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HomeMy WebLinkAbout2501 _ ` - 2S9$$9 DA DF. COUNTY . ' = - - DEPARTMENT OF PUBLIC HEALTH ~ MII.TON S. SASLAW, MD. MPN. ; ' 1s00 N. W. fOUATEENTM ~TRE~T DIRECTOR ~ ~ MIAMI~ F~,Ai~IDA 33125 ~ ~ rk'~~ , , . "b'~: • - r v adt10_'G;~ iy-: . ; . ~ I~: ~'~1"~? B$ A TRUS COPY Cff Z4~ I,OCAL RBGISTRAR'S I~CORD OF DEATH. ~ : r ' ~~":'e ; .`-:'~r"..~ A m~ y~~ ~~~t } , ; r+ O f- ~ ~ . „S, . . ~ S . • ~ . • . . . ~ , ' ~ . ~ : .~'i4:~ ~ ~ f g~, ~ b;.~, ~ ~~d nnless the raised seal D PUTY I~GYSTRAR ~ r"~=~,y' ~~•~Bureau of Vital Statistics VITAL I~CORDS ONIT ~ ~ . . t ~ ~ a~•: ~~3xed. ~ DADE COONTY HRALZH DEPARZl+1BI3T : ~'+z` 0 ' MIAMI, FLORIUA . i ,~.r#~S~t~ ~ ~ ' \~~~.....:.a-'• ' " { ~ CERT1FICATE OF DEATH ~ _ ~ I~~~wrh4~u1 u~ ~~ta~lb ~nt~ k~ti+~.i~itatice ~rrrirea BTATE fILE NO•~--- - IM~'LV11V /lf IIFA1 (11 F L O R I D A • I~ x' ~ . aa~vs•rtuR~~m~ REGISTRAR'S NO. ' Kr ~'LF~iFO-NAMf r~~s~ <•sT SEX OA)E O~ DEAi1/ +o..w, o.•. ~u~ ~ ~ _ Charles S. Stevens , Male , October 13 1972 ~ ca~.E ~~~te, r.eG~o. ~.~~~c~r~ ~.+oa.+:, wGE-..s~ uww¦ ~ R~~_-- u~+w~ ~~.r_. DAiE Of SlfliM ~~+~x•r~, D~~. ~COUNTY OF DfAlH ~ s.ru.~ a¦mo • ~.eus~ ..os ~ w.s ~~,n •e•~: t , Z~1E:ita 80 u y s: 4 ~ Dec. 6, 1891 1,. Dade - Ci' r~ T6WN. OR tOCAl10N Of OfAiM u.a~oe un ir~n MpSPiiA! OR OTHER NS111UibN-NAME ~.or u. ~u~U, ont 5~een •..c ..u..u~ • SHC~~~ •tS O~ MO ~ idorth Miami Yes I~orth ZLiarni General Hospital _ - - - - - - - - - _ _ - - - - - - ~;'n~E OF 6~RM i~• ..nr u. u.s ~,~~re CIbZEN OF WMwI COUNTRY' AuRR1E0. Nf~ER MARMED. ;SVRV~vNG SPOUSE «u~. c•i•~ .uiw~+ ~ cpn,T¦r, WIDOwE~. GrvORCED : s?ecN, ~ _ ;eor a ' U._S.A.- t~lidotred . 8i---- - - - - - -1 - - 5~:~~i SECU~TY MiMbfR JUSUAt OCCUPAiION ~a.! awo or ,rn~i oo..t ouur.c +osr ~KWD OF M1SWf55 OR IhDUSiRY vrO~uK. nlf. Mw u ~lw~tD ~ 261-01-5920 A ~~f Sh~ Foremar? - i~~_Farm Eauipmerit =!S,~Er+Cf-Sr~rE COU~+tr cnr, tOww. OR IOC~tiOr+ ~~~sme un <<..ns StREEi ~NA NUMLER T _ . o. Flori da ,p ' Da de O p a L o c k a l,~, Y e s 1 1 3 1 P e r i S t r e e t ~.~•.•ER - N~YE n~S~ r.Wi[ t•f* MOTNER - MAIDfN NAMF nr.r r~[O;! :•e• . M. E. Stevens (Unobtainahle) ~~~?.hORMAt1i-NRME MAK~NG ADGAf55 ~snetr o~ o , c~T. o. ,oW.., s,.n. 7~r~ N:r. John F.. Stevens ,~n 1131 Peri Street Locka Fla. 33054 •?I~Ct~r~iF "~rl~:~1 ~ DEwt;f w~S CwUSED Sr~ (EN?E~ c.~ar ONf C4USE IER !Mf fGi ~oi_~,bi. tf:D tcl' ~~~y~fti OnSf1 u•~ .7!•rw ' ' ' i.wrtO~~t! C~u:( _ ' _ _ _ ' ' ~O) ~ .~.~w/i~ ~ v • / { t. ~ ~^~'t~ ~ ~ _ _ --_r~ . ~ ~~5.