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Home My WebLink About1954 i.~l/. 1 ~ ~ . • ~ , ~ ~~N''tHE CiRCU1T. ~pURt ~ ' ~OF MARTIN?~OUNTY~'~FLQRIDA F ~ L C~~.~~.. 2 59456 -.,t,1t r~cr; a. th t, ihe ur,~ersi3ned_ Cterk of the. Ciu~aii ,^.o;irt ~ r~~ and fc~F Alart~n Coun;Y..f!oC~ d.~, ~:ie ::.:in~• :,~,:c n~~,. ~i Coi t bf Reeor~, do h~r_'j~y C~~rt~ty ~,~~r 5~ PAGE~~[~s•UnS_~~~~a.~s,~,;r~" tru~ ar~d ~uN 2S 1911 BOOK J Circuit ~Court of hfar in ~L'o~ri15,~` Flonda n t~~~ ,r J~)Nt'j501`L ' . _ t.~0~1.1 ..Y L ; ' ti ~ , ~.r t ;ui.aGE ' . i _ Et~U~S`~ • 1/: 1$A/~G$,- t _ Clesk @~ . ~t'~'~ d . C. ~ate - ~ ~ ~ 7 3 • ~ ~1 w~/1~' ~ -1~ r - ~ ' CEt~TIF1ED COPY , t W[= NCI2EIlY C[IZII~Y TNr COPY REPROOUGED E3ELOW YO QE A TRU[ AND GORREGY t~Ctf+Y OF TNL' ORIGINAL itECORD ON FILE IN TNt: UUltEAU OF VITAL STATISTiCS OF THE ~ j i?TAYI: OF ~LORIDA. UEPAf~TMENY OF NEALTH ANId RENAOII.ITATIVE 6ERVICES. QIVISION ` OF t1E~?l.T?t AT JACK50NVIL,LE. FLORIOA. ~ INOT VALIU UNl.E59 TNE BtAL OF TH[ BTATC OF F101110A. OEPApTM[NT OF NEALTH AND HEHAOIIITATIVf iERVIC[Y, OIV1610N OF NEALYN IY ARFIkE0.1 • ~ ° 1~" , ~ • ~ AUG 2 5 1970 ~NI[I. ~UMEAV O~ VITAL ~TATIl~IC! " . ` ~ • ~ - •t .r ~ • ' • ~~~~V'~~1 ~ . ~ - eTATt t[GIlTIIAII; O~NCCTOR. DIYIiION vF ' ~ ~ Np1LTH ~ O[~AqTMENT 0• ~HfAL7M AMO ~ . ~[MA~~UTAr1YipN11VIC[~ . HTATE BOARD oF H~?~„+ ~ CERTIFICATE OF DEATH , 69' a 6~ i~•' BUR EAU OF VITA~. BTATIi?IC1 F L O R I D A STATE FILi NO. _ (?IpTH NO REGI6TRAq'9 NO ' rlAt[ Oi O[ATM GOD6 NO. 2. YtUAI M[SIP[Mtt(I~~...I.ewe/bn1 1•.uhh.r.•• RrJwaM~~.•lw..w~. R ~i~i~M~~ • //r STAT A C9UMTY _.~r~.t,c.t~?r_~ ~O - ' ~ ~r ~ A, C1TY. OWh, OR IOCAipN IS K~CE O~ OEATN f. CITY. TOWN.011 LOC TIOM t. IS RESILE tiCE INSIpE CIT~ UYITS~ ItiSlp( ptY ; v~~q ~vi~/O.~,lj t/Gc?_Qd ~ES ~ M~ ? S bC J~ YES ~-~-`J 1 N~Yf O T ~w Mfpi(d.1it ~lrttt ~f~rull STNFET ADDII 5 ~?1 . r MOSPIT~~ OR INSTITU110NS• / ~ S ~ ' _ - 3 NAME O! f1?I/ V~i1([ La~/ I. DAiE ~ bJoi1M /N~ )'rzr OEC[At[D Of lT~pt e? p?inl) O(ATN CALL E A--- ~g or~be.t_~9,1~9~2_ S SE x 6 COLOI~ OR pACE ~ MAq111E0 ? MEY[11 YA11111t0 OATE OF Y1RiM 9 AGE ( I~ /~v1 W~t~ ~ r~~~ uti~ a:~ .rK. (~Jf At~/ ~1 . y~.