Loading...
HomeMy WebLinkAbout1511 ' r . . ~ ~ ~ ~ 265512 ' . . . ' CERTlFICATE OF DEATH Depart~ewl ~ 1~I11 u~ ReVdilf4lin $enkrs fTAT[ FIL[ NO. ava~+v~~a~rn FLORIDA itfE, OR ?R~HT IN ~w~~R"~O R[GItT11AR•f NO. ttlMAqlNT INK OKfASEO-NAME ~~~s~ .axt ~~s~ SEIf OATE OF DEATM ~ rowtw, o~i, ~ SEE tut7t00I FOt JAY W. 3VRTGN +ta1e i Octobe 2 1 3 uCE .rwn. r~aw. uencu~ wwr. AGE-uu wa. ~ n.. wae ~ wr o~TE Oi {tRTN ~ro~wr. e~.. cOUNt11 Oi OEwt?~ ac. ~ wcr, ~ w.~ ~•u~s~ ro+. w.~ rows w~ L~ O~ • Whitp s. ~ k •:~:ar.31 1905 Ir_dian River ~ CITr, ~O~MN. OR IOCATIOH Oi OEATM wYN cm ~rnt Np5~1TA1 O~ OTH(R NSi1TUflON- ~W e~+~l~, GM itwt+ ~we rwun ~ a?~ua •ti o~ r0 w Vcro Beach Yes r.di.an P~ver [+:e^~orial Ho~tal SiATE Of MRM ~ n NOt w ~.i d11ZEN Of WNAf COVNiR1f MAfdEO, ltEYER MARbED, StMVNNG S~OIKE ~r w!, aM r~ w w~ ~ _ cowtf. ~ WDOWED. ONORCED ~ ss~tr~ ~ ~.~„~s««« ::ent~ac:: LTSA n"~:arxied I_u ' 11 ~ n ...in oeu.ee~ ~~~1 SECURRII MW~ER USU~I OCN?wTq~ ~u•e i..~ a.w. owe am..e +os. o. qaq OF NlSt+ESS OR WWS1R~ u.eo. u p•~w . occ~me ~ wu.a ure. evi~ n nmw ~ ,""~"'O".6"' ~r 402-05-2582 ?y Production l~'o?-2cer ~x A~~ o- 't .fY'JfMC! N~OM ~~s+~. ~EStDENCE-SlA1E COVNT~ CITY, TOMM. OR tOCATION w~ C~n ir.wt STtEEt ANO Nl}/+iER ~ ~ v~cM. tis o~ w ~ ~a Florida ~qSt • Li2C7LG~ ia OJ"t T~']. (~7'CC` ~u. v~'_S 1II04 H:?VR'11 V`~~_•r' fATMER-PlilMf ~~n~ rwa.e ~.s. ~MOtHER-MA.'DENNAME ~~~s~ . ..~oou us• - „ lJilliam ':crtc~n u ~'r.available INIOMMNi-rtMAE MJ1RL`Ks ADGRESS ~~~nn w~.r.e. .q., cm q~o.n., s•~n. iN~ ' '3u7Ctoz1 ~n'.~G~L :~~vana Ave. ~t T'i~Yce F1 3345~ Lucxlle F.. ~ ?wRi DEwM w~5 UUSED ([nr[e avtr Or+~ C~uSE rfe io+E fdt (el fbx wnO kll nr.ew o ~i ~~+e a~n. 1~ r~loury UYf~ , N) ~L~`_ -Czsf~t'`~:. /QLC~G~'E~ G!C-CG.~~!!~ GL~CC . ~ eoNanori. u ~.w. ~...~~C_ IL~.eGt Gl~?G~lGL ~ Cy~- •Cr~ • , YMI~M G~r~ us~ ro (~1 ~ ~rr~D~~~f C~Yf1 W~, ~ « • y~py~~f O~: ~t~tIMO ~M~ tlM~/~• ~ / , ..~wo c.~s~ i.u ~ l''L ./G ~L~E'~lG Cc' C~ C.~--' ~~c-'~ ~L~l~i~'~~ l~s G~~ . ; ~ ?ART QTMER SIGNIiKIWi C : Co-ia~o..5 caw~nor~wo ro ou+w w..ai nuno To uuu er.~. m r.n ~ w~ ~ ~ YES .r~~e r~..o~ os ca.-- ~ey p..o~ re~~ie wn~~u~~ra uusr / ) q O[n~M `~QZZ~/~~LC_~%!t-~~~~'`~-rl`;~ ~i+. ~w E~' i Ir ~CUDENT AIK N1U ~ w~+rw, w•,.[.