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HomeMy WebLinkAbout2986 . „ ' , CERTIFICATE OF DEATH ~epri~ewl ~~k~~ ~wd ReV6ilit~llve $eniees f'TAT[ FIL[ NO, t ~~~~A~n~ FLORIDA ' ir?F. O~ ~bNi IN ~~^~'~R~~° . RE616TNAR•S .+o. 331 ~ItMAMtM INI[ ~w~-N~ OA1E Oi DEATH ~f ~ rus~ r~ea i~st ~.owtr, e+~, ~w ~ HEI~IRY CIAYTON DAVIilSON ~~~ale ~ June 19 2 a U~CE w.ra. INOW. ~W~K~M MM~M~ wGE-i~s~ wa~ ~ n~~ ~wu ~ w~ OATf Oi ~IRTM ~r0~+~~. O~r, CdJNTY Of OEIIiM ~ 6602 !K. / Wt~/t~ ~~~w.. ~~wa~ ..os. a.,s wws nu~ ~ . White 73 ~ k ~ ~Dec .23 I898 Saint Lu i ~ Cltr. ~OMM. OR lOGirON Of OEAM ..fw e.n irws MOSrITAI Ot Oi?1ER NSTITUf10N-NAME ~r aw u. ~nw~, erye a~r~~ .w ~+w~e~ ~ . sncr. •~s w .a ~ Fort Pierce Yes „ Fort Pierce Memorial Hos ital ~ ~ STATE Oi WiN ~~r w0~ r ~.s.~., wre CIT12M Of 1M1Ai COUNRY MARRIED, NEVEt MARbEO, SlItY1VNG S~OUSE oM r+ou+ wre ~ i towm i WIDOwED. WMQKFD . t?tt~n ~ ~~~.~..~..K, ~ Alabama • USA' Ata,rried 6lanchie Hulan ~ ~~ves ~r~~i~n SOCULL SENM111 IJIIMKR USUAI OCCWATION iun ~..s w wn owa ownw .os~ o~ cwD Of NlSIHESS Ot tNDUSiRY i OCCVMlO N w~~~~ lM~. MM Y~~IN(p 1 ~~s^^^~.~^~ ,t262-12-8715-A ,s. Feeder - Feed ,~till ~ ~Oi1f+'~"~ tESIDENCE-StAif CpJNIr dTY, T01VN, Oi lOG1T10N Msat ~wr iw~n STtEET /WD NUM4f11 ~ ~veeu• ns w w~ ~~lorida r•St. Lucie Fort Pier e IJo ~w ~ ~ fAT11ER-NAME ~~p~ ~ „pp~ ~.s~ MOTHER-MAX1fN NM~f ~rst .uope wr ~ ~ n Thomas Davidson + INIWMAM-N'WE wuAwG wDGRESS ~s~nn W~ r.o. ..0., tmr w wr++. sr•ri. ir~ Blanchie H. Davidson „c?15 id. 38th St. Ft. Pierce Fla. 33450 ?A~T 1. OfAiH WAS GWSED ~t: ~fwiFt OKiY Or~E UVSE IER l/~E f0R (s). fbl MO k ~rrw+~.u uvu i ?1 ~en.~ew a.u~ ~.e w.n. 1~. rreww uv ~ . ~ 1 ~ ~I''~.~C~~,~„/J i . . e . j~ 1 ~o».,,,o.... - i . ~wKw O~r! uS! W 1 ~A? . IYrl01~t! C~Yf! lo/. ~ ~ ro. a.s ~ co.~s~oue..ce w. l~~i1M0 ~M! YHOl~- l~IMO C~Y71 l~tl I ~ . ?ARi ¦ OTI~~ SK~jNKK~NT CONM~IaJS: COMO~AOM) COMMYtIr{ p W~M ~Y~ MOt ~f~~lf0 t0 C~Y1! 4nfM w~ .•u ~ ro~ ~~Y If YES .t~e r~wo~was ta.- 1~lS O~ MOt ~~\!O IM O(l~~Y~MINO (~Vk ' (C, 1 p Ol~~M ~ ~a~1~ Ib IM ~OYK#: II~EIEWWEO A ~~TM, ~l~~ ~ MAW INIURY OCCURffO t[M~e wry~e p ~ww~ i~fr i o~ ?~M n, ~ryr 1/ ~ ~ ~M i 7w 70~ M ~ 70i. fNNlY Ai YVOf1C ?LACE Of NIUfY.~ Mor. s~rn, r~[w~., tOCAiION ~ sntn w ~r.~. ro., em o~ tQ~.w, sr?ee ~ ~ f~K~n Rf p.w ~ owK'~ MCO.. ~~c. ~ s?ecN+r ~ - , Ir1 7M 7~f ~ CE[tiiKAT10N- wrtw w~ 'eu ra.n. o~. eE.~ u.o us~ w.+ ~~../we~ um a. ~ Mo/Ow w0~ ~M ~R OEAiM OCCU~tED *~e w~u. w nu - rM~sK~u~: TD +o..rr o.. ~w ~oe~ •.n~ a.n.. ~.ou ~ o.n. u+o. ro ~e ~esr ~•~u.wo n.e • • w.T aw.uow. wc i E , . fH eece.frs r?o. ~ ~U ' 7~~ 1I~ 7~~ eie uusus~ suao. ~ CE~TIfICJ1T10N- f f C w*we us~s a~.r Iqy~ pI q~M r.e eect .r~s rw..ou..ceo oe•o • i . ta.rr•nw a wt Wm ...s/o~ nr .MSr~e.no... wwno.~. ~ ra.n~ w• ~eu wv~ i . N~n~ OCCYt~tO OM W M~! an0 NM q~M C~uSl~s~ s~~~(O ~ E rr. _ M. m M I t CERTN1Et~rtNUf ~rvr[ w re..n ~ SK,?dAtURE aaeee p mu OATE S yNEO ~~o+*w. w~. ~eu~ ~ i ~ _ ~ : tl~ ' 71r ~ tk ~ AuRM~G ~DOlE55-CER?~frtt sr er w~ r o rso t~ o~ ~ ~ F ~y ` ~ WtlAI. CREMATION, tEMO~AI CE~?ETERY W CREMATORY-w ~ tfON c~n o~ ro~..+ s~..e i ~ ~freCVr~ • ~ s ,M Iiurial ~.~-iillcrest ::em. Garden ^ ' ~ DAiE ~ w.. au ry1N RAL NOMf-?UtitE ~NO eDOtf55 ~ suen o~ ~.r.o, ao., em w ro.n~, sun. n? ~ ~ ' June~2 1~72 l~ates Funeral ~:or:,e Box 77'7 Ft. Pierce E • f N. ~ n. , Ia . 33450 ' ; y 5. e612 ra+tw o~- r e[c,~ •-srca~rutt D4tE IfCE~vEp IOGt ~EG~SiV~ i R.w ~97o rs. . r/r u- n. ~aP. J I I henby oKtify thit to b~ ~ hw ~nd co~r'r~ct copy af the locsl ~ t ReDislra~s rooord on flk in th~ St. L~ud~ GouMy He~}th p~pa~. ~ m~nt d Fo~t Pisna. Fbrid~. ` (WNninp: Not valid unlus r~ised seal of th~ St. tud~ ' County Hselth Dspartmsnt Is affix~d.) . ; N. D. MILLER, M. D. ~ Camty N~alth Offiwr d~ Lopl Rpbiru j . . ~ ~ 0~ D~p~A~? t+oal R~1tt.a ~ = $~219 : - - - , ~ ~ - - - - - ~