Loading...
HomeMy WebLinkAbout2455 - • 2640~5 CERTIFlCATE OF DEATH or~.~~,~ ~t ~ i~~.i~ti ~nd Rclwl.;i;~.u,~ s~..~. F L O R I D A Y7ATH F~~c No. INVItiN~V (1F IltaLlll irvE, OR /R~Ni IN °''~°~R°R'm° REG16TqAR•S NO. VEQMANtNi INK ~~~D-NAME n~fr rbou .•s~ ~X . OATE Oi DEATN ~ yoM~w, o•+, nu ~ SfE nA1t0100t F01 wsnuaars , Robert HOWAT : Mele ~ November 7 19r(2 ~wCE .rwr.~. ..iow. •re~K.w u+ouw, wGE-~.~~ w.oe. i nu v.w~~ ~ o•r O~iE Oi WRM ~..o..m, wr. C01N~i11 OF OfATH uc. ~ srtcw~~ a~tw •v ~~ws~ ro~. o~n ~wu~s rr ~ ~ c?-- . Fh~ite ~ ~ ~-25-0'T Columbie CIIY, iOwN, OR IOCATION OF OEA~N w~w un ir~n F1pSMT/LL pR OTME! NSTITUi1pN-NnME IM Npt ~N ~I~Nt~~ are uai~ uo ..uwt~ ~ fi~CN~ rEf O~ MO ~ Lake Cit Fle. yes Veterans Administration Hospital STAiE OF W41M ~w wo~ ~M ~.s.~., r.~r~ UT12EN OF WMAT COUNiRII . MAtR1E0. NEVER MARIUEO. ~SUtViVNG Srp1?SE ~w rN~, oM r~~o[w w~r~ ~ tow~n~ WIDOWEO. CED~srKr~~ ' ~5~.,.~~~• • Ohio , U.S.A. marr~e 1,,. D~erthie McGee +~~E~E OECl~StD 1~._ :,.to u pi~~, SOCUI SECU~1i~l NuWEI USUAI OCN?AT10N ~a•t c..o w wwc ow.[ ou~wp rou o~ Ky.q pp wswEU pR Ir~WSTRr ocr~n~o r~ wWawO uM. MN a un~~0~ ..v~r~nw.. 6~`R . .,,,o,.~~ ~ 07 9 Wetch maker Wetches • •or~siw~. RESWENCE-SiAiE COUNTY Gir, 1OWN. OR IOCATION ~wN CM~ ~r~q SitEEi, ANO NUM~ER ~s?eta~ nt o~ wo~ Florida Davel Jacksonville yes 111 Tast 56th St. fwTHER-NM~E r~p~ .um~e - - uft MOiMER-MMDfN NM~E rNS~ .wae w~ ~s John HO~at , Je8 s3e f WOWw~Ni-NAME ~nALLM1(', ADGpfu ~sma w~ r.o. ..o., an w~o.n.. s+~~e. rr~ G. E. DuCkiett ~n VA Hosp3t81 I,ek,e City, FL 3~55 PI1RT 1. ~rnOa..ure u+n~r~~ ' OfAM WwS GUSfD ~Y: (EniEf ONIY Onlf UUSE IER ilrtE FOR (o~, (6 ~!f\1!(M ON~~i AMO 0~~11~ ~ 1~. rwsun cws~ Dissemineted mel9noma ST. WC~E COONTY fLA. F.OGi F P~~1fl~S ( Dypg. ~S ~ C MltOVt~+CI ,~l . ~ 'I . ' p•~tt'Q i ~o..o~.,o~:. N'elanome of left 83a@ OY YIBCk Ff~c~t' v` 3~ Yr8 ~ wr~CM G~r! ¦~S( 70 (0) • i ~rrlD/~tt C~V!! 10~, ~~O, q~! ~ COMfEOVIK( O~: __'~~yJy~ i sur~nc 1Mf u~on. -$~t_1~} i- - ~ - - - _ tnwa cauu i~sr - E ~ - ?ART p. OTMER SIG?a1fKANT ~ONp1T10H5: coNwnoMS cawrwurwo q oc~n~ wr wpr ~[uqo ~o uuu u~nM u. rur ~ a~ ~T~Y ~F YES .ve~~ ~~MO~N4] CO!'1• N~I1~ ~~ns w ra~ s~o~~fo oarE~r~..