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HomeMy WebLinkAbout0042 . . ~~19 _ y/ s-a~9o , , • - .T~n .o,?~ a, N~ CERTiF1CATE OF DEATe~"' e~~~i • /UNt/1U OI YfTAL RAT1lHq ~ fTATt /tL[ NO. + l•s•l ~•e- - FLOBIDA - eN ¦M~w et T N. REGt~TAA M. p'~~~'l~ 1. KAC[ N~tl?1N GODt N0. t WYAI A[MKMCt(I?~wl~r~dYr~R !/f+.r:rr~ MU~rMlr+~ta ~ •i~art~1 ~ ~r 3TATE OOIMrt~ ' •~t •ill ~l~e~~ ~ CITt.1oMM.011 ~OM e. ~s RAtc oi n~ a aTr.?o~11.011 tntAT1011 ~s IIES~otl~Cc 1¦ IMSWE GT1f LIYITSI IMSWE CITY 1IM173i . s~~~~t ~ ~O 11Ei Iq rii•. _ R~t~ w ~7..r ~w. ~re w«e.w.w) ~ s~cir ~oo~c~ .smvno~ NY~[ N Fi~t It L~M mtTE XwM A/ Ysr oi c ~ * a"TM 1 1 6 ~ ? sac s. axo~ aa iua ~ a~ as ~ t_ ~cc r~w s u~ ~.r~. ~.on ~ ~a rNUEO Ntvc+~ ~o a~e wwa) r.w. D... r~.. - t a • • rroowm o~voRtta ,••1i1 ~ 10.. usu~ ooaM~rwM `OYe ttM y...a iwe IO~. Ilra w~usrtif oR NOIIS*~r 11. wTNwAC[ t8rw w/M~M~ e.1tMn) qnm~ ar wMr aoU~111rr .ts1 ~•r- Ivhl~weMwrt6yp/t.~~/~~i~fl •~ss~t a llalt !at 1 iAT~EII'i ~u?Ilt 1.~~~~ . •r en•.r! e•r St1u rns auu?sco cvu w u.: ~urco w~asr K. socu~ scauem Na Q. w s swM~w~ R. L. Ba2'Lon ~r......~.r....~ u~....:....•rr..?..w et Ir~~r~l K iAYS[ N KI1TM [~Wr NII w prr }a We/r {N. aN lH.j wTERVAI ~E~EEN ~1 e~~ t~r fART ~ OEATn RAf CYlSEO rY: 0~6iT A~ OEAin .r•s tsl• w~ONT< N1 e~• ••r- . ' slt~ •tN ~ •'r/yo~~t• 01J[ TO 1 • ~ • 1 ~lwe s~wr (~1• , ` r~~t~sr~r ~ h~ar 01IE To (e) ~ ~ . i a~ s~ ss ~ ?~uT ~ aNae s~+srrrt co~wnaa co~wrt~s fo outw wir ~~unn ~o nt ~u~w~? atu~[ oo~~no~ iwa n w~r Ky - ru?s ~utorsr j : ~~~r• •t- lE11POnMEO~ ~ ' t~e h~t~ s ~ i .~.fYr.f7 3 •r 1~t~r• i 20~. ocsurc eow ruu~roonautca l~nr ~.n.~ y~v~ 1~ ~rt ~r Pirt ytre~ u~ ~ ¦.ti.= ~¦s ~ nonoc~rt witwc Nor~aac ~ O ? ~ ~ me. 7~~OF Ilwn X~N. Dp. Ysr ~ a ~ 20/. w~r ootviuto mr. rutc os auu~r (e. s•. h r.D..t b~.r. tol• pn. Towr. 0~ uocwloM Gowr~ ST~T[ ~ 111N4E AT ~ w~r rnac ~ li+~.J~r. raue. N~ee a4•. ac.1 MORK AT ~K 21. J~tNnI~I tM/~ewNlhos~ ,Tl~T6~.--• to ~~~~~EiS ~ndl~rt~~ A s ~lin°n'.~~ 'T'"~ Dwth oee~rnd ~t ' ~n on ~M d~t~ ~t~t~d ~bw~: .,.r eo r~?. s«~ a.~ t.w.r.eN. /rewi tlw a~w~ ~t~ad. ~ ?l~ ft~\• MOMATIM[ (De/nsMtYk) t$. ADWtE9S 7te. MTES~GMED •r• t• 1• e..>>.e. • a 2 6 ; MJAY.C~JMTOI. j~. OATE Z.1t- NAMEOFCEYETEArQRCREMATORr j~. IDCATION(LSf/.b~f.MpM(I) ~8~t) ~ . 11trOr4 (8/OC'4?~ ' s. ts•s u. ' Yst~O1~'leral Home a` °"rc ""o. "x" ?s' ""~sr"u`^s s~un~ ~ a••.=~sa 6 /?nna I,ee Denison- d r. flLf D AHD RECOROEO ~ ' St. WCIE COUMT1f FLA. . RBCER PO~TAA~ ~c~~ ' CIERK C~RCUtT COURT ~ V RECORO VE?!FtEO ~ ~ . ~ ~ Auc 2T 3 ov PM'13 Repistnrs naord on ~I~ (n th~ St. i~ud~ Cou~ty H~ehh D~p~r~ _ . . m~nt ~t Fort P;era. Fforid~. , - ~ ` . r r;-:,~:~,a=~.. (YVam+ng: Not vaJid w?l~ss ralsed seal of ths St. luc{~ {,;15i .4 - County ?leaith Oepartment is sffixed.) ~~°,'~'j=~~' . ' ~y~.L._ ~r;~, . s''yr' . N. D. MIIIER M. D. ' • - ~ ~ - Health Officer 6 tou{ istr~t r - ~ . . _ . - . ~f~ c . ~ ~.~r~~ ~`I ~ ,~4i - :'~J~'~~~+~1lr ~r ~ . ~w,? LOC.~I RQOItfiAf , ~'~i - ' , ~4. ; . g~~>: ~':1+ ~ 600K 2~0 PAGE • ~ - . . ~ . , _ . , . e~ ~