~ ~ „OUR MOW INnlRY OCCURREO ~e.na .u*u+t w~NNN IM ~A~~ ~ o~ r•n n, ner ~s~, . pR NrqlIERYINfO ~ 1a M ~ »c rA. »r E INJURII A1 WORK KAGE Of W1Ul~.r «ore. ..~r, ar~eir, r.twn, lOr•wf10N ~ sae~ w ~r.s. .w.. em o~ ro~.... sr•a ~ ~ ~ anun .~s o~ .ro. ance Mse..nc ~wc~n~ • ~ ~ ~ ~ CERT~fICwt10N- .a+M w• .w , ..wn~ o•. .e.~ u.o w• y~. »r/wu unrr o.~ ~ ae/o~o w~ .~e. rrt otwrn OCtunto n.e ~uce. a+ me " •M1SK~wW_ r0 nOMrw o~• ~l~t ~ON ~Rl~ oe~fM. ~~wu~~ o~~l, uA. 10 w1! ~eS~ ~ 1 ~n1,+0lO ~M! . W r~ [MOYrLlOGf. 9V! TI~ wee.seo .~o. JH 7t. l1~. 24 ~+l ~o n.e uuuis~ s..-~o. ~ CfRTtflUiqt~-r.~E~ICwI E7[A~itINER OR COROt+ER: o.. e~~ ~.s~s w r.y ~ p o~.n. tM! OKfDlM r~s r~o..w~+ew a.o ~ ~a.r...r.o-. a me qo~ d+o/w ne wrtsrc.rio~+. ww..~n, .w~¦ ow• •e•~ «ovr M~M OCCV~~lO OM M O~~! ~NY Ok ~O ~R UVS~~11 S~~RD. i ~ IYl i 1!! M CERTIf1ER- f ime o~ n SlGtawi~R otaeee d~~w[ DATE SIGNED ~+o~TM, o•~,.e.~r E[ t~. ~ames Carey ri.D. ;m ~r ~!«c~~ ~ ~/Ffc/ %C I~ 73 ' ~ ~AMG AW~RESS-CERiYEft 2300 5th. Avenue "~°';~ero Beacti; Florida 32960 ~ n CREMATION. RfMOvAI CfMETfR~ OR CyEMATORY-NA4ef (IOCwTCpH t~n q qww sr~n ~ tw 1:urial ,.;?i13.crest ::e^:a Garc'er_5,.. ^ort ?ierce : lorida + ~ DATE i.w+w, w~, +w~ fUNERAI MJtitE-?+,u~E ~r+0 aDDRESS ~ s+ein o~ ~ r.a. Mo., em q~o..~, s~•n, nr ~ 7s~ ~C~ ~i ~ ry~ tS~ V<"ltC?~ •'~t?~r.r;1~ '!).^.t? T'C'~/ 7~7 r~ o n'_P7_'C(? f! ^a ~ ~ OAT( etcovto ~r i e isriu~ Y. 5. ~61~ ~U?rERwl W~tEGT/q~ -SrGNAt REGt~ 7^jt1-nS.~G~.v~TU~f ~J S~ ~ R~v. i970 ri~ ' ~~~1 tM Y~C v~ / CL~ ~ ~ tw ~ ~1 3~7 ~s , , ~ ~ "I hereby certify the above to be a~rue and correct copy ~ of the local registrar's record on fiZe in the Indian ~~COUMTY~ R~ ~ Ziver County Nealth 7enartr:ent at ~~ero B~ach, rlorida.'~ ~~H.POlill~f ~ OIE~K CSflCwT COWt1 [ ' ~ RECORO YEF.IFIEO Thi.s is not valid unless the raised seal of the Indian ~ River County Health Departr:ent is affixed. • ~ ; ~t ~ ~Z 10 ~ 13 : s= ~ -i~: ~ ~ ~ ~ ~ . % ~ ~ 2~5512 . Q,~ ttY l;;•,. Cocant Hezl ~h ~ir. - , . , y I ocal Registrar ' • ~ 's'.~ • ` "i • ' ^ ,~:.y ;"i "s : t~ 'i..• . ,y... • ` t} ~ - • C C,! a//~r/Q~ ~ ~ ~ . , _ i " . . ~F; ~ D~n+sty iceg;stzar e . . : z 3 . . ~ a k ^ ~5~0 ~ , . ~ . ; ~ BUOK ~~a7 PAGE .~F',~`i - ~ w . . ~R - . . . . - - _ ~ _ ~ . , . _ . . _ ~~~c