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HomeMy WebLinkAbout1925 ~ 61619 s-. 30 63 2 • bUpEI?U OF VITAL A'TATtfTICf lTATE FIL[ NO. ~°R•~ FLORIDA ~rA ~Aee BIRTH NO. ' REGI6TRAR'S NO. r o p e r 1~ L YfYAI R[NO[NC[ PM.r Mr.14.~ l/.w.rd..+~ A.rJwr b~• ~M.ww.) ~ a~culyd 1 K~C[ Of ~[AtN GOOi NO. l • •111 CO~JNTY STATE 6. CdMT• e. o~.~.. 1~rti - - ' 1 n re/- ~~ri. iOM11.0A IOC~Tq11 t. 15 K~CE Oi OfATN f. CITY, 7piliK.OR LOCA7qM t. K RESIO(NC[ uneO? . INSIOE CITY IIMIT51 1141DE CITr IIMIT51 1 ttl~. Strllc'~l~~i YES? TES MO ` hAMf Oi (Jj nN f~ MI/iNl. /i~t Ihu/ N/rtM) J. STIIEET ApON(SS NOS?~T41 W IMSTITUTIOM v ~I ~ ~r l M~nc O~ f7rN A!i//fe /w~t ~ DATf Mewr~ IN~ 1'~p °r`i?:•"n°•+.r~ HARHY ANG~IA HARVFY' a T" Jufle 26 1967 S. SEX i CO1011 O~ ~ACE ~ MA~Rrt~,~y MfY[II MMtlll[D 4 OATE Of ~UTN ! lG[ (It KV! Y v~0l~ 1~U~ ui.D(a l~ ~M'S. ru~ am~tnl Mw,4 A~w Nwn Miw. i a• 1'~19 Wh3.tA rnoowco0 avo~cco t'il 28 1893 ~ 7t~ ~ ~ p 1~ 1 n 1~ 10~. USU~I OCCVPATION (QIM ltAl ~f wrt {Mt 1~. K1NOOi W5IMESSOA M0115TAY 11. ~M1TNItACE lSl~ft M fNt y~ t~r~fr~l 12 CIT~IEM Os I~IMT OOt/1111i? •1th p~r- Irri~/wwtNrr~fphJr.enwiJreMrdl ••^•p~ Construction ~onstruction Pennsauken h'ex 3erse USA . bl~lk 111t q_ ~ATNE~'S IuYE ~ 1~ MOTME11~5 MAIp(N NAY[ Or ~~o••~~~•? Nar Harve Sara Fidell . li SOCULL StCUl~lit b0. p IM ~ HOMATY~t Atlrtn 262-03-L~6 Clara S. Harve Rt. t~ - Box 111 - Stuart 141orida f uN~ ~ tl 1~. r.AY{t K WfN (6i@~ M// Mt CNM /!f l[~t r? <SI. ~~I (f).~ INTEIIY~I KTK[(h - . d l f~ t t O f ~~~T ~~TM w~ ~A~D ONSET AIq 0[RTN .~~t f~~~ ~¦.Ea.,~ cwsc j'bZignant Melanoma I.eft Thorax srith _ ~ I, - j "r"•`• ~•~.+r•... a~c To 1H Cerebra ~'[e~asti$~s _ 1 T?lot'i~h8._, .~en t~• s~ka .fs~ r• ! I 1 e e a 1 ~r~ ~~r (i). ~ i r e~ f~ t r at ~~~M ~ py~ Tp ~ . 1 t ~ fe 7! 2 I/~M nue t~f. ~ov r• • t- o ?rur e. ono sic~w? ~o¦orno~s canrwnwc ro a.rM ~ur r~m ~cuno io rNC .t~r H•1 w?s ~uTO?sr s ~ R CER POiTAA r~sso~MCO+ t~r d~at? ~ or A~f~~• ~ 7E5? MO~ 20~ ~ ~ OESGII~f MOM uUU~Y OCCU1111E0 (f:wftr wN /M 1 ~ 1. •~kfws a~~ ~ ~CCIOEMT wK~a NOMKIOE ~~C at•ve•t- v O O O • tlon •f T~rE Or Hwr A(wM, M~. Ytr ^ ~ ?ed~. M1v~r w. ~ , - ~ W A. ~ 1Qf MJU~1/ OCCVRR(O 7ar ItAC[ Of 1N1U~Y ~t. is sr ~eu! ?~iv. 20J Clri. TOI~N, d1 ~OCAl10M COUN711 ST~~E ~ MMKE A7 ~ IqT 1MNRf ~ ~A• ~NI. MrtM. N/~.. Ht.l f ~YORR AT 1P011K t € 7 1 ~ft~nMd tM I~eMNd /?o~n 1 _ • fn . . ~ _ •nd /ut tir ~`~1:.~ on Z..~ _ W~tA oeeurr~d~f 12:00 NOOn m on fh~ d~t~ ~~~fed ~bo.e: ~nd fo tA~ 6~st o/ m~ kno.d~d/~. /rom fM t~v~~s d~~~d. ± ~11 1N~• ~~4~yYY~ (~yp~~~rtYk1 ?2M1 •DOpE55 u.~.o~TCSw~co ; •~e te 1• StiU=lTtr~ .r'~.Oi ~L'~8 6/26/67 ~o•v~•~• . Jdhn !i. ~unsolus M. D. ~ aeer~~t~. 2~ ~41.~r~t~ ~ pnrt Z7t NAMEOfCfMETEN~(iNCRI~~Tf.q~ i3r IOC~T~OnI(~~~.fwrw.e~tw~f~l (tir~ni ~arOnu lcpnpt 1 8urial 6 29 67 Fern Nill c:~meter;t Sfuart Florida ; V,~,~e]~ j~ NIE11At [CTOII SS1p11~TIME A0011E55 ZS [~~TE F,tCD ~YIOC~IREG 26_ REGIST;~IISS~GM~TWE ~ a~..,oee R. C. Johns Stuart, Florida 6/?_7/67 Blanche ~artin~ Peputy ; - --~--~-~--~-~r•~• _ `.lr.' ~ ~~~Il~~~ ~~~~ii~~ ~}r:r~by cenih/ this to bc a true and corred copy of the Local i Pp h~ ~ Reg~strar's record on file in th~ Marrin County HQallh OQpatt- ~ O -~w . ' ~t Z~ ~/y mcint at Stuart, Florida. ~ • t , ' ~ c -~i ~9~.?I. .~.r~~~ = . ~ (tiJarn~n~: Not val~d uniess r.lt5~d se~l of the Mariitt , ~ ~ Counry He;,~th Ccpartment i~ affixed.) 5 ` }..~~,S7~AR~ ~ i ' ~ t0 • ' ~ = y: .t~~ F R 10 A`•~~.~~,? ` h. D. ASILLrP,, rn. o. ; ~ -R~ ~ t BGJK~~~ PA6E1917 Cou~~iy ?t~,,t~n Oi(icer 8~ Lvcal Re43islral 3 '_9~. .r ~2~~~~ • ~ • . ~ ' y~ O ~ `'.,~~:~,~tit~ =~L_ t „ 6~P, ~ ~t~ ato Daputy local Regist~ ~ ~i~~i~iN~lilt ~ _ ~ ~ ~ ~"~~_,v~~~ .~w~ ~ ~.,::x~