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HomeMy WebLinkAbout2211 IflFtRItIl1YV ~!F!1[ U[fHN1~~~L~~~ V~ ~~~H~~~~ ""3 . DIVlSION OF VITAL RECORDS, 301 W. PRESTON SIREET, BAti1MORE, MARYlANO 1i2~1t 25 662' ~r. ~ ~ ~ CER?IfICATE OF DEATH ~ ~ ' ' ?b hOIK ~ ^ ` - r - t.~Mf F.n~ , klve _r-- ` lo-t _ Ic UAtE `3F DiATH . _ ' • p M ~ . • t^, c-.M) L. . f \ • : t ; \ ~ : , t ' MC'~tA , DCY YtOi ) i ~ l > [ .~'t ~2 \ ~'r i l ~ • r < 1 ~ Q r " • ' ' S~~~f GF 61RtH b AGE I~n yt:~s ~t ~~•~c~ j wat x~c: 'T. ~ t ~ F:(F IoSI p+it..c?) It.~ r. .?l .G.i: iri i'~ ri • a i2-25-1892 I ~5 r~; ~ ~ ~ - , , 9. coucn cF x~tx , - (:'ctt cv tae~gn :E (I111[N GF Y. .Ai (~_'N~RI S Ml.RCIED~ ~EClA~,Zi~~ED[] _ - h'as h. D. C, t1S ++•~ootiz~t~ G'~Lt(ED M.otttgom~~*_w y~ :,,~~ip~~i ~pj~i I i A:.+?4 C~F k05=i11Lt C~ l4'STI;NlGN~if nc~ ~n h~~f~! !2a. U.Ul~t C((UPAli~~ !i..r.u ~1 wuk ae: z i.l1.i~ Of EUS~I+E`.SOR -~A`" ~ - g:tiE i'rett ot.~.s5~ Coloni al ~/i l liil ~u+'ng ~t e f ~.r~ b f t, rr t n ~ r t~ r e d ) ~ K U 4 Y ~ C=. ~ S: lver Spring, Md. ,~p ~`i`eac"Eier ~chools _ r f~ r: - ~ - - - - - , G :[E):f'EAt~ iriAers aeteosed kred. ~i ~r•'t:.,! 0~. RtS. E~t E fTM! I S e. G 1 O R i u W N ~~T• Ix S1~EE1 R4D NU~:.c+(R i 1~20~3~~Rock Rd. o~L~CSv~i~~le i~:~d r nt. CounL- ~"ot] _ _ ~ L;•~-' G~- s~~:.xt F~~ ~ ow> - ?o:~ i5. wot~tK S ~~:o~r ~a~.E <<.; M~o:z i~s~ z'`~ . W C~. ~ , . . , . ~ z t. ~illiam M. Jahnson Sr. M$ A. S``-°~~i~~ ~ ` N ~ ~:r• ~ ~ ~e5.scuu«cuam~ko. i~ MtexwAw~ ~c ' .1~EG f1'ER IY U.S RIiMiD FGRCES 1~7 i~eW E tar~ pshi re A r- •,,o: u.- n .«xtv~ci,.•. ~ . r. ~ x"°"~"~ ' _ ' S77-09-838 - 'ur _ - - - ~ _ : t~_.u ~ ~ rCRLSE OF DUSN {[nter a~.'~r one couse p!~ i::z .=r (cl, ih). md (tl~ ~ . lRrFt+i.a~~ Our+ .=y ~ r _ r^ ' , ~ :.R'.I.:r[AIkWASfAUSfUBY: j. ; C`i:i: : l;.~(:!i.-• 'C' i cc-.-j? :tr' ~ ~ , _ IwN~DiR,E (RUSE (eJ : ~ ' : i _ r ~ _ ~ f : t~. ~ ~ -i-~v; .-~--c:. ~_~•r...rf r ~ 'I eL[ ro, t~e cs ~ t:~s:~c~ct eF . ' - } • i o- ~ c ' S c ~"1 / _ _ fr~ ; , p ti t .'ons,~#eny,wf.:!,gcrej ~ _ _ i'_ r.- - t ~mned~ett ct.~e 4t?,[ ~ ^ . . . i ~ ~ . ~ - . _ ~A ~ i ^ . + ~ ~r - i j . tkli 1C~, ~3c A) R U,tii:in:tti(. ~ ~ _ C y` 1~t l•n Ei~):r.p IOU:E( + .L' r ~ ~ ~ ~ • ' j I~i_._ _ ~ ' t' ."'i' _ ~_1 OiHiR S!G~~~KANi (G?w~110hS !Cf:fR'6~:.!.S 10 i.