~4 p~~ Nwn Yu , ~ ~ ~q~? MIOOW[D dVONCEO? D ~ l i 11b ~SU~I OCCU?~TqN ~Qunr~n~e/~cat ~o~~ 1~. KINOOi WSWf55011 Y10UST~Y 11 S~RiN?L Sl~te M ny~ [N~~/~~) 12 C~IRENOS ~~Mt COUMrAr• : D~n;p wat o/ w~~~I h/t. etts iJ rtlvNl ' ~ ~ f~i G~ / ~ . ~ 1] fAlN[P 5 NAME 1 TME11~ YAIpEN ME ' f j ~ , O r i ! ~ '6 • Ul SECUR~TY NO 17 IN~ AMT f fIC TYA[ A!lrn~ ~ ~ / {0 CAYL[ 0/ O[ATN ~h:~ftr ~pl~ t~~Mt Dt/ h~t fM (~/SI_ ~a~ (tl.) INTERY~L BEIWEi• ~~IIT 1 OEA IMMEOIATEV C~USE _S[BI~jL~\L~LGSP~F4~l1Gll~__L2iiL~.~4~ - - 'y ~ OEATM J d ~ Con~ilioni. ~I~wI. OUE TO (A1 ~ - - - - r~rtA o~rt na{ t~ - a'far ra~~t (~1. ~lann~ fAt q~Crr- Obf TO (C{ T /~in/ t~pu 1arf. - - - - - - - - - - ~ - n ?ART It O~KR 514MiK~lli ~O1/p1ipN5 CphTRl~Uiitlf. i0 a~M OUt ~ql IILlARO ~O ~M( R~YIN~~ pSUS( CQNp1110N Gry[N t/1 ?Mt 1(A) ~~W ~5 A~ TCC,Y . ?(RfONMEO~ < ~ res U w L~ ~ t~'.oe,e 1 206 oESCe~sE noMr wupr oCCUR~EO. 16~ler wNrrr e/a)rr~ 1s P~.t 1 a Pat 1/ y Ue~w l~.) r s ACCIOENT SUIC~Df MpMK10E V ~ • ? ? f ~ 20c T~ME Oi llorr A/onr~. l~a~. F~u - - - ~ - - - - - - - ! ~ INJUAY O 7n. v ~ ' W D" ~w. i0Q INIUAY OCCU11Rf D 2Ol. ?I~CE Of IN1UAr It. fA M t~OM ~~it, mf CITY, TOWN. ~ IOCATpN COUNTr Si~~E ; ~ wNn [ sT ~ noT wHilf ~ N~~. Neqr~. Nr~d. ~~fn Yd~ . de.l . ~ . ~ r110RK ~T YtpRK . ~ z~ /~f~endedfhedeceu~d/romFebs19~1969__,~oDQc~29,19f~.,,d,.,~,.. ^~.,...o~ ~nc.28,1~G9 ;xi De~M o~cuired ~f _T_ _4 i~7 S~ m on ~Md~t~ ~~~~~d ~bo?~, ~nd to th~ b~at o/ mr Anorl~d~e, from tAs uwe~ starsd L'o t10NATYRC ~ ;yi (!XO?t[L~ IY - = ?~b ADDIIESS ' ?2f D~Tk '•u:MPO • ~ ~~~!'1`~ ~~.~~•C%`~%y~~ . Sonth Florida St~ e ~ ~ ~ qi+. 2jJ' DATE • ~t: N~VE O~ C MET(RrOR CII[N1ITURK : L~ P .~u CAEM4f ~ ' • ~ IjA l ATqN ((Y /er~s. w rouni~l (~[an• ~ r~ ~ ~ ~2:: A~ rOY~I 1 ~l' ~~r~ s- ' .i p / ~ /~e111 oYJ _ l.Z--_~~~~ ~"'C~i' ' ~ 7` ~7 .~,C,J , ~ Z~ F;n~~ e~ ~ CTOp S S TyqE AOD~ ~ j DAT[ R[C0. ~Y I{k II(a. Z6. 11EGi6T A11 SK. ~u~ ~ ~ ~~G ~ a~ ~ , 2 /Q6 ~ - - - - - ~ ~ ~ ~ ~°o~K 216 Y~c?1955 ,~a °~asr' . ' ' ~ . ~ : ~ , ~ p~ *r _M. . ~ . `~°'u''~',.