpN/(y/.fNi~.MtM7U/1 ~Sr~~ R[rovu ~i 68 Pine Grove Ft. Pia`ee F'. ?.l.I012 21 ~~R~l W11E s iqKAT~)[~ ApW1[SS~ ~ 2S D+1~-(CO. l~t, IIEG ~ GKTII~R~S S~WA7y11E Il~~.IYeD ~~,~CK' 6 ~ ~ ' "I hereby certify the above to be a true and correct copy of the Iocal registrar~s record on file in the Zndian River County Health Department at Vero 8each, Florida.~~ sA~mX This is not valid unl.ess the raised seal of the Indian ~~~o°A N p-=e ~.=River County Health Department is affixed. w a ~ = oN<~o ; ~0 3 pT~? ~t~t ~ ~n = Fiti~' ~i~ o ~ _ a~ • ' ' ~!f il . ~ X~~ : ~ ~ ' . i ~ V~ -~-:;n . County Heal Dir. Local Registrar ~ ;s: . .y . _ ~ . ~ ~ ~ ~'~~`t ~ ~ 2593S r::~~ ~ .~~-~`2 . ~ . , Deputy egistrar , ~C~RK~~!! i.tir~~ ~ ~7..~: ~ ~ ~ r; _ . ~