`.AtH 512: k01 REIAtED i0 TI~E T~KRIENR[ DIS:ASf CRCOI~li+1-0l1 Gt~'fM 1~ PART lia) ~ D~,, G~~ ~ • ~ . ~@l~t iF-.1+c:i4~s:-1 _ - t . j_ ; ~ ~l 1' ` : ; it _ j- ± i- -w ( t `i.ti':' ! C m i~: j , Z ~ -r . .t;' •C: , Cc-! "-f G'~ ~ ti-.^~:'y. ~ ~ C ' u4iE Gf QFffUT1~:~ I4._COkDIT~ON fOR KriKH OFfi~iKk: K'IISPf[FO~A~'3 ?Oo AUt4f5'f? 2C+~. if ~ltS. Wi[E ill~?".GS (0?SiikkEt~'.N.(E1titFYih'6 O A , : - UU~ES OF GEATtf~ _ ? ; YES ~ NO ? t/= _ ~ ~ n i'- i ~L - i~ - e(((~ENT M'RS UhDffuYlllG ?lb. i~.V.E th J!.~~RY 41c FfOW tN:JQr UCUkk[~ (Er.tcr ~atwt oi r.~.ry m Pv.t i o~ P;.A 2. I~e~n id) Q a~~ a C i ~?;epez.v, (]c ;+tE oF [t~?a HOIIR A A. Ar:.th ~3ey Yew ~ ~ ~ rr!!- nc!dy a.c9KC1 cua~inEr~ a.l! :4 i ~ "=!~,uRt C:(U1tf0 2{e P'J1(E OF 1li;J~`( /Ailf~/r! FaFq SrfE7.IKF}•_~ iN tOCAitON Shrt w. RF O. t i o. (ity e? iown ( c'~''?` S~='• m~1 f" ~~-,~2I-'IAO:w':x? ~~r,+Ff:4)~G[TL T ~li ~ i ; ~ n,.~iJ _ - _ !o - , 19•~_, thot I Iw•e t~~st `a ~ ~ ' ~ i cersijy that (I) ~snK hospito:~~~~~•~~ed the deceased ;rorr ~ ~9 , . ( ~ ) C ~ : ; sow the deceosed etive on~ ' 1 p=r-and thot in (my) (our) o~ini~n deoth occurted on the do;e ar.~ ho~r ar.d [com :~e L, 4 I ~ ccuses stti~ed above, (I) (we} (d~d) (~~d cot) vie.v the.bodv ai7er deoth. , ' _ i f , c ~ { .5 S 5••:R11rGE'_~ , , r ~ 7~t G~ 1 E S r G t:i D , j.w l ; _ ` ,f / trEl:~'1:, At:~ :IRfF ~ / ; T i ~ C ' ~ ,1, = , _ _ - r-t '_--'-r~ _ _ L'EGiiE Fi.~tS. ~ Cii~filGQ ~ PkYS. ~ • _ - ~ ~ ~ i y _ ~,s,,uv s _ - r J _ _ _ - . ~ r - ~ . T O ~ ` f~~ NRff:f ~i~Ei r- f ii r _ ~ i i~ r--- '~r~ O h{ .~i~ f , ~ t l : _ . , . ' o : : _ . ! ~ tp ~ r 1 Slfi'i! ~ 1 ! ( : _i -i. CkEM~11i~K, 43l. ~if~ 1_c !1~R! ~lf iENFi. ! 02 Ci!kRSO~. :3d O(~Si9N ((Ay a lor^j {(s~~j l ~ p 'J. ~ ~ i :,N~ruis~.,~~ - • ; F ~ Cnurch s' i j` +-~^^y~ ~ 7 Ci ~~?t '.•;ee~r_f.l ~ark ~`.@G:• $ll~ t Z ' I t U~Pci[TOQ ~ +~S , N Y`a RE( u B f~EG:S1Cl(JQt c 25E. : RA?. S S Gl~AT~.t£ i i E .:au2er s ~a~~~, i:c. ~•isc ~~e.~~. Fa G~ 1~7v ' : I i ~a S~ . L ~ ti+ '~?I` - ~ •i • - - _ . . - ' ~ 's-= ° ~ 259662 ! FttE~ AHD RECORDED ' ST. LUCIE COUMTY FIA. ~ ~ pnr.cp PAITR~S ~L _ _ - ~T ,j.~c. ' l, . Ju~ ~ 07 PH 'T3 a# i f x i ' ~ . _ _ ,a .r~..i'-~,r~., ~ x. . , ._r _ . , ~ _ ~.,r _ _ .