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HomeMy WebLinkAbout1486 n ~ / s~`~sCER P~~~;~. L CIERK C~;'LUIT COU11T 26~5492 al~CO~~ YEN~ilEO...w AcT 9 10 ii AM'13 z~'S~~2 ~~w~:~ ORANGE COUNTY HEALTH DEPARTMENT , P. 0. Box 3187, Orlando, Florida 32802 * Phone $49-3326. ext. 134, 135 _ - - - . . • - • • - - - ; • f%.e ~ frwTS ~o~o w Krni~x ~ ~ CERTIFlCATE OF DEATH ~ - . ' = ; su~~?u o? vr*w~ ~r*wrnnc~ T 1.0 B I D 1! ~~T~ nu wo. i s~ N. ~ w ~ • H. 1. ?LI~c1 N w.rw coo[ HO. L vsr'L wal/Kwot4~~..Mi..r~..a l~..n+.... s•d.~.w~w.wwl . ~ttG-~ 5~-11 ~~c~i~w Ii~r~f~"RivIIt : A cm. *cw..c~ ~ccwro~ 6 rtAU p 0[aTN s. uri. ro:ROR wc.to~ n Rcs~aMu ~a cm ur~T» ~Y:iu ws~o[ tm? Uu~ri~ ORLA2ID0 .is ~ uo O ~sQ ~ ~ ~ Y/M[ OI (//Mt 1~ MyY~t• f~+ ahNt ~16~M1 ~ V~ l(f~GM Oi L STR([T AOOR~f3 ON A~A~f11 ~ 'M~ ORANGE 1~2-SORIAL 2~~ lt's24-28th Ave .z,p ~o[~ 1 ~ I trr N,iI~. Lwr wT[ AI..A D.i Yw Jq;x EDh1ARp MOOR~ l0 2 1959 cn,. «r~ S. S[v]tw ~ COIOyR~ +011 R~C[ M~RII[O m MiYill MA~IlKO W7[ Ci ~~RTN 1. lG[ (lt Kp~ r VC~A ~ TUt t~o[! t~ ~/K ~7ole ~u14e Nf00~N 0(~C[O J L~~~v/O l~t~ql XwW Oqs Rw~~ ~(w. ~ 10~- 1tSYLL O0CYf4T+Jit (CMt ll~I~/uarl ~aee IQ6- KrW W WSwlSS Wl wOUST~Y f1. tt7tiMKACi ISIW M~?t1/R eMYr/l 1_~7t1ID1 aI MMT {n1~fIR~~ '~#~t'9ti~c~+~`"'~'0`'b`Y`~'~~=:iij~faoturer Chi.cago, I11. USA ~ 1~. i~111E~'S kAYC 1~. M4THIR'S NAIDttI NANE Jare a 2~!oox~e I~:a r~,a ret Coone ~ IS- w~3 O[CCASEO [Y[il M U. 1 AAYEO ?OAC[SI 1{. sOCMI S(WRITY IIO. D. i?1?OItM a N!lMTYlt , I I~a. r. r~trw~ ll! H. w~ w~ ~r 1W~ ~l Kw~d . no 75-O1-g24 w~~.. Birmin , . t~. cwwt N oi~~ (fa.u..wtr..~ c..,e p.. t..~/r. <e). sR1(e).) IKTE~YAI ~ETMtFEM ~a~t i a~TH rws uuxo tr: o+atT ruo ouTN . ~MY(OU1L CAUS[ (U cti.a~,.,,..,. ~ To <6,' a ; ' ' - ...d f. .e... r~~,r • . / - r.rty t?. t.~k-- ouc t0 (t1 ~ttUy~,~3~`~9 . z h~ KLN {tX. - - O ?IJIT U Ot:ut Sr.~s~GUCt CoM~tTiiO~es CdnfewJrM 1~ OUTM RIT WT iD ~o ~1( TWt4Ml COIOI 6MA MT 1(e) . MAS ~IiTOK~ rE11fp~MEOt • S KS? MG~ ~ da. ~ IJ6. Of3C1Nt tq~K ~NJURY 0{tWIR[O. (Ea~a ~1~rs yl~s/ fs Pet 1 w P~rt /1 bYer 1~.) ACC~OE~T SUK~OE IK~Y~C~CE ~ O O O t J Xl[. Tir[ OF H•~ar X~wl~. Dq. )'ip _ a7 Wu~IY a. nt. f a p. ~a. i : ~ fid. suuRr o:.:~.s+~c~ Zlk. K~CE CI [MJJRY I, la ~r ~ry~ ~~y, ~AJ. trtr. towN_ o~ toutpw oouxTr iTFTE p+tttt ~T ~ ~T IM11N.[ ~ j'~~?I. W~d, ~~Ett U6{.. dt.I . ` ~ lpAlf AT 4?AIC ~ i i !1. J ~N~ncMd ih~ d~owMd /r•, ~ ~ ~ ~ , to . " •x -~~nd l~~t wv h~ ~lir~ oe fQ.= l ~ - . - L4sth w: orrsd ar ' ~~_f?'Z on th~ d~t~ ~~~~sd •ao.~; ~nd to tM D~at o! m~ RnowNd(~. /rem tb~ uu~ ~ta~~d. iL t~¢~sal _::i ~ j,~~ yp t q ~ i:J a:; :.FSS Ilc. OATt ::~3Ht. ~ ~ : ~ l? _ - ;'i ~'.c-~ ''=n, ~ ~ /0 G- r-9 _ . . ~.~r ~ . 23s ''ru. C'r- • 2X~ O~TL 2Jt. ~tat; Ci CF~tiTFA~ W CIlfMAI<:-"tY Zaf. LQGt7w?lf (CYf. f0!'a. N F~i~l~) {S~NtI y ~ ~;,~Q t : ; ~ r.~- ..aY'r' 1~0/?/~9 CroAtl~~~n.-, Vero >?-~soh L_wlorl~ls ~~~t'Jh~t~, .J~": : L. j r.i ti~ T~ aATE D_:. !Y LOC~II REC. tb. QE.:'~S'iAR S S~.:h:t~i ~q~'~~ _ . t ~ ~!..J f ~ - .d~ ~ ~ ! =Y~ . t f ~ ,~,,,_.~....~..r ~ V i t.~ 1359 C~~A/JCes,.A t~~~---R W" + ~ - - _ - - - - ~ - ~ . `s _ - ~ ' CEi:TIFIED COP1' ~ ` I hereby certify the above to be a true and corrert copy of the Local Registrar~s record on file in the Oran~e County }iealth Departn~nt, Orlendo,.,~',Y~ ida. e .,~~f I,„ l~ , ,....,,~~f j I~ '~``~j'"tY°'~f~~~~.'• ~ ~ • E s . r Count~~ Ficalth Oliicer and Local Registrar . ~ . . 1~1; 6 , ~ 1g?3 ; _ : - ~ r~ ~ ' , V= ~y . E;. _-t:~.et- ''6.~1 ' G~`~''~•~;i- ~ ti~ Uate issued Deputy, i~g~sktrdti ! '~=~z.-" ~ WAit;~i~~~: Not vc?lid unless raised seul of the Oren~;e ~ County Hr~lth Department is affixed. , 30~~39 ~E14~5