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HomeMy WebLinkAbout0261 2f~~?~.0~~ s~~,~~~'`~~~~~ • .~.tq~~ c~u~r 26~40~ R4f'^R ; Y: .r. ~ ~Q~ ~w ~ ~ 1 sa ~K'' ~ / r~ _ _ . . . . _ . .~Y.~ . . , . zes~ e.- S'fATt eowao o~ Mew~~+ ~.:=RTIFlCATE OF DEATH ~~•~s • ruaU?u or v~w~. ~rrwT~a~nct arwTS f.~s Ha '•a•l FLORIDA p~oD~rl~ BIRTH NO. REGISTRAR•! ?i0. ea~cui~d ?tACE 0/ aEATN COOE NO. 2. utY~t RtNOCNC[(ra...r..r.dpr~ !l.ww...: R...~w..W~~.r.w,..) 001iMTY Si'ATE I. COiJMTY ; Saint ?ucie~ b6-.025 • . • Iq CtTY• TO~IfN.O~ lOG1TqM t. K PIACE OF DfATN t. C1TY. TOMtN.011 IOCATqM t. ~5 RESlCENCE ¦~~~~t ~NS~DE 5~ UNITSt lhS~DE S~T11 UM~TSI r,l.. cort ?ierce YES~y Nop Foi-t Pi.erce rESp ~o? ~uyf Oi (!J ~M is W~it~I./irs Wuf at6au~) t. Lf~cGTN OF STRFET AOOIIESS ON A FAI1Ml MpS?R?t 011 ~T1TY7~+ Ft. riez~ce ~~em. riosn. ~Y~r's 610 S. 12th. Street YES? ~oL~ ~ iunt oF FbN Viiete L..r 1. wT[ M.aU Dq Yso oceuus c~v•• r~~ I:s.:ille Agnes rord o~T~ H~ril 3, 1962 S. SEIf S GOIOA OR ~ACE 7. MARA~[D ~ MEYEw MA1tR1ED~ OAT[ OF ~INTN 9 1~GE (Iw ftv1• K tADE~1 t PiAR ynD[R2t Wtf. IYIAitW~/1 XW~ Mr~ Ywn Xb.. ~ t• : e^.31e 1 r?hite w~oowcoO ava~cco Feb. 29 1886 ra ~sw1 ~ 1a. ~y~ATpw (Ci~t 4i~[~JrMt fi+It 10~. KtNOOf WSrKESS0~1 ~OUSTRY Il. WlTi4KACE (S7dt Mh/ti/q tNt~l/~l 1, pTIII7i Of wW1T OONA7RYT .ie~ y•r- tw+~I ~wt ywrtfpqk.aes ~/~s~uN) ¦•~•p~ :-iousewife Cleveland Ohio U.~.A. ll~et fq! ~ATME11'S NAME 1~_ MOTNERY MA{DEN NANE O~ ' ~~?••~~R•~ Unavailab~e unavailable 15. Nn3 OtCE~SEO EYE11 W Y. i ARMEO FORC[S~ 16. SOCUL SECUR~TY ?W, I7_ IMiOR t N61Y1TY11[ J. Yj. : atZ S 1!'r. v. w~r.~/ U/ M~ M' wr r f~Y~ .rwsl \o ~ ~~u•u Ft. P~ erce r ~a. Fun~?~1 Il. C~Yf[ 01 OtATN I~~ ~i pr liu/6r (01. {a). taf (c)•) IMTERYAI 8ETN2Ert dlf~<t0• ~ARTLOEATNM~SCAYYG~Y: ONSE7AIWOGTM r.~. ~~~couTC uus~ c•y Retro~eritoneal Sarcoma -•_os. sirie.z. cw~t'r:,..~~.... a,c ro ce~ , .iee u• .ra;ca q.e ru~ r• ~ . 1 e e•~ ~Da~ raur t~). C [!t ~wlrr- +1ts1Ar72 11i~t~kat Iasf. ~ TO (t) LOw~ i• t- ~ _ ratr u. Or~w S+us~u~? ~.o~oirwas taaauurac io ourn sur ~qt Rcu~[o ro rnc turwca~ oisrwsc CanirqN wr~w w?u~t . w~s AuiOVSY F- IFAfOAMED/ - c~t C~at~ ~ . or D~fer~ ' 1'ESG ie~w,w~ IDO. ocses~ac ?aw uuuer oeeuea¢o. eE:.rrr ~r.v~ y~w/..r P..e tw P.n tt ywe~ ~e.) ••r4•s ~ acuecKr wKioc +w~,cme " •yo~f- u ~ ? ? ~ tDc TtrE OF /!N? Xpt~, Dsf, Yto - •~d~• ~ uuuaY p D. a. W ~ 20L. tMliiRt OCCYi1RE0 20t. ILACE OF iNiUAY (t. p., ia ~r Mput io~tt, 20j. C1Tr. TpMIF. 011 lOGT10M tOUATY STATE YMLLE AT ~ ?pT ~tN~IF ~ N[ta~, rtr~d. o~fu Gf0-. ~lc.) MORK AT M~WtJ( 21. 1 ~tt~ndd tM d~~~d rom ~:u 1~~1 , to ^gi 1~ ~nd /ue wr h ~~lir~ oe~ ' . D~ath oeevrr~d~t m on tM d~f~ at~eW ~Aw~: ~nd to tA~ Mat of m~ knorl~d~~, /rom th~ e~w~a at~t~d. •1] lt~~s ~`~~a •r• te 1• (~i+« a tLk) ?Ib ~DO~ESS 72r. ~7E S:GUEG • ~e.p~.~. . ::elvin i~'ol~co~~sky, ::.J. 8C8 Orange ~venue,: t.°ierce !:/9/62 ~CCUT~t~. ~~i~ ~TE 23t. M~K[ OF CErETERY OR CRENATOR~ - 13/. LOCATqh jGlt/./NCR. r KraIY! (S~le) ; rtcra.~ c ~M ; ~e.~ova~` c.~3-7-62 Ca2va. Cemete Cleveland, ~hio { C. S. j612 2l. Nr.EMI ~5 S~GNATYRE ADORE55 25. WTE ItECO. ~Y LpCJ1L AEG. 26- 11EG~STRAR'S S~GpATU1tE I a...,oas Jose~h ~I. Yates rt. Pie: c::, Fla. L~-9-o2 A.,na I.ee Ler.isan, d. r. ~ ~ . i k ~ i ! F ~ . ~ ~ ; 1 heroby oortify thk te be e true and oomect oopy aF tfie Loca1 ~ Registrors record on fite fn ffi~ St. Lucfa County_ HoaF~t~ Dopcrf . e ment et Fon PiQrco. Florida. ~•C, ~ ~ '~..\,,.i i (iNarning: (vot valid unlest raised scal of the St. Lucle ,1~~"' = Couny 'Health ~epartment is affixed.) ~ ~ . : ~ ~ ; . - N. D. MIILER, AA. D. ~ ~ - ~ Co Heaith Officer b loca) Registrar . ,r - ~ ~ = E - i`/,>~:'Y 1~,~ .S = s ~ 3 ~3 • ~ ~ R Dass De~wty locsl Reai~f.~r / ~ ~ \ 4 ~ ~ ~ 3 ~ ti i~1~~ t x - . . \ - y.'. _ - ' ~ . ' _ - _ . . _ . x~ ~