~ra c~vs~ ~ „~es ! p yes ~ ~v.sbo6l~j ACODENT. SU~C~DE Ot A ~ roN*w, o~~, ~t~e ~ NOUR MOW INIY~~ OCCUR~EO ~~M~~~ ~*vM O~ ~MWft IM IMf 1 p/Atl H~ aer ~ .fOMIUDf: Ol WAEiE~MU~tED ~ ~a~ ~N 7i~ x. t9i. INJUNY AT WqIK /IACE OF NiRIl1/ ~ow. ~~~r, s~rtt. rnaon, IOCATION ~ fntet p~.~.o. wo., c~n O~ ror», s~~n ~ ~ f?tC~H tIS O~ w01 Qnlq µpp.,IK. I!1lCNU~ ~ ~ CERiu~GT~ .~wrw w~ +w ra+m w~ ~w ~o usr s.w Nu. wuve o.. ~ pq/~~Qt v~t~r Mt OEAiN OCCUt~EO ~i nu ?uu, p. ~w ?nrs~wH: TO ~a.~w wr ?eu wOr w~r~~ oe~m_ ~Mw~ ~ o.n. ~.a, ro me usr •fl1ND ~N~ ~l~ OiCfASfD /~Or ~~~}~7G i~~~. ~ 2 1~~[ ~7~ 1/1 ~O~ r7 [MOwUDGf. OYt 2 ~~I 7b yc . c M~o me uusus~ sr.no. CERTYIUI~ON-MFOKAI EItAMY~ER OR C0?0NER: ou r~n usa a ne ,q~~ « q~n, ~we aceoir.i ..s r~p.our.ceo wwa ~ ta•rwwno.. d mt wor ~..o/q ~~n wv~srw~rqr~, xa rt pwq.~, ro.~rw wr rt~~ .p~~ O(~tw pCCV~~fO ON ME O~tf wY 011! q M! C~YS[~f1 StU10. 1h M.' I ~ CERTIIIE~-/+AMf inre p~ ru..rr S o[on~ o~ nn! OATE S1GNE0 ~.o»*M, o.~, *w~ John J. Robinson M.D. - ~ : r~ u_ = 2 MA0.1N('i ADORESS-CERIIf/ER srner a~.~. . an o~ eo.+.. sr.re ~ ~ T~ VA Ho tal Lek~e Cit Floride 0 ~URlM, GREMATION, ~F~.~pVAt CEMETfRr OR CREMAiOR~-N~E ?OGTiON un w w.r.~ sute ~ s?a~n ~ Removal 2~~ ~rergreen Cemetery ~ Jacksonville Flp~ida ~ OATE ~rparw, wr, nu~ FUNERAt MOME-NAME AHD AODRtSS ~ snm o~ ~ r o. r.o., un o~ or.., su~ ~ ' r ~ ~w iffiths Flinerel~, Jac~sonv~f~e~,.Fl~: s. ~61y rur+c wi ou~e~-s~~ruru~ eeG~st~eTsieH~rwrt wye a~ ~rEC~ " iiev.1970 ~ rH- T .~i~~ ~ ~67 ~o_~~~~L. .f~- .~,r:, . ~ : : ~ , ~ ? ~~.rr'~.~.r'~' ~ -K~ i~ ~ 1 ~ fi~. - ~ This is a true copy of the original certificate filed`,~i1~ ~ Columbia County Health Departme~~ -Lake City, Flor'ic~~-~W ~ i ~ t , . • ~.;-z ~Tot valid un less raise d sea~ o f' t he Co l u m bia Coun ty He ` ~ . ~ is affixed) ~ ~ ~ ~ - ~'3 ~ ~ Date / 7` Signedby ~ ~ ,`.c.C~ ~ ~t.t~ ~ ~ . Eliz eth J. C s, ~ g~~~~ . ~Deputy Registrar ~ Columbia County Health Dept ~ - ~ ~ ~ ~ . . _ , . ~