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HomeMy WebLinkAbout1110 NOQTH CaRC:ilNA STA7E BOARD OF HEAITH OFFfCE OF VITAL STATISTICS 263115 ""'S~"``"~,~~~ t«,~, ,,,a _ CE2TlFfCATE OF DEATH _ .a : _ - . _ ~ ..-e c: . - _ w~: of ~~.~K ~ :_..,~e..r ~-e_.s~ ~ / _ . .t'cuvicenc-~ co~~x ~ur~.ca+s, , ~N ~ 9, l 973 ~ t :O10! o~ fKE STAiE Ai WM ~or :AiE Ci EIliN wCif a. .iue w. r v~ceTi n~a r..aw .aas -av.~rn r 9~6 bb e •O••m wn ~a~e ..aa , ;r,.l.e , ~'n~i,te i li(o•~th Ca.toLv-.~ , ~:~ly 23, %'_a.E Cf C:A:N t15Ual tEStCENC: ^+^r~ ae[.vn .niq ~ ..sneu.¢+~a ~eyo.~te~uroa .:+rua C•t~ven °RNe~ Be•tn ,,~••EIVo~t.t.f: Cc~.tol.ena ~ Gtccue,s r:~.~ :,i ~•d n ra+l uw s+a~ .uo r.re~ uLOE CIiY ISMiT' C! ~'JVr'A: Ot ~ , ~eean ra n ro ~yyM ~ rIPJ~~IJ ~A..~~~: ~~w.~{~. • 41__7 P'd ~p.~r MA7TM. KErE~ MARR~ED. SUS~IMMG S?7JSf y~^R uv~ r'.o~w w~r.n ' TitET AD~D~ESS OR RFA. Ns ~.KS~E CiiY UM11S ~,",~,"x~:~a.~ei$ „ l~c~'ri-e Puy3e ~owte 2, lSO~ 1 ub "no CSi1Z"eN OF WMA( COUN/1A SOCL1t SECU71iY 1~t;M6f~ USUAL OCCI:?Ai~pi uw w ~o~ ~nwe a.ww wsr IUND OF ~tW+rESS U! AYttAitt 17. t1 IIa w~pP~ 12b. twMFR'S ?UM~ YOiME7'S AM~OFH NAM~E1_ --L 1S. ~d YL~ ¦ ~~wl1~.p. /'~J~Cl~ SNFOZAUNf'S NAME ~ AOO~fSS s~ n l~iw f~mse.~n.e J,~.~.~~tr~ ~Y. ~nu.~'O ? giuG ldl~i_ 'i!'.MV.A._ No/Lt.~1 l.a~tD~_~7.Q :i. • - - - - - s - - s a r - - a = iwoF ~ DUM CJ145E0 ~Y: wni w~ or~ uuae ~s ~we rd a+. ~ ~m ~o-~nir ~ oum < me~ ~ / ~ ~ ~ ~ i p v~..a.a c.~rr } IIV! co.a*o~s r un. 'wrr~« ~j.t yt p Y O~! ~0. O~ ~f w ~P~Ons+[! 0? w.b0u~! CMMN. Y'~:~4 fIK;~.pta l~"~G C~10f 4f~ 1 a W we 'o, o~ •t ~~aw/.r! oi. P~iT ~1. O1hFf :X,?~ifCAHT COrp7i0l~6 -a!arrtr.e ro oeuw wr ..or .e.~o w cwu~s ura. ewn ~ w wUi0I57? ~ rE5 ~•ea s.~a.~es eows~oe~ i ms wo ' D[iHr~a CY6! O 06as ~ } 190. 9d 19t ~ ACCWE~+T, 51,~C:DE, HCW~fCtDE, Ot W#fEiwwA OESCiYE NOW RUIi[t OCN~dFD ~e+ra w?nwc v~ua+ w?w~ ~ a?.n ~ mi. ~w ~ @ Yao. 20d q T:uE Cf .o+a nws .w .ou :UU3T AT VrQ![ PL1CE ~~`3:it~7 ••a.~ s...., ~n.t!..vmw . ~ v2 ~LiO C:rii1+Tt Sii~ic ~ 6~nMtI ~vxrr m w.a OAK[ rO['_ fK JlLT) xJC K ~ eurs+c~ s:a~ ~••~n.em ucrue~ r+o.~ n_ CElf1f1CA?10N-MEOKAI FI WINft 07 ACT.NG A~eCKAI E7U~lY:;2 w ~e ..u6 o ne 3 lh ~p V / ~ ~ .MO tAiT L`~ '.M M~ ~anf OM Q_ _ [f~JM - llYN~lp~ d M~~ YO/C! MNlZl~fJ7a[1M. M I/ dNb~. pUM MLf p/ ~O .M. ~,y{WL fl~~ /~/v ~~ti ZT.IX:1.m`O ~f V' ~ s tl~fm a+ Y~ . IK`r /K (ALYS STYO. ~AP'! fY OI[_'O!M vlt I~OMIl+fFO L! _ M 0~ M S~GNATL'1~ Of "f j e cr mu Dafa - ' - ~e. 7~.Z ls ~ V ( ~ nt~~ f~ ~?1 ~ i 6~.i.~L Cifly+li)01~, O~i OwTE NM~E'~OF CFME:B~ Qt iCRY tOCAt~N ~ „ z<b~/22 73 ,~tieentz~t l~t~o~,iat Pmrk :,~1'1e~ f3ert~,., h'on,tR Ca~taLsna ~ '"^t srr+..n ru~.w? a:ccto~ uc-x~ ra. ~~.i' • ~o#X,~r~~~b~ititL ~1c~xe ~r.a, l4'ee~ J3~tr_, l'1.C'. t : : ~ - ~ - e• te~' 'O~ ftC 1 tEC'w"- SiGr+nt`ylE O! SfG~S:iAIy~ ~ r~,e~ (yiy~;,:,~~ c~.yr.w '~~~F „'°"p" - . ~ - .,~.'~~y 7~ 1~JA ~ { ~ ~`~G'~.= ~ ~ ~ t % / - ~ - ~ n . = C ~c, ~it / 5.-~ 'j. v • it •,C . ~ ~ -r- G ; fILEQ tiKC •:ECOROEO • ' ~c. ST.I.UCIE COUHTT F~A. ~ ~~ti lF.... :E RCG. ~ '~tiR~S \ CLERK ~.:~'.,:U:i COURT Shb o1 NortA Ct~oiiM. Gsryn Ca+nt~? F i' C^ R./ E~~+E ~ ~ Tht~ SAipo, RcRister of DNdt I11 ~nd foI s~iA Ca~t~r r~1- ~=y a~A Srat4 do hcrtbp artiy tA~f tM tontofns and ~'txhad is SEF 6 4 09 PN'~3 ~''~:3 2 ftuf ~Ifd ~OCYli1~ WQr O~ [~N Orla~~ ~~fpN pp (t11 ~ my said oHrct, Book/9'l.~ Pag1 ~ Yr. s my Mnd and sal. this tn},~ da of 19 er , 1.1J ~ ReA.sr:r ct Oe~4s ~i./0 pury Registet af . s 'J 263 ~ ~ ~ li K ~ - ~ 6~Q': ~i~ i'AGI ~~0~7 ~ . ~ _ _ ~.w . _ _ _ . ~