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HomeMy WebLinkAbout0490 . , ~ ~ . r- . - 266959~'" ~ . ~ CERTIFICATc OF DEATH DeP.n.e.~ w i k.hL .¦J Rd~.L:i:~,u.e 5~..;cr. F L O~ I D A aTwTC r~tc Ho. ' l11~~1411N (]i ID.11711 i~tE. Ot ~[iNi IN ~~~'Q'«`~O REGI6TRAR•8 NO. ?[lMANiNt IMK ~~~0-N~ yFY DwiE d OEwin ~ ~ow~+. ~•r,~.~.~ ~ SI[ 1W0100[ Ioi "'~`"K"~ ' K~ ~d"~SCN N~ALIS'I~t SR ~Male ~ i1 30 1973 UC! .n.n. www..,.~ucu. +r..w. AGE-uH 'w.c.. 'wwa pwtE Of 4[iM ~.o~..r. tir. COIN+TI W OfwM ~K. t WC~If 1 Y~nwr Ite~~l~ ~Ol. i Yr! bOU~f ~ rlu ~ 6602 ~ 68 H ~k ! Feb. 2, 1905 St. Lucie . dww. O! l T Oi ..sw e.n ...m HOSM4t OR Oi~Ft 7r571JUT~W~I-t+iM~f ~r .~w w~~ur~. e~ra ~neu w wi.u~ ~ - . s.ecu. .ts a ..o ~ n F`t. Pierce Yes Ft. Pierce 1Kemorial Haspital ~ STwTE 01 4lM ~r ro~ r v.~.~., wr~ qTiZQ~ Of wNAT CQlni~ll !wA1tILEv0, NEVft w~tLED, SUtWVNG S?OUSE ~ r.w, on~ .uw..w~ ~ a ~nc1i 1x~ towwr i' I W lr~il rl~Cl ~nt~~ ~ rwu uw.a Rl i 7c~2~'1 BdCJCJ@~ .r.~ «cux~ _ n. un~. r w.a SOCuI SENtlTY NIMVE~ USN~I OCCU~wT~On ~u.~ a+.~ a.o.. w.u a..~.w .ou w RwD OI WS~+ESS 04 WDNSitY OCCVNI~ y rOS W. Pfw r~~~' ~ ~ti•~.. o~. ~t 404-O1-0211 ~y "~'aYm~x (Retired) ~M ~~~s .wCf M~OM ~'O"'- ~ESWE?KE-SI~fE COU?~T11 C~T~, fOWn. Ot ~OCwi~On c++ .rws ST~EFT wr+0 NuWf~ + fMfCHI ~f! 01 wO~ ~'Y Flaric~a St.Iucie I~4 Ft. Pierce ~.~Yes 662 S. 9th St. il~itiff-NAM( ~q~ ust ;ry7Trt~[.-hulpfNN~MF' ~~yt rNU u~* ~s G31V1I1 W . I~CAZ].S"tEY' ~Z~e T~'rCIt'pSQ22 11~lWMANT-NAME ~MAI?WG ADGRESS IY~~n w~.r.1. ~0., 4n O~ W~.~. M~tt. tr~ vs E~~-'th ~S~-'r' ~n 602 S. 9t11 St. Ft. FiexCe Flari,da 33450 ~ ?~et O~wM wws Cwus[o ~r, ~t~rti a+t? oNt c~usE rEt ie~t rot NL M1~, ~vio ~.p .••.o,....n ~..n..,, a. ..ra. ~ ..u.u. o.an ..u a.n. Q c.f Cerebral bebaorrhage j . . ~o..,..o.,. . -~tw e.v~ ~.s~ q ( ~ . r~~~~tf C~Yit M~. ~ M p. M tl~ CO~NON+CI O': ;...~.e ~ •.n.a c.~w ~.s~ ~ (q i . ?w~i r. Otn[e S~Gn~K~u+t COo~piq~aS cornwa car.a,n.~.c .o o.... wOi q~~4Y ~O 4v9 GMw w~•n ~ a~ I~a5~ ' Y YES vw ar~~wGf co«- ~ Hypertensive k arterfosclerotic cardiovascular diseas~^'°'~' ~•..