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HomeMy WebLinkAbout1198 /CO ~S~s ~ " . V~~y~ :~~-4y~td~e~`. . , . ~ , , ~ ~I ; . ~ 26318i ` • . ~ 2Als 1~- A'TATI eowao or w~r+ CERTtFfCATE OF DEATH ~a••• • \YRi/tU OR YITAL sTAT!lilC~ Rwt~ f~u Na ~•aa1 ~•a- FLOSIDA ord •b~a etRTH NO• RC616TIIAq•f NO. ~ prop~el~ 1. KACt O/ KAT11 GODi N0. 2. YfuwL A[SIY[NCi(~a.nM~.tli..t l/:..N.aww R..ifwrMlw+.i.:+W s:~eut~~ COY~IY a STATE OOYNTY •nd •111 De ~l~e• lA y~T~ C17~.TOMN. 1At11 l. IS ?LAC'E OF OEA . . K RESIOEMCE ¦an~l~t INS~OE C17r LlMITSt IN510E pTT L/MI 1f1~. YES NO? tES MO 1. MAIIE Oi (!f MI i~ ~M~itd. /fM a0rut ~J4eN) STREET wDO~ESS . MOSrITAL OII IIISTITYTION MwM[ o? E'b~! dfi~fft IwM 1. DAtE XMa1 Dq Ya? O[C~Af[O ~ cz1n.•• r+•e~ , • oun~ DE S. SEX OOLA~ O~ 11ACE MMIR~EOG1 MEY[R MAAlliEO i. 011TE Oi NIITN ACE Ih ~t~?1 / Y~iDQ ~ TW {MOE~ H~S. . yk" lYt XwY~ MP Rww N(~. r 1 t• 7~ 11ltppMEp ? qV~011CE0 y 1~Si l~ 10~. YSY~L OCCWA710w f()/re tW ~/o~rt M~t IOA. K1M0 OF ~11SYQ55 OR Yt011S~QV I t. MRTIVLACE (Stdt R Mr~ lt Crt~IDI Ci ~w1T 001MRtf •~t~ ~~r- tsriy~tNwrNyM~r.aesy~MM ' ¦...at ; ~ kFSTERN GA U. S. A. Dl~olt l~k 1~. FATNELL'S MAME 1~, rOTNERS ~AiOEA N1WE •r ~,,..~~s.~ ~ U~1KNO+:N 1S. MAS DECEASEO EYER M Y. i AtYEO /Oi1C[Si K- SOCYL SENRITY M0. /7. ~II ~ ilY1MTYK H~•v@ .1~~• ' I I+..~. ~ wtiywl W~w. ww w~ irr d.~wwl y f A~~ 1 0 Ave '~J" rua.~.l 1~. tau~[ N et~?TN I~ler ~ Nr arw ya ti~r/r c.). t0). ~a! (c).j Urtutv~L sETrrt[M Ai~~~t~T ~~TLOEATNVASCAYSEO~Y: - ~T~~TM w~uo~?T[ c~YSE (y I Hemis here .~.s ei~• u c'. e•r- - r~a.:. a.u~r.... r~:... o~ ro u~ 66 da .s~. s~. .,k....s a ~ 1•• a t ~Ewr n~ar~~). r r~ai~trsr +~~t /k aNn- DuE TO (t) ~ - .?ssa¦ ss tr•~ ur« t..r. ' o ru~T K or~ s~wicwr oao~nas co~nwirtrc m ou.w wir woT uuao m na narw.? oausc caam~ ctitw w wt Nu . w~s ~utorsr borr• •f- F, f[ItFO~ItEW t~r A~~tY s ~ - o r s. e• r• 7p~a. ~ t0e. ocsuuc Mow uuuar occusRCC. (a~ta .rw. N~.~ ts Arf l r Art 1J yYs. tIJ ¦~kl~i ~~1 1- ACCIOEMT SUICIOE 1qMK10E •/~N1- ~ ? ? Q •oe~. ~~t. T~wE Of tr... ~t..u. nw. r.~... ` uuu~r n. o ~ 20/. tK/Y11Y OOCUMEO mr. rUICE OF UUUIIY i~ M~DMt M~t. 7D/. pT~. ~N. OII IOCaT1011 OOUNTY STATE ~ wNac ~T ~ Mot ~mac ~ J~r..v~er. yf~s ~tp.. ue.) ~ IrOQK AT MIOIIK t , 21. I~tNnd~dtMd~owMd/eom ~t-- 2~~ ~9~ ~o ~'C. ~~19 ~•nd/wf N~ him ~li?~on Dw~tA occu~nd ~t m on th~ d~t~ ~t~eW ~bw~: ~nd [o tM 6Nt af a~ Rno~/ad/~, lrom tA~ uuw~ ~t~t~d. ? 11 1~~~• jy- LIaNATfI~( (I~!/IK M fYlt) AODAESS ~L. WTE SIfiNEO •r• N 1• ~..p~.e. • ~ o~i D, Fort Pierce Fla. - 1-5-b5 ~aerr~t~. ~•~~TqIL j~. aT~ jj~. MANEOFCEMETEAYOIICAEMATORY ~OCAT1011((~, (/.lM~A.MtMtwf/) ~8'~ft~ aMOV~ (spr~~h~ Fine Grove Ft. Pierce Fla. ' ' -~'~I. S.~als-" L-F'OIIERRt 'l~SKw~?i r-. n~Tr ~ccn~~ u REC. 2f. 11E61S1M11'S S~GMTYRE . . a.•. ~ass ?e c S Peek Cit 2-22-65 Anna i.ee Deniso~, d. r. I hereby cert ~y-this to be a true and correct copy of the locai Registrars r~rd on file in the St. lucie County Health Depart- ment at ~ort Pie:ce., Pbr+de. Ft1E0 4~; ~ - 4ECORpE ? ~ (VIfa1'~ir~gs N~i•valid untess raised sea! of the St. Lucie ST. ~UCtf ~~y~nr ; ; • County~_Heaith Department is affixed.) RdZ~= ~"v?TRAS : - _ RF i•~ ;CUiT COURT C~~.1 ~ ~ Y~ ~ IE~ * ~ N. D. MIIIER, M. D. ~ County Heaith Officer & local Registrar ~P . j ~2 16 PN f '?3 ~,e. ~o i ~uxc~/ ~tZ~'...~ea/ Dst~ P~tY ~9ist~a~ 12+~1C7~ $O~~c ~.1L] PAf~~~ . ~ ~ . ~ ~~~t-` ~ ~ K~,. ~ y . ,