~1 ~ :•J•.u~iuf~.`~ ~~r i ; -ov:~..o•al. n i Ipl ! _ _ _ _ . . _ ~ ~ .fl ~ / S ~ ~ ..r ~y'iw~~S•e.ni' out io.t~:s. ~~.v•.:e...e o+ ~ ~ ~ (q ~ ~ . : . .uze - - - ; ~ - - - - ~ - ~ . , CTHEi S~Grat~K~Nt CONDItWH. :~c:nc•.s .o-.~n~un..c. •o or.+~ ~,~r ~,r •nr~c .,~s~ .-.r• . .a• "AUiO?Sv i If 11E5 rt.r r~..o~.~~s cc~~~ ' „ei e. ..o, s+oe~ec oere~.~ ..vse ~ d oe.~~ i , ~ ,Q.~v C f/,4 ---1.. I~o ~ ~ ! ~GCIDE~~T, SUK~IIE ~f T1~TE OF ~N1URY ~ ro~~r~ n..!•• M10U7 E HGV~ IN1Up~ OCCURREO ~ t~.rea n~fV~F •iI :w1b~~ n+ r.~r ~ o~ ~~qr ~,M -~:~E Gt U'-0FTERVP:fD } C'- . 1 I ~ -L«. M ~ ! r~~UR ~ ~f wGRK - -j-iIACE OF iN1JRI . s~n.. .~_i.,~., IOCrTlO'~ s•ne~ c. ~ . ~ . _ . D~ fOMN. SI~lf ! ! SI[,~• •FS G~ ra7~ ~(l/~!:/ NCf:..lT[ +SIf<•~ 1 ~:4 ~ :c t~ATN1\- ~!~'.~ti D~• rt~• ~ rnr.•w C~~^ ~ ~'S~ Sa ~«f~ •l:'~! ON ~~~sD/~ [ rX~t :~~5~ i!{DFwi» 6GCUiifD wf MF ~u(f. C.w :ri ~ ~ r','> C N ) ~ /~J~+TN 0~ tU• ~UO Itlt Of~M ~ o.n. .~c~. m w ur [y•.~•. t.~i ~Z].,~ / L'O l N Jt / Cf Yt ~MOtrll(K! DVf ~ . F i 7~ J . ~l' rn _ . ~ 3 _ ~ ' ~ L17`~ M ro rn~ u~s~ su"= ~-E~ I"IU?ION-N.EDK~?L EItAhUNERC4tCOkkOtvEa~a. •~e i.ti:ti o• ~~e~ »o~~.:~~ ce.c.. i~~e ~e~~u«c ~_.s .u»o.~.:~tc Df~D F.~.. -V O~ MI l~D~ ~N~J~G~ ~N( le~'~fSi~.~'Y.Y I O~~A..:'., ~`ltiiN C~~• •1~• MJ.~ ~ ~ : E ~'-~•'•C~~HL CM ht J~:f ~MO OVE K) 'n! (~~SE ) ~t~~f0_" _ " _ _ ' _ _ i _ " _ _ _ ' ' ' ' ' _ f M. ~ J2? . ~ ~ EFS;oicr NAME ~v O~ rr..r, 1 SlGNATIiRf ~ c~r.~le ci nq~ TDAiE SIGD~ED ~..r..aw o.• ~1~~~ ' ~ ' ~ ~ i7 :'A - - - !/~--f ~ ~ _.r, ~,,c~r;.y'_ 11~ / y 7 L ~ t ~ . , - - a_t~C-l J - - . . r ? - : ~.•~G ~pDRESS-CfR ~irfR ~ i'ae' o~ o~o un c• ro.•• s-.a i z T 7 C 'J l/~'-t--` l~, f4 ~.i~7 ~ ~G, ~i C/ :~41 CPEMI.i3pN. REMOVAI 'CEMEIERY R CREa~AI(:RY--NAME ~lc3C/~tlpN nrr o~ ro... v.~t ~ ' ~ ' ' . . ~ Cre_m~t7~on~-- ~~~?~a~'QVe. Park_-CTematory - .tiami,_Florida-------_ r :~~~7E o.., .eu~ 'NNEQAI MOME-- NA~tE AN9 ADC~ESS ~ 1~~!!t Ot ~ ~ o ~o . C.~r o~ tO++M, St~~f, 7r?i , Uct. 16~ _1972__,1 Bess Memorial Cha el 90 N'+~ 16 St M' ' Fi ' _':E~A~ I - IAlURE RfG15IR - SIG~+4iUif DATE ~ECE~~fD ~Y IOC~I ¦EG~SiRp¦ l '_'~i'. 7M )N ~ ~~L~ ' s ~ a ~ °N~',6 ~ ~ s~ ' („'f ~ w J ~ ~>4~ ~ RE: The South 42 feet of Lot 5 and the South 42 feet of the West r' 27 feet of Lot 4, of Block 2 of Oakland Park, as per plat ~ ~ _ ~v - d ~ of said Subdivision on file in Plat Book 2, at page 7, of the ~ Q7 public records of St. Lucie County, Florida 7 U ~ ~ C~Q ~ ~ JJ[CWfr ~ ~ ` N ` ` ' ~ ~ ~ ~ ¢ o k z~s Y'~~: ~~JOz E~CK ~ ~ - ~ ~ ~~>~=~~~.T ~~A~ rn~ : _