~°,~M~l~w~wu~04Yf~ : ( w ~~~rw '~ti ~ ~ iM P•~!el~~ ~ GOF . q~~ 11.Mi ~O~+r Mr • , epyi ~ ~Oy~UOE~ OR VOfIEWWEO ~ NOW INW~11 Q~CUlIED w~w p.ww~~ ~w ~.n ~ q r~n .nr n~ - ~r~S..~,M•- ~ . ~ ~10a M'7Y u+A7~1r wT WOtK ?uCE O~ ua~r .o... .~r~,, ~.cro.+. ~ ?OCwuOe~ ~ tnu~ w ~.r.~- ..o., em o~ ~o.n., p.p ~ ~vwn wf w w~ owin wt.,~a. ~fncw~ ~ 70. M~ f 71~ ' , CERJKwTqa- ort. .w +a.w a.• nu ...o s... ~...i.a ..r.~ a. ~ w/i:d'woi w. oe~~w oeeue~to o.i .~..ci. o-. se I»731CtaM: T +V~fw M~ KY ~O~'r •~t1~ M.w. .•n~ww~ n.e , O f~.ov~~ Aun. ...a. w wti war . ~ n. .u..ue ..o. ~h ' ;7,~ ~ i + a~..+o.neoe~. a.e 1~~~~ ~7~ 7i~ 4.~30~~3 il~~ ~y ~ 1i4~:14 h~ ron.iw.ait~sr..~a CElTY~Gi~Or+-aEOK~I E+4wtvEt Ot COtOw[e~ w~.n ..vi w n.~ .oy o. r.~. ~ecra.. ~.i •io-.w~+crs ~e.~ • ~.......o. a wy w~. wia ~.e .n~sne..c.~, w.«o-•. .o-~•. o.. A ' OI~A OCCNNO W rf M/1 ~w~ M~O M 41M~f1 ~t~HO. M•7b. T ~O 1~ 1~~~ x M . 7)s • . . CE~Tw~f~-N~wE .r~n o. •.rn SrGa~iutE ' auu r.wr ~TE S~Gr+FD ~~a.n., w.,.w~ Bernard D. Ross, M.D. ~ ~ ~ G•~,. _ ~lc~ ~J,~ 5/2!~/73 ` a~wl? ,?DOtE11- f~TrK1 ~,.~i~ o. ..r o..o. c.n w.~. tM ~ort S~ Lucie Shono?..^.c Cer.ter ~'ort PS.erce or~i~a 1}~ G •W+w?. UE~u?TqN, fEMpVµ CfMETEIt~t O~ CtEMAfOA?-w.aw~E IOCnT101i c.n w p.w fr.r~ ~ wcr~ ~ Ft. Pierce C~tery ( Ft. Pierce Flo~ i~a . DATE ~.o.R~. qs, n~~ fuhEtA? nO~tE-na~~E aw0 ~CDRESS s~ u* o~ ~.~.s. wo., or~ o~ ~or., sr.r~. t~r ~ ! „j~+ia 1, 1973 ,,.BAIRU ~~.L HQ~~ 901 N. 7 St. Ft, pierce Fiori~a 33950 ~ Y. S. ~61Z ~WE ECT _y(;N~ iEGI Y-S~G+'~~iW)f ~ O~R ~EC[nIO ~f ~OU~ st.~iu~~ A.~. iqio :M ~w Tf~ 15 9~3 ftl~L+ ~'~`.~UNTY FIA. ST l~+C~Ecy; p, ~ RAS ~ I heroby osrtify thb to b~ • trw ~~d oorroet copy of the lace I F. ~ u l; L 0 U RT Repistrars t~oord on fil~ in fh~ St. t,ucl~ Cou~ry H~ehh D~p~rt- rLFFF ~i-' , ment at foA Piatu, fb~ic~, p: r~, r_' v c-"~ ~ ~ i, i a' y~''o , (Warning: Not vaJid ur~lsts raJsed seat of ihe St. LucN 2 49 PM !~3 `•F y9'~ Cpunty Healih Oep~rtment is ~ffix~d.) w_ S~ . ~ ' w • • • _ _ N. MIIIER, M. 0. L~• j` - e9 2VU9 , : ~ _ Coypiy Health Officer d~ l 1 R istrsr 59 ~ ~ ( f ,,~~n ~ . ~ j_ys~~ ; / 6 - ot ~ ~ 0~l~ Os~w1Y Lotei"Reai.t.~r ~ • . 2~i~ ~ 4g ~ t~